Gerontology
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Review Meta Analysis
Effects of Physical Exercise Interventions on Gait-Related Dual-Task Interference in Older Adults: A Systematic Review and Meta-Analysis.
Dual-task interference during walking can substantially limit mobility and increase the risk of falls among community-dwelling older adults. Previous systematic reviews examining intervention effects on dual-task gait and mobility have not assessed relative dual-task costs (DTC) or investigated whether there are differences in treatment-related changes based on the type of dual task or the type of control group. The purpose of this systematic review was to examine the effects of physical exercise interventions on dual-task performance during walking in older adults. ⋯ Evidence from subgroup comparisons showed no difference in treatment-related changes between cognitive-motor and motor-motor dual tasks, or when interventions were compared to active or inactive controls. In summary, physical exercise interventions can improve dual-task walking in older adults primarily by increasing the speed at which individuals walk in dual-task conditions. Currently, evidence concerning whether physical exercise interventions reduce DTC or alter the self-selected dual-task strategy during unobstructed walking is greatly lacking, mainly due to the failure of studies to measure and report reciprocal dual-task effects on the non-gait task.
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Predictors of the placebo response (PR) in randomized controlled trials (RCT) have been searched for ever since RCT have become the standard for testing novel therapies and age and gender are routinely documented data in all trials irrespective of the drug tested, its indication, and the primary and secondary end points chosen. To evaluate whether age and gender have been found to be reliable predictors of the PR across medical subspecialties, we extracted 75 systematic reviews, meta-analyses, and meta-regressions performed in major medical areas (neurology, psychiatry, internal medicine) known for high PR rates. The literature database used contains approximately 2,500 papers on various aspects of the genuine PR. ⋯ While younger age may contribute to the PR in some conditions, sex does not. There is currently no evidence that the PR is different in the elderly. PR are, however, markedly influenced by the symptom severity at baseline, and by the likelihood of receiving active treatment in placebo- controlled trials.
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Prospective memory refers to memory for future intentions and is a critical predictor of functional capacity in late adulthood. For many other cognitive abilities, self- and informant-rated methods of assessment are routinely used to guide clinical decision-making. However, little is known about the validity (and consequently the clinical utility) of subjective reports of prospective memory difficulties. ⋯ These data indicate that self-report and informant report may neither accurately measure prospective memory of older people, nor be sensitive to objective prospective memory difficulties in people with MCI and dementia. These data have potentially important implications for clinical practice.