Improvisational Movement for People With Memory Loss and Their Caregivers
Condition: Alzheimer's Disease (Incl Subtypes); Dementia; Mild Cognitive Impairment
MeSH terms: Alzheimer Disease; Memory Disorders; Amnesia; Cognitive Dysfunction
Study type: Interventional

Summary: 
      Dementia is a progressive decline in cognition that impairs a person's ability to perform
      activities of daily living. Changes in mood, gait, and balance are prominent secondary
      symptoms of Alzheimer's dementia that can dramatically decrease quality of life for the
      person with dementia and increase caregiver burden. The overall aim of this study is to
      determine the independent and combined effects of dance movement and social engagement on
      quality of life in people with early-stage dementia, and test the neural mechanisms of these
      effects.
    

Detailed description: 
      Dementia is a progressive decline in cognition that impairs a person's ability to perform
      activities of daily living. Alzheimer's disease is the most common form of dementia, the most
      common neurodegenerative disease in older adults, and the 6th leading cause of death in the
      US. Neuropsychiatric symptoms (apathy, depression, anxiety) and altered gait and balance are
      prominent secondary symptoms of Alzheimer's disease that increase medical costs and decrease
      quality of life for both the person with dementia and their caregiver.

      In a report from the Secretariat (Executive Board, 134th Session, December 20th, 2013), the
      World Health Organization identified a need to integrate evidence-based palliative care
      services into the continuum of care for serious chronic diseases, including Alzheimer's
      disease. However, two recent NIH workshops identified major gaps in the evidence supporting
      the wider use of non-pharmacologic activities to ameliorate secondary symptoms of chronic
      disease. Arts-based activities were identified as particularly understudied for symptom
      management, given growing evidence that various arts-based activities can improve quality of
      life, relieve symptoms, and reduce reliance on medications. It is important that these
      benefits can be achieved without adding medications. Dance is an arts-based activity that can
      improve quality of life, decrease symptoms of depression, and improve balance in healthy
      older adults, those with Parkinson disease, and Alzheimer's disease. Thus, dance is a
      non-pharmacological intervention that simultaneously addresses two sets of prominent
      secondary symptoms in Alzheimer's disease: 1) gait and balance and 2) neuropsychiatric
      symptoms. However, the mechanisms through which dance exerts these effects are unknown.

      Pilot data from the investigators' laboratory suggest that participating in a group
      improvisational movement class twice weekly improved balance and connectivity in
      motor-related brain regions, as well as improving mood and connectivity in brain regions
      associated with social engagement. Improvisation is the ability to create new gestures and
      movements spontaneously. Improvisation can be a part of many different art forms. However,
      improvisational movement can also be practiced as a specific dance form. The objective in
      improvisational movement is that choreographed movement is replaced by a cue or prompt that
      allows the possibility for multiple responses. This unique form of dance is especially
      well-suited for people with dementia because it: 1) does not rely heavily on memory of
      repeated movements; 2) can be seamlessly adapted to include sitting, standing, or moving
      around the room; 3) is cognitively challenging; and 4) fosters a social, playful atmosphere.
      Participants seemed to benefit from both the social nature of the class and the movement.
      Therefore, the overall aim of this proposal is to experimentally determine the independent
      and combined effects of dance movement and social engagement on quality of life in people
      with early stage dementia, and test the neural mechanisms of these effects.

      To accomplish this goal, the investigators will use a 2x2 factorial design and randomize 120
      community-dwelling older adults adjudicated as having early-stage dementia of the presumed
      Alzheimer's type to one of four 3-month interventions: 1) Dance Group, 2) Non-group Dance, 3)
      Social Group, or 4) No Contact Control.

      It is not hypothesized that dance affects the underlying disease course, and therefore no
      improvement is expected in cognition.
    

Intervention name(s): Dance Group; Non-Group Dance; Social Group; No Contact
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): Active imagination refers to working with imagery and is crucial in improvisatory practice. Verbal auditory cues are used to create movement scenarios that cue or activate the motor imagination. Variability means the improvisational method does not aim to learn a specific movement pattern and habituate to it. Cues are delivered quickly, one after another. Within an average of two minutes, tasks requiring quicker decision-making are introduced. Pacing is the rate at which new movement prompts are presented. Quick changes in pace avoid defaulting to habitual responses, thereby facilitating new movement options. Participants cannot rely on copying another, memory, or anticipation to address the motor problem.; The caregiver will be asked to stay in the area while the subject is dancing. A video camera will be affixed in an upper corner of the room to record individual dance sessions. This recording will yield data that a trained student or staff member can view and code to document movement fidelity (e.g., that the person has responded to the dance prompts and for the purpose of comparing the amount of quality of movements that occur in individual vs. group dance settings). For the first two sessions, study staff would observe the full dance session from outside the room to be sure that instruction was clear and adherence was attained, and that no safety issues arise.; The social group will consist of improvisational party games to foster curiosity and playfulness, use imagery, and encourage non-judgment. Games that may be used include 'Balderdash', 'Wise and Otherwise', 'Charades', 'Pictionary', and 'Tell Me A Story' cards. These games will also use the same core strategies as the dance group. Games will be varied within an hour-long session to incorporate pacing and variability into the social group, akin to the dance group. The social group will occur 2x/week for 1 hour each time and be led by the same instructors who lead the Dance Group, to control for effects of personality of the group leader.; The condition of not receiving an intervention can have ethical implications and reduce retention rates. Therefore, these participants will be invited to join in a weekly community improvisational dance class after they complete the study, for as many sessions as they would like.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized controlled trial. Investigators will use a 2x2 factorial design to test the separate and combined effects of social engagement and dance movement on QoL in 120 community-dwelling older adults adjudicated as having mild cognitive impairment (MCI) or early-stage dementia of the presumed AD or mixed AD/vascular type. Participants will be randomized to one of four 12-week interventions: 1) Dance Group 2) Non-group Dance, 3) Social Group, or 4) No Contact Control.
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Improvisation; Memory loss; Caregivers; Quality of Life; Dance; Social Group; MRI; mild cognitive impairment; MCI; Social engagement