Prefrontal Cortex Dynamics of the Elderly During a Cognitive Stimulation Programme
NCT ID: NCT04693611
Last Updated: 2021-09-01
Study Results
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Basic Information
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COMPLETED
NA
36 participants
INTERVENTIONAL
2021-04-14
2021-08-31
Brief Summary
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Detailed Description
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The PFC is considered the centre of cognitive function, where it encompasses attention, memory and executive functions.
Attention is the cognitive function that allows us to orient to the relevant stimuli and process them to respond accordingly. Given its functionality, it is distinguished into three types of attention: selective, divided and sustained. Attentional dysfunction can be present in several conditions where cognitive deficit is the main symptom, such as Alzheimer's disease.
With regard to memory, it is subdivided according to time storage, i.e. short or long term. Short-term memory is capable of operating with certain perceived information for a limited space of time and can later be forgotten or transferred to long-term memory. Two other complementary components are distinguished in this type of memory: immediate memory and recent memory. Long-term memory is a latent memory with unlimited capacity that can remain outside the conscious circuit until circumstances require another mode of response. It involves separate, interdependent and dynamic processes of storage, consolidation and evocation. It is made up of two major subsystems: implicit or non-declarative memory, and explicit or declarative memory.
Regarding executive functions, they designate the cognitive processes of control and integration aimed at the execution of behaviour directed at complex objectives, requiring sub-components such as attention, programming, time sequencing, inhibition of competing processes and information, monitoring and selection of strategies. Executive functions include various processes such as working memory, planning, response to reactions and error corrections, cognitive flexibility, inhibition, decision making.
There is evidence that in the early stages of NCD, people are able to learn and improve their cognitive function through interventions such as CS. CS is recommended by the National Institute for Health and Clinical Excellence as a non-pharmacological therapy for people with mild to moderate NCD and is an intervention where the cognitive domains are not used in isolation but integrated. An individual format is associated with better results. In a systematic review on CS, studies have shown strong evidence that CS has a positive impact on cognitive function, depression, daily life activities and behaviour for people with NCD.
However, no studies are known that have analyzed prefrontal cortex activity in the elderly population associated with a functional method of infrared spectroscopy (fNIRS). This method provides information on hemodynamic changes associated with cortical activation by measuring in a non-invasive way changes in the relative ratios of deoxygenated hemoglobin (HHb) and oxygenated hemoglobin (HbO2).
Monitoring and recording the dynamics in the PFC of the elderly during a cognitive stimulation programme with the fNIRS method may contribute to expanding knowledge about aspects related to neurodegenerative processes and cognitive function in the elderly.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
DOUBLE
Study Groups
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Intervention Group
Participants who meet the inclusion criteria will be randomised to the CS intervention group or to the control group that will maintain their usual treatment.
Participants in the intervention group will participate in two CS sessions per 12 weeks besides their treatment as usual.
Individual cognitive stimulation therapy (iCST)
The intervention group will receive 24 individual CS sessions per participant. Each session will last approximately 45 minutes and will have the following structure: session introduction (5 minutes); reality orientation (10 minutes); stimulation of cognitive domain (25 minutes); session closure (5 minutes). The sessions will be led by a previously trained therapist. The intervention program will include several activities based on the principles of CS and adjusted for participants without any neurocognitive disorder.
Functional near-infrared spectroscopy (fNIRS)
The acquisition by fNIRS will be performed in each CS session in four regions of interest (ROIs) in the prefrontal cortex: left dorsolateral prefrontal cortex (LDLPFC); left medial prefrontal cortex (LMPFC); right medial prefrontal cortex (RMPFC); right dorsolateral prefrontal cortex (RDLPFC).
Control Group
Participants in the control group will maintain their usual treatment: social interaction activities, stimulation of personal skills, and any prescribed dementia-specific medication.
No interventions assigned to this group
Interventions
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Individual cognitive stimulation therapy (iCST)
The intervention group will receive 24 individual CS sessions per participant. Each session will last approximately 45 minutes and will have the following structure: session introduction (5 minutes); reality orientation (10 minutes); stimulation of cognitive domain (25 minutes); session closure (5 minutes). The sessions will be led by a previously trained therapist. The intervention program will include several activities based on the principles of CS and adjusted for participants without any neurocognitive disorder.
Functional near-infrared spectroscopy (fNIRS)
The acquisition by fNIRS will be performed in each CS session in four regions of interest (ROIs) in the prefrontal cortex: left dorsolateral prefrontal cortex (LDLPFC); left medial prefrontal cortex (LMPFC); right medial prefrontal cortex (RMPFC); right dorsolateral prefrontal cortex (RDLPFC).
Eligibility Criteria
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Inclusion Criteria
* Being able to communicate and understand.
* Being a native Portuguese speaker.
* Educational level equal to or higher than 4 years old.
* Have given informed consent for the project, duly completed and signed, after prior information.
* Have a score of 22 or more points in the MMSE.
Exclusion Criteria
* Severe sensory and physical limitations that prevent participation.
* Low level of consciousness and minimal attention span.
* Presence of severe neuropsychiatric symptoms (such as agitation, psychosis, severe depressive and anxiety symptoms, apathy), or presence of uncontrolled delirium that would prevent participation in the sessions.
* History of seizures or cerebrovascular disease.
* Movement disorders diagnosis.
* Psychoactive substances consumption.
65 Years
ALL
Yes
Sponsors
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CEDIARA - Assoc. Solidariedade Social de Ribeira de Fráguas
OTHER
Responsible Party
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Principal Investigators
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Susana I Justo Henriques, Ph.D.
Role: PRINCIPAL_INVESTIGATOR
Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra
Rosa C Gomes Silva, Ph.D.
Role: PRINCIPAL_INVESTIGATOR
Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra
Telmo A Santos Pereira, Ph.D.
Role: PRINCIPAL_INVESTIGATOR
Polytechnic Institute of Coimbra, Coimbra Health School
João L Alves Apóstolo, Ph.D.
Role: PRINCIPAL_INVESTIGATOR
Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra
Daniel F Borges Silva, M.Sc.
Role: PRINCIPAL_INVESTIGATOR
Polytechnic Institute of Coimbra, Coimbra Health School
Locations
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Cediara - Social Solidarity Association of Ribeira de Fráguas
Ribeira de Fráguas, Albergaria-a-Velha, Portugal
Countries
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References
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Apóstolo JLA, Bobrowicz-Campos EM, dos Reis IAC, Henriques SJ, Correia CAV. Exploring the screening capacity of the European Portuguese version of the 15-item Geriatric Depression Scale. Revista de Psicopatología y Psicología Clínica. 2018; 23: 99-107. doi: 10.5944/rppc.vol.23.num.2.2018.21050
Apóstolo J, Loureiro L, Reis I, Silva I, Cardoso D, Sfetcu R. Contribution to the adaptation of the Geriatric Depression Scale -15 into Portuguese. Revista de Enfermagem Referência. 2014; IV(3): 65-73. doi: 10.12707/RIV14033
Clare L, Woods RT. Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer's disease: A review. Neuropsychological Rehabilitation. 2004; 14: 385-401. doi: 10.1080/09602010443000074
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Filipin F, Feldman M, Taragano FE, Martelli M, Sánchez V, García V, et al. The efficacy of cognitive stimulation on depression and cognition in elderly patients with cognitive impairment: A retrospective cohort study. AIMS Medical Science. 2015; 3(1): 1-14. doi: 10.3934/medsci.2016.1.1
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Guerreiro M, Silva AP, Botelho MA, Leitão O, Castro-Caldas A, Garcia C. Adaptação à população portuguesa da tradução do Mini Mental State Examination. Revista Portuguesa de Neurologia. 1994; 1: 9-10.
Justo-Henriques SI, Marques-Castro AE, Otero P, Vazquez FL, Torres AJ. [Long-term individual cognitive stimulation program in patients with mild neurocognitive disorder: a pilot study]. Rev Neurol. 2019 Apr 1;68(7):281-289. doi: 10.33588/rn.6807.2018321. Spanish.
Justo-Henriques SI, Otero P, Torres AJ, Vazquez FL. Effect of long-term individual cognitive stimulation intervention for people with mild neurocognitive disorder. Rev Neurol. 2021 Aug 15;73(4):121-129. doi: 10.33588/rn.7304.2021114. English, Spanish.
Lima CF, Meireles LP, Fonseca R, Castro SL, Garrett C. The Frontal Assessment Battery (FAB) in Parkinson's disease and correlations with formal measures of executive functioning. J Neurol. 2008 Nov;255(11):1756-61. doi: 10.1007/s00415-008-0024-6. Epub 2008 Sep 25.
Lobbia A, Carbone E, Faggian S, Gardini S, Piras F, Spector E, et al. The efficacy of cognitive stimulation therapy (CST) for people with mild-to-moderate dementia: A review. European Psychologist. 2018; 24(3): 257-277. doi: 10.1027/1016-9040/a000342
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Pereira T, Castro MA, Villafaina S, Carvalho Santos A, Fuentes-Garcia JP. Dynamics of the Prefrontal Cortex during Chess-Based Problem-Solving Tasks in Competition-Experienced Chess Players: An fNIR Study. Sensors (Basel). 2020 Jul 14;20(14):3917. doi: 10.3390/s20143917.
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Related Links
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2017 Demographic Statistics
Dementia: assessment, management and support for people living with dementia and their carers
Mental health and older adults
Other Identifiers
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16122020
Identifier Type: -
Identifier Source: org_study_id
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