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Would older adults with mild cognitive impairment adhere to and benefit from a structured lifestyle activity intervention to enhance cognition?: a cluster randomized controlled trial


Lam, Linda Chiu-Wa, Chan, Wai-chi, Leung, Tony, Fung, Ada Wai-Tung, Leung, Edward Man-Fuk


Plos One, Volume: 10, No.: 3, Pages.: e0118173-e0118173

Year of Publication



Background: Epidemiologic evidence suggests that cognitive and physical activities are associated with better cognition in late life. The present study was conducted to examine the possible benefits of four structured lifestyle activity interventions and compare their effectiveness in optimizing cognition for older adults with mild cognitive impairment (MCI).; Method and Findings: This was a 12-month cluster randomized controlled trial. 555 community-dwelling Chinese older adults with MCI (295 with multiple-domain deficits (mdMCI), 260 with single-domain deficit (sdMCI)) were recruited. Participants were randomized into physical exercise (P), cognitive activity (C), integrated cognitive and physical exercise (CP), and social activity (S, active control) groups. Interventions comprised of one-hour structured activities three times per week. Primary outcome was Clinical Dementia Rating sum of boxes (CDR-SOB) scores. Secondary outcomes included Chinese versions of Alzheimer’s Disease Assessment Scale – Cognitive subscale (ADAS-Cog), delayed recall, Mini-Mental State Examination, Category Verbal Fluency Test (CVFT) and Disability Assessment for Dementia – Instrumental Activities of Daily Living (DAD-IADL). Percentage adherence to programs and factors affecting adherence were also examined. At 12th month, 423 (76.2%) completed final assessment. There was no change in CDR-SOB and DAD-IADL scores across time and intervention groups. Multilevel normal model and linear link function showed improvement in ADAS-Cog, delayed recall and CVFT with time (p<0.05). Post-hoc subgroup analyses showed that the CP group, compared with other intervention groups, had more significant improvements of ADAS-Cog, delayed recall and CVFT performance with sdMCI participants (p<0.05). Overall adherence rate was 73.3%. Improvements in ADAS-Cog and delayed recall scores were associated with adherence after controlling for age, education, and intervention groups (univariate analyses).; Conclusions: Structured lifestyle activity interventions were not associated with changes in everyday functioning, albeit with some improvements in cognitive scores across time. Higher adherence was associated with greater improvement in cognitive scores. Factors to enhance adherence should be specially considered in the design of psychosocial interventions for older adults with cognitive decline.; Trial Registration: ChiCTR-TRC-11001359.;

Bibtex Citation

@article{Lam_2015, doi = {10.1371/journal.pone.0118173}, url = {}, year = 2015, month = {mar}, publisher = {Public Library of Science ({PLoS})}, volume = {10}, number = {3}, pages = {e0118173}, author = {Linda Chiu-wa Lam and Wai Chi Chan and Tony Leung and Ada Wai-tung Fung and Edward Man-fuk Leung}, editor = {Alan Winston}, title = {Would Older Adults with Mild Cognitive Impairment Adhere to and Benefit from a Structured Lifestyle Activity Intervention to Enhance Cognition?: A Cluster Randomized Controlled Trial}, journal = {{PLOS} {ONE}} }


activities of daily living, activity, affect, age factors, aged, aged, 80 and over, cognition, female, geriatric assessment, humans, interventions, life style, lifestyle, male, middle aged, mild cognitive impairment, outcome assessment (health care), psychology, rehabilitation, structured, time factors

Countries of Study

Hong Kong

Types of Dementia

Mild Cognitive Impairment (MCI)

Types of Study

Cluster RCT

Type of Outcomes

ADLs/IADLs, Cognition

Type of Interventions

Non-pharmacological Treatment

Non-Pharmaceutical Interventions

Adult safeguarding and abuse detection/prevention, Exercise (inc. dancing), Other, Social activities (e.g. lunch clubs, cinema outings, trips to sporting events etc, peer support)