Dual Task Training for Mild Cognitive Impairment

Overseen By Lakshmi Kannan

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Illinois at Chicago

Must not be taking: Sedatives

Disqualifiers: Neurological, Cardiopulmonary, Musculoskeletal, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

142 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new approach to help older adults with mild cognitive impairment (MCI) improve balance and reduce fall risk. The study focuses on "dual task perturbation training," which combines cognitive exercises (such as memory and reaction games) with physical balance training on a motorized treadmill. Participants face balance challenges while performing mental tasks to determine if this method enhances stability and cognitive function. Suitable candidates for this trial are those over 55 with mild cognitive impairment who can walk 10 meters without assistance. As an unphased trial, it offers participants the chance to contribute to innovative research that could enhance balance and cognitive function in older adults.

Will I have to stop taking my current medications?

The trial does not specify whether you need to stop taking your current medications, but you cannot participate if you are on sedative drugs.

What prior data suggests that this dual task perturbation training is safe for older adults with mild cognitive impairment?

Studies have shown that dual task perturbation training helps older adults with mild cognitive impairment (MCI) improve balance and reduce the risk of falls. This method combines mental exercises, such as memory games, with physical activities to enhance both brain and body function.

Research indicates that older adults with MCI find tasks requiring both thinking and moving more challenging. However, this training is generally well-tolerated, with no significant reports of serious side effects. Previous findings suggest that this type of training can improve balance and physical responses without causing harm.

This study does not involve traditional medications but focuses on exercises that might help prevent falls. This intervention is considered safe for most participants, as it mainly involves familiar activities like walking, with added mental challenges to engage the mind. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about dual task perturbation training for mild cognitive impairment because it combines physical and cognitive exercises in a novel way. Unlike traditional treatments that may focus solely on cognitive exercises or physical therapy, this approach integrates both simultaneously, potentially enhancing the brain’s ability to manage multiple tasks. This method aims to improve working memory, executive functioning, and other cognitive skills while also helping with balance and coordination. By challenging the brain and body together, researchers hope to see more significant improvements in cognitive function and daily living skills than with standard care options.

What evidence suggests that this trial's dual task perturbation training could be effective for mild cognitive impairment?

Research has shown that older adults with mild cognitive impairment (OAwMCI) often struggle with balance and movement, particularly when performing dual tasks like thinking and walking. Studies indicate they face challenges with both tasks, increasing their risk of falling. In this trial, participants will engage in dual task training, which combines thinking exercises with balance challenges. Previous studies have demonstrated that this training helps them manage balance disturbances, reduce falls, and improve balance maintenance. These findings suggest that dual task training could effectively enhance balance and reduce fall risks in OAwMCI. ^{1 2 3 5 6}

Who Is on the Research Team?

Tanvi Bhatt

Principal Investigator

University of Illinois at Chicago

Are You a Good Fit for This Trial?

This trial is for older adults over 55 with mild cognitive impairment (MOCA score <26). Participants must be able to walk unassisted for more than 10 meters, not use sedatives, have no recent major surgeries or hospitalizations, and can't have chronic neurological, cardiopulmonary, musculoskeletal diseases. They should understand English and meet certain heart rate and blood pressure criteria.

Inclusion Criteria

Can understand and communicate in English

I haven't had major surgery or been hospitalized in the last 6 and 3 months, respectively.

I do not have any chronic conditions like stroke, Parkinson's, Alzheimer's, heart or lung issues.

Exclusion Criteria

I haven't had any major surgeries or bone fractures in the last six months.

My heart rate, blood pressure, and oxygen levels are within safe ranges.

I weigh more than 220 lbs.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Single Session Training

Participants receive a single session of dual-task perturbation training to familiarize with cognitive tasks and undergo perturbation trials.

1 session

1 visit (in-person)

Multiple Session Training

Participants undergo 4 weeks of dual-task perturbation training involving cognitive and motor tasks to improve balance and cognitive function.

4 weeks

Multiple visits (in-person)

Follow-up

Participants are monitored for retention of improvements in stability control, cognition, and fall reduction for at least 3 months post-training.

3 months

What Are the Treatments Tested in This Trial?

Interventions

• Dual task perturbation training

Trial Overview

The study tests dual task perturbation training on a treadmill designed to improve balance and prevent falls in older adults with mild cognitive impairment. It aims to enhance coordination of limbs, muscle responses, balance control, and cognition through controlled disturbances during walking.

How Is the Trial Designed?

Group I: Single session dual task perturbation training-OAwMCI Experimental Treatment 1 Intervention

Participants will receive single session training of dual task. Six cognitive games that target working memory, executive functioning, visuomotor reactions, and language fluency will be provided in standing to get themselves familiarized. Following the cognitive tasks, participants will receive 12 slips without performing cognitive task (Single task training) at the highest intensity. Subsequently, 12 slips during standing while performing a cognitive task (dual task) will be administered. Similarly, they will then undergo 12 dual task walking trials (at self-selected speed) followed by 12 walking slips.

Group II: Multiple session dual task perturbation training-OAwMCI Experimental Treatment 1 Intervention

All participants will undergo stance and walking perturbation training for 4 weeks. Six cognitive games that target working memory, executive functioning, visuomotor reactions, and language fluency will be provided in standing to get themselves familiarized. Following the cognitive tasks, participants will receive 12 slips without performing cognitive task (Single task training) at the highest intensity. Subsequently, 12 slips during standing while performing a cognitive task (dual task) will be administered. Similarly, they will then undergo 12 dual task walking trials (at self-selected speed) followed by 12 walking slips.

Group III: Single session dual task perturbation training-CIOA Active Control 1 Intervention

All participants will receive only one training session of dual task. Six cognitive games that target working memory, executive functioning, visuomotor reactions, and language fluency will be provided in standing to get themselves familiarized. Following the cognitive tasks, participants will receive 12 slips without performing cognitive task (Single task training) at the highest intensity. Subsequently, 12 slips during standing while performing a cognitive task (dual task) will be administered. Similarly, they will then undergo 12 dual task walking trials (at self-selected speed) followed by 12 walking slips.

Who Is Running the Clinical Trial?

University of Illinois at Chicago

Lead Sponsor

Trials

653

Recruited

1,574,000+

National Institute on Aging (NIA)

Collaborator

Trials

1,841

Recruited

28,150,000+

Roybal Predoctoral pilot grant

Collaborator

Trials

1

Recruited

140+

Published Research Related to This Trial

In patients with cognitive impairment (CI), smaller brain volumes are linked to poorer dual-task performance, particularly in cognitive tasks, which negatively affects gait and balance.

The study suggests that cognitive dual-task effects are more critical for understanding functional decline in CI than motor dual-task effects, indicating that strategies focusing on cognitive tasks may help improve overall function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Brain volumes and dual-task performance correlates among individuals with cognitive impairment: a retrospective analysis. Longhurst, JK., Wise, MA., Krist, DJ., et al.[2021]

This study investigates the effectiveness of perturbation-based balance training (PBT) compared to conventional intensive balance training (CIBT) in improving reactive stepping ability in 24 adults with chronic incomplete spinal cord injury over 8 weeks.

The primary outcome measures the ability to recover balance using a single step, which will help determine which training method is more effective for enhancing balance control and reducing fall risk in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intensive Balance Training for Adults With Incomplete Spinal Cord Injuries: Protocol for an Assessor-Blinded Randomized Clinical Trial. Unger, J., Chan, K., Scovil, CY., et al.[2023]

A pilot study involving 22 participants with mild cognitive impairment showed that a novel sensor-based balance training program significantly reduced postural sway and fear of falling after 4 weeks of training, indicating its potential efficacy in improving balance.

The majority of participants (92%) found the training enjoyable and felt that the real-time feedback from wearable sensors was helpful, suggesting a positive user experience that supports the feasibility of this intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sensor-based balance training with motion feedback in people with mild cognitive impairment. Schwenk, M., Sabbagh, M., Lin, I., et al.[2020]

In a study of 20 subacute stroke patients, dual-task training combining balance and cognitive exercises showed improvements in specific balance metrics, such as weight distribution and stability, after 4 weeks of rehabilitation.

While the dual-task training did not significantly outperform conventional balance training in overall balance or cognitive function, it demonstrated potential benefits in certain balance parameters, suggesting it could be a valuable addition to rehabilitation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of dual-task training on balance and cognition in patients with subacute post-stroke. Choi, JH., Kim, BR., Han, EY., et al.[2022]

Healthy older adults who underwent five sessions of cognitive dual-task training showed significant improvements in balance and mobility compared to an untrained control group, indicating the effectiveness of this training method.

The study highlights the role of executive control in maintaining balance in older adults, suggesting that cognitive training can enhance motor performance and has implications for developing interventions to improve balance in aging populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Benefits of cognitive dual-task training on balance performance in healthy older adults. Li, KZ., Roudaia, E., Lussier, M., et al.[2010]

Perturbation-based balance training is emerging as a promising method for preventing falls in older adults, focusing on task-specific training that may lead to better adaptation and retention of balance skills.

While the approach shows potential efficacy, further research is needed to address safety concerns and practical implementation issues before it can be widely adopted in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice. McCrum, C., Bhatt, TS., Gerards, MHG., et al.[2023]

A study is evaluating the effectiveness of a three-session perturbation-based balance training (PBT) protocol in older adults, aiming to improve balance control and reduce falls, compared to usual care.

The research will assess balance and fear of falling at multiple time points and gather qualitative feedback on the acceptability of PBT, potentially showing that fewer training sessions can still lead to significant benefits in fall prevention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perturbation-based balance training to improve balance control and reduce falls in older adults - study protocol for a randomized controlled trial. Gerards, MHG., Marcellis, RGJ., Poeze, M., et al.[2021]

A new Perturbation-Based-Balance Training (PBBT) program using hands-free bicycling is being tested on 68 pre-frail older adults to improve their balance and reduce fall risks, addressing a critical need for those who cannot participate in traditional balance training.

The study aims to determine if balance skills learned while sitting can be transferred to standing and walking, potentially helping frail older adults improve their reactive and proactive balance responses in real-life situations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effects of Bicycle Simulator Training on Anticipatory and Compensatory Postural Control in Older Adults: Study Protocol for a Single-Blind Randomized Controlled Trial. Batcir, S., Lubovsky, O., Bachner, YG., et al.[2021]

Both multitask training (MTT) and multicomponent training (MCT) effectively improved cognitive functions, processing speed, gait speed, and balance in 42 participants with mild cognitive impairment, showing that both training methods are beneficial.

While MCT led to greater improvements in single-task and dual-task gait speed, MTT was more effective for enhancing balance functions, suggesting that different training strategies can target specific cognitive and physical outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Multitask Versus Multicomponent Training on Cognitive and Motor Functions in Persons With Mild Cognitive Impairment: A Randomized Trial. Bilgin, BF., Iyigun, G.[2022]

A systematic review of 42 studies involving 1,480 participants found that dual-task training significantly improves postural stability in various populations, especially in elderly individuals and chronic stroke patients.

While dual-task training generally enhances stability, acute dual tasks can have mixed effects, with some studies showing improvements and others indicating decrements, particularly in patients with multiple sclerosis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of dual tasks and dual-task training on postural stability: a systematic review and meta-analysis. Ghai, S., Ghai, I., Effenberg, AO.[2018]

A short-term perturbation-based balance training (PBBT) program significantly improved reactive balance responses in stroke patients, as evidenced by higher multiple-step thresholds compared to a weight shifting and gait training group, with effect sizes of 1.07 and 1.10 for forward and backward translations, respectively.

Participants in the PBBT group also reported increased balance confidence, indicated by a moderate effect size of 0.74 on the Activity-specific Balance Confidence scale, highlighting the potential of PBBT in enhancing both physical and psychological aspects of balance in rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Perturbation-Based Balance Training in Subacute Persons With Stroke: A Randomized Controlled Trial. Handelzalts, S., Kenner-Furman, M., Gray, G., et al.[2019]

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