Logopenic Progressive Aphasia, Neurodegenerative Diseases, Non-fluent Aphasia, Primary Progressive Aphasia, Semantic Dementia
Conditions
Keywords
Primary Progressive Aphasia, Home-Based Exercise Intervention, Pilot Study
Brief summary
This pilot study aims to evaluate the feasibility of a novel home-based multicomponent exercise program in adults clinically diagnosed with Primary Progressive Aphasia
Detailed description
Exercise is known to induce changes in brain neuroplasticity in the elderly and is thought to have a protective effect against cognitive decline in patients already suffering from neurodegenerative diseases. While the benefits of exercise in the context of mild cognitive impairment and Alzheimer's disease have been extensively studied, little information is available on the potential benefits of exercise for other atypical neurodegenerative diseases, such as primary progressive aphasia (PPA). A multimodal exercise intervention (combination of aerobic and resistance exercises) could potentially slow overall cognitive decline in PPA, which is characterized by a gradual and isolated dissolution of language function, by promoting neurogenesis and neuroplasticity. In healthy but inactive older adults, exercise increases grey and white matter volume in prefrontal and temporal cortical regions, which are specifically impaired in PPA and play an important role in executive functions, episodic memory and language skills. Exercise could thus modulate certain executive, memory and language difficulties generally observed in this clinical population. This pilot study aims to evaluate the feasibility of a novel home-based multicomponent exercise program in adults clinically diagnosed with any of the three main variants of PPA (semantic, non-fluent/agrammatic or logopenic). The feasibility outcomes will be based on: 1) total recruitment and recruitment rate, 2) program completion rate, 3) compliance and 4) participants' ability to train at home with or without a caregivers' presence. A minimum of 12 participants will be recruited through McGill University's Douglas Research Institute and will complete a 6-month home-based multimodal intervention program. They will train two to three times a week for 45 minutes and be supervised via videoconference by a kinesiologist from the EPIC Center at the Montreal Heart Institute. If desired, participants will be accompanied by a partner, close friend, or relative to facilitate communication, especially if they have difficulty understanding instructions or expressing themselves. To assess changes in cognition, physical and psychological functions, participants will complete neuropsychological and functional assessments in-person at baseline. These assessments will also be completed at three and six months post-intervention. The knowledge gained from this pilot project will be used to assess the feasibility of a full randomized control trial aimed at assessing the effects of multimodal exercise intervention in PPA patients. Ultimately, an increased understanding of the potential beneficial effects of physical exercise in PPA will allow for more tailored rehabilitative approaches in this clinical population.
Interventions
OTHERHome-based multicomponent exercise intervention program
A novel home-based multicomponent exercise intervention program was designed using a multimodal training circuit. This 24-week circuit program was created to improve functional (resistance) and aerobic health. Participants will be asked to train two to three times a week for 45 minutes. They will be supervised via videoconference by a trained kinesiologist from the EPIC Center at the Montreal Heart Institute. If desired, participants can complete their exercises with a partner, friend, or relative to facilitate communication. Participants will be asked to document the perceived intensity of their exercises in a booklet after each workout. The perceived intensity of their exercises will be measured by a validated effort perception scale graduated from 0 to 10 (Borg scale; Williams, 2017). Progressions will increase every five weeks and will be subject to modification if not properly tolerated or if found to be below a 3 on the Borg rate of perceived exertion scale (moderate intensity).
Sponsors
Montreal Heart Institute
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* A clinical diagnosis of Primary Progressive Aphasia * Fluent in French or English * Able to read, understand and sign the information and consent form * Have access to the internet * Have access to a tablet (i.e. iPad or Android) or a computer
Exclusion criteria
* Any absolute and relative contraindication to exercise testing and/or physical training (e.g., any severe musculoskeletal disease impairing their mobility) * Any severe respiratory disease (e.g., asthma, COPD, COVID-19) * Any severe exercise intolerance
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Evaluate the total recruitment rate of a 6-month exercise intervention in individuals with Primary Progressive Aphasia | 6 months post-intervention | Total recruitment (number of participants screened compared to final enrollments) |
| Evaluate the satisfaction of a 6-month exercise intervention in individuals with Primary Progressive Aphasia | 6 months post-intervention | Satisfaction (feedback given by the participants and their caregivers will be considered using a satisfaction questionnaire and qualitative feedback). Ability to train at home with or without their caregivers' presence will also be taken into account. |
| Evaluate the compliance rate of a 6-month exercise intervention in individuals with Primary Progressive Aphasia | 6 months post-intervention | Compliance (total number of in-person evaluations and home-based training sessions attended compared to the maximum possible) |
| Evaluate the program completion rate of a 6-month exercise intervention in individuals with Primary Progressive Aphasia | 6 months post-intervention | Program completion rate (number of participants that completed their in-person evaluations as well as the home-based interventions after 6 months compared to the participants enrolled) |
| Evaluate the recruitment rate of a 6-month exercise intervention in individuals with Primary Progressive Aphasia | 6 months post-intervention | Recruitment rate (number of participants that can be enrolled per month) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Document changes in reading comprehension | Baseline and 6 months post-intervention | Participants will complete the Chapman-Cook (scores range from 0-30, with a higher score indicating better reading comprehension). |
| Document changes in oral expression | Baseline and 6 months post-intervention | Participants will complete the word/sentence repetition subtasks from the Boston Diagnostic Aphasia Examination (BDAE) (scores range from 0-14, with higher scores indicating better oral expression). |
| Document changes in lexical retrieval | Baseline and 6 months post-intervention | Participants will complete the Boston Naming Test (scores range from 0-30, with a higher score indicating better lexical retrieval). |
| Document changes in executive functions and processing speed | Baseline and 6 months post-intervention | Participants will complete validated neuropsychological tests and iPad tests (scores are measured in milliseconds, with lower reaction times indicating faster processing speeds). |
| Document changes in endurance | Baseline and 6 months post-intervention | Endurance will be assessed with a 6 min walking test (scores are measured in the number of meters walked, with a higher number of meters indicating a better score). |
| Document change in balance performance | Baseline and 6 months post-intervention | Balance performance will be assessed with a timed one-leg standing test (scores are measured in seconds, with a higher time indicating a better score). |
| Document change in upper limb muscle strength | Baseline and 6 months post-intervention | Upper limb muscle strength will be assessed with a grip strength test (scores are measured with the maximum force/tension generated by one's forearm muscles, with a higher kilogram indicating a better score). |
| Document change in lower limb muscle strength | Baseline and 6 months post-intervention | Lower limb muscle strength will be assessed with a timed Sit-to-Stand test (scores are measured in seconds, with a lower time indicating a better score). |
| Document changes in walking speed | Baseline and 6 months post-intervention | Walking speed will be assessed with a 10-meter walking test (scores are measured in seconds, with a lower time indicating a better score). |
| Document changes functional mobility | Baseline and 6 months post-intervention | Functional mobility will be assessed with the Timed up and Go test (scores are measured in seconds, with a lower time indicating a better score). |
| Document changes in cardiorespiratory fitness | Baseline and 6 months post-intervention | Cardiorespiratory fitness will be assessed with the Matthews cardiorespiratory fitness questionnaire (the score is an estimation of individual VO2 max (ml.kg.min) and ranges from 15-50, with a higher score indicating a higher VO2max). |
| Document changes in general cognitive functioning | Baseline and 6 months post-intervention | Participants will complete the Montreal Cognitive Assessment (scores range from 0-28, with a higher score indicating better cognitive functioning). |
| Document changes in auditory long-term memory | Baseline and 6 months post-intervention | Participants will complete the Rey auditory verbal learning test (scores range from 0-15, with a higher score indicating a better auditory long-term memory). |
| Document changes in visual long-term memory | Baseline and 6 months post-intervention | Participants will complete the Rey-Osterrieth complex figure test (scores range from 0-36, with a higher score indicating a better visual long-term memory). |
| Document changes in verbal working memory | Baseline and 6 months post-intervention | Participants will complete the forward and backward digit span subtasks of the Wechsler Adult Intelligence Scale-IV (scores range from 0-32, with a higher number indicating a better score). |
| Document changes in visual working memory | Baseline and 6 months post-intervention | Participants will complete the spatial span subtask of the Wechsler Memory Scale-III (scores range from 0-32, with a higher number indicating a better score). |
| Document changes in nonverbal fluency | Baseline and 6 months post-intervention | Participants will complete the Ruff figure fluency test (scores are based on the total number of figures drawn, with a higher number indicating a better score). |
| Document changes in verbal fluency | Baseline and 6 months post-intervention | Participants will complete phonemic and semantic fluency tasks (scores are based on the total number of words given, with a higher number indicating a better score). |
| Document changes in writing ability | Baseline and 6 months post-intervention | Participants will complete the Bernard Croisile dictation task (scores range from 0-18, with a higher score indicating better writing ability). |
| Document changes in auditory comprehension | Baseline and 6 months post-intervention | Participants will complete the Boston Diagnostic Aphasia Examination (BDAE) subtasks: word, body part, commands, story comprehension, and the word-picture matching (scores range from 0-36, with higher scores indicating better auditory comprehension). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Document changes in self-reported physical activity | Baseline and 6 months post-intervention | Physical Activity Scale for the Elderly questionnaire (scores range from 0-400, with a higher score indicating better level of physical activity). |
| Document changes in neuropsychiatric symptoms | Baseline and 6 months post-intervention | The Neuropsychiatric Inventory-Questionnaire is completed by the participants' caregiver (scores range from 0-36 for symptom severity and from 0-60 for the caregiver's distress, with higher scores indicating higher severity/distress). |
| Document Cognitive Reserve | Baseline | Rami and colleagues' cognitive reserve questionnaire (scores range from 0-26, with a higher score indicating a greater cognitive reserve). |
| Document perceived social support | Baseline | Lubben Social Network Scale questionnaire (scores range from 0-30, with a higher score indicating more social engagement) |
| Document changes in perceived stress | Baseline and 6 months post-intervention | Perceived Stress Scale questionnaire (scores range from 0-4, with 0 no stress,1 mild stress, 3 moderate stress and 4 severe). |
| Document changes in quality-of-life | Baseline and 6 months post-intervention | 12-Item Short Form Health Survey. This questionnaire gives two scores - a mental component scale (MCS) and a physical component scale (PCS) score. Results are reported as Z-scores (mean of 50 and standard deviation of 10) and so each 10 increment of 10 points above or below 50, corresponds to one standard deviation away from the average. |
| Document changes in anxiety | Baseline and 6 months post-intervention | State-Trait Anxiety Inventory questionnaire (scores range from 20-80, with a higher score indicating higher anxiety). |
| Document changes in depressive symptomatology | Baseline and 6 months post-intervention | Geriatric Depression Scale questionnaire (scores range from 0-30, with a higher score indicating larger depressive symptomatology). |
| Document changes in risk of sleep apnea | Baseline and 6 months post-intervention | Using the Berlin Questionnaire, participants are classified into high risk or low risk based on their responses to the individual items and their overall scores in the symptom categories (high risk = if there are 2 or more categories where the score is positive/ low risk = if there are only 1 or no categories where the score is positive). |
| Document changes in sleep quality | Baseline and 6 months post-intervention | Pittsburg Sleep Quality Index questionnaire (scores range from 0-21, with a higher score indicating worse sleep quality). |
Countries
Canada
Outcome results
None listed