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Randomized Controlled Trial
. 2022;26(10):909-917.
doi: 10.1007/s12603-022-1843-3.

Clinical Efficacy of Multidomain Interventions among Multimorbid Older People Stratified by the Status of Physio-Cognitive Declines: A Secondary Analysis from the Randomized Controlled Trial for Healthy Aging

W-J Lee  1 , L-N Peng, M-H Lin, C-H Lin, L-K Chen
Affiliations
Randomized Controlled Trial

Clinical Efficacy of Multidomain Interventions among Multimorbid Older People Stratified by the Status of Physio-Cognitive Declines: A Secondary Analysis from the Randomized Controlled Trial for Healthy Aging

W-J Lee et al. J Nutr Health Aging. 2022.

Abstract

Objectives: To investigate the clinical efficacy of integrated multidomain intervention among community-living older adults with multimorbidity and physio-cognitive decline syndrome (PCDS).

Design, setting and participants: This is the secondary analysis from a randomized controlled trial that data of 340 participants with Montreal Cognitive Assessment (MoCA) scores≥18 were excerpted for analysis.

Intervention: Sixteen 2-hour sessions per year were provided for participants, including physical exercise, cognitive training, dietician education and individualized integrated care for multimorbidity.

Measurements: Handgrip strength, 6-m walking speed, MoCA (total score and sub-domains), Cardiovascular Health Study (CHS) frailty score, quality of life, and serum biochemistry biomarkers.

Results: Overall, 96/340 (28.2%) of all participants have PCDS, and the integrated multidomain intervention significantly improved global cognitive performance (overall difference 1.1, 95% CI 0.4 - 1.8, p=0.003), and domains of concentration (overall difference 0.3, 95%CI 0.1 - 0.5, p=0.011), language (overall difference 0.2, 95%CI 0.1 - 0.3, p=0.006), abstract thinking (overall difference 0.1, 95%CI 0.0 - 0.3, p=0.027), and orientation(overall difference 0.2, 95%CI 0.0 - 0.4, p=0.013) across all timepoints among those with PCDS. Besides, interventions also significantly reduced frailty score among those with cognitive impairment no dementia (overall difference -0.3, 95%CI -0.5 - -0.1, p=0.011) and mobility impairment no disability (overall difference -0.3, 95%CI -0.4 - -0.1, p=0.004). and improved quality of life at domain of physical role limitation among those with PCDS (overall difference 5.3, 95%CI 0.3 - 10.4, p=0.038).

Conclusions: The integrated multidomain lifestyle intervention plus multimorbidity management significantly improved cognitive function, and enhanced quality of life among older adults with multimorbidity and PCDS in the communities.

Keywords: Integrated care; cognition; frailty; multidomain intervention; physio-cognitive decline syndrome.

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Conflict of interest statement

No potential conflict of interest was reported by the authors

Figures

Figure 1
Figure 1
CONSORT flow diagram for the trial profile
Figure 2
Figure 2
Mean changes in cognitive performance from baseline to 3,6,9,12 months in groups with physio-cognitive decline syndrome, cognitive impairment no dementia, mobility impairment no disability or robust * denotes p<0.05. ** denotes p<0.01. Generalized linear mixed model was used to compare overall difference, and individual time points between groups. CIND denotes cognitive impairment no dementia. MIND denotes mobility impairment no disability.
Figure 3
Figure 3
Mean changes in physical function from baseline to 3,6,9,12 months in groups with physio-cognitive decline syndrome, cognitive impairment no dementia, mobility impairment no disability or robust * denotes p<0.05. ** denotes p<0.01. Generalized linear mixed model was used to compare overall difference, and individual time points between groups; CIND denotes cognitive impairment no dementia. MIND denotes mobility impairment no disability.
Figure 4
Figure 4
Mean changes in quality of life from baseline to 3,6,9,12 months in groups with physio-cognitive decline syndrome, cognitive impairment no dementia, mobility impairment no disability or robust * denotes p<0.05. ** denotes p<0.01. Generalized linear mixed model was used to compare overall difference, and individual time points between groups; CIND denotes cognitive impairment no dementia. MIND denotes mobility impairment no disability.
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