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Effects of Aerobic Dance on Cognition in Older Adults with Mild Cognitive Impairment: A Systematic Review and Meta-Analysis


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Background: Regular aerobic exercises could improve global cognition in older adults with mild cognitive impairment (MCI), such as aerobic dance a type of commonly practiced aerobic exercises. However, its effects remain debatable in improving the cognitive function in patients with MCI. Objective: The aim of this systematic review and meta-analysis is to evaluate the effects of aerobic dance on cognitive function among older adults with MCI. Methods: We searched articles in the MEDLINE, PubMed, Embase, and The Cochrane Library databases from inception to 28 February 2019, with the following criteria: 1) randomized controlled trials; 2) older adults with MCI; 3) aerobic dance intervention. Results: Five studies of 842 participants were identified. This meta-analysis showed that aerobic dance can significantly improve global cognition (Mini-Mental State Examination: MD = 1.43; 95% CI:[0.59, 2.27]; p = 0.0009; Alzheimer's Disease Assessment Scale-Cognitive Subscale: MD=-2.30; 95% CI:[-3.60, -1.00]; p = 0.0005), and delayed recall ability (SMD = 0.46;95% CI: [0.30, 0.62]; p < 0.00001) in older adults with MCI. In addition, have positive effects on improving executive function (Trial-Making Test A: MD = -2.37;95% CI:[-4.16, -0.58]; p = 0.010; Trial-Making Test B: MD = -16.0; 95% CI: [-30.03, -2.11]; p = 0.020) and immediate recall ability (SMD = 0.24;95% CI: [0.01, 0.46]; p = 0.04). Conclusion: Aerobic dance significantly improves global cognitive function and memory in older adults with MCI. In addition, it also benefits executive function. However, due to the limitations as the review states, more randomized controlled trials with better study design and larger sample sizes should be conducted in the future research to make it much clearer.
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Journal of Alzheimer’s Disease 74 (2020) 679–690
DOI 10.3233/JAD-190681
IOS Press
Effects of Aerobic Dance on Cognition
in Older Adults with Mild Cognitive
Impairment: A Systematic Review
and Meta-Analysis
Yi Zhua,1, Qian Zhongb,1, Jie Jia,1, Jinhui Mac, Han Wud, Yaxin Gaob, Nawab Aliband Tong Wanga,
aDepartment of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu,
bFirst Clinical Medical College, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu,
cDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
dDepartment of Rehabilitation, Nanjing Drum Tower Hospital, The Affiliated Hospital of the Medical School at
Nanjing University, Nanjing, Jiangsu, China
Accepted 16 January 2020
Background: Regular aerobic exercises could improve global cognition in older adults with mild cognitive impairment
(MCI), such as aerobic dance a type of commonly practiced aerobic exercises. However, its effects remain debatable in
improving the cognitive function in patients with MCI.
Objective: The aim of this systematic review and meta-analysis is to evaluate the effects of aerobic dance on cognitive
function among older adults with MCI.
Methods: We searched articles in the MEDLINE, PubMed, Embase, and The Cochrane Library databases from inception
to 28 February 2019, with the following criteria: 1) randomized controlled trials; 2) older adults with MCI; 3) aerobic dance
Results: Five studies of 842 participants were identified. This meta-analysis showed that aerobic dance can significantly
improve global cognition (Mini-Mental State Examination: MD = 1.43; 95%CI:[0.59, 2.27]; p= 0.0009; Alzheimer’s Dis-
ease Assessment Scale-Cognitive Subscale: MD=–2.30; 95%CI:[–3.60, –1.00]; p= 0.0005), and delayed recall ability
(SMD = 0.46;95%CI: [0.30, 0.62]; p< 0.00001) in older adults with MCI. In addition, have positive effects on improving
executive function (Trial-Making Test A: MD= –2.37;95%CI:[–4.16, –0.58]; p= 0.010; Trial-Making Test B: MD= –16.0;
95%CI: [–30.03, –2.11]; p= 0.020) and immediate recall ability (SMD=0.24;95%CI: [0.01, 0.46]; p= 0.04).
Conclusion: Aerobic dance significantly improves global cognitive function and memory in older adults with MCI. In
addition, it also benefits executive function. However, due to the limitations as the review states, more randomized controlled
trials with better study design and larger sample sizes should be conducted in the future research to make it much clearer.
Keywords: Aerobic dance, cognition, executive function, memory, meta-analysis, mild cognitive function, randomized
controlled trials
1These authors contributed equally to this work.
Correspondence to: Tong Wang, Rehabilitation Center, The
First Affiliated Hospital of Nanjing Medical University, No.
300 of Guangzhou Road, Nanjing, Jiangsu 210029, China.
Tel.: +86 139 5168 0478; Fax: +86 25 8331 8752; E-mail:
Mild cognitive impairment (MCI) is an interme-
diary phase between the typical aging process and
dementia. MCI includes group of people who suf-
fer from cognitive impairment that occur at the
early stage of dementia [1]. According to two recent
ISSN 1387-2877/20/$35.00 © 2020 – IOS Press and the authors. All rights reserved
680 Y. Zhu et al. / Aerobic Dancing Improves Cognition in MCI
meta-analysis of people aged over 60, the prevalence
of MCI is about 15% [2, 3], while a third, a Chinese
cohort study conducted in Beijing, indicated that the
prevalence of MCI among elders was 16.6% [4]. In
addition, the conversion rates from MCI to demen-
tia and Alzheimer’s disease (AD) are 34% and 28%,
respectively [2, 3]. Reduction of the risk factors could
be an effective measurement against MCI [5], lead-
ing to a drop of the onset of AD at an early age. In
addition, 15% of MCI can be reversed to normal [2].
Although there is no positive evidence supporting
pharmacological interventions in alleviating cogni-
tive function decline of MCI patients [6–9]. However,
several non-pharmacologic interventions, including a
Mediterranean diet [10], social connections [8, 11],
and cognitive training [12–14] have shown promising
results through observational research. In compar-
ison, it has been widely illustrated that physical
exercise plays an important role in slowing down
the progression from MCI to dementia [11, 15–19],
specifically benefiting executive function and mem-
ory [17, 19]. The possible mechanism could be the
fact that physical exercise not only increase blood
flow to the brain and improve function of cardiovas-
cular system as well as it changes the whole metabolic
system. Furthermore, physical exercise also involves
cognitive and social activities, which might enhance
overall brain function [20]. Two recent systematic
reviews and meta-analysis reported that intervention
such as physical activities including aerobic exer-
cises, can improve cognitive function among older
adults with MCI [21, 22]. Aerobic exercises are those
exercises that involve large muscle groups activation,
such as dancing, jogging, swimming and cycling, etc.
Dance is a very popular community-based activity
and commonly practiced aerobic exercise through-
out the world. That requires emotional expression,
social interaction, sensory stimulation, motor coor-
dination, and bodily movements along with music.
However, the intensity, duration, and frequency of
such exercise may vary, such as in cha-cha, rumba,
waltz, Tai Chi, etc. [23]. As believed, social connec-
tions may improve cognitive functions among older
adults with MCI as a result of dancing [8, 11]. In addi-
tion, another study has indicated that music training
may have a stimulatory effect on sensorimotor and
auditory system, which may enhance cortical plas-
ticity [24]. Since dance training combines all these
factors, it therefore may enhance cognitive functions.
Furthermore, it improves mood, fitness level, and
self-confidence [25]. Although the exact mechanism
of action of this phenomenon is not clear so far, sev-
eral publications have founded possible mechanism,
such as cell and functional magnetic resonance imag-
ing (fMRI) theories [26–28].
Moreover, several recent studies have shown that
aerobic dance could improve global cognition as well
as other specific domains, such as executive function
and memory retention in older adults without cog-
nitive impairment [29–31]. Although few trials have
focused on observing the effects of aerobic dance on
cognitive impairment among older adults with MCI,
the effects of aerobic dance on the global cognition
or specific domain of the patients with MCI remains
unclear. The aim of the current systematic review and
meta-analysis is to determine the effects of aerobic
dance on cognitive function in older adults with MCI
within the published literature.
Literature research
This study was conducted according to the
Preferred Reporting Items for Systematic Review
and Meta-analysis (PRISMA) statement [32]. We
searched MEDLINE, PubMed, Embase, and the
Cochrane Central Register of Controlled Trials for
studies on the effects of aerobic dance. The search
items included the combination of Medical Sub-
ject Heading terms (MeSH) and free words. Taking
‘mild cognitive impairment’ as an example: the rele-
vant ‘MeSH’ is [cognition dysfunction], and the free
word including: [Cognitive Impairments] [Mild Neu-
rocognitive Disorder] [Cognitive Declines] [Mental
Deterioration], etc. Firstly, we used ‘or’ to combine
all those items. Secondly, we searched and combined
the ‘MeSH’ and free words of ‘dance’, ‘cognition’,
and ‘RCTs’, respectively. Thirdly, we used ‘AND’ to
combine all items. Finally, we searched ‘All Field’
(search strategies for all databases are presented in
detail in the Supplementary Material). All searches
including MEDLINE, PubMed, Embase, and the
Cochrane Library were performed from database
inception to 28 February 2019.
Inclusion and exclusion criteria
To be eligible for inclusion in this systematic
review, a research work has to satisfy the follow-
ing criteria: 1) Study population over 50 years old,
Y. Zhu et al. / Aerobic Dancing Improves Cognition in MCI 681
diagnosed as MCI by neurologists; 2) Aerobic dance
as an intervention, such as cha-cha, rumba, waltz,
and Tai Chi; 3) Participants in the control group
received health education and/or exercise but not
aerobic dance training; 4) Outcome measurements
involved global cognition or other specific domains
such as memory and executive function; 5) Ran-
domized controlled trial (RCTs); 6) Published in
peer-reviewed journals in English language.
Conference abstracts, case reports, and protocols
were excluded from this review. Moreover, studies
including elderly with Parkinson’s disease, stroke,
cardiovascular disease, and other severe illnesses
were also excluded from this study.
Fig. 1. Flowchart for searching and selection of the included studies.
682 Y. Zhu et al. / Aerobic Dancing Improves Cognition in MCI
Study selection and data extraction
Two independent reviewers (ZQ and GYX) eval-
uated eligible studies and then extracted data.
Disagreements were resolved by discussion or judge-
ment from the third reviewer (ZY). The following
information were extracted from each study: authors,
country, age, sex proportion, number of participants,
type of intervention, duration, frequency, intensity,
the cognitive measurements, and their outcomes.
Quality assessments
Two independent reviewers (ZQ and GYX)
assessed the risk of bias in the included trials using
the Cochrane Risk of Bias Tool [33]. Furthermore,
Selection Bias, Performance Bias, Detection Bias,
Attrition Bias, Reporting Bias, and other Biases were
evaluated, then assigned each of the above items as
either high risk, low risk, or unclear according to
the levels of bias. Disagreements between the two
reviewers were resolved by discussion.
Statistical analysis
All the data was analyzed using RevMan V5.3
(Copenhagen: The Nordic Cochrane Centre, The
Cochrane Collaboration, 2014). In the meta-analysis,
we synthesized continuous outcome data using mean
difference (MD) and standard deviation (SD). When
different measurements for the same outcome were
performed in different studies, we used standardized
mean difference (SMD) to obtain the summarized
effect instead.
In addition, according to the difference of fre-
quency and duration between trials, the clinic
heterogeneity was observed; as a consequence,
we used the random-effects model with generic
inverse-variance was used to pool the effect and its
corresponding 95% confidence interval (CI). I2statis-
tic were used to examine the heterogeneity of the
included studies. Large I2(>75%) suggests high het-
erogeneity in meta-analysis [33], therefore we only
pooled studies when I2was below 75%. In addi-
tion, to determine the causes of the heterogeneity,
we conducted a sensitivity analysis by eliminating
the studies one by one to identify the study that is
heterogeneous from the other studies, by examining
whether the I2statistics changed substantially. Other-
wise, we used a sub-group to modify the effects of the
outcomes and the two-side pvalue <0.05 to indicate
that the statistics are significant. Furthermore, Funnel
plot was not used for assessing publication bias since
the number of articles involved in the meta-analysis
was very small.
Identification of studies
The flow chart (Fig. 1) illustrates the search strat-
egy. Thirty-six articles were identified from the three
main electronic databases, while four more arti-
cles were obtained from other sources for further
eligibility screening. These articles were imported
into the Endnote (a common reference manage-
ment software) and thirteen duplicates were removed
through the build-in function of the software.
Subsequently, two reviewers (ZQ, GYX) removed
ineligible articles by reading their titles, abstracts,
and/or full text. Ultimately, only five studies were
included in this systematic review and meta-analysis
Study characteristics
The detailed characteristics of each trial are pre-
sented in Table 1. All the studies were reported
between 2012 and 2018, and were conducted in
four different regions (one from America [34], two
from China [35, 37], one from Japan [36], and one
from Greece [38]). A total of 842 participants were
included in the review out of which 263 (31%) were
male and the rest were female.
In addition, the dance style also varied across dif-
ferent studies, such as salsa, rumba, waltz, cha-cha,
blues, jitterbug, tango, and Tai Chi. Four publications
[34, 36–38] adopted a combination of salsa, rumba,
waltz, cha-cha, blues, jitterbug, and tango, while one
study [35] used Tai Chi only as their intervention. All
the studies described their dance routine and were
divided into three parts: 1) warm up for 5 to 10 min
to reduce the risk of muscle injury and impacts on
the respiratory system; 2) aerobic dance for about
30 min; 3) cool down for 5 to 10 min. Four trials [34,
35, 37, 38] were conducted twice or three times a
week, while the other was once a week [36]. In addi-
tion, the duration of two studies was three month [34,
37], while that of the other was about a year [35,
36, 38]. Only two studies [34, 37] clearly stated their
exercise intensity and both were 60%–80% HR max.
As for as age is concerned, the participants of four
trials [34–37] were about 75 years old whether they
were in the intervention group or control group, while
Y. Zhu et al. / Aerobic Dancing Improves Cognition in MCI 683
Table 1
Characteristics of included trials
Dancing Control
Trial Location Age (y) Proportion Intervention Age (y) Proportion Intervention Intervention Outcome measures
mean (SD) of female mean (SD) of female (frequency,
Barnes [34] America 71.7 (5.5) 67.7% (21/31) Dance (traditional
aerobic format)
73.9 (6.3) 62.5% (20/32) Stretching 60 min/day, 3
times/week, 12
1) Delayed recall/RAVLT
(95%CI: [0.30, 0.62];
p< 0.00001)
2) Immediately
recall/RAVLT (95%CI:
[0.01, 0.46]; p= 0.04)
3) Executive
function/VFT (95% CI:
[–3.43, 3.88]; p= 0.9),
TMT-A (95% CI:
[–4.16, –0.58];
p= 0.010), TMT-B
(95% CI: [–30.03,
–2.11]; p= 0.020)
Lam [35] Hong Kong (China) 77.2 (6.3) 73.1% (125/171) Tai Chi 78.3 (6.6) 78.9% (172/218) stretching and
tonging exercise
30 min/day,
3 days/week
1 year
1) Global cognitive
function/MMSE (95%
CI: [0.59, 2.27];
p= 0.0009), ADAS-Cog
(95% CI: [–3.60,
–1.00]; p= 0.0005)
2) Delayed recall/10 min
delayed recall (95%CI:
[0.30, 0.62];
p< 0.00001)
3) Immediately
recall/DST, forward
and backward (95%CI:
[0.01, 0.46]; p= 0.04)
4) Executive
function/VFT (95% CI:
[–3.43, 3.88]; p= 0.9),
TMT-A (95% CI:
[–4.16, –0.58];
p= 0.010), TMT-B
(95% CI: [–30.03,
–2.11]; p= 0.020)
684 Y. Zhu et al. / Aerobic Dancing Improves Cognition in MCI
Table 1
Lazarou [38] Greece 65.89 (10.76) 80.3% (53/66) Dance (Tango,
Waltz, Foxtrot,
Rumba, Cha
Cha, Swing,
67.92 (9.47) 76.2% (48/63) Non dance 60 min/day,
10 months
1) Global cognitive
function/MMSE (95% CI:
[0.59, 2.27]; p= 0.0009),
2) Delayed recall/RBMT2
(95%CI: [0.30, 0.62];
p< 0.00001)
3) Immediately
recall/RBMT1 (95%CI:
[0.01, 0.46]; p= 0.04)
4) Executive function/FAS
(95% CI: [0.58,2.88];
p= 0.003)
Doi [36] Japan 75.7 (4.1) 50.7% Dance (Salsa,
Rumba, Waltz,
Cha Cha, Blues,
76.0 (4.9) 46.3% Playing music
T: 60min/week 1) Global cognitive
function/MMSE (95% CI:
[0.59, 2.27]; p= 0.0009)
C: 90 min/week
40 weeks
2) Delayed recall/20 min
delayed story memory
recall (95%CI: [0.30, 0.62];
p< 0.00001)
3) Executive function/TMT-A
(95% CI: [–4.16, –0.58];
p= 0.010), TMT-B (95%
CI: [–30.03, –2.11];
p= 0.020)
Zhu [37] China 70.3 (6.7) 51.7% (15/29) Aerobic dance
routine, usual
69.0 (7.3) 67.7% (21/31) Usual care only 35 min/day,
3 times/week
3 months
1) Global cognitive
2) Delayed recall/WMSR
(95%CI: [0.30, 0.62];
p< 0.00001)
3) Immediately recall/DST,
forward and backward
(95%CI: [0.01, 0.46];
p= 0.04)
4) Executive function/TMT-A
(95% CI: [–4.16, –0.58];
p= 0.010), TMT-B (95%
CI: [–30.03, –2.11];
p= 0.020)
T, Training group; C, Control group; SD, standard deviation; HRmax, maximum heart rate; RAVLT, Rey Auditory Verbal Learning Test; VFT, Verbal Fluency Test; TMT-A, Trial-making Test
part A; TMT-B, Trial-making Test part B; MMSE, Mini-Mental System Examination; ADAS-Cog, Alzheimer’s Disease Assessment Scale-Cognitive Subscale; DST, Digit Span Task; RBMT,
Rivermead Behavioral Memory Test; FAS, F-A-S test; WMSR, Wechsler Memory Scale-Revised.
Y. Zhu et al. / Aerobic Dancing Improves Cognition in MCI 685
in the other article their age was around 65 years old
The outcomes of these trials were global cog-
nition, memory (immediate and delayed recall),
and executive function. These were measured using
different cognitive assessment tools, for example,
Global cognition was assessed using the Mini-Mental
System Examination (MMSE) [35, 36, 38], Mon-
treal Cognitive Assessment (MoCA) [37, 38], and/or
Alzheimer’s Disease Assessment Scale-Cognitive
Subscale (ADAS-Cog) [35]. On the other hand, exec-
utive function was assessed by Verbal Fluency Test
(VFT) [34, 35], FAS (F-A-S test) [38], TMT-A (Trial-
making test A) [34–38], and/or TMT-B (Trail Making
Test B) [34–38]. The common assessed components
of memory were immediate and delayed recall abil-
ity. In addition Digit Span Task (DST) [35, 37], Rey
Auditory Verbal Learning Test (RAVLT) [34], and
Rivermead Behavioral Memory Test 1 (RBMT1) [38]
were used to assess immediate recall ability. Wechsler
Memory Scale-Revised (WMSR) [37], RAVLT [34],
Rivermead Behavioral Memory Test 2 (RBMT2)
[38], and 10 min or 20 min story memory recall tests
[35, 36] were used to assess delayed recall ability.
All the five included studies adopted aerobic dance as
their interventions, with stretching, toning exercise,
health education, and usual care as their controls.
Quality assessment
To sum up, all the 5 studies were of an exem-
plary standard. Regarding the selection bias (i.e.,
randomization sequence generation), all the five arti-
cles tended to have an extremely low risk since they
generated the randomization sequencing numbers by
standard ways such as using number generators on a
computer or algorithm. Two studies [37, 38] clearly
showcased their method for allocation concealment,
and we considered their selection bias (allocation
concealment) as low risk. The other three studies did
not mention allocation concealment and were con-
sidered as ‘unclear’ [34–36]. Due to the nature of the
intervention, blinding the instructor and participants
was impossible in all five studies. However, outcome
assessments were blinded in all the five studies. We
considered their blinding bias as high risk. For the
attrition bias, almost every trial gave the desired out-
comes. Reasons for dropping were clearly stated in
each of the included trial. Therefore, we considered
their risk of attrition bias as low. We considered the
reporting bias for each trial as low risk, since all the
outcomes they intended to study were reported and
Fig. 2. Risk of bias in trials of each item. Green circle: The risk of
bias was low. Red circle: The risk of bias was high. Yellow circle:
The risk of bias was unclear.
discussed in each study. Detailed information about
the bias assessment was shown in Fig. 2.
Effects of aerobic dance intervention on MCI
Global cognition
Figure 3 summarizes the results on global cogni-
tion. All five trials assessed global cognition while
using different assessment tools. To reduce hetero-
geneity, we used subgroups to analyze the outcomes
based on the assessment tools. Results from pooling
of three studies used MMSE to measure cognition
impairment showing that aerobic dance could signifi-
cantly improve global cognition (MD = 1.43; 95%CI:
[0.59, 2.27]; p= 0.0009) [35, 36, 38]. Results from
the subgroup of two studies using MoCA, showed
a high heterogeneity, so we did not pool the effect
[32, 33]. One of the two trials reported that aerobic
dance could improve global cognition by comparing
MoCA scores among experimental and control group
[38], but the other did not find any improvement.
The main difference between those two studies were
686 Y. Zhu et al. / Aerobic Dancing Improves Cognition in MCI
Fig. 3. Forest plot for aerobic dancing on global cognitive ability. MMSE, Mini-Mental State Examination; ADAS-Cog, Alzheimer’s Disease
Assessment Scale-Cognitive Subscale.
Fig. 4. Forest plot for aerobic dancing on executive ability. TMT-A: Trial Making Test-part A; TMT-B: Trial Making Test-part B.
as follows: First, the duration was different. Zhu’s
et al. trial trained participants for 3 months and found
that there was no difference between the groups [32].
While Lazarou et al. with a longer period of study
(10-month) found the effects were significant [33].
Second, the frequency of the two trials were different
(35 min per day three times a week and 60 min per
day two times a week), respectively. Thirdly, the sam-
ple size was different, the trial with 129 participants
reported that MoCA scores improved significantly
through aerobic dance [33], on the other hand, the
other study with 59 participants reported the opposite
result [32]. In addition, results of one study [35] using
ASAD-cog to assess cognition indicated that aero-
bic dance enhanced global cognition in older adults
with MCI (MD = –2.30; 95% CI: [–3.60, –1.00];
p= 0.0005).
Executive function
Figures 4 and 5 shows the effects of aerobic dance
on executive function, which was assessed by using
VFT,FAS, TMT-A, or TMT-B. Results of the analysis
of each subgroup showed that aerobic dance posi-
tively enhance the ability of verbal fluency (VFT:
MD = 0.22; 95%CI: [–3.43, 3.88]; p= 0.9; FAS:
MD = 1.73; 95%CI: [0.58,2.88]; p= 0.003) and exec-
utive function (TMT-A: MD =–2.37; 95%CI: [–4.16,
–0.58]; p= 0.010; TMT-B: MD = –16.07; 95%CI:
[–30.03, –2.11]; p= 0.020).
Memory was another domain of cognition and
was commonly assessed by a participant’s ability
of immediate and delayed recall. Among the five
included trials, two used Digit Span Task [35, 37],
Y. Zhu et al. / Aerobic Dancing Improves Cognition in MCI 687
Fig. 5. Forest plot for aerobic dancing on verbal fluency. VFT, Verbal fluency test; FAS, F-A-S test.
Fig. 6. Forest plot for aerobic dancing on immediately recall ability.
Fig. 7. Forest plot for aerobic dancing on delayed recall ability.
while one employed RAVLT [34] and the other used
RBMT1 [38] to assess the immediate memory recall.
To ensure that the results from different trials could
be synthesized, we calculated the standardized mean
difference for each study first. The pooled results on
SMD (Fig. 6) showed that aerobic dance interven-
tion significantly improve immediate recall ability in
older adults with MCI (SMD = 0.24; 95%CI: [0.01,
0.46]; p= 0.04). Similarly, the pooled results for
delayed recall, were assessed using WMSR, RAVLT,
RBMT2, and 10 min or 20 min story memory recall
tests. Their results showed that aerobic dance sig-
nificantly improve delayed recall ability amongst
elderly with MCI (SMD = 0.46; 95%CI: [0.30, 0.62];
p< 0.00001). Finally, all the detailed data is shown in
Fig. 7.
Our systematic review and meta-analysis collected
data from five RCTs freely available in the current
literature. According to the results, aerobic dance
significantly improves global cognition and mem-
ory in MCI patients. Additionally, the results showed
that executive function and memory was slightly
improved by performing aerobic dance.
However, some of the outcomes of these trials
were inconsistent. As prior research indicated that
688 Y. Zhu et al. / Aerobic Dancing Improves Cognition in MCI
changes in some domains of cognitive function may
not be sensitive in a short period [21], different dura-
tions of these trails may lead to inconsistency in their
outcome. For example, Barnes conducted a 3-month
intervention and found that there was no difference
between the experimental and control group in either
global cognitive function and other domains [34]. On
the contrary, other trials of longer duration or follow
up period confirmed that cognitive function could be
improved to some extent [35–38]. Moreover, Lam
et al. reported better delayed recall ability 1 year later,
while surprisingly there was no difference between
experimental and control group after five months of
intervention [35]. While using MoCA as the outcome
of global cognition, one study found that there was no
improvements after three months’ intervention [37];
on the other hand, the study with a 10-month training
showed significant effects [38]. Only two involved
studies clearly mentioned the intensity of aerobic
dancing, with a target peak heart rate of 60%–75%
and 60%–80% of maximum heart rate, respectively
[29, 32]. This suggest that intensity maybe another
factor of getting inconsistent results. Furthermore,
the location, proportion of male and female, and their
respective age were differences between studies. Two
studies were from China [35, 37], one from America
[34], and the remaining two studies were from Japan
[36] and Greece [38], respectively. Sex distribution
is another different characteristic, as two trials had
balanced proportion between male and female and
they were both around 50% [36, 37]. In Lam’s et al.
[35] and Lazarous’s et al. [38] studies, the proportion
of female was 76% and 78%, respectively, meaning
they were almost three times as male. In addition, the
type of aerobic dance intervention was not the same
among five studies. For example, in Takehiko’s [36]
and Lazarou’s [38] studies, the training group per-
formed a mixed type of aerobic dance, while in the
remaining other three trials, only one type of dance
was practiced [34, 35, 37]. Despite the fact that not
all of the factors were the same, they showed positive
effects on improving cognitive function of MCI by
taking part in aerobic dancing activities.
One study with 60 participants conducted in
Greece, which chose specific traditional Greek dance
as their intervention that lasted for 24 weeks with two
times a week for 60 min a session. Their result showed
that dance improve cognitive functions, such as atten-
tion, verbal fluency, and executive function in MCI
[39]. In addition, another similar study with a larger
sample size using eight types of ballroom dance in
Filipinos showed almost the same results [40].
The exact mechanism of how aerobic dance
improves cognitive function in older adults with
MCI remains unclear. However, two studies tried to
find this possible mechanism. One is the changes in
rhythm and the spatial awareness of the body dur-
ing dance movements that activate place cells and
grid cells [26]. The other possible mechanism may
be that aerobic exercise delays the degeneration of
nerve cells [27]. In addition, Qi et al.’s resting state-
fMRI study showed change among cortical activation
after aerobic dance. They found significant increase
in the amplitude of low-frequency fluctuation in the
bilateral frontotemporal, entorhinal, anterior cingu-
late, and parohippocampal cortex after three months
of aerobic dance in MCI patients. As a matter of
fact, many cognitive functions such as memory, exec-
utive function, and learning depend on the frontal
cortex and medial temporal lobe, and activation of
these areas through dance may result in functional
improvements [28].
Strengths and limitations
Our systemic review and meta-analysis focused on
identifying the possible effects of aerobic dance, that
could be used as a treatment option for MCI patients.
All the trials in this review were conducted and pub-
lished within the last 5 years; therefore their results
were the latest and most convincing. Furthermore,
to ensure the quality of our study, we only included
RCTs designed with high quality for this review.
However, there were some limitations of this
review. Firstly, since aerobic dance was an emerg-
ing non-pharmaceutical intervention, very few trials
in the area were available in the literature so far. Sec-
ondly, the sample size in each trial was not too large.
Thirdly, the characteristics of the participants are
quite different across different trials, such as cultural
background, living conditions, social connections,
and level of education. Therefore, the heterogene-
ity of the studies in this review is substantial and
consequently, the obtained results may not be very
convincing. In addition, literature search was only
performed in the English language medium; there-
fore, some trials reported in other language may be
Implications for future research
As discussed, RCTs with large sample size, longer
intervention and follow-up period are needed to reach
a better conclusion of the possible effects of aerobic
Y. Zhu et al. / Aerobic Dancing Improves Cognition in MCI 689
dance on cognitive function in patients with MCI.
Only a few studies used resting state-fMRI and
positron emission tomography to reveal the neural
activities, brain volume, and functional connection
between brain networks in MCI patients [41, 42].
These studies have revealed that aerobic exercise
might increase the thickness of grey matter and hip-
pocampal volume [43, 44]. But the mechanism of
the effects of aerobic dancing on cognitive functions
remains unclear. Therefore, further studies should
include more conventional methods to reveal the cor-
relation between the changes in neural activation,
functional connections, and cognitive improvement
in such patients.
This research review found that aerobic dance sig-
nificantly improves global cognition and memory in
older adults with MCI. In addition, it also benefits
execution function to a large degree. On the other
hand, due to the limitations stated, better design and
large sample size trials are needed to reveal the true
effects of aerobic dance on people with MCI in the
This study was supported by National Natu-
ral Science Foundation of China (NSFC), Youth
Funding, Grant No. 81802244 and the Science &
Technology Department of Jiangsu Province, Grant
No.BE2013724, BE2017734.
Authors’ disclosures available online (https://
The supplementary material is available in the
electronic version of this article:
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... Therefore, non-pharmacological interventions that are enjoyable and fun are more likely to improve adherence among individuals [10]. A growing body of evidence suggests that dance therapy (DT) appears to be a better intervention and has shown significant benefits in terms of improving cognitive function and other health-related outcomes [7,11,12]. DT is a physical and mental activity in which the body moves purposefully and rhythmically to music and is often considered an enjoyable form of multimodal activity [13]. This physical and cognitive practice associated with music can motivate individuals, channel emotions, trigger memories, and avoid boredom, thus creating an interest in continuing the practice [14]. ...
... DT may help maintain or improve cognitive function and reduce the risk of developing dementia over time. However, existing systematic reviews of DT have reported inconsistent results regarding improvements in cognitive function [7,11,12]. Furthermore, there is limited examination of key issues, such as mental health, which have been strongly associated with quality of life in individuals with MCI [18]. Therefore, we conducted a systematic review and meta-analysis of all available relevant evidence (including published and grey literature) to examine the effects of DT compared with any control group (positive control or no intervention) on global cognitive function, specific cognitive subdomains, mental health, and quality of life in older adults with MCI. ...
... Impaired memory function is the primary observable symptom in older adults with MCI [3]. Encouragingly, our results showed that DT was associated with a significant improvement in memory, which is consistent with the findings of previous systematic reviews [7,11,12]. Dance practice involves the complex cognitive process of learning and remembering dance sequences or movements, requiring the involvement of different somatosensory and cognitive brain areas [41]. In recent years, a growing number of studies have evaluated the effects of dance on the structure and function of the brain. ...
Full-text available
Background Individuals with mild cognitive impairment are at high risk of developing dementia. Dance therapy has promising applications in delaying cognitive decline. However, the effectiveness of dance therapy for older adults with mild cognitive impairment is unclear. The objective of this review was to evaluate the effectiveness of dance therapy on global cognitive function, specific cognitive subdomains, quality of life, and mental health in older adults with mild cognitive impairment to enrich health management strategies for dementia. Methods Electronic databases and grey literature were searched from inception up to September 23, 2023. The language was limited to English and Chinese. Relevant studies were screened and assessed for risk of bias. A meta-analysis and subgroup analyses stratified by measurement instrument, dance type, intervention duration, and frequency were conducted using the STATA 16.0 software. This review was conducted in accordance with the PRISMA guidelines. Results Ten studies involving 984 participants aged 55 years and over who met the eligibility criteria were included. Dance therapy significantly improved global cognitive function, memory, executive function, attention, language, and mental health (i.e., depression and neuropsychiatric symptoms). However, the effects of dance therapy on processing speed, visuospatial ability, and quality of life in older adults with mild cognitive impairment remain inconclusive. Moreover, dance interventions of longer duration (> 3 months) improved global cognition more than shorter interventions. Conclusion This review reported that dance therapy was effective in improving global cognitive function, memory, executive function, attention, language, and mental health (i.e., depression and neuropsychiatric symptoms). Hence, it may be an effective non-pharmacological complementary treatment for older adults with mild cognitive impairment.
... Dance-based therapy, which purposefully sets movements to music, is an emerging form of movement therapy for individuals with mild cognitive impairments (MCIs), a precursor to dementia or Alzheimer's involving reduced attention, executive function, spatial cognition, and working memory, that elicits improvements in cognitive function in individuals with MCI (Gauthier et al., 2006;Lazarou et al., 2017;Sanford, 2017;Zhu et al., 2018Zhu et al., , 2020. Dance-based therapy is a logical approach for improving cognitive function, as exercise or general physical activity are among the few interventions shown to improve cognitive function in individuals with MCI (Geda et al., 2010;Thom and Clare, 2011). ...
... Currently, it is unclear how to personalize dance-based therapy parameters for individuals with MCI. Studies of dance-based therapy use different music, dance types, and study designs (Hackney and Earhart, 2009;McKee and Hackney, 2013;Lazarou et al., 2017;Zhu et al., 2020). Improving our understanding of the relationships between individual-specific deficits associated with MCI and the ability to perform different movements during dance-based therapy is needed to inform the objective design of personalized dance-based therapies for individuals with MCI. ...
... Our results showing distinct motor control deficits related to aging vs. cognitive impairment inform clinical understanding of the mechanisms underlying impaired gait performance in HOA and MCI. Creative dance-based movement therapies aim to challenge both motor and cognitive function and have shown positive impacts on spatial cognition, executive function, balance, and mobility in individuals with Parkinson's and MCI (Hackney et al., 2007a,b;McKee and Hackney, 2013;Zhu et al., 2020). Our results show that different temporal features of music and spatial components of movements challenge distinct motor (e.g., strength or balance) and cognitive (e.g., working memory, set-shifting, or motorcognitive integration) features (Thom and Clare, 2011;Montero-Odasso et al., 2012;Earhart, 2013;Browne and Franz, 2018). ...
Full-text available
Introduction: Dance-based therapies are an emerging form of movement therapy aiming to improve motor and cognitive function in older adults with mild cognitive impairments (MCIs). Despite the promising effects of dance-based therapies on function, it remains unclear how age-related declines in motor and cognitive function affect movement capacity and influence which movements and rhythms maximize dance therapy efficacy. Here, we evaluated the effects of age and MCI on the ability to accurately modulate spatial ( i.e. , joint kinematics), temporal ( i.e. , step timing), and spatiotemporal features of gait to achieve spatial and temporal targets during walking. Methods: We developed novel rhythmic movement sequences—nine spatial, nine temporal, and four spatiotemporal—that deviated from typical spatial and temporal features of walking. Healthy young adults (HYA), healthy older adults (HOA), and adults with MCI were trained on each gait modification before performing the modification overground, with kinematic data recorded using wearable sensors. Results: HOA performed spatial ( p = 0.010) and spatiotemporal ( p = 0.048) gait modifications less accurately than HYA. Individuals with MCI performed spatiotemporal gait modifications less accurately than HOA ( p = 0.017). Spatial modifications to the swing phase of gait ( p = 0.006, Cohen’s d = −1.3), and four- and six-step Duple rhythms during temporal modifications ( p ≤ 0.030, Cohen’s d ≤ 0.9) elicited the largest differences in gait performance in HYA vs. HOA and HOA vs. MCI, respectively. Discussion: These findings suggest that age-related declines in strength and balance reduce the ability to accurately modulate spatial gait features, while declines in working memory in individuals with MCI may reduce the ability to perform longer temporal gait modification sequences. Differences in rhythmic movement sequence performance highlight motor and cognitive factors potentially underlying deficits in gait modulation capacity, which may guide therapy personalization and provide more sensitive indices to track intervention efficacy.
... Во многих исследованиях было отмечено положительное влияние на когнитивный статус у пациентов с УКН регулярных аэробных упражнений, которые включали плавание, занятия на тренажерах, скандинавскую ходьбу и даже обычные регулярные прогулки на свежем воздухе [13,24]. В систематическом обзоре и метаанализе был показан положительный эффект аэробных упражнений в отношении общих показателей когнитивного статуса, а также памяти и управляющих функций [24]. ...
... Во многих исследованиях было отмечено положительное влияние на когнитивный статус у пациентов с УКН регулярных аэробных упражнений, которые включали плавание, занятия на тренажерах, скандинавскую ходьбу и даже обычные регулярные прогулки на свежем воздухе [13,24]. В систематическом обзоре и метаанализе был показан положительный эффект аэробных упражнений в отношении общих показателей когнитивного статуса, а также памяти и управляющих функций [24]. ...
Full-text available
Cognitive impairments (CI) are among the most common types of neurological disorders that occur in the practice of both neurologists and doctors of other specialties. The article discusses the modern principles of CI classification according to severity, their clinical signs, diagnostic criteria, and the most important approaches to managing patients with dementia and non-dementia CI. A review of current publications on the treatment of mild CI syndrome (MIS) and dementia was carried out, it was shown that the treatment should be comprehensive and include nondrug methods (regular physical activity, cognitive training), correction of all vascular risk factors, as well as drug treatment aimed at improvement of cognitive functions. At the same time, the strategy for choosing drug therapy for CI is determined by the degree of their severity. The importance of early detection of CI is due to the fact that timely diagnosis of these disorders expands the potential for secondary prevention and therapeutic intervention, which can delay or even prevent the onset of professional and social maladjustment due to the development of dementia. The possibilities of modern neuroprotective and symptomatic therapy of CI, the place of akatinol memantine in the treatment of CI syndrome and dementia are shown. Modern data on the use of this drug in various nosological variants of diseases with MCI syndrome and dementia of varying severity are presented.
... 11,15,16 Two systematic reviews and meta-analyses of the effects of aerobic dancing on cognitive function in older adults with mild cognitive impairment showed aerobic dancing significantly improved global cognitive function and had a positive effect on improving executive function. 17,18 An aerobic dancing intervention program (slow waltz) developed specifically for older adults improved short-term memory and executive function in the training group. 19 Research also has shown home-based training is a low-cost, safe and effective exercise option to increase muscle strength and function in healthy and non-healthy older adults. ...
Full-text available
During the Coronavirus disease (COVID-19), the physical activity of older adults is at a lower level. The study aimed to examine the effectiveness of aerobic dancing on physical fitness and cognitive function in older adults. We conducted a randomized controlled trial with 34 older adults who were assigned into an aerobic dancing group and a control group. Three dance sessions weekly for 60 min were scheduled for the aerobic dancing group for a total of 12 weeks. Physical fitness, blood pressure, lipids, glucose, cognitive function were assessed before and after the intervention. Baseline adjusted Analysis of Covariance (ANCOVA) was used to determine whether outcome variables varied between groups at pre-test and post-test. Effect size (Cohen's d) was calculated to determine the differences between groups from baseline to post-test. After 12 weeks, we found that the aerobic dancing group showed significant improvement in memory (portrait memory: F = 10.45, p = 0.003, d = 1.18). The Limit of Stability (LOS) parameters in the aerobic dancing group displayed a significant increase after the intervention (right angle: F = 5.90, p = 0.022, d = 0.60; right-anterior angle: F = 4.23, p = 0.049, d = 0.12). Some beneficial effects were found on flexibility, grip strength, balance and subjective well-being (sit and reach: F = 0.25, p = 0.62, d = −0.40; grip strength: F = 3.38, p = 0.08, d = 0.89; one-legged standing with eyes closed: F = 1.26, p = 0.27, d = 0.50) in the aerobic dancing group. Aerobic dancing training was effective in improving memory and balance ability in older adults during the COVID-19 pandemic in China. In the future, aerobic dancing is a promising tool to encourage physical activity in older adults.
... The mechanism that occurs is aerobic dance increases blood flow to the brain and improves the function of the cardiovascular system and changes the entire metabolic system. Apart from that, physical and social activity, aerobic exercise can also improve overall brain function (Zhu et al., 2020). Exercise also increases brain volume, memory, and executive function (Miyazaki et al., 2022). ...
Full-text available
This study analyzes the differences between the concentration levels of the rote low-impact aerobics dance group and the video low-impact aerobics dance group. The subjects in this study were 36 adolescents aged 18-20 years who voluntarily participated. Subjects were divided ordinal pairing into two groups, namely 18 people in the rote low-impact aerobics dance group and 18 people in the video low-impact aerobics dance group. The duration of the exercise is 30 minutes sessions with an intensity of 50-70% HRmax, and the frequency of exercise is 3 times/week for 6 weeks. Concentration levels were evaluated pretest and posttest the intervention using the Grid Concentration Test. The data analysis used the Independent Sample Test with a significant level (p ≤ 0.05). The results showed that there was an increase in the average concentration between the pretest and posttest in the rote low-impact aerobics dance group (scores 6.89 ± 2.45 and 9.56 ± 2.64, p = 0.000), and the video low-impact aerobics dance group (scores 7.39 ± 2.38 and 9.11 ± 2.45, p = 0.000). Based on the pretest and posttest data it was concluded that there was an increase in the level of concentration in both groups, but there was no difference between the rote low-impact aerobics dance and video low-impact aerobics dance on concentration.
... Since we did not conduct an independent search for cognitive outcomes, there may be a bias in the data selection procedure. The present result replicates prior meta-analytical studies, showing robust beneficial effects of DMI on several cognitive domains, including executive functions [88], memory [38] and global cognition [37] in clinically normal older adults and in participants diagnosed with MCI [39,89]. ...
Full-text available
Background: Lifestyle-based multimodal interventions that integrate physical, sensory, cognitive and social enrichment are suggested to promote healthy mental aging and resilience against aging and Alzheimer's disease (AD). Objectives: This meta-analysis examined the efficacy of dance movement interventions (DMI) as an integrated mind-body activity on outcomes of psychological health in older adults. Methods: Pre-registration was carried out with PROSPERO (CRD42021265112). PubMed, Web of Science and PsycINFO were searched for randomized controlled trials (RCT) evaluating the effects of DMI (>4 weeks' duration) compared to comparators on measures of psychological health (primary outcome) and cognitive function (additional outcome) among older adults without dementia (aged ≥55). Data of 14 primary RCT (n = 983, n-DMI = 494, n-control = 489) were synthesized using a random effects meta-analysis with robust variance estimation. Results: DMI had a small positive effect on overall psychological health (g = 0.30; 95% confidence interval [CI]: 0.06, 0.53; p = 0.02, I2= 65.04) compared to control conditions. Small effects of DMI on positive and negative psychological domains as well as quality of life were not statistically significant. DMI had a medium positive effect on general cognitive function (g = 0.50; 95% CI: 0.12, 0.89, p = 0.02, I2= 79.61) over comparators. None of the primary intervention studies evaluated measures of neuroplasticity. Conclusions: We found that DMI was effective in promoting mental health amongst older adults without dementia, suggesting that the multimodal enrichment tool is a potential strategy for health promotion and prevention of AD. High-quality intervention studies are needed to expand evidence on DMI-induced changes in specific psychological domains and identify underlying neurophysiological correlates.
Neurodegenerative diseases have reached alarming numbers in the past decade. Unfortunately, clinical trials testing potential therapeutics have proven futile. In the absence of disease-modifying therapies, physical activity has emerged as the single most accessible lifestyle modification with the potential to fight off cognitive decline and neurodegeneration. In this review, we discuss findings from epidemiological, clinical, and molecular studies investigating the potential of lifestyle modifications in promoting brain health. We propose an evidence-based multidomain approach that includes physical activity, diet, cognitive training, and sleep hygiene to treat and prevent neurodegenerative diseases.
Background: To date quantitative meta-analysis with large samples to investigate the effects and potential moderators of physical activity (PA) on executive function (EF) in older adults with dementia is insufficient. Therefore, we conducted this meta-analysis. Design: Meta-analysis of randomized controlled trials (RCTs). Participants: Old people with Alzheimer's disease (AD) or related dementia of varying types and severity as the primary diagnosis. Methods: PubMed, Web of Science, the Cochrane Library and Embase databases were searched for relevant studies published from 01 January, 2010 to 01 March, 2022. The results of executive function were reported in all RCTs. Random-effects meta-analysis was used to calculate the size of effects. Subgroup analyses of three moderators (including the specific sub-domains of EF, exercise prescription variables, and sample characteristics) were performed. Results: Eighteen RCTs were included with a combined sample size of 1366. Overall, PA interventions improved overall EF (standardized mean difference [SMD]=0.23, 95% confidence interval [CI] 0.05 to 0.41, p<0.05). The EF sub-domain "planning" was significant moderator (SMD=0.31, 95%CI 0.11 to 1.51, p<0.01), but inhibitory control, working memory and cognitive flexibility were not significant. Regarding exercise prescription variables, type of resistance training; moderate intensity; total duration ≤24 weeks and short (once or twice a week) frequency improved overall EF performance. Session length may be a moderator. Regarding sample characteristics, old-old, AD and both dementia and AD had significant benefits. Conclusions and implications: EF in older adults with AD or related dementia benefited from physical activity, and the benefit was affected by the type, intensity, total duration, frequency of exercise. Physical activity can be an alternative intervention in aging patients with dementia, to improve EF performance or prevent or EF decline.
Although dance interventions may have lots of advantages in improving frailty, there are few papers focusing on the effects such interventions have on frail older adults living in the community setting. This study investigates whether a dance intervention can improve the level of frailty among Chinese older adults living in the community setting. The dance intervention was done five times a week for 16 weeks. Participants in the control group maintained their normal daily activities. Assessments were conducted at baseline, 8 weeks, and 16 weeks. Mixed models were used to test for the effects on frailty, depression, short physical performance battery, and grip strength between the groups over time. The level of frailty ( p < .05) and depression ( p < .001) decreased, and short physical performance battery ( p < .001) increased over time in the dance group compared with the control group. A dance intervention lasting 16 weeks showed improved frailty, depression, and physical performance among Chinese older adults living in the community setting.
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One of the major problems that elderly people are facing is dementia. For scientist’s dementia is a medical, social and economic problem, as it has been characterized as the epidemic of the 21st century. Prevention and treatment in the initial stages of dementia are essential, and community awareness and specialization of health professionals are required, with the aim of early and valid diagnosis of the disease. Activities are recommended to the senior citizens to improve their physical and mental health. Dance has been suggested as an appropriate recreational activity for the elderly that brings functional adjustments to the various systems of the body, psychological benefits, and makes exercise to seem interesting and entertaining as it combines the performance of multiple animations with musical accompaniment. A Greek traditional dance program was performed where our sample consisted of 30 healthy elderly and 30 with Mild Cognitive Impairment – MCI. It lasted 24 weeks, two times a week for 60 min. Specific traditional dances from all over Greece were selected. The dances were of a moderate intensity at the beginning with a gradual increase in intensity, according to the age and physical abilities of the participants. The results showed a significant improvement in: attention (S4viac-Healthy: z = -3.085, p = 0.002; MCI: z = -3.695, p < 0.001, S4viti-Healthy: z = -2.800, p = 0.005; MCI: z = -3.538, p < 0.001), anxiety (Healthy: z = -2.042, p = 0.041; MCI: z = -2.168, p = 0.030), verbal fluency for MCI (Verflx: t = -2.396, df = 29, p = 0.023, Verfls: t = -3.619, df = 29, p = 0.001, Verfmo: t = -3.295, df = 29, p = 0.003) and in executive functions (FUCAS: z = –2.168, p = 0.030). Significant improvement also showed in physical condition (Arm curl– Healthy: z = –3.253, p = 0.001; MCI: z = -3.308, p = 0.001, Chair stand – Healthy: t = –3.232, df = 29, p = 0.003; MCI: t = -2.242, df = 29, p = 0.033, Back scratch– Healthy: z = -1.946, p = 0.052; MCI: z = -2.845, p = 0.004, 2 min step– Healthy: z = –2.325, p = 0.020; MCI: z = -2.625, p = 0.009, FootUpandGo– Healthy: z = -4.289, p < 0.001; MCI: z = -3.137, p = 0.002, Sit and Reach: z = -3.082, p = 0.002, Balance on One leg: z = -3.301, p = 0.001) and Quality of life (Healthy: z = -1.937, p = 0.053; MCI: z = -2.130, p = 0.033). This study proves that dancing not only improves the cognitive and physical condition of the elderly but also contributes to a better quality of life.
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The current study aimed to evaluate the effect of a specially designed moderate-intensity aerobic dance (SDMIAD) on brain spontaneous activity in older adults with mild cognitive impairment (MCI) using resting-state functional magnetic resonance imaging (RS-fMRI). A total of 38 subjects with MCI were recruited to the current study and were randomized into two groups: Exercise (EG, n=19) and control (CG, n=19). The EG was treated with a SDMIAD and usual care for 3 months. The CG only received usual care. None of the patients were administered medicine that affected cognition during the intervention. The cognitive assessments and RS-fMRI examination were performed on the two groups at recruitment and after 3 months. The cognitive functions were assessed by various neuropsychological tests. The brain spontaneous activity change was assessed using an index, the amplitude of low-frequency fluctuation (ALFF) of fMRI signal. Cognitive assessments demonstrated that EG had significantly improved results in the Mini-Mental State Examination, the Montreal Cognitive Assessment, Wechsler Memory Scale-Revised Logical Memory (WMS-R LM) and the Symbol Digit Modalities Test (all P<0.05), and the difference in changes in WMS-R LM from baseline to 3 months between the EG and the CG was also statistically significant (P<0.05) after 3 months of SDMIAD. The performance of all the cognitive assessments did not demonstrate significant differences in CG. Compared with baseline, EG exhibited significantly increased ALFF in several areas, including the bilateral fronto-temporal, entorhinal, anterior cingulate and parohippocampal cortex after 3 months of SDMIAD (P<0.05); whereas the CG exhibited significantly increased ALFF only in a few areas, including right temporal and posterior cingulate cortex (P<0.05). The SDMIAD may effectively improve the cognitive function in older adults with MCI. RS-fMRI provided a quantitative method for evaluating the effect of aerobic exercise on cognitive function.
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Background Mild cognitive impairment (MCI) is known as a transitional stage or phase between normal aging and dementia. In addition, it is associated with an increased risk of dementia. Research has shown that moderate-intensity exercise is associated with a decreased risk of cognitive impairment. Two recent studies demonstrated that dance interventions are associated with improved cognitive function in the elderly with MCI. Purpose We evaluated the effect of a moderate-intensity aerobic dance routine on the cognitive function in patients with MCI. Patients and methods This is a single-blind randomized controlled trial. Sixty MCI patients were randomized to receive either treatment (aerobic dance routine + usual care) or control (usual care only) for 3 months. All patients received usual care for an additional 3 months thereafter. The aerobic dance routine was a specially designed dance routine which involved cognitive effort for patients to memorize the complex movements. Wechsler memory scale-revised logical memory (WMS-R LM) and event-related evoked potentials (ERPs) P300 latency were used to assess patients’ cognitive function at baseline, 3 months, and 6 months. Results Twenty-nine patients received exercise therapy and 31 patients received usual care. Patients in the treatment group showed a greater improvement in memory (difference in WMS-R LM changes over 3 months 4.6; 95% CI 2.2, 7.0; p<0.001) and processing speed (difference in P300 latency changes over 6 months −20.0; 95% CI=−39.5, −0.4; p<0.05) compared to control. Conclusion This dance routine improves cognitive function, especially episodic memory and processing speed, in MCI patients and merits promotion in communities.
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The aim of this study was to analyze the prevalence of mild cognitive impairment (MCI) among the aging population (60 years of age and above) in China. Epidemiological investigations on MCI in online Chinese journals were identified manually using the CQVIP, CNKI, and Wanfang databases. Articles from journals published in English were identified using PubMed and Web of Science. Original studies that included prevalence surveys of MCI were selected. Forty-eight relevant studies were included in the analysis, covering 22 provinces in China. Our results showed that the pooled prevalence of MCI in the older Chinese population was 14.71% (95% confidence interval [CI], 14.50-14.92%). The prevalence was 16.72% (95% CI, 15.68-17.71%) in clinical samples vs. 14.61% (95% CI, 14.40-14.83%) in nonclinical samples (χ2=16.60, P<0.01), and 15.20% (95% CI, 14.91-15.49%) in screened samples vs. 14.16% (95% CI, 13.85-14.46%) in diagnosed samples (χ2=22.11, P<0.01). People of older age, of female sex, or living in rural areas or western China were associated with a higher prevalence of MCI. The prevalence of MCI was high in Chinese older adults, and even higher in those who were older, female, or living in rural areas or western China. Future studies are recommended to address the prevalence of MCI in the other 12 provinces of China. Furthermore, diagnostic assessments should be included in the identification of MCI.
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Alzheimer’s disease (AD) is a progressive neurodegenerative disease with the syndrome of cognitive and functional decline. Pharmacotherapy has always been in a dominant position for the treatment of AD. However, in most cases, drug therapy is accompanied with clinical delays when older adults have suffered from cognitive decline in episodic memory, working memory, and executive function. On the other hand, accumulating evidence suggests that exercise intervention may ameliorate the progression of cognitive impairment in aging ones while the standard strategy is lacking based on different levels of cognitive decline especially in mild cognitive impairment (MCI) and AD. MCI is the preclinical stage of AD in which neurodegeneration may be reversed via neuroplasticity. Therefore, taking exercise intervention in the early stage of MCI and healthy aging at the risk of AD could slow down the process of cognitive impairment and provide a promising cost-effective nonpharmacological therapy to dementia.
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Cognitive training in MCI may stimulate pre-existing neural reserves or recruit neural circuitry as “compensatory scaffolding” prompting neuroplastic reorganization to meet task demands (Reuter-Lorenz & Park, 2014). However, existing systematic reviews and meta-analytic studies exploring the benefits of cognitive interventions in MCI have been mixed. An updated examination regarding the efficacy of cognitive intervention in MCI is needed given improvements in adherence to MCI diagnostic criteria in subject selection, better defined interventions and strategies applied, increased use of neuropsychological measures pre- and post-intervention, as well as identification of moderator variables which may influence treatment. As such, this meta-analytic review was conducted to examine the efficacy of cognitive intervention in individuals diagnosed with mild cognitive impairment (MCI) versus MCI controls based on performance of neuropsychological outcome measures in randomized controlled trials (RCT). RCT studies published from January 1995 to June 2017 were obtained through source databases of MEDLINE-R, PubMed, Healthstar, Global Health, PSYCH-INFO, and Health and Psychological Instruments using search parameters for MCI diagnostic category (mild cognitive impairment, MCI, pre-Alzheimer’s disease, early cognitive decline, early onset Alzheimer’s disease, and preclinical Alzheimer’s disease) and the intervention or training conducted (intervention, training, stimulation, rehabilitation, or treatment). Other inclusion and exclusion criteria included subject selection based on established MCI criteria, RCT design in an outpatient setting, MCI controls (active or passive), and outcomes based on objective neuropsychological measures. From the 1199 abstracts identified, 26 articles met inclusion criteria for the meta-analyses completed across eleven (11) countries; 92.31% of which have been published within the past 7 years. A series of meta-analyses were performed to examine the effects of cognitive intervention by cognitive domain, type of training, and intervention content (cognitive domain targeted). We found significant, moderate effects for multicomponent training (Hedges’ g observed = 0.398; CI [0.164, 0.631]; Z = 3.337; p = 0.001; Q = 55.511; df = 15; p = 0.000; I² = 72.978%; τ² = 0.146) as well as multidomain-focused strategies (Hedges’ g = 0.230; 95% CI [0.108, 0.352]; Z = 3.692; p < 0.001; Q = 12.713; df = 12; p = 0.390; I² = 5.612; τ² = 0.003). The effects for other interventions explored by cognitive domain, training type, or intervention content were indeterminate due to concerns for heterogeneity, bias, and small cell sizes. In addition, subgroup and meta-regression analyses were conducted with the moderators of MCI category, mode of intervention, training type, intervention content, program duration (total hours), type of control group (active or passive), post-intervention follow-up assessment period, and control for repeat administration. We found significant overall effects for intervention content with memory focused interventions appearing to be more effective than multidomain approaches. There was no evidence of an influence on outcomes for the other covariates examined. Overall, these findings suggest individuals with MCI who received multicomponent training or interventions targeting multiple domains (including lifestyle changes) were apt to display an improvement on outcome measures of cognition post-intervention. As such, multicomponent and multidomain forms of intervention may prompt recruitment of alternate neural processes as well as support primary networks to meet task demands simultaneously. In addition, interventions with memory and multidomain forms of content appear to be particularly helpful, with memory-based approaches possibly being more effective than multidomain methods. Other factors, such as program duration, appear to have less of an influence on intervention outcomes. Given this, although the creation of new primary network paths appears strained in MCI, interventions with memory-based or multidomain forms of content may facilitate partial activation of compensatory scaffolding and neuroplastic reorganization. The positive benefit of memory-based strategies may also reflect transfer effects indicative of compensatory network activation and the multiple-pathways involved in memory processes. Limitations of this review are similar to other meta-analysis in MCI, including a modest number studies, small sample sizes, multiple forms of interventions and types of training applied (some overlapping), and, while greatly improved in our view, a large diversity of instruments used to measure outcome. This is apt to have contributed to the presence of heterogeneity and publication bias precluding a more definitive determination of the outcomes observed. Electronic supplementary material The online version of this article (10.1007/s11065-017-9363-3) contains supplementary material, which is available to authorized users.
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Background: Many studies have highlighted the positive effects of dance in people with neurodegenerative diseases. Objectives: To explore the effects of International Ballroom Dancing on cognitive function in elders with amnestic mild cognitive impairment (aMCI). Methods: One-hundred twenty-nine elderly patients with aMCI diagnosis (mean age 66.8 ± 10.1 years) were randomly assigned into 2 groups: intervention group (IG, n = 66) and control group (CG, n = 63). The IG exercised systematically for 10 months, and both groups were submitted to extensive neuropsychological assessment prior and after the 10-month period. Results: According to the independent sample t test at the follow-up, significant differences between groups were found in benefit of the IG while the CG showed worse performance in the majority of neuropsychological tests. According to the Student t test, better performance is detected in IG in contrast with CG, which had worse performance almost in all scales. Conclusion: Dance may be an important nonpharmacological approach that can benefit cognitive functions.
Background: People with mild cognitive impairment (MCI) are considered a high-risk population for developing dementia and therefore potential targets for preventive interventions. So far, no pharmacological interventions have proven to be effective. Latest evidence has laid the groundwork for the hypothesis that dancing can have beneficial effect on cognition by improving neuroplasticity. Objective: This study aimed to examine whether a structured modular ballroom dance intervention (INDAK) could improve cognition among Filipino older persons with MCI. Methods: A two-armed, single-blinded, quasi-experimental study was conducted in a community-based population at Marikina City, Philippines. Two hundred seven participants older than 60 years old with MCI participated through self-assigned allocation to dance (N=101) and control (N=106) groups. The intervention group received INDAK consisting eight types of ballroom dances with increasing complexity lasting one hour, twice a week for 48 weeks. Neurologists and psychologists blinded to the group allocation administered baseline and post intervention assessments using Alzheimer's Disease Assessment Scale - Cognitive (ADAS-Cog), Filipino version of the Montreal Cognitive Assessment (MoCA-P), Boston Naming Test (BNT), Geriatric Depression Scale (GDS), Instrumental Activities of Daily Living (IADL) and Disability Assessment for Dementia (DAD). Results: Baseline sociodemographic and clinical characteristics did not differ between groups. The mean differences between baseline and 48-week assessments were compared between dancers and controls, showing that the intervention group improved in ADAS-Cog, MoCA-P, BNT and GDS. Conclusion: INDAK is potentially a novel, ecological and inexpensive non-pharmacological intervention that can improve cognition among older Filipinos with MCI.
Background: Substantial studies have reported the prevalence and the affecting factors of subjective cognitive decline (SCD). The complaints screening scale has also been used for probing. However, little is known in China. Objective: To investigate the prevalence and risk factors of SCD, and explore an SCD complaints screening scale in China. Methods: Stratified cluster random sampling was conducted. 2,689 residents aged 60-80 years completed questionnaire 1. 814 residents were included for clinical and neuropsychological evaluations. Two standards were used to make the diagnosis of mild cognitive impairment (MCI) and SCD, and a preliminary screening rate comparison was carried out. Finally, we assessed the risk factors of SCD and the correlation between the SCD-questionnaire 9 (SCD-Q9) and the Auditory Verbal Learning Test-Long Delay Free Recall (AVLT-LR). Results: 1) Standard 1 (ADNI2): the prevalence of SCD was 18.8% (95% CI = 14.7-22.9%) and zero conformed to six criteria (SCD plus). 2) Standard 2 (Jak/Bondi): the prevalence of SCD was 14.4% (95% CI = 10.7-18.1%). 3) Standard 1 had a relatively higher "false" positive rate, whereas Standard 2 had higher "false" negative rate. 4) Age, low education, fewer close friends, and daily drinking were independent risk factors for SCD progressing to MCI. 5) Total points of SCD-Q9 were negatively correlated to the value of AVLT-LR. Conclusions: The prevalence of SCD is high in the ShunYi District in Beijing, China. Age, low education, less social support, and daily drinking are independent risk factors. The brief SCD-Q9 can be used as a reference.