Home-based,caregiver-assisted multimodal exercise and cognitive training via videoconferencing for older adults with mild dementia: A mixed-methods pilot study
Restricted accessResearch articleFirst published online January, 2026
Home-based,caregiver-assisted multimodal exercise and cognitive training via videoconferencing for older adults with mild dementia: A mixed-methods pilot study
Evidence on the effects of caregiver-assisted combined exercise and cognitive interventions for persons with dementia (PwD) is inconsistent.
Objective
This study aimed to evaluate the feasibility and preliminary effects of a home-based Caregiver-Assisted Multimodal Exercise and Cognitive Training (CA-MECT) intervention via videoconferencing for persons with mild dementia in comparison with exercise or cognitive training alone and the control condition.
Methods
Thirty-three participants were randomized into a combined intervention, exercise, cognitive training, or control group. The combined intervention was a 12-week caregiver-assisted home-based sequentially combined multimodal exercise and cognitive training via videoconferencing. The exercise and cognitive training groups received a 12-week home-based Caregiver-Assisted Multimodal Exercise (CA-ME) and Caregiver-Assisted Cognitive Training (CA-CT), respectively, while the control group received health education. Validated instruments were used to evaluate cognitive, psychological, functional, and health-related quality of life (HRQoL) outcomes.
Results
CA-MECT was feasible, safe, and highly acceptable for PwD and their caregivers. Exploratory analyses suggested that compared with the control group, the CA-MECT participants showed potential improvements in global cognition, immediate recall, attention, number and severity of neuropsychiatric symptoms (NPS), and caregivers’ distress, though no clear benefits were observed in functional ability or HRQoL. When compared with single-component interventions, CA-MECT appeared to yield more favorable outcomes for immediate recall (versus CA-CT) and NPS severity (versus CA-ME), whereas its effects on processing speed were less favorable than both comparators.
Conclusions
CA-MECT is feasible and shows promise in improving cognition and NPS among PwD. Future studies are warranted to fully explore its efficacy and sustainability.
LongSBenoistCWeidnerW. World Alzheimer Report 2023. Reducing dementia risk: never too early, never too late. London: Alzheimer’s Disease International, 2023.
RaziNAMMinhatHSZulkefliNAM, et al.A systematic review on caregiver’s burden among caregivers of dementia patients in Malaysia. Malays J Med Health Sci2023; 19: 1–10.
4.
JiaJWeiCChenS, et al.The cost of Alzheimer’s disease in China and re-estimation of costs worldwide. Alzheimers Dement2018; 14: 483–491.
5.
HillNLKolanowskiAMGillDJ. Plasticity in early Alzheimer disease: an opportunity for intervention. Top Geriatr Rehabil2011; 27: 257–267.
ZhangJZhangYWangJ, et al.Recent advances in Alzheimer’s disease: mechanisms, clinical trials and new drug development strategies. Signal Transduct Target Ther2024; 9: 211.
8.
BalbimGMFalckRSBarhaCK, et al.Effects of exercise training on the cognitive function of older adults with different types of dementia: a systematic review and meta-analysis. Br J Sports Med2022; 56: 933–940.
9.
WangYYYangLZhangJ, et al.The effect of cognitive intervention on cognitive function in older adults with Alzheimer’s disease: a systematic review and meta-analysis. Neuropsychol Rev2022; 32: 247–273.
10.
FisslerPKüsterOSchleeW, et al.Novelty interventions to enhance broad cognitive abilities and prevent dementia: synergistic approaches for the facilitation of positive plastic change. Prog Brain Res2013; 207: 403–434.
11.
XueDDLiPWCYuDSF, et al.Combined exercise and cognitive interventions for adults with mild cognitive impairment and dementia: a systematic review and network meta-analysis. Int J Nurs Stud2023; 147: 104592.
12.
YoungDKNgPYKwokT, et al.The effects of an expanded cognitive stimulation therapy model on the improvement of cognitive ability of elderly with mild stage Dementia living in a community - a randomized waitlist controlled trial. Aging Ment Health2019; 23: 855–862.
13.
JiaoFLiuHSZengZJ, et al.Effects of aerobic exercise combined with cognitive stimulation on cognitive function and quality of life in patients with Alzheimer’s disease. Chin J Gerontol2022; 42: 87–90.
14.
van SantenJDroesRMTwiskJWR, et al.Effects of exergaming on cognitive and social functioning of people with dementia: a randomized controlled trial. J Am Med Dir Assoc2020; 21: 1958–1967.
15.
TanakaSYamagamiTYamaguchiH. Effects of a group-based physical and cognitive intervention on social activity and quality of life for elderly people with dementia in a geriatric health service facility: a quasi-randomised controlled trial. Psychogeriatrics2020; 21: 71–79.
16.
VenturelliMSollimaACèE, et al.Effectiveness of exercise- and cognitive-based treatments on salivary cortisol levels and sundowning syndrome symptoms in patients with Alzheimer’s disease. J Alzheimers Dis2016; 53: 1631–1640.
17.
BamidisPDFisslerPPapageorgiouSG, et al.Gains in cognition through combined cognitive and physical training: the role of training dosage and severity of neurocognitive disorder. Front Aging Neurosci2015; 7: 152.
18.
ArnoldSELounevaNCaoK, et al.Cellular, synaptic, and biochemical features of resilient cognition in Alzheimer’s disease. Neurobiol Aging2013; 34: 157–168.
19.
KrutkaDGCaranoKT. Videoconferencing for global citizenship education: wise practices for social studies educators. J Soc Stud Educ Res2016; 7: 109–136.
20.
WangLZhouYFangX, et al.Care burden on family caregivers of patients with dementia and affecting factors in China: a systematic review. Front Psychiatry2022; 13: 1004552.
21.
KorPPKYuCTKLiuJYW, et al.Pilot evaluation of a home-based multi-sensory cognitive stimulation intervention for older people with dementia and caregiver dyads during the COVID-19 pandemic. Int J Older People Nurs2022; 17: e12471.
22.
PadalaKPPadalaPRLensingSY, et al.Home-based exercise program improves balance and fear of falling in community-dwelling older adults with mild Alzheimer’s disease: a pilot study. J Alzheimers Dis2017; 59: 565–574.
23.
OrrellMYatesLLeungP, et al.The impact of individual cognitive stimulation therapy (iCST) on cognition, quality of life, caregiver health, and family relationships in dementia: a randomised controlled trial. PLoS Med2017; 14: e1002269.
24.
VreugdenhilACannellJDaviesA, et al.A community-based exercise programme to improve functional ability in people with Alzheimer’s disease: a randomized controlled trial. Scand J Caring Sci2012; 26: 12–19.
25.
MenengicKNYeldanICinarN, et al.Effectiveness of motor-cognitive dual-task exercise via telerehabilitation in Alzheimer’s disease: an online pilot randomized controlled study. Clin Neurol Neurosurg2022; 223: 107501.
26.
EldridgeSMChanCLCampbellMJ, et al.CONSORT 2010 Statement: extension to randomised pilot and feasibility trials. Br Med J2016; 355: i5239.
27.
HughesCPBergLDanzigerWL, et al.A new clinical scale for the staging of dementia. Br J Psychiatry1982; 140: 566–572.
28.
WarburtonDEJamnikVKBredinSS, et al.The physical activity readiness questionnaire for everyone (PAR-Q+) and electronic physical activity readiness medical examination (ePARmed-X+). Health Fit J Can2011; 4: 3–23.
29.
American College of Sports Medicine. ACSM’s resource manual for guidelines for exercise testing and prescription. 10th ed. Philadelphia: Lippincott Williams & Wilkins, 2018.
30.
JitapunkulSPillayIEbrahimS. The abbreviated mental test: its use and validity. Age Ageing1991; 20: 332–336.
31.
BrowneRH. On the use of a pilot sample for sample size determination. Stat Med1995; 14: 1933–1940.
32.
HoffmannTCGlasziouPPBoutronI, et al.Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Br Med J2014; 348: g1687.
33.
NasreddineZSPhillipsNABédirianV, et al.The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc2005; 53: 695–699.
34.
SunYAnCHeW, et al.A preliminary study of the application of Montreal cognitive assessment Beijing version in community dwelling older adults residing in Shenyang. Chin J Behav Med Brain Sci2012; 21: 948–950.
35.
GuoQHLvCZHongX. Auditory verbal memory test in Chinese elderly. Chin Ment Health J2001; 15: 13–15.
36.
GuoQHSunYTYuPM, et al.Norm of auditory verbal learning test in the normal aged in China community. Chin J Clin Psychol2007; 15: 132–134,141.
37.
LuJGuoQHongZ, et al.Trail making test used by Chinese elderly patients with mild cognitive impairment and mild Alzheimer’s dementia. Chin J Clin Psychol2006; 14: 118–120.
38.
WangRYZhouJHHuangYC, et al.Reliability of the Chinese version of the trail making test and Stroop color and word test among older adults. Int J Gerontol2018; 12: 336–339.
39.
WeiMShiJLiT, et al.Diagnostic accuracy of the Chinese version of the trail-making test for screening cognitive impairment. J Am Geriatr Soc2018; 66: 92–99.
40.
GuoQHHongZLvC, et al.Application of stroop color-word test on Chinese elderly patients with mild cognitive impairment and mild Alzheimer’s dementia. Chin J Neurol2005; 38: 701–704.
41.
ChenYWuQH. The performance of stroop color-word test in persons with different severity of Alzheimer’s disease. Nerv Dis Ment Healt2006; 6: 131–132.
42.
DaiXRyanJJPaoloAM, et al.Factor analysis of the mainland Chinese version of the wechsler adult intelligence scale (WAIS-RC) in a brain-damaged sample. Int J Neurosci1990; 55: 107–111.
KauferDICummingsJLKetchelP, et al.Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory. J Neuropsychiatry Clin Neurosci2000; 12: 233–239.
45.
PfefferRIKurosakiTTJrHC, et al.Measurement of functional activities in older adults in the community. J Gerontol1982; 37: 323–329.
46.
LogsdonRGGibbonsLEMcCurrySM, et al.Assessing quality of life in older adults with cognitive impairment. Psychosom Med2002; 64: 510–519.
47.
WanLP. Cross-cultural adaptation of Quality of Life-Alzheimer’s Disease and Alzheimer’s Disease Knowledge Scale Chinese version. Master’s thesis, Shanxi Medical University, Shanxi, China, 2013.
48.
ZhangHAiYWuY, et al.The reliability and validity for Chinese quality of life – Alzheimer’s disease. Chin J Health Stat2013; 30: 57–59.
GreimelSWymanJFZhangL, et al.Recruitment and screening methods in Alzheimer’s disease research: the FIT-AD trial. J Gerontol A Biol Sci Med Sci2022; 77: 547–553.
53.
BartlettRMilneRCroucherR. Strategies to improve recruitment of people with dementia to research studies. Dementia2019; 18: 2494–2504.
FørsundLHGrovEKHelvikAS, et al.The experience of lived space in persons with dementia: a systematic meta-synthesis. BMC Geriatr2018; 18: 33.
56.
BanduraA. Health promotion by social cognitive means. Health Educ Behav2004; 31: 143–164.
57.
BeishonLHauntonVSubramaniamH, et al.Qualitative analysis of the cognition and flow (CoGFlowS) study: an individualized approach to cognitive training for dementia is needed. J Alzheimers Dis2021; 83: 209–225.
58.
LeeLLArthurAAvisM. Using self-efficacy theory to develop interventions that help older people overcome psychological barriers to physical activity: a discussion paper. Int J Nurs Stud2008; 45: 1690–1699.
59.
Benitez-LugoMLVazquez-MarrufoMPinero-PintoE, et al.Analysis of physical-cognitive tasks including feedback-based technology for Alzheimer’s disorder in a randomized experimental pilot study. J Clin Med2023; 12: 5484.
60.
ZhaoXHuangXCaiY, et al.The relative effectiveness of different combination modes for exercise and cognitive training on cognitive function in people with mild cognitive impairment or Alzheimer’s disease: a network meta-analysis. Aging Ment Health2022; 26: 2328–2338.
61.
FabelKWolfSAEhningerD, et al.Additive effects of physical exercise and environmental enrichment on adult hippocampal neurogenesis in mice. Front Neurosci2009; 3: 994.
62.
LiangJHLiJYJiaRX, et al.Comparison of cognitive intervention strategies for older adults with mild to moderate Alzheimer’s disease: a Bayesian meta-analytic review. J Am Med Dir Assoc2019; 20: 347–355.
63.
FasnachtJSWueestASBerresM, et al.Conversion between the Montreal cognitive assessment and the Mini-mental Status examination. J Am Geriatr Soc2023; 71: 869–879.
64.
YangZYangJYuDSF, et al.Effects of sport stacking on cognition in patients with mild Alzheimer’s disease and MCI: preliminary findings of randomized controlled trial. J Geriatr Psychiatry Neurol2024; 37: 24–38.
65.
ChuangICChiauHYLiaoWW, et al.Effects of computer-based cognitive training combined with physical training for older adults with cognitive impairment: a four-arm randomized controlled trial. Digit Health2023; 9: 20552076231203633.
66.
YehTTChangKCWuCY, et al.Clinical efficacy of aerobic exercise combined with computer-based cognitive training in stroke: a multicenter randomized controlled trial. Top Stroke Rehabil2021; 29: 255–264.
67.
Fiatarone SinghMAGatesNSaigalN, et al.The study of mental and resistance training (SMART) study-resistance training and/or cognitive training in mild cognitive impairment: a randomized, double-blind, double-sham controlled trial. J Am Med Dir Assoc2014; 15: 873–880.
68.
ZhaoXHuangXZouB, et al.Compared to exercise, the effects of exercise combined with cognitive training in people with mild cognitive impairment: a network meta-analysis. Aging Ment Health2024; 29: 154–166.
69.
Anderson-HanleyCBarcelosNMZimmermanEA, et al.The Aerobic and Cognitive Exercise Study (ACES) for community-dwelling older adults with or at-risk for mild cognitive impairment (MCI): neuropsychological, neurobiological and neuroimaging outcomes of a randomized clinical trial. Front Aging Neurosci2018; 10: 76.
70.
KarssemeijerEGAAaronsonJABossersWJR, et al.The quest for synergy between physical exercise and cognitive stimulation via exergaming in people with dementia: a randomized controlled trial. Alzheimers Res Ther2019; 11: 3.
71.
AndradeC. Multiple testing and protection against a Type 1 (false positive) error using the Bonferroni and Hochberg corrections. Indian J Psychol Med2019; 41: 99–100.
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