Alexander Prinz

Background: The global prevalence of dementia is increasing, necessitating effective non-pharmacological interventions due to the limitations and side effects of pharmacological treatments. Digital health interventions, including Virtual Reality (VR), offer promising alternatives. This study assessed the feasibility, safety, and potential side effects of interactive computer-generated VR (CGVR) for individuals with dementia (IwD), focusing on reaction tests of varying complexity. Methods: In the feasibility study recruited 32 participants with mild to moderate dementia, assessed by the Mini-Mental-State-Examination (MMSE). Participants underwent a single CGVR session involving virtual reaction wall tasks of varying difficulty. Pre- and post-exposure assessments, alongside feedback forms, evaluated cognitive and motor functions, mood, anxiety, and balance (paired t-test). Results: Of the 32 participants, 29 completed the study (9% drop-out). Observational data indicated high levels of engagement and enjoyment. No adverse effects on cognitive or motor functions were observed, with slight non-significant improvements across most parameters. MMSE scores correlated significantly with task feasibility and reaction/motor times, highlighting the influence of cognitive status on performance. Conclusions: CGVR demonstrated high feasibility and acceptability among IwD, with no adverse effects and potential to enhance cognitive and motor skills. Further research is required to explore long-term efficacy and optimize therapeutic applications.

Dementia, marked by cognitive decline, significantly impacts daily life. With global prevalence rising, traditional treatments manage symptoms but have side effects and offer no cure. Non-pharmacological interventions, like serious games, are gaining importance. This study assesses the feasibility and benefits of serious games for people with mild to moderate dementia over a 10-week intervention. Sixty-one patients were recruited, with 35 completing the study. The intervention included six games focusing on physical and cognitive training. Outcome measures were motor function, cognitive assessments, quality of life, and depression. Results showed significant improvements in dynamic balance ( p = .013) but no significant changes in other measures. The findings suggest that serious games are feasible and can improve motor functions like balance. However, short intervention periods may limit their impact on cognitive function and quality of life. Longer interventions and personalized game designs are recommended for greater benefits.

Background: Physical activity interventions for people with dementia have shown promising effects in improving cognition and physical function or slowing disease-related decline. Immersive virtual reality (iVR), using head-mounted displays, facilitates realistic experiences by blurring the boundaries between VR and the real world. The use of iVR for people with dementia offers the potential to increase active time and improve dementia therapy and care through exercise interventions. However, the feasibility of using VR use in people with dementia, considering changes in motor, cognitive, psychological, and physiological parameters, remains insufficiently investigated. Objective: This study aims to investigate the feasibility of using iVR in people with dementia or mild cognitive impairment in nursing homes. Specifically, we examined changes in motor performance (balance and mobility), cognitive performance (global cognition and executive functions), emotional responses, and fear of falling using iVR. Methods: Utilizing a pre-post design, this study recruited 35 participants with mild-to-moderate dementia, assessed by the Mini-Mental State Examination (MMSE). Participants underwent a single session involving iVR exposure, with pre- and postexposure assessments and a feedback form, to exclude negative effects on cognitive and motor functions, mood, anxiety levels, and balance performance. The use of iVR involved 4 scenes, with a total length of 8 minutes. These scenes depicted a park with short and rather passive impressions presented as a 360° video in a head-mounted display. Before and after using the iVR, cognitive parameters were assessed using the Trail-Making Test A (TMT-A), motor parameters were assessed using the FICSIT-4 (Frailty and Injuries: Cooperative Studies of Intervention Techniques-4) and Timed-Up-and-Go (TUG) tests, and psychological parameters were assessed using the Dementia Mood Picture Test, State-Trait Anxiety Inventory, and Short Falls Efficacy Scale-International (Short FES-I). The Emotion Rating Scale and the duration of use were recorded during use, and a feedback questionnaire was completed afterward in addition to the posttests. Paired t tests and Wilcoxon tests were used to examine pre-post differences. Results: Of the 35 initial participants, 33 completed the study, which corresponds to a dropout rate of 6%. All 33 participants, who had a mean of 83.71 (SD 5.01) years, had dementia. They showed no statistically significant difference in cognitive and motor performance before and after iVR use. Thus, no negative effects on cognitive and motor functions, mood, anxiety levels, and balance performance were observed. The emotion rating scale also showed that 72% (n=24) felt joy and fun during iVR use, 100% (n=33) showed no emotions such as fear, sadness, or anger, and 93% (n=31) were attentive during iVR use. Conclusions: The feasibility of using iVR for people with dementia can be rated positively. There were no changes in motor, cognitive, or emotional parameters that would increase the risk of falls or other negative emotional reactions during or after iVR use. Further studies are needed to investigate prolonged use in a more stimulating computer-generated environment and possible physical and cognitive tasks for people with dementia in nursing homes. Trial Registration: German Clinical Trials Register DRKS00030616; https://drks.de/search/de/trial/DRKS00030616

The loss of independence is one of the greatest consequences of dementia. Multidimensional music-based exercise programs could counteract. The present study investigates the effects of such a program on people with dementia and bases on a 24-week intervention with three measurement time points. Sixty-nine people with dementia were randomly assigned to the intervention (n = 43) and control group (n = 26). The following outcome parameters were measured: leg strength, gait, grip strength, balance, reaction time, selected cognitive abilities, and quality of life. A mixed ANOVA with repeated measurement showed significant interaction effects between group and time. After 24-weeks in contrast to the control group the intervention group significantly improved in leg strength ( P = .001), balance ( P = .001), gait ( P = .001), grip strength (right P = .002, left P = .011), reaction time ( P = .003), global cognition ( P = .039), verbal fluency ( P = .002), attention ( P = .013) and quality of life ( P = .011). In conclusion, the program enhanced selected cognitive and motor skills and quality of life.

Eine Demenz ist eine neurodegenerative Erkrankung, die mit einer Abnahme der kognitiven und motorischen Fähigkeiten einhergeht und den Verlust der Selbstständigkeit und die Pflegebedürftigkeit zur Folge hat. Im Laufe der Jahre wird sie für etwa 60% der Einweisungen in Pflegeheime verantwortlich sein. Damit Menschen mit Demenz trotz ihrer Pflegebedürftigkeit einen angenehmen Lebensabend genießen können, ist es wichtig, ihre kognitiven und motorischen Fähigkeiten zu erhalten und ihre Lebensqualität zu steigern. Zurzeit wird dies vorzugsweise mit Medikamenten versucht. Allerdings sind medikamentöse Therapien bei Demenz begrenzt und immer von Nebenwirkungen begleitet. Daher sind nicht-medikamentöse Interventionen von großer Bedeutung. Studien legen nahe, dass eine Kombination aus körperlicher Aktivität und Musik positive Auswirkungen auf Demenzpatienten hat. Ziel dieser Studie war es, ein musikbasiertes gesundheitsförderndes Krafttraining für Demenzpatienten zu entwickeln und dessen Einfluss auf ausgewählte kognitive und motorische Fähigkeiten sowie auf die Lebensqualität zu analysieren. An der Studie nahmen 16 Heimbewohnerinnen mit einer Demenz (82,5±4,1 Jahre) teil. Die Patientinnen führten über einen Zeitraum von 12 Wochen eine musikbasierte Kraftintervention zweimal wöchentlich jeweils 60 min durch. Es wurden ausgewählte kognitive Fähigkeiten sowie die motorische Reaktionsfähigkeit, Griffkraft und Mobilität untersucht. Darüber hinaus sollten durch den NOSGER II Erkenntnisse über die Lebensqualität gewonnen werden. Die Intervention bewirkte signifikante Verbesserungen in der Griffkraft links (p=,002) und rechts (p=,001) und der Reaktionsfähigkeit (p=,032). In allen anderen Outcome-Parametern konnten zwar keine Verbesserungen, aber auch keine signifikanten Verschlechterungen festgestellt werden. Anhand eines Beobachtungsbogens wurden wichtige Erkenntnisse für die Praktikabilität des Bewegungsprogrammes bei Demenzpatienten gewonnen. Es ist zusammenfassend festzustellen, dass das entwickelte musikbasierte gesundheitsfördernde Krafttraining mit Demenzpatientinnen durchführbar war und von den Teilnehmerinnen nicht nur akzeptiert, sondern auch gern absolviert wurde. Zwölf Wochen Training führten zu signifikanten Verbesserungen in ausgewählten motorischen Fähigkeiten und zur Stabilisierung kognitiver Fähigkeiten. Ein musikbasiertes Übungsprogramm könnte eine vielversprechende Ergänzung zu den medikamentösen Therapien für Menschen mit Demenz sein. Dementia is a neurodegenerative disease that is associated with a decrease in cognitive and motor skills and results in the loss of independence and the need for care. Hitherto, dementia is responsible for around 60% of nursing home admissions. In order for people with dementia to enjoy their sunset life despite the need for care, it is important to maintain their cognitive and motor skills and to improve their quality of life. Currently this is mostly and preferably managed with medication. However, drug therapies for dementia are limited and always accompanied by side effects. Therefore non-drug interventions are gaining more prominence. Studies suggest that a combination of physical activity and music has positive effects on people with dementia. The objective of this study was to develop music-based, health-promoting strength training for dementia patients and to analyze its influence on selected cognitive and motor skills as well as on quality of life. 16 residents with dementia (82.5±4.1 years) took part in the study. The patients performed a music-based strength intervention twice a week for 60 minutes each time over a period of 12 weeks. Selected cognitive abilities as well as motor responsiveness, grip strength and mobility were examined. In addition, the NOSGERII provided information about the quality of life. The intervention resulted in significant improvements in grip strength left (p=.002) and right (p=.001) and responsiveness (p=.032). In all of the other outcome parameters, no improvements, but also no significant worsening, could be ascertained. With the help of an observation sheet, important findings for the practicability of the exercise program in dementia patients were obtained. In summary, it can be stated that the music-based, health-promoting strength training that was developed was feasible with dementia patients and was not only accepted by the participants, but also carried through to the end. Twelve weeks of training resulted in significant improvements in selected motor skills and stabilization of cognitive skills. Conclusively, music-based exercise programs could be a promising addition to medication therapy for people with dementia. Received: 15 June 2021 Accepted after revision: 03 November 2021 Publication Date: 21 February 2022 (online) © 2022. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany

One of the most common causes of needing care in old age is dementia. In order to enjoy a pleasant retirement for people with dementia, it is essential for them to maintain their independence. Studies have shown that a combination of physical activity and music has positive effects on dementia patients. Therefore, this study aimed to investigate the feasibility of implementing a multidimensional music-based exercise program for dementia patients and the effects on an intervention group (IG) compared to a control group (CG, usual care). The study design was based on a 12-week intervention with two (IG/CG) by two (pretest/posttest) parallel groups and block randomization with unequal group sizes. Participants had to be able to move independently or with a walker and not have severe cardiovascular disease or cardiac arrhythmias. Fifty-three blinded dementia patients (age: 83.63 ± 6.03 years) from inpatient facilities participated in the study and were assigned from the exercise instructors to IG (n = 34) and CG (n = 19). The primary outcomes were feasibility (Observation sheet), modified Chair Rising test, Timed Up and Go test, hand dynamometer test, FICSIT‑4 (Frailty and Injuries: Cooperative Studies of Intervention Techniques), and drop bar test. Secondary endpoints included: verbal fluency (“animals”), the Mini-Mental State Examination, memory, Trail Making Test A, and Qualidem. Forty-nine subjects were analyzed (IG = 32; CG = 17). There were significant differences between the groups in the modified Chair Rising test (p = 0.033), FICSIT‑4 (p = 0.035), and Timed Up and Go test (p = 0.005) at posttest, which showed improved performance of the IG compared to the CG. The IG additionally showed improvements in the modified Chair Rising test (p = 0.000), drop bar test (p = 0.033), hand dynamometer test (p = 0.001), Timed Up and Go test (p = 0.000), verbal fluency (p = 0.002) and Trail Making Test A (p = 0.04) after 12 weeks. There were no adverse events or side effects. The multidimensional music-based exercise program could be performed by the dementia patients and was well received. The improved functional mobility could contribute to a lower risk of falls and thus maintain independence. For the follow-up study, the number of subjects, randomization, and parameters should be considered.