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Water-based Activity to Enhance Recall in Veterans: A Randomized Clinical Trial


Brief Summary:

This four-year study will evaluate the efficacy of an exercise training augmentation for
cognitive training intervention to improve memory performance in Veterans with a diagnosis of
amnestic Mild Cognitive Impairment (aMCI). This is a two-phased trial: 1) an exercise phase
and 2) a cognitive training program. The exercise phase will be an aquatic based exercise
program. A combination of exercise and cognitive training programs designed for persons
without cognitive impairment have significantly improved memory more than other single
intervention groups (exercise only, cognitive training only) and given the success of
combination training programs with healthy older adults, it is important to adapt these
programs for persons beginning to exhibit clinically significant memory problems, such as
those with aMCI.


Inclusion Criteria:

– Veterans, aged 50 to 90, of any racial or ethnic group

– Diagnosis of single or multi-domain amnestic MCI using criteria per National Institute
on Aging/Alzheimer’s Association Guidelines

– Available informant for completion of the Clinical Dementia Rating Scale

– Visual and auditory acuity to allow neuropsychological testing

– Willingness to participate in clinical trial for 14 months (8-month treatment phase,
6-month no-contact follow-up phase)

– Musculoskeletal illness or injury (i.e., osteoporosis, degenerative disc or joint
disease, arthritis, obesity)

– Approval by Primary Care Provider to participate in water-based physical exercise

Exclusion Criteria:

Psychiatric Exclusions

– Current, uncontrolled severe psychiatric disorder, such as Bipolar I, Schizophrenia,
or Major Depressive Disorder as determined by the Mini International Neuropsychiatric
Interview (MINI)

– Diagnosis of dementia, Clinical Dementia Rating Scale (CDR) > 0.5; modified Hachinksi
score 4; or delirium. Those Veterans with scores indicative of dementia (CDR > 0.5,
modified Hachinksi 4) will be referred to the Memory Disorders Clinic at VAPAHCS for a
full diagnostic work-up

Medical Exclusions

– History of neurological (e.g., multiple sclerosis, seizure disorder, stroke,) or
system illness affecting CNS function (e.g., liver failure, kidney failure, congestive
heart failure, systemic cancer)

– Acute illness or unstable chronic illness, e.g., history of severe liver disease
(cirrhosis, esophageal varices, ascites, portal hypertension, hepatic encephalopathy)

– Current severe cardiac disease (e.g., uncontrolled atrial fibrillation, defined as
mean 24 hour heart rate >85 beats/min, or 24 hour maximal ventricular rate >150
beats/min; uncontrolled ventricular arrhythmias, defined as recurrent ventricular
tachycardia >3 beats in succession, or 24 hour PVC count >20%; active pericarditis or
myocarditis; Class III/IV heart failure and / or ejection fraction < 20%; thrombophlebitis; pulmonary disease with a drop in O2 Sat with exercise to 90% without oxygen; embolism within past 6 months) - Inability to participate in an exercise stress test - Inability to read, verbalize understanding and voluntarily sign the Informed Consent


  • VA Palo Alto Health Care System, Palo Alto, CA, Palo Alto, California, United States, 94304-1290
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