Effectiveness of Simultaneous Combined Intervention for Enhancing Cognitive Function in Patients with Moderate Alzheimer's Disease

Ines Ben Ayed; Achraf Ammar; Chirine Aouichaoui; Salma Naija; Sana Ben Amor; Jordan M Glenn; Hamdi Chtourou; Haitham Jahrami; Khaled Trabelsi; Yassine Trabelsi; Farid El Massioui

doi:10.3233/ADR-249003

Effectiveness of Simultaneous Combined Intervention for Enhancing Cognitive Function in Patients with Moderate Alzheimer's Disease

J Alzheimers Dis Rep. 2024 May 17;8(1):833-845. doi: 10.3233/ADR-249003. eCollection 2024.

Authors

Ines Ben Ayed^{1

2

3}, Achraf Ammar^{4

5

6}, Chirine Aouichaoui^{1

7}, Salma Naija⁸, Sana Ben Amor⁸, Jordan M Glenn⁹, Hamdi Chtourou^{6

10}, Haitham Jahrami¹¹, Khaled Trabelsi^{3

6}, Yassine Trabelsi¹, Farid El Massioui²

Affiliations

¹ Research Laboratory, Exercise Physiology and Physiopathology: from Integrated to Molecular "Biology, Medicine and Health", LR19ES09, Faculty of Medicine of Sousse, Sousse University, Sousse, Tunisia.
² Laboratory of Human and Artificial Cognition (EA 4004), Psychology UFR, University of Vin-cennes/Saint-Denis, Saint-Denis, France.
³ Research Laboratory, Education, Motricity, Sport and Health (EM2S), LR15JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia.
⁴ Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, Mainz, Germany.
⁵ Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.
⁶ High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia.
⁷ High Institute of Sport and Physical Education of Ksar Saïd, University of Manouba, Cité Nasr, Tunisia.
⁸ Neurology Department, University Hospital Sahloul Sousse, Sousse, Tunisia.
⁹ Department of Health, Exercise Science Research Center Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA.
¹⁰ Research Unit, Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis, Tunisia.
¹¹ Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.

Abstract

Background: The evidence supporting the effectiveness of combined interventions in Alzheimer's disease (AD) patients remains inconclusive.

Objective: The aim of this study was to evaluate the mid- and long-term effectiveness of physical training, alone or combined with cognitive games, on cognitive performance in patients with moderate AD.

Methods: Seventy-nine AD patients (≈73% females, age of ≈70±1 years) were randomly divided into three groups: aerobic-based training (AT-group, n = 27), aerobic-based training plus cognitive games (ACT-group, n = 25), and a control group engaged in reading (CG, n = 26), two sessions per week. Cognitive performance was evaluated at the start, 4th week (W4), end of the 8th week (W8), and after a 4-week detraining period (W12), using problem-solving (Tower-of-Hanoi), selective attention (Stroop-test), and working memory (Digit-Span-test) assessments. Stress levels and quality of life were also evaluated.Results:: Aerobic and combined training induced a positive effect on all cognitive functions tested at W4 (except problem-solving) and W8 (all p < 0.001) with greater improvements in working-memory and problem-solving in ACT-group (p < 0.05). Depression levels also decreased significantly, and quality of life improved at W8 (p < 0.001) in both groups. After 4 weeks of detraining, the beneficial effect of AT and ACT was still observed. The CG did not show any significant improvements at all time points.Conclusions:: Physical and cognitive interventions appear effective for improving cognitive-functions, quality-of-life, and reducing depression in AD patients. Combined training emerges as a more effective strategy to mitigate AD progression. Further research is necessary to validate these results and explore their potential for preventing early cognitive decline.

Keywords: Alzheimer’s disease; cognitive decline; combined intervention; dementia; low-cost intervention; problem-solving; selective attention; working memory.