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Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease

From Fundación Maria Wolff (Drs. Olazarán and Serrano, and R. Muñiz), Madrid; Consulta de Neurología (Dr. Olazarán), CEP Hermanos Sangro, Madrid; Servicio de Neurología (Drs. Olazarán, Navarro, Galiano, and Fernández-Bullido) and Geriatría (Dr. Serra), Hospital Gregorio Marañón, Madrid, Spain; Silberstein Aging and Dementia Research Center (Dr. Reisberg), NYU School of Medicine Medical Center, New York, NY; Servicio de Neurología (Dr. Peña-Casanova), Hospital del Mar, Barcelona; Servicio de Neurología (Dr. del Ser), Hospital Severo Ochoa, Leganés; Unidad de Geriatría (Dr. Cruz-Jentoft), Hospital Ramón y Cajal, Madrid; Consulta de Neurología (Dr. Navarro), CEP Vicente Soldevilla, Madrid; Servicio de Neurología (Dr. García de la Rocha) and Psiquiatría (Dr. González-Salvador), Hospital Gómez Ulla, Madrid; Servicio de Neurología (Dr. Frank), Hospital la Paz, Madrid; Consulta de Neurología (Dr. Galiano and Fernández-Bullido), CEP Moratalaz, Madrid; and Servicio de Neurología (Dr. Sevilla), Hospital de la Princesa, Madrid, Spain.

Address correspondence and reprint requests to Dr. Rubén Muñiz, Director de Investigación, Fundación Maria Wolff, Cardenal Silíceo 14, 28002 Madrid, Spain; e-mail: ruben{at}mariawolff.es

Objective: To evaluate the efficacy of a cognitive-motor program in patients with early Alzheimer disease (AD) who are treated with a cholinesterase inhibitor (ChEI).

Methods: Patients with mild cognitive impairment (MCI) (12), mild AD (48), and moderate AD (24) (Global Deterioration Scale stages 3, 4, and 5) were randomized to receive psychosocial support plus cognitive-motor intervention (experimental group) or psychosocial support alone (control group). Cognitive-motor intervention (CMI) consisted of a 1-year structured program of 103 sessions of cognitive exercises, plus social and psychomotor activities. The primary efficacy measure was the cognitive subscale of the AD Assessment Scale (ADAS-cog). Secondary efficacy measures were the Mini-Mental State Examination, the Functional Activities Questionnaire, and the Geriatric Depression Scale. Evaluations were conducted at 1, 3, 6, and 12 months by blinded evaluators.

Results: Patients in the CMI group maintained cognitive status at month 6, whereas patients in the control group had significantly declined at that time. Cognitive response was higher in the patients with fewer years of formal education. In addition, more patients in the experimental group maintained or improved their affective status at month 12 (experimental group, 75%; control group, 47%; p = 0.017).

Conclusions: A long-term CMI in ChEI-treated early Alzheimer disease patients produced additional mood and cognitive benefits.

Received November 10, 2003. Accepted in final form August 31, 2004.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the December 28 issue to find the title link for this article.

*These authors contributed equally to this work as first authors.

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