Brain and body stimulation (CogEx) for older people with mild to moderate dementia: A feasibility study

INTERVENTION: This pilot compares CogEx (a new intervention integrating Cognitive Stimulation Therapy and the UpRight Exercise Programme into one programme) with CST in older people with mild to moderate dementia living in the community and in residential aged care facility. Two groups of CogEx (one in the community and one in a residential aged care facility) will be compared with two groups of CST (one in the community and one in a residential aged care facility). The usual size of a CST group is 8‐10 people and this will be used for all groups. The group sessions will be held for 1.5hours twice a week for 7 weeks in a residential aged care facility and in a community aged care group. Both groups will be facilitated by a health professional (occupational therapist or nurse or physiotherapist) who has completed the CST Master training day. At the Master training day each facilitator will be given an CST manual that outlines the content of activities within each of the group sessions. The structure of a CST session is: Introduction (Welcome, group name, theme song, orientation discussion current affairs); Main Activity (Level A – seeking opinion, social interaction; Level B – less complex relaxed exercise. The manual dictates the topic e.g. childhood; food; sound); Finally (thanks for attending and contribution; theme song; Reminders re next session and content; farewells). The resources used within the group sessions vary depending on topic such as music, food or art supplies. The newspaper of the day is used for the orientation discussion. The CogEx structure is the same as CST but also included are a combination of exercises aimed at challenging the different physiological systems involved in the maintenance of balance (muscle strength, visual integration, vestibular adaptation, balance strategy retraining, and sensory integration). All exercises can be started at a simple, low level and progressed (The exercises can be performed at a low, moderate or hard level through decreasing the amount of support used (2 hands to 1 had to no hands) or increasing the challenge). Examples of the exercises are: Normal stance to unsupported to decrease base of support Normal stance weight shift to moving hips in a figure 8 to marching on the spot Step forwards/backwards/sideways/diagonally to walk on spot on heels/toes to walking forward/backwards on heels/toes All the exercises have been piloted and found to be safe and acceptable in a residential care setting. The exercises are progressed according to the abilities of the group. The intensity of the exercise is mild to moderate depending on the abilities of the group. The exercises and progressions are also manualised. The instructor will complete an attendance log to monitor adherence. CONDITION: mild to moderate dementia PRIMARY OUTCOME: Brief Balance Evaluation Systems Test (brief‐BESTest) (Padgett, Jacobs, & Kasser, 2012) Montreal Cognitive Assessment (MoCA) (Nasreddine et al., 2005) Short Physical Performance Battery (SPPB) (Guralnik et al., 1994). SECONDARY OUTCOME: : Quality of Life‐Alzheimer’s Disease (QOL‐AD) – Version for the person with dementia (Logsdon, Gibbons, McCurry, & Teri, 1999) CNS Vital Signs (CNSVS) (Gualtieri & Johnson, 2006) 2. Able to have a “meaningful” conversation 3. Able to hear well enough to participate in a small group discussion 4. Able to see well enough to see most pictures 5. Likely to remain in a group for 1.5 hours INCLUSION CRITERIA: 1. Aged 65 years or older living in the community or in a residential aged care facility with a diagnosis of mild to moderate dementia, scoring >15 or above on the Montreal Cognitive assessment