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Background and purpose People with dementia show disease-specific sit-to-stand (STS) movement disorders, which relate to deficits of integrating cognitive aspects of motor processes into motor action organization. During STS training in rehabilitation therapy, compensatory STS movement maneuvers are taught aiming to improve patients' STS ability. Previous clinical STS measures do not address these maneuvers or assess cognitive aspects of their motor action organization. The purpose of this study was to develop and validate a motor-cognitive STS assessment instrument for people with dementia (Assessment of Compensatory Sit-to-Stand Maneuvers in People With Dementia, ACSID). Methods The ACSID covers the recall, initiation, and effective performance of compensatory STS movement maneuvers. The inter- and intrarater reliability, concurrent validity, sensitivity to change, and feasibility were investigated by secondary analysis of data of 97 participants from a randomized controlled trial to improve motor-cognitive performances in people with mild to moderate dementia (mean [standard deviation] age: 82.5 [5.9] years, Mini-Mental Status Examination: 21.9 [2.9] points). Concurrent validity of the individual ACSID items was assessed against reference criteria derived from video-motion analysis. Results Good to excellent inter- (kappa [κ] = 0.64-0.99; intraclass correlation coefficient [ICC] = 0.74-0.89) and intrarater (κ= 0.77-0.91; ICC = 0.77-0.91), concurrent validity (point-biserial correlation coefficients = |0.56|-|0.84|), and sensitivity to change (standardized response means = 0.61-1.00) were found. Feasibility was excellent with a high completion rate (96.9%), no critical events during assessment, and no floor or ceiling effects. Conclusions The ACSID represents the first observation-based assessment instrument to document motor and cognitive aspects in the execution of a motor key feature in people with dementia, and has been shown to be reliable, valid, feasible, and sensitive to intervention-induced changes.

Objective To investigate validity, test-retest reliability, sensitivity to change, and feasibility of dual task (DT) assessments in patients with dementia. Design Validation study. Setting Post ward-rehabilitation. Participants Geriatric patients (n = 105) with dementia (age 82.7 ± 5.9, MMSE score 21.9). Main outcome measures Psychometric quality of DT performance of different DT-tests. Analyses were performed for motor and cognitive performance, and relative DT costs (DTCs). Results Spearman’s rank correlations (r s ) between examined DT-tests were moderate-high for motor tasks (r s = 0.29–0.90), small-high for cognitive tasks (r s = 0.12–0.55) and small-high for relative DTCs (motor DTCs r s = 0.02-0.61, cognitive DTCs r s = −0.19 to 0.06, combined DTCs r s = −0.11 to 0.31). Correlations with external assessment were moderate-high for motor tasks (r s = 0.25–0.84), small-moderate for cognitive tasks (r s = −0.10 to 0.46) and small-moderate for relative DTCs (motor DTCs r s = −0.09 to 0.17, cognitive DTCs r s = −0.03 to 0.21, combined DTCs r s = −0.07 to 0.26). Test-retest reliability was excellent for motor tasks (ICC = 0.75–0.96), fair-excellent for cognitive tasks (ICC = 0.51–0.88) and poor-good for relative DTCs (motor DTCs ICC = 0.10–0.74, cognitive DTCs ICC = 0.05–0.65, combined DTCs ICC = 0.15–0.71). Sensitivity to change was acceptable-excellent for trained DT-tests ( p ≤ 0.01). Effect sizes were small-large for gait parameters (SRM = 0.30–1.12), large for cognitive tasks (SRM = 0.82–0.95) and small-large for relative DTCs (motor DTCs SRM = 0.15–0.77, cognitive DTCs SRM = 0.56-0.98, combined DTCs SRM = 0.40–1.10). Completion time ranged from 13.1 to 16.9 min. Conclusions All DT-tests showed acceptable-excellent psychometric properties in patients with dementia with highest quality for the gait-based tests ‘Walking & Counting’ and ‘Walking & reciting ABC’.

Background: Some studies have already suggested that exergame interventions can be effective to improve physical, cognitive, motor-cognitive, and psychological outcomes in patients with dementia (PwD). However, little is known about the training volume required to induce such positive effects and the inter-individual differences in training response among PwD. The aim of the study was to analyze the time course of changes in motor-cognitive exergame performances during a task-specific training program and to identify predictors of early training response in PwD. Methods: Secondary analyses of data from the intervention group (IG) of a randomized, placebo-controlled trial to improve motor-cognitive performances in PwD. Fifty-six geriatric patients with mild-to-moderate dementia randomized to the IG underwent a 10-week, task-specific training program (2×/week) on an exergame-based balance training system (Physiomat®), combining postural control tasks with cognitive tasks of an established neuropsychological test (Trail Making Test). Main outcome was the time required to complete different Physiomat®-Tasks (PTs) assessed at baseline (T1), training session 7 (TS7) and 14 (TS14), and post-intervention after 20 training sessions (T2). Reliable change indices were used to identify early responders from T1 to TS7. A multivariate logistic regression analysis was performed to determine independent predictors of early training response. Results: Completion time significantly improved already from T1 to TS7 in all PTs (p ≤ .001–.006), with moderate to very large effect sizes (r = .38–.52; Cohen’s d = .85–1.45). For most PTs, significant progressive improvements from TS7 to TS14 and TS14 to T2 were not observed. Thirty-one (59.6%) participants were classified as early responders and 21 (40.4%) as non-early responders. Lower baseline exergame performance and lower visuospatial and divided attention abilities were independently associated with early training response. Conclusions: Substantial task-specific improvements in complex motor-cognitive exergame performances can be obtained within a surprisingly short intervention period in PwD. Our results confirm that not only an excellent training response can be achieved in this patient population, but also that more vulnerable patients with greater deficits in domain-specific cognitive functions associated with fall risk may even reap the most and fastest benefit from motor-cognitive exergame interventions. Trial registration: ISRCTN registry, ISRCTN37232817 (retrospectively registered on 04/02/2012).

To examine the effects of a computerized, game-based training on motor-cognitive performances, the transfer of training effects on untrained tasks, and the sustainability of training gains in people with dementia.Ninety-nine individuals with a mean age of 82.9 (5.8) and dementia participated in a 10-week randomized controlled trial with three-month follow-up. The intervention group (IG) received a motor-cognitive training on (Physiomat®) including concurrent dual-tasks of balance control with cognitive demands (Physiomat®-Trail Making Tasks (PTMTs)). The control group (CG) performed non-specific, low-intensity exercises. Duration and accuracy at different complexity levels of trained and untrained PTMTs and the number of successfully performed tasks (PTMT score) were assessed.Physiomat® training significantly improved the duration and accuracy at almost all complexity levels of trained (P ≤ 0.001-0.047, ηPhysiomat® is feasible and has the potential to sustainably improve motor-cognitive performances in people with dementia.

Fear of falling and depression in the elderly and among cognitively impaired people lead to restrictions in quality of life. Being more active is associated with improved mental health as documented in cross-sectional and longitudinal studies. This is especially true for depression. Such epidemiologic evidence is lacking in fear of falling. This review summarizes current evidence from epidemiological and randomized controlled trials (RCTs) and gives an outlook for future research perspectives. The majority of studies included in this review document a significant reduction of depression and fear of falling in older persons by physical training with less evidence in persons with cognitive impairment. With respect to intensity, duration, and amount of exercise, evidence-based recommendations were limited by the small number of high-quality comparative RCTs. High-intensity strength or endurance training was the most effective for reducing depression, while participation in Tai-Chi or multifactorial training programs was most effective to reduce fear of falling.

Background: Exergames often used for training purpose can also be applied to create assessments based on quantitative data derived from the game. A number of studies relate to these use functionalities developing specific assessment tasks by using the game software and provided good data on psychometric properties. However, (1) assessments often include tasks other than the original game task used for training and therefore relate to similar but not to identical or integrated performances trained, (2) people with diagnosed dementia have insufficiently been addressed in validation studies, and (3) studies did commonly not present validation data such as sensitivity to change, although this is a paramount objective for validation to evaluate responsiveness in intervention studies. Objective: Specific assessment parameters have been developed using quantitative data directly derived from the data stream during the game task of a training device (Physiomat). The aim of this study was to present data on construct validity, test–retest reliability, sensitivity to change, and feasibility of this internal assessment approach, which allows the quantification of Physiomat training effects on motor-cognitive functions in 105 multimorbid patients with mild-to-moderate dementia (mean age 82.7±5.9). Methods: Physiomat assessment includes various tasks at different complexity levels demanding balance and cognitive abilities. For construct validity, motor-cognitive Physiomat assessment tasks were compared with established motor and cognitive tests using Spearman’s rank correlations (rs). For test–retest reliability, we used intra-class correlations (ICC3,1) and focused on all Physiomat tasks. Sensitivity to change of trained Physiomat tasks was tested using Wilcoxon statistic and standardized response means (SRMs). Completion rate and time were calculated for feasibility. Results: Analyses have mostly shown moderate-to-high correlations between established motor as well as cognitive tests and simple (rs=−.22 to .68, P ≤.001-.03), moderate (rs=−.33 to .71, P ≤.001-.004), and complex motor-cognitive Physiomat tasks (rs=−.22 to .83, P ≤.001-.30) indicating a good construct validity. Moderate-to-high correlations between test and retest assessments were found for simple, moderate, and complex motor-cognitive tasks (ICC=.47-.83, P ≤.001) indicating good test–retest reliability. Sensitivity to change was good to excellent for Physiomat assessment as it reproduced significant improvements (P ≤.001) with mostly moderate-to-large effect sizes (SRM=0.5-2.0) regarding all trained tasks. Completion time averaged 25.8 minutes. Completion rate was high for initial Physiomat measures. No adverse events occurred during assessment. Conclusions: Overall, Physiomat proved to have good psychometric qualities in people with mild-to-moderate dementia representing a reliable, valid, responsive, and feasible assessment strategy for multimorbid older adults with or without cognitive impairment, which relates to identical and integrated performances trained by using the game. [JMIR Serious Games 2016;4(2):e12]

Exergaming can be effective to improve physical and cognitive functions, motor-cognitive per-formances, and psychological outcomes in older persons with or without cognitive impairment. However, little is known about the training volume required to achieve positive effects. The aim of this study was to evaluate the time course of improvements in motor-cognitive game performances during an exergame intervention in Persons with Dementia (PwD). Fifty-six PwD (mean age = 82.7 ± 6.2, MMSE = 22.2 ± 2.8) took part in a 10-week task-specific training program (2/week = 20 sessions) on an interactive, exergame-based balance training system (Physiomat®), combining postural control tasks with cognitive tasks of an established neuropsychological test (modified Trail-Making-Test). Physiomat® performance was assessed at baseline (T1), after training session 7 (TS7) and 14 (TS14), and at post-intervention after 20 training sessions (T2) as the time required to complete different Physiomat®-Trail-Making-Tasks (PTMT). Significant improvements with large effect sizes in all PTMT were observed from T1 to TS7 (p ≤ 0.001–0.003; Cohen’s d = 0.80–1.40 for effect sizes). Physiomat® performance in most PTMT did not significantly improve from TS7 to TS14, nor from TS14 to T2. Across all PTMT, significant improvements with moderate-to-large effect sizes (p ≤ 0.001–0.036; Cohen’s d = 0.43–1.07) were found from TS7 to T2. Results suggest that large task-specific improvements in complex motor-cognitive performances can be achieved in PwD within a surprisingly short exergame intervention. For further increase of the performance level, a higher training volume may to be necessary to fully exploit rehabilitation potential in this vulnerable population.