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

Trial Summary

What is the purpose of this trial?

Studies have determined that compared to cognitively intact older adults (CIOA), older adults with mild cognitive impairment (OAwMCI) exhibit more pronounced balance and gait impairments which lead to an increased risk of falls and mobility decline. Such impairments are evident during dual-tasking (i.e., simultaneous performance of cognitive and motor task) and OAwMCI have demonstrated an increased cognitive-motor interference (deteriorated performance of either or both cognitive/motor task). Furthermore, our preliminary laboratory findings indicate that compared to CIOA, OAwMCI in response to large-magnitude treadmill perturbations exhibits poor reactive responses (first line of defense against balance loss) and are unable to modulate their responses as the magnitude of perturbation increases. Despite that conventional exercise methods offer beneficial effects; they comprise of self-initiated task-specific exercises and may not focus on training reactive responses. Additionally, due to the presence of subtle balance and gait deficits, clinical measures used may not be sensitive enough to determine the risk of fall post-training. Furthermore, these training methods incorporate multiple sessions due to which adherence to exercise training is difficult with only a fraction of the older adults benefiting from it. Therefore, it is essential to incorporate a task-specific strategy that promotes factors associated with falling like balance control, muscular responses, coordination of limbs, and cognition through which OAwMCI may acquire maximum benefits to prevent a balance loss. One feasible method, which harnesses technology that can be used to deliver balance disturbances either while standing or walking in a consistent and controlled manner, is via a custom-based motorized treadmill. The scientific rigor from preliminary studies has reported a successful reduction of falls through a single session exposing CIOA to multiple treadmill-induced perturbations during gait and has shown significant improvement in reactive responses. For that reason, this stage 1 pilot study will examine the feasibility, applicability, and tolerability of a combined cognitive, and perturbation training on biomechanical determinants associated with falls and promote physical activity: kinematic variables, muscular responses, and cognitive function.

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 data supports the effectiveness of the treatment Dual Task Training for Mild Cognitive Impairment?

Research shows that dual-task training can improve balance and cognitive functions in people with mild cognitive impairment, as well as enhance postural stability in elderly participants and those with chronic stroke. Additionally, perturbation-based balance training is effective in preventing falls in older adults, suggesting potential benefits for improving balance in this population. ^{1 2 3 4 5}

Is Dual Task Training for Mild Cognitive Impairment safe for humans?

Perturbation-based balance training, which is similar to Dual Task Training, has been studied for safety in older adults and people with conditions like Parkinson's disease and stroke. It is generally considered safe, but more research is needed to fully understand its safety in different populations. ^{2 6 7 8 9}

How is dual-task training different from other treatments for mild cognitive impairment?

Dual-task training is unique because it combines physical and cognitive tasks simultaneously, which can improve both balance and cognitive functions. This approach is different from traditional treatments that may focus on either physical or cognitive exercises separately. ^{1 3 4 10 11}

Research Team

Tanvi Bhatt

Principal Investigator

University of Illinois at Chicago

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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 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]

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]

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]

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]

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

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

2. Switzerland pubmed.ncbi.nlm.nih.gov

Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice. [2023]

3. Korea (South) pubmed.ncbi.nlm.nih.gov

The effect of dual-task training on balance and cognition in patients with subacute post-stroke. [2022]

4. New Zealand pubmed.ncbi.nlm.nih.gov

Effects of dual tasks and dual-task training on postural stability: a systematic review and meta-analysis. [2018]

5. United States pubmed.ncbi.nlm.nih.gov

Sensor-based balance training with motion feedback in people with mild cognitive impairment. [2020]

6. United States pubmed.ncbi.nlm.nih.gov

Effects of Perturbation-Based Balance Training in Subacute Persons With Stroke: A Randomized Controlled Trial. [2019]

7. Switzerland 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. [2021]

8. England 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. [2021]

9. United States pubmed.ncbi.nlm.nih.gov

Intensive Balance Training for Adults With Incomplete Spinal Cord Injuries: Protocol for an Assessor-Blinded Randomized Clinical Trial. [2023]

10. Austria pubmed.ncbi.nlm.nih.gov

Brain volumes and dual-task performance correlates among individuals with cognitive impairment: a retrospective analysis. [2021]

11. United States pubmed.ncbi.nlm.nih.gov

Benefits of cognitive dual-task training on balance performance in healthy older adults. [2010]