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 2 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 3 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 4 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. 5 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. 6 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.