Promotion of Cognitive Function Maintenance Exercises in the Community: “Brain Wakawaka Club” Activities to Keep the Brain Young

Abstract

According to estimates by the Japanese Cabinet Office, there will be approximately 6.02 million elderly people with dementia in 2020, and the prevalence of dementia among those age 65 years and above will be very high at 16.7%. Therefore, it is important to prevent dementia in local communities. However, even though exercises for physical strength maintenance are conducted in many local communities, there are very few exercises to prevent declines in cognitive function. Thus, the “Brain Wakawaka Club” makes tours to local communities with the students of the Department of Occupational Therapy, and conducts cognitive function evaluation and maintenance exercises for elderly people. This activity is expected to contribute to the prevention of dementia among the elderly in the community.

1. Introduction

The Annual Report on the Aging Society (2017) by the Japanese Cabinet Office [1] estimated that, in 2020, there will be 6.02–6.31 million elderly people with dementia, and the prevalence of dementia among the elderly aged 65 years and above will be 16.7–17.5%, while in 2030, there will be about 7.44–8.30 million elderly people with dementia, and the prevalence of dementia among the elderly aged 65 years and above will be 20.2–22.5%. In other words, in the near future, one in five people will be suffering from dementia. In addition, it was estimated that there will be 4 million people with mild dementia [2], so in addition to early detection and early treatment of dementia, support measures for dementia prevention to suppress the increase in the number of dementia patients are also important.

On the other hand, in an attitude survey (2020) regarding aging anxiety among individuals aged 20 and above [3], 83.8% of participants responded feeling anxiety over aging, and 48.2% of participants responded feeling anxiety over dementia. This result shows that society has a high level of interest in dementia prevention.

In light of this social background, in accordance with the Five-Year Plan for the Promotion of Dementia Measures (Orange Plan) (2012) and the Comprehensive Strategy to Accelerate Dementia Measures (New Orange Plan) (2015) by the Ministry of Health, Labor and Welfare, elderly individuals in the community have started to carry out group activities in the local community, such as the Fureai Salon. However, even though exercises for the purpose of physical strength maintenance and muscle strengthening are often conducted in many local communities, exercises for cognitive function maintenance and cognitive decline prevention are rarely conducted [4]. In fact, “not knowing what type of exercises to incorporate” is an opinion also often heard from local communities. Therefore, it is believed that enlightenment activities that incorporate exercises for cognitive function maintenance and cognitive decline prevention in the program of each local community are important.

At the same time, in recent years, an exercise that stimulates cognitive functions while exercising for dementia prevention (cognicise) has attracted much attention [5, 6, 7], and the effects are anticipated. Thus, the activities of the “Brain Wakawaka Club” aim to contribute to the prevention of decline in cognitive function among the elderly in communities by conducting cognitive function evaluation, as well as cognicise and left-right asymmetrical upper limb movement as cognitive function maintenance exercises for the elderly in local communities over time.

2. Activity contents

Teaching staff of Kinjo University, who are occupational therapists, and students of the Department of Occupational Therapy participated in local community activities once a week for five consecutive weeks and performed cognitive function evaluation and guidance for cognicise on the elderly. Cognitive function evaluation was performed once during the 5 weeks on the elderly individuals who participated in this activity. Then, the elderly individuals checked the cognitive function evaluation results with the teaching staff at Kinjo University once a year and recognized changes in their own cognitive function over time.

Cognicise was performed with the elderly when cognitive function evaluation was not conducted. The contents of cognicise performed in the 5 weeks were continued as an activity in the local communities.

The specific contents of the cognitive function evaluation and cognicise are as follows.

2.1 Cognitive function valuation

After measuring the blood pressure of the elderly participants in local communities, and checking their physical condition that day, evaluation of cognitive function was conducted by Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and CogEvoⓇ (Total Brain Care Co., Ltd.) (Figures 1 and 2) [8, 9, 10, 11, 12].

Figure 1.

A look at cognitive function evaluation.

Figure 2.

Contents of cognitive function evaluation by CogEvo^Ⓡ [12]. CogEvo^Ⓡ is an application in which five types of tasks are performed using a tablet, and the five aspects of cognitive functions, namely planning ability, memory, attention, orientation and spatial awareness, can be evaluated based on execution time and number of errors (adapted from the Total Brain Care Co., Ltd. website with partial modification).

In the evaluation by CogEvo^Ⓡ, five types of tasks shown in Figure 2 were performed using a tablet. This evaluation is an application that enables fun task execution by game sensation, and enables the evaluation of the five aspects of cognitive functions, namely planning ability, memory, attention, orientation, and spatial awareness, from the execution time and accuracy rate of the tasks [12].

The results of the cognitive function evaluation on elderly individuals were mainly recorded using the CogEvo^Ⓡ record sheet shown in Figure 3.

Figure 3.

Results of cognitive function evaluation by CogEvo^Ⓡ (sample). The results of CogEvo^Ⓡ were displayed as the score and judgment results based on the task execution time (total time) and accuracy rate for the five aspects of planning ability, memory, attention, orientation and spatial awareness, and were shown in a radar chart.

2.2 Cognitive function maintenance exercises including cognicise

The tasks performed included reading Kanji indicating colors (the color of the characters and that of the Kanji indicating the color are different) displayed on the screen while walking or stepping, an exercise involving moving four limbs according to instructions while singing (Figure 4), and an exercise involving moving the left and right hands at the same time with different movements. In addition, the exercises were mainly guided by the students of the Department of Occupational Therapy.

Figure 4.

Exercise following the movement of the leader while singing. The leader is the student on the right. The student on the left follows the exercise of the leader, while singing the lyrics displayed at the top of the figure at the same time.

In 2020, when the spread of COVID-19 infection was remarkable, activities in local communities were restricted, and only cognitive function evaluation could be conducted in local communities. Thus, for cognitive function maintenance exercises (Figure 5), manuals describing methods to perform the exercises, and DVDs introducing the exercise methods were produced (Figures 4 and 5). These were then distributed to local communities to provide exercise guidance to the elderly. Nine types of exercises were prepared for the cognitive function maintenance exercises. These were filmed while changing the exercise difficulty level and exercise speed. Then, the videos were edited so that the elderly could understand them easily, such as by adding subtitles to the videos filmed, and DVDs explaining the content of the exercises were produced.

Figure 5.

Exercise where one waits to see one’s the opponent’s move before doing anything to ensure victory against the leader in rock-paper-scissors. The leader is the student on the right. The student on the left shows their hand after the leader to ensure victory.

3. Results of activity

We herein report the activity contents in one local community where the “Brain Wakawaka Club” activities could be continued for 3 years.

A total of 23 elderly people participated in our club, including 5 men and 18 women (mean age of 71.9 ± 7.2 years: 58–86 years). Among them, a total of 13 elderly people participated every year, including 3 men and 10 women (mean age of 70.9 ± 8.1 years: 58–86 years). The results of their cognitive function evaluation by MMSE, FAB, and CogEvo^Ⓡ were compared over the years, and it was found that none showed significant changes (Figures 6 and 7). With regard to cognitive function maintenance exercises, the local community representative reported that exercises performed during the “Brain Wakawaka Club” were carried out as a continuous activity.

Figure 6.

Changes in MMSE and FAB scores over time. There were no significant changes in the MMSE and FAB scores over time. (It could not be conducted in 2020 due to the shortening of the cognitive function evaluation time caused by the spread of COVID-19 infection).

Figure 7.

Changes in time required for the five types of tasks by CogEvo^Ⓡ over time. Changes in the average time required were observed for each task, but there were no statistically significant changes over time in all five tasks.

4. Discussion

Cognicise is expected to improve cognitive function and suppress the progression of cerebral atrophy by activating the brain, compared to exercises where one only moves the body [4, 5, 6, 7, 8, 13]. Due to the small number of subjects, the very short guidance regarding cognitive function maintenance exercises at 5 weeks out of a year, and the inability to confirm the continuous implementation of the guided exercises in local communities, this activity of the “Brain Wakawaka Club” has many issues in terms of verification. Thus, it cannot be said that the activity of our club contributes to the prevention of cognitive decline.

On the other hand, the elderly individuals participating in the “Brain Wakawaka Club” provided comments such as “I am grateful because I can check my own cognitive function every year and understand my own condition,” “It is fun to be able to exercise with the young students,” “I feel lonely and sorry that I could not meet the students due to COVID-19 this year,” “I really wish to exercise with the students next year”, and “I am grateful because DVDs were made as a measure against COVID-19, and we can exercise while reviewing ourselves from now on.” Thus, as the local community responded well to the activity of our club, we expect that this activity will contribute to activities for the health maintenance of the elderly in the community.

In addition, the participating students expressed thoughts such as “By knowing the exercises for cognitive function maintenance, I came to understand that various cognitive functions are related to casual human movements,” “This became a practice for speaking with patients in a clinical setting,” “I understood that talking speed is also important when providing explanations to the elderly so that they can understand me easily,” and “I realized the embarrassment when talking with patients in the clinical setting,” and it was thought that a learning effect can also be expected for occupational therapists in clinical settings.

In the future, we would like to expand the “Brain Wakawaka Club” range of activities and verify the same of our club in the community.

Conflict of interest

The authors declare that they have no competing interests.