Cognitive training for elderly people without cognitive impairment: an occupational therapy Intervention during the COVID-19 pandemic

Cruz, Gabrieli Pereira da; Pereira, Laísa Souza; Raymundo, Taiuani Marquine

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Sumário

Original Article • Cad. Bras. Ter. Ocup. 30 • 2022 • https://doi.org/10.1590/2526-8910.ctoAO22963030 copy

Cognitive training for elderly people without cognitive impairment: an occupational therapy Intervention during the COVID-19 pandemic¹ 1 Interventional research approved by the Ethics Committee for Research on Human Beings of UFPR, under opinion No. 3.756.734, and published in the Brazilian Registry of Clinical Trials (Registration number RBR-3bq3gq), resulting from the Course Completion Work (TCC) of the Occupational Therapy Course at the Federal University of Paraná.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

In view of the cognitive changes resulting from the normal aging process, this study aimed to compare the performance of routine and cognitive activities, quality of life and depressive symptoms of healthy elderly participants and non-participants of cognitive training applied by occupational therapists.

Method

non-randomized clinical trial, matched by allocation into groups, with a quantitative approach of analytical character, longitudinal measured through standardized assessments: Geriatric Depression Scale, Revised-Addenbrooke Cognitive Examination, the Routine Tasks Inventory-Extended, Quality Assessment of life of the World Health Organization WHOQOL (BREF and OLD), and Instrument for the Assessment of Attitudes towards Aging, applied pre and post-intervention. There were 24 sessions, twice a week, lasting 60 minutes each. The intervention was based on the natural cognitive decline of aging, and covered analyzed activities and games.

Results

case group (n=10), aged between 62 and 74 years (M=67.50, SD= 3.95): control group (n=11), aged between 61 and 73 years (M=68, SD= 4.12). The effect size calculation (Cohen’s d) revealed a training effect for the following variables: Depressive symptoms (1.12); Cognition: memory (0.82), visual-spatial function (0.55), fluency (0.56), MMSE (1.00) and ACE-R (0.98); Quality of life: sensory functioning (0.61); intimacy (0.51) and physical (0.50). No gain effects were observed for the other variables.

Conclusion

the cognitive training was accompanied by an improvement of the participants in part of the standardized assessments, suggesting that the intervention favors the improvement of cognitive functions and quality of life and reduction of depressive symptoms of elderly participants.

Keywords:
Occupational Therapy; Cognition; Cognitive Aging; Elderly

Characteristics	Case group (n=10)				Control group (n=11)
Characteristics	Mean	SD	Median	Min-Max	Mean	SD	Median	Min-Max
Age	67	3.95	66	62-74	68.0	4.12	68	61-73
Sex
	n		%		n		%
Male	5		50		5		45.5
Female	5		50		6		54.5
Scholarity
	n		%		n		%
Complete high school	5		50		7		63.6
University education	3		30		3		27.3
Postgraduate	2		20		1		9.1
Marital status
	n		%		n		%
Single	2		20		0		0
Married	4		40		8		72.7
Divorced	3		30		2		18.2
Widower/widow	1		10		1		9.1
Monthly income
	n		%		n		%
Up to a salary	0		0		2		18.2
Two to three salaries	1		10		4		36.4
Four to six salaries	6		60		4		36.4
Above six minimum wages	3		30		1		9.1

Domain			BADL	IADL	COM
Case	Pre	RTI-E	4.69 (DP 0.24)	5.56 (DP 0.56)	5.99 (DP 0.04)
	Post		4.67 (DP 0.26)	5.56 (DP 0.39)	5.99 (DP 0.04)
	Effect size (Cohen’s d)		0.07	0	0
Control	Pre		4.61 (DP 0.04)	5.69 (DP 0.36)	5.99 (DP 0.04)
	Post		4.61 (DP 0.04)	5.56 (DP 0.52)	5.99 (DP 0.04)
	Effect size (Cohen’s d)		0	0.29p	0
Significance				0.930-;	1.00-;
				0.352-;	1.00-;
				0.823-;	1.00-;
				0.882-	1.00-
Group	F		0.28	0.14	0
	p		0.604	0.713	1
			0.01	0.01	0
Moment	F		0.69	0.27	0
	p		0.417	0.612	1
			0.04	0.01	0
Group x Moment	F		0.43	0.02	0
	p		0.521	0.881	1
			0.02	0	0
SW (p)				<0.001*	<0.001*

Domain	Case			Control			Significance	Group			Moment			Group x Moment			SW (p)
Domain	Pre	Post	Effect size (Cohen’s d)	Pre	Post	Effect size (Cohen’s d)	Significance	F	p	$η_{G}^{2}$	F	p	$η_{G}^{2}$	F	p	$η_{G}^{2}$	SW (p)
ACE-R
Attention and Guidance	17.1	17.4	0.34^p	16.55	16.55	0	0.299^-; 1.00^-; 0.191^-; 0.261^-	2.7	0.117	0.12	0.52	0.478	0.03	0.01	0.927	0	<0.001*
Attention and Guidance	(SD 0.99)	(SD 0.7)	0.34^p	(SD 1.04)	(SD 1.63)	0	0.299^-; 1.00^-; 0.191^-; 0.261^-	2.7	0.117	0.12	0.52	0.478	0.03	0.01	0.927	0	<0.001*
Memory	23.8	25	0.82^g	22.55	22.27	0.08	0.065^-; 0.859^-; 0.413^-; 0.043^d	2.46	0.133	0.11	0.12	0.303	0.06	1.52	0.232	0.07	<0.001*
Memory	(SD 1.62)	(SD 1.25)	0.82^g	(SD 2.98)	(SD 3.26)	0.08	0.065^-; 0.859^-; 0.413^-; 0.043^d	2.46	0.133	0.11	0.12	0.303	0.06	1.52	0.232	0.07	<0.001*
Fluency	11.1	11.9	0.56^m	11	10.91	0.04	0.150^-; 0.837^-; 0.971^-; 0.314^-	0.43	0.52	0.02	0.11	0.746	0.01	0.61	0.445	0.03	0.032*
Fluency	(SD 1.6)	(SD 1.2)	0.56^m	(SD 1.79)	(SD 2.07)	0.04	0.150^-; 0.837^-; 0.971^-; 0.314^-	0.43	0.52	0.02	0.11	0.746	0.01	0.61	0.445	0.03	0.032*
Language	25.6	25.7	0.16	25.18	24.18	1.01^g	0.773^-; 0.056^-; 0.11^-; 0.006^d	13.65	0.002*	0.42	2.72	0.115	0.13	3.5	0.077	0.16	<0.001*
Language	(SD 0.7)	(SD 0.48)	0.16	(SD 0.6)	(SD 1.25)	1.01^g	0.773^-; 0.056^-; 0.11^-; 0.006^d	13.65	0.002*	0.42	2.72	0.115	0.13	3.5	0.077	0.16	<0.001*
Visual-spatial	15	15.5	0.55m	13	14	0.49^p	0.037^a ;0.309^-; 0.023^c; 0.022^d	13.79	0.001*	0.42	5.01	0.037*	0.21	0.83	0.374	0.04	<0.001*
Visual-spatial	(SD 0.94)	(SD 0.85)	0.55m	(SD 2.05)	(SD 1.95)	0.49^p	0.037^a ;0.309^-; 0.023^c; 0.022^d	13.79	0.001*	0.42	5.01	0.037*	0.21	0.83	0.374	0.04	<0.001*
MMSE	27.9	29.2	1.00g	27.55	27.55	0	0.041^a; 1.00^-; 0.536^-; 0.012^d	5.7	0.028*	0.23	0.66	0.425	0.03	1.77	0.199	0.09	<0.001*
MMSE	(SD 1.66)	(SD 0.79)	1.00g	(SD 1.51)	(SD 1.75)	0	0.041^a; 1.00^-; 0.536^-; 0.012^d	5.7	0.028*	0.23	0.66	0.425	0.03	1.77	0.199	0.09	<0.001*
ACE-R	92.6	95.5	0.98^g	88.27	87.91	0.06	0.032a; 1.00-; 0.028c; 0.008d	14.07	0.001*	0.31	1.06	0.315	0.01	2	0.174	0.02	0.085
ACE-R	(SD 2.84)	(SD 3.03)	0.98^g	(SD 4.65)	(SD 6.3)	0.06	0.032a; 1.00-; 0.028c; 0.008d	14.07	0.001*	0.31	1.06	0.315	0.01	2	0.174	0.02	0.085

Domain	Case		Effect size (Cohen’s d)	Control		Effect size (Cohen’s d)	Significance	Group			Moment			Group x Moment			SW (p)
Domain	Pre	Post	Effect size (Cohen’s d)	Pre	Post	Effect size (Cohen’s d)	Significance	F	p	$η_{G}^{2}$	F	p	$η_{G}^{2}$	F	p	$η_{G}^{2}$	SW (p)
WHOQOL-Old
FS	74.38	84.38	0.61^m	88.07	84.66	0.17	0.094^-; 0.41^-; 0.138^-; 0.45^-	1.43	0.246	0.07	0.79	0.386	0.04	2.9	0.105	0.13	<0.001*
FS	(SD 20.72)	(SD 10.31)	0.61^m	(SD 17.56)	(SD 20.8)	0.17	0.094^-; 0.41^-; 0.138^-; 0.45^-	1.43	0.246	0.07	0.79	0.386	0.04	2.9	0.105	0.13	<0.001*
AUT	73.75	71.88	0.11	59.66	60.23	0.03	0.565^-; 0.85^-; 0.043c; 0.19^-	3.98	0.061	0.15	0.04	0.841	0	0.18	0.681	0	0.42
AUT	(SD 14.67)	(SD 18.92)	0.11	(SD 14.35)	(SD 16.6)	0.03	0.565^-; 0.85^-; 0.043c; 0.19^-	3.98	0.061	0.15	0.04	0.841	0	0.18	0.681	0	0.42
PPF	73.12	71.88	0.07	60.8	63.64	0.13	0.774^-; 1.00^-; 0.163^-; 0.619^-	1.23	0.282	0.06	0.2	0.659	0.01	0.04	0.842	0	0.021*
PPF	(SD 17.19)	(SD 17.98)	0.07	(SD 18.35)	(SD 22.85)	0.13	0.774^-; 1.00^-; 0.163^-; 0.619^-	1.23	0.282	0.06	0.2	0.659	0.01	0.04	0.842	0	0.021*
PSO	65.62	71.25	0.27^p	64.77	57.39	0.37^p	0.2^-; 0.351^-; 0.642^-; 0.272^-	0.87	0.362	0.04	0.11	0.747	0	3.21	0.089	0.03	0.256
PSO	(SD 22.29)	(SD 17.97)	0.27^p	(SD 12.27)	(SD 24.66)	0.37^p	0.2^-; 0.351^-; 0.642^-; 0.272^-	0.87	0.362	0.04	0.11	0.747	0	3.21	0.089	0.03	0.256
MEM	56.25	58.12	0.06	70.45	76.14	0.34^p	0.605^-; 0.341^-; 0.108^-; 0.056^-	3.04	0.097	0.13	2.22	0.153	0.01	0.54	0.473	0	0.074
MEM	(SD 28.57)	(SD 24.83)	0.06	(SD 16.32)	(SD 16.73)	0.34^p	0.605^-; 0.341^-; 0.108^-; 0.056^-	3.04	0.097	0.13	2.22	0.153	0.01	0.54	0.473	0	0.074
INT	61.25	73.12	0.51^m	76.7	75	0.09	0.104^-; 0.733^-; 0.165^-; 0.695^-	0.96	0.34	0.05	1.43	0.246	0.07	1.97	0.177	0.09	0.006*
INT	(SD 28.53)	(SD 15.32)	0.51^m	(SD 18.77)	(SD 18.11)	0.09	0.104^-; 0.733^-; 0.165^-; 0.695^-	0.96	0.34	0.05	1.43	0.246	0.07	1.97	0.177	0.09	0.006*
Total	67.4	71.77	0.25^p	70.08	69.51	0.04	0.126^-; 0.933^-; 0.526^-; 0.751^-	0	0.973	0	0.58	0.456	0	1.11	0.305	0.01	0.155
Total	(SD 19.21)	(SD 14.26)	0.25^p	(SD 9.68)	(SD 14.93)	0.04	0.126^-; 0.933^-; 0.526^-; 0.751^-	0	0.973	0	0.58	0.456	0	1.11	0.305	0.01	0.155
WHOQOL-Bref
FIS	75	75	0	75.65	69.81	0.50m	1.00^-; 0.035b; 0.776^-; 0.357^-	0.2	0.663	0.01	4.69	0.043*	0.02	4.26	0.053	0.02	0.114
FIS	(SD 13.26)	(SD 12.6)	0	(SD 9.42)	(SD 13.21)	0.50m	1.00^-; 0.035b; 0.776^-; 0.357^-	0.2	0.663	0.01	4.69	0.043*	0.02	4.26	0.053	0.02	0.114
PSI	75.42	75.42	0	71.97	67.05	0.42p	0.865^-; 0.293^-; 0.831^-; 0.317^-	0.55	0.469	0.03	0.36	0.555	0.02	0.53	0.477	0.03	0.032*
PSI	(SD 14.76)	(SD 12.34)	0	(SD 8.14)	(SD 14.37)	0.42p	0.865^-; 0.293^-; 0.831^-; 0.317^-	0.55	0.469	0.03	0.36	0.555	0.02	0.53	0.477	0.03	0.032*
SOC	71.67	72.5	0.04	62.88	59.85	0.19	0.831^-; 0.394^-; 0.337^-; 0.127^-	2.08	0.165	0.09	0.18	0.677	0	0.47	0.501	0	0.157
SOC	(SD 22.29)	(SD 18.86)	0.04	(SD 14.61)	(SD 16.59)	0.19	0.831^-; 0.394^-; 0.337^-; 0.127^-	2.08	0.165	0.09	0.18	0.677	0	0.47	0.501	0	0.157
AMB	74.69	76.88	0.15	70.17	68.47	0.17	0.319^-; 0.17-; 0.571^-; 0.179^-	1.64	0.216	0.08	0.02	0.899	0	2.82	0.11	0.01	0.247
AMB	(SD 13.3)	(SD 14.15)	0.15	(SD 9.41)	(SD 10.31)	0.17	0.319^-; 0.17-; 0.571^-; 0.179^-	1.64	0.216	0.08	0.02	0.899	0	2.82	0.11	0.01	0.247
AAQ
PPSI	15.4	14.7	0.14	18.18	19.27	0.21^p	0.401^-; 0.497^-; 0.156^-; 0.028d	4.23	0.054	0.18	0.02	0.881	0	1.19	0.289	0.06	0.002*
PPSI	(SD 4.95)	(SD 4.6)	0.14	(SD 5.29)	(SD 4.73)	0.21^p	0.401^-; 0.497^-; 0.156^-; 0.028d	4.23	0.054	0.18	0.02	0.881	0	1.19	0.289	0.06	0.002*
CPSI	31.4	30.2	0.21^p	29.55	29.18	0.1	0.169^-; 0.684^-; 0.189^-; 0.355^-	1.58	0.223	0.08	3.16	0.092	0.14	0.31	0.583	0.02	0.007*
CPSI	(SD 5.21)	(SD 5.92)	0.21^p	(SD 3.47)	(SD 3.52)	0.1	0.169^-; 0.684^-; 0.189^-; 0.355^-	1.58	0.223	0.08	3.16	0.092	0.14	0.31	0.583	0.02	0.007*
MFIS	29.1	28.8	0.04	26.91	25.82	0.18	0.778^-; 0.575^-; 0.322^-; 0.168^-	1.04	0.321	0.05	0.53	0.474	0	0.16	0.691	0	0.107
MFIS	(SD 6.84)	(SD 6.51)	0.04	(SD 6.16)	(SD 5.4)	0.18	0.778^-; 0.575^-; 0.322^-; 0.168^-	1.04	0.321	0.05	0.53	0.474	0	0.16	0.691	0	0.107
Total	93.1	92.3	0.05	86.27	83.73	0.24p	0.72^-; 0.207^-; 0.192^-; 0.097^-	2.32	0.144	0.1	2.06	0.168	0.01	0.53	0.475	0	0.051
Total	(SD 13.66)	(SD 13.19)	0.05	(SD 9.92)	(SD 10.7)	0.24p	0.72^-; 0.207^-; 0.192^-; 0.097^-	2.32	0.144	0.1	2.06	0.168	0.01	0.53	0.475	0	0.051

Universidade Federal de São Carlos, Departamento de Terapia Ocupacional Rodovia Washington Luis, Km 235, Caixa Postal 676, CEP: , 13565-905, São Carlos, SP - Brasil, Tel.: 55-16-3361-8749 - São Carlos - SP - Brazil
E-mail: cadto@ufscar.br

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[1] Author’s Contributions

Gabrieli Pereira da Cruz collaborated in the structuring and application of the cognitive training, analysis of activities, data collection and writing of the initial and final version of the manuscript. Laísa Souza Pereira collaborated in the structuring and application of the cognitive training, analysis of activities, and data collection. Taiuani Marquine Raymundo worked equally in the critical review of the manuscript and contributed to the approval of the final version to be published. All authors approved the final version of the text.

Case	Pre	GDS	2.8 (DP 1.55)
	Post		1.4 (DP 0.84)
	*Effect size (Cohen’s d)*		1.12g
Control	Pre		2.55 (DP 1.13)
	Post		3.18 (DP 2.14)
	*Effect size (Cohen’s d)*		0.36p
Significance			0.02^a a Significant difference between moments for the case group by the paired Wilcoxon test. bSignificant difference between moments for the control group by the paired Wilcoxon test. cSignificant difference between groups for the pre-moment by the Wilcoxon test. dSignificant difference between groups for the post moment by the Wilcoxon test. SW: Shapiro-Wilk. p: p-value. *p-value < 0.05. pSmall effect size (Cohen’s d 0.20 to 0.49). gLarge effect size (Cohen’s d ≥0.80). ; 0.343b; 0.611c; 0.031d
Group	F		1.65
	p		0.214
	$η_{G}^{2}$		0.08
Moment	F		1.68
	p		0.211
	$η_{G}^{2}$		0.08
Group x Moment	F		8.43
	p		0.009*
	$η_{G}^{2}$		0.31
SW (p)			0.004*