Social Dancing Intervention for Older Adults at High Risk of Alzheimer's Disease and Other Dementias

Social dancing is a complex sensorimotor rhythmic activity integrating physical, cognitive
and social elements with the potential to ameliorate a wide range of physical and cognitive
impairments in older individuals at risk of Alzheimer's disease (AD) and related dementias.
The few extant studies report that dancing stimulates multiple cognitive processes, including
attention, processing speed, and executive function, but these discoveries were made in small
samples, lacking control conditions, and did not investigate the underlying biological
mechanisms.

Executive function (EF) is an umbrella term for the management of cognitive processes,
including working memory, reasoning, task flexibility, and problem solving that are central
to planning, goal-directed action, and coordination of daily activities. Impairment of EF and
related processes such as processing speed and attention is seen in normal aging as well as
early in dementia, and is associated with difficulty in performing daily activities and
increased risk of adverse events such as falls. Encouragingly, aerobic exercise is reported
to enhance cognition, especially EF. Cognitively impaired seniors fall more, and have higher
prevalence and severity of balance and gait problems than cognitively intact fallers. Given
social dancing's multimodal cognitive and physical benefits; it may help maintain mobility
and reduce falls in individuals at risk for dementia. In support, the investigators reported
that older social dancers had better balance and gait than non-dancers.

The investigators propose a 6-month pilot single blind, randomized clinical trial (RCT)
comparing social dancing (ballroom dancing) versus active control (walking) in 32 older
adults at high risk of dementia. The overall hypothesis is that social dancing in cognitively
vulnerable seniors will induce neuroplasticity that will enhance cognitive processes and
improving everyday behaviors. The objective for this pilot trial is to obtain preliminary
data on intervention effects (trajectory and asymptote) on EF to design a full-scale RCT.

Social dancing appeals to older adults, has intrinsic value, is enjoyable, and has high
potential for sustainability. This trial is novel and high risk, but will provide the
evidence base to develop a definitive full-scale RCT to support or refute prescription of
social dancing to prevent cognitive decline in older adults at high risk of AD and related
dementias.

Inclusion Criteria:

- Adults aged 65 and older

- A score of ≤ 6 on the Memory Impairment Screen or ≥ 1 on the AD-8

- Plan to be in area for next year or more

- English speaking

- Willing to complete an Functional Magnetic Resonance Imaging (MRI)

Exclusion Criteria:

- Presence of dementia based on previous physician diagnosis of dementia or dementia
diagnosed by the study clinician at initial visit.

- Serious chronic or acute illness such as cancer (late stage, metastatic, or on active
treatment), chronic pulmonary disease on ventilator or continuous oxygen therapy or
active liver disease.

- Mobility limitations solely due to musculoskeletal or cardiovascular conditions that
prevent participation in the intervention programs.

- Any medical condition or chronic medication use (e.g., neuroleptics) in the judgment
of the screening clinician that will compromise safety or affect cognitive
functioning.

- Terminal illness with life expectancy less than 12 months.

- Presence of progressive, degenerative neurologic disease (e.g., Parkinson's disease or
Amyotrophic lateral sclerosis).

- Severe auditory or visual loss.

- Active psychoses or psychiatric symptoms (such as agitation) noted during the clinic
visit that will prevent completion of study protocols.

- Either participation in competitive dancing or recreational dancing at a frequency
>1/month in the past six months.

- Participation in other interventional study that overlaps with intervention period of
this study.