JUNE 2017! 1-Cognitive training. 2-Blood pressure. 3-Physical activity

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2 JUNE 2017! 1-Cognitive training 2-Blood pressure 3-Physical activity

3 Physical exercise, cognitive training and multi-domain intervention to improve cognition in older adults Dr. Laura Middleton Physical Activity as a Therapeutic Strategy for MCI and Dementia Dr. Teresa Liu-Ambrose Aerobic Exercise to Promote Cognitive and Brain Plasticity in Vascular Cognitive Impairment Dr. Karen Li Multi-modal training to improve cognition and mobility Dr. Louis Bherer Effects of multi-domain intervention on cognition and gait in older adults and at risk populations

4 Effects of multi-domain intervention on cognition and gait in older adults and at risk populations Louis Bherer, Ph.D. Full Professor, Department of Medicine, University of Montréal, Preventive Medicine and Physical Activity Center (ÉPIC) Research center, Montreal Heart Institute and Montréal Geriatric Institute Montréal, Canada CGS, Montréal 20 Avril 2018

5 I have no conflict of interest

6 A Multi-domain intervention in older adults +

7 (In Press) RESTORATIVE NEUROLOGY And NEUROSCIENCE V.S. Far modality transfer Younger DT-cost: tasks coordination (DM/SM) *

8 Journal of Gerontology: Psychological Sciences, /week x 12 weeks Combined training exercises

9 Synergic effect of cognitive training and physical exercise intervention? Aerobic + DT-training Aerobic + Lessons Stretching + DT-training Stretching + Lessons

10 Recruited N = 182 Randomized N = 137 Withdrew N = 46 Aerobic + DT-training N = 38 Aerobic + Comp- Less N = 33 Stretching + DT-Training N = 36 Stretching + Com-Less N = 29 4 withdrew 34 began 1 withdrew 32 began 4 withdrew 32 began 2 withdrew 27 began Completed N=22 Completed N=16 Completed N=20 Completed N=18 N = 76

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12 8 Change in the number of Chair Stands Number of chair stands in 30 s Combined (AR + DT) Physical (AR + CL) Cognitive (ST + DT) Control (ST + CL) 0 Seconds Change in the switching condition of the Stroop task Combined (AR + DT) Physical (AR + CL) Cognitive (ST + DT) Control (ST + CL) 2 4 6

13 Transfer effects to untrained Dual-Task? Synergic effect of AR+DT on Task-set cost

14 Functional benefits in real life?

15 SWS at comfortable pace for 30s along a 37m hallway Auditory start and stop cues (distance recorded)

16 Multi-domain intervention with clinical populations

17 n = 352 patients pre frail/frail (65 et +) 2 groups (12 weeks) Multidisciplinary intervention (n=176) (exercise training (60min 2x/week), protein shake, memory training(90min 2x/semaine), medication review). Usual care (n=176) Interventions provided in Primary Health care center 18 month follow up Journals of Gerontology: Medical Sciences, 2018

18 SPPB (Short Physical Performance Battery), grip strength & measures of functional capacity at 3 and 10 months several cognitive measures (short term memory, verbal fluency) at 3 and 18 months number of medications (9.5%) Journals of Gerontology: Medical Sciences, 2018

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20 Sub analysis of FINGER study JAMA: Neurology, 2018

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23 Reviews and Meta-Analyses

24 20 studies using multidomain intervention (exercise + cognition) in order adults without cognitive deficits (total 2667 participants) Global effect size of multidomain vs. control = 0,29

25 Combined intervention associated with larger benefits than exercise intervention alone but not more than cognitive training.

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27 10 RCTs that applied a combined cognitive physical intervention with cognitive function as an outcome Small to medium positive effect of combined cognitivephysical interventions on global cognition in MCI and dementia (SMD =0.32[0.17;0.47], p<0.00). Moderate to large positive effect of combined interventions on ADL (SMD =0.65[0.09;1.21], p<0.01) and a small tomedium positive effect for mood (SMD =0.27[0.04;0.50], p<0.01). These functional benefits emphasize the clinical relevance of combined cognitive and physical training strategies. But heterogeneity in types of interventions and study designs and it remains unknown if combined intervention is better than individual interventions.

28 Conclusion: Challenges and limits of multi-domain or combined interventions Synergic effect requires active ingredient and positive effect of each individual intervention Further studies needed to identify the best parameters or conditions of each type of intervention or domain Limits in implementing multiple intervention studies: Volume of training reduced vs. past studies Heavy load of combining multiple interventions Large dropout rate, important commitment from participants Dropout or preference may vary by domain or modality

29 SYNchronizing, Exercises, Remedies in GaIt and Cognition (SYNERGIC) A randomized controlled double blind trial Équipe 12 5 sites au Canada Dr Manuel Montero-Odasso (Team Leader), St.Joseph Health Care, Parkwood Hospital, London, Ontario. Dr Louis Bherer (Co-Leader), Université de Montréal, Montréal, Québec. Dr Teresa Liu-Ambrose, University of British Columbia, Vancouver, Colombie britannique. Dr Laura Middleton, University of Waterloo, Walterloo, Ontario Dr Quincy Almeida, Wilfrid Laurier University, Waterloo, Ontario Clinicaltrials.org : NCT

30 SYNERGIC Trial Protocol Overview SYNERGIC TRIAL ( SYNchronizing Exercises, and Remedies in GaIt and Cognition) Uniquely designed to evaluate the effect of aerobic and progressive resistance training exercises, isolated or combined with cognitive training and vitamin D supplementation, in older adults with MCI

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33 Neurosciences/Psychologie/Neuropsychologie Karen Z. H. Li, Ph.D. (U Concordia) Kinésiologie Sarah A. Fraser, Ph.D. (U of Ottawa) Nicolas Berryman, Ph.D. (U Bishop) Manon Maheux, Ph.D. Antony Karelis, Ph.D. (UQAM) Kristell Pothier, Ph.D. Laurent Bosquet, Ph.D, (U de Poitiers) Catherine-Alexandra Grégoire, Ph.D. Olivier Dupuy, Ph.D., (U de Poitiers) Navin Kaushal, Ph.D. Antoine Langeard, Ph.D. Christine Gagnon, Ph.D. Lynden Rodrigues Maxime Lussier, Ph.D. Laurence Desjardins-Crépeau Ingéniérie David Predovan Frédéric Lesage, Ph.D. (Polytechnique de Mtl) Anne Julien-Rocheleau Philippe Pouliot, Ph.D. (Polytechnique de Mtl) Élisabeth Charlebois-Cloutier Thomas Vincent, Ph.D. (PERFORM/Concordia) Tudor Vrinceanu Médecine Ramzi Houdeib Marie-Jeanne Kergoat, MD, Gériatre (IUGM) Francis Comte Minh Vu, MD, Gériatre (IUGM et CHUM) Béatrice Bérubé Anil Nigam, MD, Cardiologue (EPIC/ICM) Kathia Saillant Martin Juneau, Cardiologue (EPIC) Chaire de recherche Mirella et Lino Saputo en Santé Cardiovasculaire et prévention des troubles cognitifs

34 Dual task training condition Left hand Right hand Stimulus: Trial types: Simple Pure (SP) Simple Mixed (SM) Dual Mixte (DM) Feedback: DM speed based on SM Two transfer conditions Within modality transfer task Left hand Right hand Left hand Right hand Cross modality transfer task GO STOP LEFT RIGHT

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