Effects of cognitive stimulation and physical exercise on cognitive performance in persons with dementia essay article review example

Effects of cognitive stimulation and physical exercise on cognitive performance in persons with dementia essay article review example


Dementia is not a disease but a general term for the decline in mental ability which is severe enough that it could interfere in daily life, amongst all other types of dementia Alzheimer’s is the most common. At least 47.5 million people are living with dementia around the world, which is more than the population of Canada. (Alzheimer’s Association, 2015) As nurses, we work in different fields of health care and one of them is dementia care where we get to interact with older adults as well as their families. Using evidence-based practice is one of the competencies a nurse need to follow in their career. Critiquing a research can help us to be sure about the evidence and to find its weakness and strengths of the study. The purpose of this paper is to critique the research study, Mental and Physical Activities Delay Cognitive Decline in Older Persons with Dementia. This paper will be critiqued in various sections like title and abstract, literature review, framework, research question and method. (Cheng, Chow, Song, Edwin, Chan, Lee & Lam, 2014)


Title and Abstract

The title and the abstract clearly reflects on the study. The title mentions that the age group is older adults with dementia. It also indicates the purpose being mental and physical activities delaying cognitive decline which reflects the research study. The abstract was organized and had subheadings. The first subheading was the objective of the research followed by design, setting, participants, interventions, measurements, results and conclusion.(Cheng et al., 2014) All the subheadings of the study had a summarised detail which makes it easier for the readers to know what to expect in the research. The title and abstract are short, clear, to the point and also provides an overview of the research.


The purpose of the paper was “to examine the effects of cognitive stimulation (mah-jong) and physical exercise (tai chi [TC]) on cognitive performance in persons with dementia”. (Cheng et al., 2014) The purpose of the study was clearly stated in the abstract with a heading; objective which was easy to identify. The objective of the paper does fit our case scenario of dementia with an appropriate age range. This research study has significance to nursing as future nurses working with older adults can propose to involve older adults in physical as well as mental activities that can delay cognitive decline. The introduction further elaborates on researches which involved different physical and mental activities that did not test the long-term effects.

Literature Review

The study has reviewed up to date researches and articles relevant to the paper which range from 1995 to 2012. (Cheng et al., 2014) The literature was adequately covered. The introduction refers to the different article that used similar objective of cognitive decline through physical and mental activities but the different outcome and the time period varied, some were long term were as others were short term. Further, it mentions two leisure activities conducted for this study including rationale from the reviewed articles. The introduction doesn’t have any statistical information provided. The referred articles are used to support this study and initiate a different design and method to get better results. The study refers to the latest research and also provides the rationale to the selected activities showing some delay in cognitive decline. The study hypothesized d that mah-jong and tai chi (TC) would lead to enhanced cognitive performance relative to simple handicraft as a control. (Cheng et al., 2014) The rationale and literature justify the study and is covered fair-minded.


There is no definition provided for conceptual or operation. The dependable variable is cognitive decline and the independent variable is mental and physical activity. There is three leisure activity in the study, mah-jong, tai chi (TC) and simple handicrafts. (Cheng et al., 2014) All the activities took place for one hour three times per week. Considering the population, tai chi was performed in seated position in 12 form of yang style. All the three activities are briefly explained in the subheading intervention. The section includes obtaining informed consent from the family members with an assent of the participants as well as considering ethical observations. (Cheng et al., 2014)


Population and sample

The population used in this study were residents from nine nursing homes. The sampling method used was clustering and rationale to using cluster design was provided. The rationale provided was to avoid contamination within the nursing homes. (Cheng et al., 2014) The study has three experimental conditions i.e. the leisure activities conducted in all nine houses which are provided in the form of a flow diagram to make it easy to understand. There are an inclusion and exclusion criteria for the study. For the inclusion criteria assessment, Mini Mental State Examination (MMSE) was used and a score of 10 to 24 and suffering from at least mild dementia with a score of 0.5 or more by Clinical Dementia Rating. (Cheng et al., 2014) The exclusion criteria were being bedridden, someone with audio or visual impairment, and someone with participation in any of the three activities in previous 3 months or having conflicts to participate in exercise activities. (Cheng et al., 2014) The sampling and population used were appropriate for this study given the purpose of the study and the research design being randomized controlled trail. Effects of cognitive stimulation and physical exercise on cognitive performance in persons with dementia essay article review example.

Research Design

This is a quantitative study. This study was randomized controlled trail with clustering method and open-label design. The open-label design was not avoidable as the activities couldn’t be masked and it was not possible to prevent the participants from talking to the interviewer about the activities. (Cheng et al., 2014)  The sample population being from nine nursing home the selection was random. The research design was appropriate for this study as Cheng et al. mentions in the introduction “a randomized controlled trial is necessary for conclusions about causal effects to be made.”

Measures and data collection

Data collection for this study was done through the various tests mentioned above and through the nursing home staff that recorded on a daily log sheet measuring their participation. The participants were free to participate in activities for the other group. Mini Mental State Examination (MMSE) was used as a primary outcome. Forward and backward digit sequence, digit span, 15-word immediate and 30-minute delayed recall and categorical verbal fluency were the secondary outcomes. (Cheng et al., 2014)  The cognitive assessments and 15-item Geriatric depression scale were administered by trained interviewers. Total cholesterol, high-density lipoprotein, triglycerides, and glucose were measured by a registered nurse using calibrated portable devices. (Cheng et al., 2014) Low- density lipoprotein cholesterol was measured using the Friedewald formula. The home staff provided information on cholinesterase inhibitor use and diagnosed coronary heart disease, stroke, hypertension, diabetes and chronic obstructive pulmonary disease. (Cheng et al., 2014) The study also measured APOE4; a genetic predisposition for Alzheimer disease along with depression and chronic illness. (Cheng et al., 2014) All the outcome measures were obtained at baseline for 3, 6, and 9 months. Throughout the study, the assessment was thoroughly done and presented in a flow chart. The flow chart presents data about the study and also mentions the sample size at baseline, at 3, 6 and 9 month. The above-mentioned test, scale and method for measurement were appropriate and suitable for the study.

Data Analysis

As mentioned before, the study hypothesized mah-jong and tai chi (TC) would lead to enhanced cognitive performance relative to simple handicraft as the control. (Cheng et al., 2014) The subheading “statistical analysis” in the study has clear steps of proving the hypothesis. The steps are easy to follow and do prove the hypothesis. The data used statistical methods to prove the hypothesis and provided 95% confidence interval to support their data. The data was analyzed using the computer program called Stata version 11.1. (Cheng et al., 2014) Since the nursing home staff were recording the participant’s activities bias should be eliminated. Effects of cognitive stimulation and physical exercise on cognitive performance in persons with dementia essay article review example.



The subheading results in this study is easy to follow and clearly states the findings from the study. At baseline, all the all the groups had no difference, but as time progressed people with lower APOE4 had lower word list recall and MMSE. By 6 and 9 months, there were  significant difference among the group. (Cheng et al., 2014) At 9-month assessment, tai chi showed significantly difference on the forward digit span measure. (Cheng et al., 2014)There were no effects measured for verbal memory and digit backward memory for tai chi as well as mah-jong. The findings are further summarized into a table which provides clear and easy to understand information. The table has all the various assessment, tests, method and scales and the scores which makes it easy to refer and find the results. The primary outcome measuring MMSE score showed difference between mah-jong, tai chi and simple handicraft. Over the 9-month period time, the simple handicraft group dropped scores whereas mah-jong and tai chi gained points resulting in proving the hypothesis true. (Cheng et al., 2014)


There is a table in the discussion section which displays results of mixed effect regression which is grouped into columns of MMSE, verbal immediate recall, verbal delayed recall, categorical fluency, digit forward span, digit forward sequence, digit backward span and digit backward sequence. (Cheng et al., 2014) The regression shows 95% interval confidence and the p-value. This makes it easy to guess if the hypothesis is true or not. There are boxplots presenting information regarding forward digit sequence, forward digit span, and MMSE. The discussion was clear and to the point, and summarized the result finding without numbers. The discussion further discusses the results comparing with another research study to establish the importance of this study. Effects of cognitive stimulation and physical exercise on cognitive performance in persons with dementia essay article review example.

Recommendations and study limitation

There are no recommendations given in the study, but the subheading following results is study limitation which gives the readers an insight of the study limitations faced during the study. Few of the limitations faced during the study were lack of blinding, participants being recruited for activities leading to a possible selection bias. (Cheng et al., 2014) Even after having all these limitations, the nursing homes were dedicated and helped towards the study. The study limitations basically summarize barriers they faced during the study. Even though the study was not conducted in Canada or U.S it is relevant to the topic as the method and techniques were appropriate.


The study is clear and precise to the point, there are a lot of things that could be added to the study to enhance the information like statistics of dementia, global issues, implication, and recommendations. The lack of these sections doesn’t make the study weak in any manner. The information provided in this study can be used to support a presentation and also used as a credible resource to back up the presentation. After critically analyzing this study, the paper can be used as a source of evidence as the findings are logical and clearly presented that is easily understandable. The paper does provide a lot of information regarding physical and mental exercise to delay cognitive decline.

Effects of cognitive stimulation and physical exercise on cognitive performance in persons with dementia essay article review example





Alzheimer’s Association (2015) What Is Dementia? (n.d.). Retrieved from http://www.alz.org/what-is-dementia.asp#

Cheng, S-T., Chow, P., Song, Y-Q., Edwin, Y., Chan, A., Lee, T., & Lam, J., (2014) Mental and physical activities delay cognitive decline in older persons with dementia. American Journal of Geriatric Psychiatry. 22, 63-74. Retrieved from: http://dx.doi.org.login.ezproxy.library.ualberta.ca/10.1016/j.jagp.2013.01.060

Effects of cognitive stimulation and physical exercise on cognitive performance in persons with dementia essay article review example