JMIR Publications

ABSTRACT

Background:

Age related cognitive decline can threaten independence in older adults, creating an urgent need for effective and practical preventive strategies. Non pharmacological approaches such as physical activity, cognitive stimulation and combined programmes show promise, but their comparative effectiveness and the specific cognitive domains they influence are not yet clearly established.

Objective:

This study evaluated the effects of three non pharmacological interventions. These consisted of a physical activity programme using Zumba, a video game based cognitive stimulation programme and a combined physical and cognitive programme. The aim was to determine their effects on global cognition and specific cognitive domains in community dwelling older adults in the Klang Valley of Malaysia. A secondary objective was to examine the influence of adherence on cognitive outcomes.

Methods:

Participants were assigned to four groups which were physical, cognitive, combined and control. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) at baseline and after the intervention period. Mixed analysis of variance was used to examine changes over time and differences between groups. Additional analyses included the Kruskal Wallis test, the Mann Whitney U test and the Wilcoxon Signed Rank test. These were conducted under both intention to treat (ITT) and per protocol (PP) approaches. Adherence was defined as attending at least 50% of scheduled sessions and participants were reclassified for PP analyses based on this threshold. Cognitive subdomains were also examined to identify domain specific changes.

Results:

Mixed analysis of variance showed a significant improvement in global cognition over time across all groups (P = .008). There was no significant interaction between Time × Group (P = .638), indicating that the magnitude of improvement was similar across the intervention types. Findings from the non parametric analyses under both ITT and PP approaches supported these results. Participants who attended at least 50 percent of the cognitive stimulation sessions demonstrated moderate improvements in global cognition in the per protocol analysis (r = 0.46). Those who achieved at least 50 percent adherence to both components of the combined intervention showed even larger cognitive gains, with an effect size of r = 0.66. Subdomain analyses indicated consistent improvements in language across interventions, visuospatial improvements in the combined group and orientation improvements in the cognitive group.

Conclusions:

All intervention types were associated with cognitive improvement over time, and the level of improvement was comparable between groups. Adherence played a key role, with sustained participation in the cognitive and combined programmes producing the greatest benefits. These findings support the use of adherence focused multimodal non pharmacological programmes as practical strategies to promote healthy cognitive ageing in older adults. Clinical Trial: ClinicalTrials.gov (NCT06376656)