Improvisational Movement for People With Memory Loss and Their Caregivers

Dementia is a progressive decline in cognition that impairs a person's ability to perform
activities of daily living. Alzheimer's disease is the most common form of dementia, the most
common neurodegenerative disease in older adults, and the 6th leading cause of death in the
US. Neuropsychiatric symptoms (apathy, depression, anxiety) and altered gait and balance are
prominent secondary symptoms of Alzheimer's disease that increase medical costs and decrease
quality of life for both the person with dementia and their caregiver.

In a report from the Secretariat (Executive Board, 134th Session, December 20th, 2013), the
World Health Organization identified a need to integrate evidence-based palliative care
services into the continuum of care for serious chronic diseases, including Alzheimer's
disease. However, two recent NIH workshops identified major gaps in the evidence supporting
the wider use of non-pharmacologic activities to ameliorate secondary symptoms of chronic
disease. Arts-based activities were identified as particularly understudied for symptom
management, given growing evidence that various arts-based activities can improve quality of
life, relieve symptoms, and reduce reliance on medications. It is important that these
benefits can be achieved without adding medications. Dance is an arts-based activity that can
improve quality of life, decrease symptoms of depression, and improve balance in healthy
older adults, those with Parkinson disease, and Alzheimer's disease. Thus, dance is a
non-pharmacological intervention that simultaneously addresses two sets of prominent
secondary symptoms in Alzheimer's disease: 1) gait and balance and 2) neuropsychiatric
symptoms. However, the mechanisms through which dance exerts these effects are unknown.

Pilot data from the investigators' laboratory suggest that participating in a group
improvisational movement class twice weekly improved balance and connectivity in
motor-related brain regions, as well as improving mood and connectivity in brain regions
associated with social engagement. Improvisation is the ability to create new gestures and
movements spontaneously. Improvisation can be a part of many different art forms. However,
improvisational movement can also be practiced as a specific dance form. The objective in
improvisational movement is that choreographed movement is replaced by a cue or prompt that
allows the possibility for multiple responses. This unique form of dance is especially
well-suited for people with dementia because it: 1) does not rely heavily on memory of
repeated movements; 2) can be seamlessly adapted to include sitting, standing, or moving
around the room; 3) is cognitively challenging; and 4) fosters a social, playful atmosphere.
Participants seemed to benefit from both the social nature of the class and the movement.
Therefore, the overall aim of this proposal is to experimentally determine the independent
and combined effects of dance movement and social engagement on quality of life in people
with early stage dementia, and test the neural mechanisms of these effects.

To accomplish this goal, the investigators will use a 2x2 factorial design and randomize 120
community-dwelling older adults adjudicated as having early-stage dementia of the presumed
Alzheimer's type to one of four 3-month interventions: 1) Dance Group, 2) Non-group Dance, 3)
Social Group, or 4) No Contact Control.

It is not hypothesized that dance affects the underlying disease course, and therefore no
improvement is expected in cognition.

Inclusion Criteria:

Age 60-85 years

Adjudicated as having mild cognitive impairment or early-stage dementia of Alzheimer's,
vascular, or mixed Alzheimer's/vascular type

MRI compatible

English speaking

Have study partner who is around the person with dementia approximately 10 hours/week and
is willing to be an active study partner.

Able to attend bi-weekly intervention classes or come to study visits for no-contact
control.

Not enrolled in another interventional study for at least 3 months prior to beginning this
study.

Exclusion Criteria:

Untreated depression

Other causes of dementia (for example, frontotemporal, early onset, Lewy body or
Parkinsonian dementia)

Current cancer treatment or other major medical problems that might independently affect
cognition or movement

Other neurological disorders (e.g., Parkinson disease, multiple sclerosis)

Taking medication that could negatively influence safety during intervention

Planned extensive travel during the study period

Any reason for which the study doctor or personal physician feels the intervention is
contraindicated for the participant