“ … Claudia Dalterio, Madelyn Gerardi, Safeer Mughal, and Kartik Nath Thanks to Union College … ”
Abstract
The portable Interactive Physical and Cognitive Exercise System (iPACES, v 2.8), tablet, smart watch and an under-desk stationary elliptical will be sent to the home of a participant and used in-home for three months in this experiment. We aim to examine the effects of cognitive and physical stimulation, in adolescents on the autism spectrum. This three-week intervention of exergaming will add to the finding of previous studies that used a 20 minute bout of exergaming. Participants will receive the iPACES set-up and necessary testing materials via mail to remain consistent with the social distancing guidelines due to COVID-19. To begin the experiment, participants will be given a series of questionnaires and cognitive tasks, such as Stroop, Color Trails, and Digit Span via a video call on a remote video conference platform (e.g. Zoom) remaining consistent with the tele-health guidelines. Participants will then be asked to use the game and peddler combination 3-5 times weekly for 30-45 minutes. While this proposed study does not attempt to maximize participation in exercise, it aims to support the belief that exergaming produces a positive effect on cognitive functioning and the reduction of autism-related behaviors of repetition and physical self-stimulation. It will also indirectly investigate the possibility of the use of exergaming as a viable treatment for autism and the feasibility of a remote protocol.
With the prevalence of dementia and neurocognitive decline on the rise, older adult populations have begun seeking out non-pharmacological methods to prevent or ameliorate their symptoms. Specifically, prior research has shown greater cognitive benefits from simultaneous exercise and cognitive stimulation than exercise alone, particularly for patients with mild cognitive impairment (MCI). In response to the COVID-19 pandemic, we conducted a pilot study to test the feasibility of a remote, home-based, exercise intervention for older adults. For three months, six older adults engaged in integrative physical and cognitive exercise via a neuro-exergame called the interactive Physical and Cognitive Exercise System (iPACES v2.0), which involves pedaling an under-desk elliptical while playing an interactive video game. Participants completed the Montreal Cognitive Assessment (MoCA) before and after the intervention, and exit interviews were conducted via Zoom at the conclusion of the study. While participants found the neuro-exergame to be entertaining, several setup and technical difficulties arose that made their overall experience more difficult. Our findings suggest that a more effective intervention would involve more user-friendly features that allow for greater ease of use by older adults with MCI.
There is a dementia epidemic that is affecting the older adult population, and researchers are exploring accessible ways to ameliorate the cognitive decline associated with Alzheimer's Disease and related dementias. Non-pharmacological interventions such as interactive physical and cognitive exercise are being investigated to understand the physiological and cognitive effects in older adults. Twenty-seven older adults were enrolled in a single-bout neuro-exergaming intervention of the interactive Physical and Cognitive Exercise System (iPACESv2.0), a neuro-exergame that consists of pedaling an under-desk elliptical while playing an interactive video game. The study explores the cognitive and biomarker outcomes in participants with mild cognitive impairment (MCI). The intervention featured a neuropsychological battery and salivary analysis to measure changes in executive function and biomarkers associated with neuroplasticity. Analyses revealed a significant increase in executive function and salivary alpha-amylase in the MCI population, suggesting cognitive improvements occurred after the intervention. This study provides encouraging preliminary support for the use of interactive exergaming interventions as clinical treatments to ameliorate the cognitive decline associated with Alzheimer's disease.
“ … Can Benefit My Pursuit of a Career in Medicine, by Kartik Nath • he Long Lost Variable: Humanities’ Impact on Engineering … Pursuit of a Career in Medicine, by Kartik Nath • he Long Lost Variable: Humanities’ Impact on … ”
Abstract
We all know not to leave school without a plan, a skill-set, a career path, but without the Arts and Humanities? Why not?
“ … at Union College, Schenectady NY ~ May 22nd, 2020 KartikNath, Michela Michielli, Carli Voellm, Kylie Alberts, … ”
Abstract
Objective: Researchers are focusing on behavioral interventions to counteract the cognitive decline associated with dementia. The interactive and Physical Cognitive Exercise System (iPACES v2.75) study at Union College is a single-bout multimodal intervention, consisting of pedaling an under-desk elliptical which controls progress while playing a video game, for patients with mild cognitive impairment (MCI). Our investigation focuses on the neurobiological mechanisms of cognitive decline by looking at the correlation between changes in biological markers and improvements in cognitive function. Participants and Methods: 27 older adults were recruited from multiple sites in NY and MA. Participants pedaled an under desk elliptical and used an iPad for iPACES, in which they traveled along a virtual bike path and completing errands. Two domains of cognitive function: executive function and verbal memory, were measured pre and post exercise with the paper and electronic Stroop (A:C ratio and CCII metric of BrainBaseline) and ADAS-COG. Salivary samples to analyze biomarker changes were taken before and after the exercise. The samples were assayed using the Enzyme-Linked Immunosorbent Assay (ELISA) for IGF-1, alpha-amylase, and cortisol. Paired t-tests were used to evaluate pre to post changes in IGF-1, Alpha-Amylase, cortisol, Stroop, and ADAS-Cog. Results: Significant improvements in the overall sample were noted on the ADAS-Cog (p = .05), Stroop CCII (p = .01) and alpha amylase (p = .01). There was a significantly greater improvement among MCI on the Stroop CCII (p = .04) and alpha amylase (p = .04). Conclusions: Our results support the idea that alpha-amylase is an effective biomarker for multi-modal interventions for patients with MCI. Since there was a significant improvement in the increase in alpha-amylase, it shows that there was an effective physiological response to the physical exercise that could be part of the broader neurobiological mechanisms leading to cognitive improvements. Further investigation is needed into single-bout interventions to understand how to maximize the effectiveness of the exercise to spur the neurobiological mechanism. Our study supports the notion that the combined physical and mental exercise benefits cognition, and should be the basis of more interventions and research for patients at risk for dementia. Authors: Kartik Nath, Professor Cay Anderson-Hanley
The interactive Physical and Cognitive Exercise (iPACES) is a neuro-exergame that combines interactive cognitive gaming with physical exercise to target executive function for patients with mild cognitive impairment (MCI). This thesis includes the novel use of iPACES with Parkinson's Disease (PD) patients. PD with mild cognitive impairment (PD-MCI) presents with heterogeneity of motor and neuropsychological outcomes (Cammisuli et al., 2019). The goal of this study was to understand if iPACES is feasible to use in the PD population.
This study was organized into a feasibility and a single-bout pilot study. Patients with Parkinson's from clinics in the USA were invited to briefly pedal-n-play the iPACES neuro- exergame, paired with a portable under-desk elliptical pedaler. Feedback on portability and usability was collected. The study (n=15, age = 74.3, SD = 9.8, range = 51-90 yrs old) revealed some insight into the usability of iPACES components. Then, patients with Parkinson's were invited to volunteer for a remote 1-hour neuropsychological protocol with a single bout 20- minute pedal-n-play session, to assess a cognitive change post exercise session. Two participants (n=2, age=74) volunteered, and a single case of the data was obtained. An anecdotal review of the change over time revealed an increase in executive function after a single session of iPACES.
The novel iPACES neuro-exergame study for PD patients is a proof of concept for the future interventions for PD-MCI patients. Future research must address adaptations such as game customization, gather more data, work through equipment challenges, and evaluate more PD-MCI patients.
Mild Cognitive Impairment (MCI) poses a serious risk to the older population. This disease may be a precursor to a more debilitating dementia, such as Alzheimer's Disease (AD), and it affects the cognitive abilities as well as overall quality of life of those who suffer from it (Alzheimer's Association, 2014). Finding preventative ways to combat these neurodegenerative illnesses is imperative for our increasing older population at risk. Prior research has shown benefits to cognition from physical exercise (Colcombe & Kramer, 2003); however, only a fraction of older adults actually achieve recommended levels (Chodzko-Zajko et al., 2009). Some researchers have explored the use of potentially more motivating exergames and have found benefits above and beyond physical exercise alone perhaps due to synergistic effects of physical and mental engagements (Anderson-Hanley et al., 2012A; Zhu et al., 2016). The current study attempts to replicate and extend prior research by examining the cognitive impact of a single bout of a neuro-exergame in which older adults engaged in interactive Physical and Cognitive Exercise (iPACES v2.5). This involved pedaling an under-table elliptical while playing an iPad-based videogame, which simulated independent living everyday function of running errands and retracing one's path home. Fourteen older adults (mean age = 65.6 years old) were assessed pre- and post-exercise with neuropsychological tests of executive function (Stroop and Trails) as well as verbal memory (ADAS Word Recall). While no significant changes were observed in the sample taken as a whole, a repeated measures ANOVA (controlling for age) indicated a significantly greater benefit to verbal memory for MCI participants in contrast with normative older adults (<em>p</em> = .008). Further research is needed to confirm this finding in a larger sample, but it is consistent with some prior research on single bouts of exercise benefiting cognition of MCI more than normative older adults (Anderson-Hanley et al., 2016; Cohen et al., 2014). The implications of this type of research suggest that neuro-exergaming is feasible, including for those with MCI, and may yield immediate benefits to cognition; follow-up trials are needed to examine long-term use, factors affecting outcomes, and underlying mechanisms.<strong> </strong>
