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Volume 23, Issue 3 (Autumn 2021)
Advances in Cognitive Sciences 2021, 23(3): 28-40 |
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Ethics code: IR.IAU.QOM.REC.1398.012
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Sangi S, Zargham Hajbi M, Ashayeri H, Aghayousefi A. Design and effectiveness of an educational package based on increased cognitive, emotional, and neuromuscular activity in depression in the elderly with mild cognitive impairment Kahrizak Nursing Home for the elderly and disabled in Tehran. Advances in Cognitive Sciences 2021; 23 (3) :28-40
URL: http://icssjournal.ir/article-1-1109-en.html
URL: http://icssjournal.ir/article-1-1109-en.html
1- PhD, Department of Psychology, Qom Branch, Islamic Azad University, Qom, Iran
2- Assistant Professor, Department of Psychology, Qom Branch, Islamic Azad University, Qom, Iran
3- Neuropsychiatries, Professor of Tehran University of Medical Sciences, Tehran, Iran
4- Associate Professor, Department of Psychology, Payame Noor University, Tehran, Iran
2- Assistant Professor, Department of Psychology, Qom Branch, Islamic Azad University, Qom, Iran
3- Neuropsychiatries, Professor of Tehran University of Medical Sciences, Tehran, Iran
4- Associate Professor, Department of Psychology, Payame Noor University, Tehran, Iran
Abstract: (1398 Views)
Introduction
One of the significant complications of aging is disorders caused by impaired cognitive function. On the other hand, dementia and mild cognitive impairment are associated with an increased risk of depression, social dysfunction, anxiety, psychological stress, and poor quality of life associated with mental health. Emotional disorders and stressful events can affect cognitive function, including attention and memory, and depressed people develop memory deficits in tasks that require more difficult processing. There is considerable evidence to support cognitive rehabilitation to improve executive function, and cognitive exercises improve the overall cognitive function of patients with dementia. Therefore, Designing educational methods based on cognitive rehabilitation improves the overall cognitive function of patients with dementia. In the present study, the efficacy of an educational package was addressed based on increased cognitive, emotional, and neuro-muscular activity in depression in the elderly with mild cognitive impairment.
Methods
In this study with pre-test and post-test design and control group, the study population consists of all male and female elderly residents of Kahrizak Nursing Home for the elderly and the disabled in 2018. Thus, four sections of the nursing home were selected, and in the next stage, a number of rooms were randomly selected and examined. According to Cochran's formula, 300 of them were selected as a sample by cluster sampling method. In cluster sampling, the sampling unit is a cluster or group of elements; therefore, the sample group's selection process is facilitated. From this number, 30 of the elderly with mild cognitive disorders were selected as the primary sample that was selected by simple random sampling method and was placed in two experimental and control groups. After identifying the study population and selecting the sample, the researcher referred to the sanatorium, and with the coordination of the sanatorium officials, treatment sessions began. Inclusion criteria were: no significant physical, sensory, or emotional disabilities and acute physical illnesses, and exclusion criteria were: suffering from psychiatric illnesses, other neurological diseases, participation in other psychological intervention programs, severe impairment in perception, and Verbal expression was achieved. This study is approved by the National Ethics Committee in Biomedical Research with the number IR.IAU.QOM.REC.1398.012 and also the ethical considerations considered in this study, the confidentiality of information, obtaining written consent from the elderly (clients) in order to He was interested in participating in research and was free to participate in research. Participants’ mini-mental state examination questionnaire (MMSE), depression (GDS), and social isolation (UClA) were completed. A-18 rehabilitation sessions program was performed in over eight weeks and two to three weeks. The implementation stages of the training protocol consisted of four stages:1- Emotional interventions through continuous individual sessions and doing awareness skills exercises (emotion recognition training, motivation training, impulsivity training) adaptation skills training (practicing useful and useless methods, practicing your week, practicing challenging negative thoughts) and acceptance skills exercises (practice of seeing the positive aspects, practice of happiness and satisfaction) were held (practice time is approximately 20 minutes) 2- Warm-up phase: In each session, the elderly performed gentle exercises during cognitive and neuromuscular exercises. (Exercise time is approximately 10 minutes) 3- Dual cognitive and neuromuscular homework exercises: through the performance of dual homework exercises and in the form of integrated cognitive motor exercises to strengthen the executive functions by exercises distance recovery, selective attention, continuous attention, time orientation, and verbal comprehension were presented in each session and exercises, including inverse number counting, addition, and subtraction of numbers, answering general information questions, spelling words, not using a word, completing a sentence with the appropriate word, counting numbers, contrast and the synonyms of the words were naming the days of the week, vice versa, the names of animals and places,. Side and back, sit and stand, stand and sit, hold a book on the head, hit the ball while standing, throw the ball into the basket while standing, walk and hit the ball, step from both sides were another. (Exercise time is approximately 20 minutes) 4- Cooling phase: At the end of each session, the elderly did relaxation exercises (the exercise time is approximately 10 minutes), and data were analyzed with analysis of covariance model. The control group did not receive any intervention at that time, and the training of this group was postponed until after the research. In the post-test phase, both groups’ prevalence of the mini-mental state examination questionnaire, depression, and social isolation was measured repeatedly. In this research, descriptive statistics methods are used to describe the variables better. The statistical indicators used include the calculation of frequency, mean and standard deviation. Also, the statistical method of multivariate analysis of covariance has been used to answer the research hypotheses.
Results
The findings revealed that the experimental group received cognitive rehabilitation intervention, compared with the control group, based on the mental state examination scores (F=24.30, P£0.01) significantly better cognitive function; depression ratings (F=17.67, P£0.01) lower depression rates and according to social isolationist attitudes (F=25.58, P£0.01) less social isolation.
Conclusion
The study results showed that increased cognitive, emotional, and neuromuscular activity is effective in improving cognitive function, reducing depression, and social isolation in mild cognitive impairment. Also, Educational package based on increased cognitive, emotional, and neuromuscular activity using mental and cognitive exercises, increasing patients' level of awareness and insight, increasing emotional adjustment, empowerment, and independence of patients have a significant effect on improving cognitive function, reducing depression And the social isolation of those with mild cognitive impairment. The partial square (effect size) for the effect of the independent variable on the dependent variable is 0.524, which indicates that 52% of the changes in the dependent variable are explained by the independent variable. In other words, education based on increased cognitive, emotional, and neuromuscular activity has affected 52% of the daily performance of the elderly (MCI). Therefore, due to the increase in the elderly population and the development of their problems t in society, it is suggested that this educational package be designed as software that includes the combined effect of the variables of this research, and more people be treated with this educational package. Cognitive rehabilitation interventions can also be used to improve other problems in the elderly, including disorders such as anxiety and obsessions caused by the problems of this age group and the problems of their caregivers.
Ethical Considerations
Compliance with ethical guidelines
Among the ethical principles observed were not violating the rights of individuals participating in the research, respecting human rights, and keeping the results of their research confidential. Before the intervention, the participants were explained of the study's objectives, and informed consent was obtained from them. Also, after completing the training sessions on the training groups and performing the post-test, the treatment sessions were intensively performed on the control group to observe the ethical principles.
Authors’ contributions
Samira Sangi and Majid Zargham Hajbi proceeded to select and define the concepts of the action plan and, in collaboration with Hassan Ashayeri and Alireza Aghaseofi, prepared initial manuscript. All authors performed a search of the research literature and research background. Samira Sangi and Majid Zargham Hajbi also designed and performed the experiments and collected and analyzed the data. All authors provided critical feedback and contributed to the formation of the research, analysis, and manuscript. All authors discussed the results and participated in compiling and editing the final version of the article.
Funding
No financial support has been received from any organization for this research.
Acknowledgments
The authors would like to thank the entire Kahrizak elderly sanatorium who helped us in this research.
Conflict of interest
This study did not have any conflict of interest.
One of the significant complications of aging is disorders caused by impaired cognitive function. On the other hand, dementia and mild cognitive impairment are associated with an increased risk of depression, social dysfunction, anxiety, psychological stress, and poor quality of life associated with mental health. Emotional disorders and stressful events can affect cognitive function, including attention and memory, and depressed people develop memory deficits in tasks that require more difficult processing. There is considerable evidence to support cognitive rehabilitation to improve executive function, and cognitive exercises improve the overall cognitive function of patients with dementia. Therefore, Designing educational methods based on cognitive rehabilitation improves the overall cognitive function of patients with dementia. In the present study, the efficacy of an educational package was addressed based on increased cognitive, emotional, and neuro-muscular activity in depression in the elderly with mild cognitive impairment.
Methods
In this study with pre-test and post-test design and control group, the study population consists of all male and female elderly residents of Kahrizak Nursing Home for the elderly and the disabled in 2018. Thus, four sections of the nursing home were selected, and in the next stage, a number of rooms were randomly selected and examined. According to Cochran's formula, 300 of them were selected as a sample by cluster sampling method. In cluster sampling, the sampling unit is a cluster or group of elements; therefore, the sample group's selection process is facilitated. From this number, 30 of the elderly with mild cognitive disorders were selected as the primary sample that was selected by simple random sampling method and was placed in two experimental and control groups. After identifying the study population and selecting the sample, the researcher referred to the sanatorium, and with the coordination of the sanatorium officials, treatment sessions began. Inclusion criteria were: no significant physical, sensory, or emotional disabilities and acute physical illnesses, and exclusion criteria were: suffering from psychiatric illnesses, other neurological diseases, participation in other psychological intervention programs, severe impairment in perception, and Verbal expression was achieved. This study is approved by the National Ethics Committee in Biomedical Research with the number IR.IAU.QOM.REC.1398.012 and also the ethical considerations considered in this study, the confidentiality of information, obtaining written consent from the elderly (clients) in order to He was interested in participating in research and was free to participate in research. Participants’ mini-mental state examination questionnaire (MMSE), depression (GDS), and social isolation (UClA) were completed. A-18 rehabilitation sessions program was performed in over eight weeks and two to three weeks. The implementation stages of the training protocol consisted of four stages:1- Emotional interventions through continuous individual sessions and doing awareness skills exercises (emotion recognition training, motivation training, impulsivity training) adaptation skills training (practicing useful and useless methods, practicing your week, practicing challenging negative thoughts) and acceptance skills exercises (practice of seeing the positive aspects, practice of happiness and satisfaction) were held (practice time is approximately 20 minutes) 2- Warm-up phase: In each session, the elderly performed gentle exercises during cognitive and neuromuscular exercises. (Exercise time is approximately 10 minutes) 3- Dual cognitive and neuromuscular homework exercises: through the performance of dual homework exercises and in the form of integrated cognitive motor exercises to strengthen the executive functions by exercises distance recovery, selective attention, continuous attention, time orientation, and verbal comprehension were presented in each session and exercises, including inverse number counting, addition, and subtraction of numbers, answering general information questions, spelling words, not using a word, completing a sentence with the appropriate word, counting numbers, contrast and the synonyms of the words were naming the days of the week, vice versa, the names of animals and places,. Side and back, sit and stand, stand and sit, hold a book on the head, hit the ball while standing, throw the ball into the basket while standing, walk and hit the ball, step from both sides were another. (Exercise time is approximately 20 minutes) 4- Cooling phase: At the end of each session, the elderly did relaxation exercises (the exercise time is approximately 10 minutes), and data were analyzed with analysis of covariance model. The control group did not receive any intervention at that time, and the training of this group was postponed until after the research. In the post-test phase, both groups’ prevalence of the mini-mental state examination questionnaire, depression, and social isolation was measured repeatedly. In this research, descriptive statistics methods are used to describe the variables better. The statistical indicators used include the calculation of frequency, mean and standard deviation. Also, the statistical method of multivariate analysis of covariance has been used to answer the research hypotheses.
Results
The findings revealed that the experimental group received cognitive rehabilitation intervention, compared with the control group, based on the mental state examination scores (F=24.30, P£0.01) significantly better cognitive function; depression ratings (F=17.67, P£0.01) lower depression rates and according to social isolationist attitudes (F=25.58, P£0.01) less social isolation.
Conclusion
The study results showed that increased cognitive, emotional, and neuromuscular activity is effective in improving cognitive function, reducing depression, and social isolation in mild cognitive impairment. Also, Educational package based on increased cognitive, emotional, and neuromuscular activity using mental and cognitive exercises, increasing patients' level of awareness and insight, increasing emotional adjustment, empowerment, and independence of patients have a significant effect on improving cognitive function, reducing depression And the social isolation of those with mild cognitive impairment. The partial square (effect size) for the effect of the independent variable on the dependent variable is 0.524, which indicates that 52% of the changes in the dependent variable are explained by the independent variable. In other words, education based on increased cognitive, emotional, and neuromuscular activity has affected 52% of the daily performance of the elderly (MCI). Therefore, due to the increase in the elderly population and the development of their problems t in society, it is suggested that this educational package be designed as software that includes the combined effect of the variables of this research, and more people be treated with this educational package. Cognitive rehabilitation interventions can also be used to improve other problems in the elderly, including disorders such as anxiety and obsessions caused by the problems of this age group and the problems of their caregivers.
Ethical Considerations
Compliance with ethical guidelines
Among the ethical principles observed were not violating the rights of individuals participating in the research, respecting human rights, and keeping the results of their research confidential. Before the intervention, the participants were explained of the study's objectives, and informed consent was obtained from them. Also, after completing the training sessions on the training groups and performing the post-test, the treatment sessions were intensively performed on the control group to observe the ethical principles.
Authors’ contributions
Samira Sangi and Majid Zargham Hajbi proceeded to select and define the concepts of the action plan and, in collaboration with Hassan Ashayeri and Alireza Aghaseofi, prepared initial manuscript. All authors performed a search of the research literature and research background. Samira Sangi and Majid Zargham Hajbi also designed and performed the experiments and collected and analyzed the data. All authors provided critical feedback and contributed to the formation of the research, analysis, and manuscript. All authors discussed the results and participated in compiling and editing the final version of the article.
Funding
No financial support has been received from any organization for this research.
Acknowledgments
The authors would like to thank the entire Kahrizak elderly sanatorium who helped us in this research.
Conflict of interest
This study did not have any conflict of interest.
Type of Study: Research |
Received: 2020/03/13 | Accepted: 2021/06/29 | Published: 2021/11/16
Received: 2020/03/13 | Accepted: 2021/06/29 | Published: 2021/11/16
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