Assignment 1: Quantitative Journal Article Review
The Effectiveness of Non-Medicinal Intervention Methods for Early Stages of Alzheimer’s
Juliana Spyropoulos
Yorkville University
PSYC 6213: Research Methods
Professor Penny Hamblin
July 25, 2021
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Abstract
In this research review we will be referencing a 2014 study looking at improving cognitive
functioning in older adults at risk of Alzheimer’s disease: Effects of functional tasks exercise on older
adults with cognitive impairment at risk of Alzheimer’s disease: a randomised controlled trial. This study
is a true experiment, as group membership was randomly assigned. A single-blind randomized control
method was used in this cross-sectional study, with an active control group compared with the
experimental group (Goodwin, 2017). The primary objective of this study was to examine how functional
task exercise programs (FcTSim) compare to low movement cognitive training programs when measuring
improvement in cognitive impairment for aging brains. I will reference this study in my future research
project focused on understanding which non-medicinal methods are effective at improving cognition for
aging people experiencing early symptoms of Alzheimer’s and cognitive impairment. The analyses in this
study will support my research objectives by clarifying which types of cognition building programs have
effects on sample populations. This study will outline a comprehensive method to distinguish early
symptoms of cognition loss and how the measure the improvement of early symptoms.
Law, L. L. F., Barnett, F., Yau, M. K., & Gray, M. A. (2014). Effects of functional tasks exercise on older
adults with cognitive impairment at risk of Alzheimer’s disease: a randomised controlled trial. Age and
Ageing, 43(6), 813–820. doi:10.1093/ageing/afu055
Statement of Problem
People with mild cognitive impairment are at high risk of developing Alzheimer’s disease and
other dementias. Since the risk of cognitive impairment increases with age, the growing percentage of
older adults that make up our community will raise the rate of those living with Alzheimer’s and forms of
dementia. Proposed research questions include whether the inclusion of physical movement can increase
the effectiveness of basic cognitive training and ask if positive effects do occur from functional tasks
exercise (FcTSim) will they be sustained over time? There is a social need to research more effective
intervention methods during the early stages of cognitive impairment to extend cognitive longevity.
Literature Review
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Prior research from a 2007 study by Tashiro and Gage has found that spatial learning or frequent
exposure to enriching and textured environments can protect newly generated immature cells and promote
their prolonged survival and healthy functioning connection with more neurons within the brain.
Stretching and various forms of physical activity have also been studied to affect cognition tests in brains
without impairment positively. Studies using animals have also shown that combining an enriching
environment and exercise can induce neurogenesis, more so than when only one of these conditions is
present.
Hypotheses to Be Tested
The research hypothesis developed for this study predicted that FcTSim can be used as a means
of cognitive exercise intervention to influence neural cognitive domains and to improve cognition when
compared to cognition training without a movement component. The null hypothesis to be disproved is
that adding physical movement and stimulation within an FcTSim program will not improve cognitive
function any more than cognitive improvement programing without movement (Goodwin, 2017).
Method
This study was designed with a single-blind randomized control trial and with an active control
group compared (no physical component) with the experimental group (FcTSim program).
Participants
Adults age 60+ with mild cognitive decline living in the community (out-patient clinic of
Occupational Therapy Department in Hong Kong) were eligible for the study if they met the inclusion
criteria for mild cognitive impairment.
Measurements
Assessments were undertaken at time of FcTSim program, at 11–12 weeks and during the followup at 6 months by an independent assessor. Assessment is composed of standardized tests: Cognitive
Status Examination (NCSE), Verbal Learning Test (VLT), and Category Verbal Fluency Test (CVFT).
Procedure
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A NCSE composite score was calculated by adding all subtest assessment scores (maximum 82)
and a NCSE normal domains score (0–10) was calculated by adding up the number of domains scored
normal.
Statistics
The statistically significant level was set at P < 0.05. Between-group differences in demographics
were measured at baseline and compared using independent sample t-tests to determine the effect size.
Repeated measures of analysis of variance (ANOVA) were performed to evaluate the intervention effect
by time from baseline to post-training and from baseline to 6-month follow-up. Analysis of covariance
(ANCOVA) was performed post-intervention and 6-month follow-up to evaluate the between-group
differences. Baseline cognition score, education, age, and ambulatory level were measured as covariates.
Cohen’s d was calculated at post-intervention and follow-up to estimate the between-group effect sizes.
Results
No significant baseline differences were found for demographic characteristics (range P = 0.659–
0.873) or neuropsychological assessment results (range P = 0.203–0.910) between the two groups. The
results of repeated-measures ANOVA revealed that both the FcTSim and AC group showed significant
within-group improvements in all outcomes at post-intervention and at 6-month follow-up. Results of
ANCOVA showed the FcTSim group demonstrated significant between-group differences for general
cognitive functioning. (NCSE composite score; F1,77 = 5.19, P = 0.025 memory (CVVLT delayed recall;
F1,75 = 4.24, P = 0.043), executive function (TMT-A; F1,77 = 6.82, P = 0.011) and everyday problem
solving ability (C-PEDL; F1,77 = 7.45, P = 0.008).
Implications for Counselors, Clients, and Counselling
This study can support counsellors to design their session styles and enrich office space in ways
that support healthy cognitive functioning. Counselors can include FcTSim style physical activity within
sessions to awake the mind for all clients but particularly ones experiencing mild cognitive impairment.
Clients can also benefit from these finding by initiating physical activity within their own mental health
routines and by selecting counsellors who include this within their practices.
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Summary
The null hypothesis of this study can be rejected and the research hypothesis confirmed as the
results of the statistical analysis find significant difference between the experimental FcTSim group and
the control group. Intervening with cognitive FcTSim exercises does improve cognition when compared
to cognition training without any movement component.
Interpretation
The researches of this study used eight separate cognitive assessments, measured at three
distanced time points to come to an aggregate NCSE composite score, effectively measuring cognitive
ability over time. While I would argue this to be an effective measurement of cognition, the results can
still be skewed by the Hawthorne effect (Goodwin, 2017). While subjects were blind to the true topic of
the study, the questions the eight assessments used to reveal cognitive ability to be revealing of the nature
of the experiment. Unrelated assessments can also be used to truly make this experiment single-blind
(Goodwin, 2017). The small sample size (n=83) for this experiment was comprised of only one ethnic
group, older Chinese people from Hong Kong, and should be tested in other countries to improve external
validity of results. This small sample size prevented stratification of patients’ precise cognitive subgroups or different age groups to compare effects across demographics which could demonstrate unique
responses to FcTSim. The experiments effectively used ANCOVA testing to include gender and
ambulatory level as covariates to control for their confounding effects on cognitive ability and improve
internal validity (Goodwin, 2017).
For Further Study
Long-term research should be conducted to determine whether mild cognitively impaired people
practicing FcTSim are less likely to develop Alzheimer’s disease. Ethical implications regarding consent
for those more cognitively impaired must first be considered.
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References:
Law, L. L. F., Barnett, F., Yau, M. K., & Gray, M. A. (2014). Effects of functional tasks exercise on older
adults with cognitive impairment at risk of Alzheimer’s disease: a randomised controlled trial. Age and
Ageing, 43(6), 813–820. doi:10.1093/ageing/afu055
Tashiro A, Makino H, Gage FH. Experience-specific functional modification of the dentate gyrus through
adult neurogenesis: a critical period during an immature stage. J Neurosci 2007; 27: 3252–9.
Goodwin, K. A., & Goodwin, C. J. (2017). Research in psychology: Methods and designs (8th ed.).
Hoboken, NJ: John Wiley & Sons.