Exercise interventions for visual processing and functional mobility in dementia and mild cognitive impairment

Visual processing deficits are seen early onset dementia and can impact other cognitive functions and mobility, leading to increased dependency and fall risk. While exercise interventions might be beneficial to address these issues, the optimal exercise-based approach for improving cognitive functions and mobility in this population remains unclear.

This thesis aimed to investigate the effects of technology-integrated motor-cognitive dual- task exercise on visual processing, functional mobility, and balance in people with dementia (PwD) and cognitive impairment. A systematic overview of exercise studies (Chapter 2) showed that multicomponent and multitasking exercises combining cognitive and physical activities were most effective for improving independence and visuomotor skills in PwD. Observational studies investigated interest in technology use among older adults using data from the Cognitive Function and Ageing Studies (CFAS-II, Chapter 3) and identified early visual processing impairments as a sensitive predictor of future dementia risk using the EPIC-Norfolk cohort (Chapter 4). The CFAS-II study showed that older people, females and those with less access to technologies were less willing to use assistive technologies, while the EPIC-Norfolk cohort showed potential screening of future dementia development using a visual processing test.

Two experimental studies investigated the effects of dual-task exergame technologies and combined cognitive-physical exercises. An 8-week home-based exergame intervention in 50 older adults demonstrated variable effects on cognitive or fall risk-related outcomes depending on the cognitive or physical domain trained (Chapter 5). A pilot study with 24 participants found that combined eye movement and resistance band exercises improved visual sensitivity and visuospatial working memory in both cognitively intact and impaired older adults (Chapter 6).

These findings suggest that technology-integrated dual-task exercises combining visual processing and physical components may be effective in improving visual-cognitive functions and mobility in older adults with cognitive impairment. However, the optimal exercise type, intensity, and duration require further investigation through well-designed clinical trials. This research contributes to the literature supporting multimodal, technology- based interventions for maintaining cognitive and physical function in older adults. Future studies should examine long-term effects on fall risk and activities of daily living in larger, more diverse populations of people with varying levels of cognitive impairment.