| ObjectivesTo analyse the relationship between physical and cognitive functioning in elderly people at high risk of dementia by using an online mobile medical mobile phone We Chat app for static self-management and dynamic supervision and management of middle-aged people with different risk factors for dementia,and to compare the difference in physical and cognitive functioning between dynamic and static interventions in elderly people at high risk of dementia,so as to provide a basis for urging elderly people at high risk of dementia to adjust This study will provide a basis for the early prevention and treatment of dementia in elderly people at risk of dementia.MethodsA total of 54 middle-aged and elderly people aged 55-75 years with two or more risk factors for dementia were included according to inclusion and exclusion criteria.General demographic information was collected on the subjects,including gender,age,education,family history of dementia,smoking,obesity and physical inactivity,depression,history of hypertension,dyslipidaemia,diabetes and cardiovascular disease.The blank control group(n=16),the static self-management group(n=17)and the dynamic supervision and management group(n=21)were randomly divided into two groups: the blank control group did not undergo any intervention and the static self-management group received educational materials on dementia risk factors through a We Chat app(PRODEMOS Brain Health)with no interactive function.The program used by the subjects in the dynamic supervision group has interactive functions,allowing them to actively set their own behavioural goals,consult with the coach for help,advice and support,and manage the risk factors for dementia that correspond to their own situation.The Mini-mental state examination(MMSE)was used to assess overall cognitive ability and to record scores on three subscales: delayed recall,attention and calculation,and temporal orientation.Inhibitory control was assessed using the stroop colour words test(SCWT)for executive functioning,the two-element 1-back task paradigm for refreshment,and the Shape trails test(STT),as modified by Kuo Kee-ho et al.for transformational functioning.For physical function,upper limb strength was assessed using the grip strength and 30-s forearm flexion test;lower limb strength was assessed using five sit-to-stand tests;and mean stride speed and stride length were recorded for a 4-m walk on level ground.One-way ANOVA or t-test and multiple linear regression analyses were performed for dementia risk factors,physical function and cognitive function in middle-aged and elderly people at high risk of dementia,respectively.Repeated-measures ANOVAs were conducted on data results for each task of cognitive and physical function in the blank control group,static self-management group and dynamic supervision and management group before,3 months after and 9 months after the intervention,respectively.ResultsMultiple linear regression analysis revealed that the presence or absence of a history of cardiovascular disease predicted overall cognitive function(β=-0.272,p=0.084);educational attainment predicted temporal orientation(β=2.194,p=0.036),refreshment(β=0.299,p=0.068)and conversion(β=-0.508,p=0.001).Gender(β=0.492,p=0.034)and the presence of a history of cardiovascular disease(β=0.222,p=0.085)predicted grip strength;education predicted upper limb strength as represented by the 30 s forearm flexion test(β=0.28,p=0.073).the 30 s forearm flexion test predicted correct SCWT(β=0.32,p=0.063)and TMTA elapsed time(β=-0.344,p=0.035).Results of the repeated measures ANOVA of cognitive function before and after the intervention showed no significant difference before and after the intervention in the blank control group compared to before the intervention(p > 0.05);a significant increase in twoelement 1-back correct rate 3 months after the intervention in the static self-management group(t=3.017,p=0.024);and 9 months after the intervention in SCWT correct rate(t=1.114,p=0.001),and two-element 1-back correct(t=4.117,p=0.002),the dynamic supervision and management group had significantly higher total MMSE scores(t=1.828,p=0.033),SCWT correct(t= 2.515,p=0.039),and two-element 1-back correct rate(t=3.315,p=0.01)increased significantly;9 months after intervention delayed recall(t=2.782,p=0.04),total MMSE score(t=2.956,p=0.024),SCWT correct rate(t=3.36,p=0.01),and two-element 1-back correct rate(t=6.472,p=0.01)increased significantly.The results of the repeated measures variance of physical function before and after the intervention showed no significant difference within each group in the blank control group compared to before the intervention(p>0.05);no significant difference in all physical functions in the static self-management group 3 months after the intervention(p>0.05),and a significant increase in the 30 s forearm flexion test(t=3.352,p=0.013)and step speed(t=3.02,P= 0.016);the dynamic supervision and management group showed a significant increase in 30 s forearm flexion test(t=3.684,p=0.04)3 months after the intervention and a significant increase in grip strength(t=8.557,p=0.001),30 s forearm flexion test(t=11.69,p=0.001)and gait speed(t=5.06,p=0.01)9 months after the intervention.In the comparison between groups,the static self-management group showed no significant difference(p>0.05)in all functional levels compared to the blank control group after 3 months of intervention,and walking speed(t=3.02,p=0.016)was significantly better than the blank control group after 9 months of intervention;the dynamic supervision and management group showed no significant difference(p>0.05)compared to both the blank control and static self-management groups after 3 months of intervention,and the dynamic supervision and management group showed no significant difference(p>0.05)compared to the blank control group after 9 months of intervention.Inhibition control(t=2.525,p=0.037)and walking speed(t=2.049,p=0.04)were significantly better than the static selfmanagement group and the blank control group after 9 months of intervention.Conclusions:The presence of a history of cardiovascular disease,educational attainment,and upper limb strength predict overall cognitive ability and executive function in middle-aged and older adults at high risk of dementia.After 3 months of intervention,static health management improved executive function in the elderly population at risk of dementia;dynamic supervision and management improved overall cognitive function,executive function and upper limb strength.After 9 months of intervention,static health management improved executive function,upper limb strength and gait speed;dynamic supervision improved overall cognitive function,delayed recall,executive function,upper limb strength and gait speed in the elderly population at high risk of dementia.Both dynamic and static health management can improve gait speed and executive function in the elderly population at risk of dementia,but dynamic supervision and management can improve them even more.Future preventive interventions based on mobile health could be implemented in the elderly population at high risk of dementia. |
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