The Effect Of Baduanjin On Attention In Old Patients With Mild Cognitive Impairment

ObjectiveTo explore effectiveness of Baduanjin on attention ability in the patients with mild cognitive impairment(MCI)through randomized controlled design,and to investigate the relationship between the changes in the dorsal attention network(DAN)and the attention abilities.MethodsA total of 135 eligible subjects were randomly allocated into Baduanjin group,brisk walking group or health education group,so that there were 45 in each group.Subjects in health education group were given a lecture about cognitive health knowledge every two months.Based on that,Baduanjin group and brisk walking group participanted in Baduanjin or brisk walking exercise for six months.Repeated measurement of the global cognitive function,selective attention,divided attention and processing speed at baseline and every two months after that.Sustained attention and functional magnetic resonance imaging(fMRI)were measured at baseline and after 6 months.Statistical analysis used SPSS 20.0 software.Per-Protocol Set and Full Analysis Set were analysed with one-way analysis of variance(ANOVA)or nonparametric test.Linear mixed models were used to adjust group effect,time effect and interaction effect.Independent component analysis(ICA)was used to analysis activated intensity of the DAN.Using difference of T-value to correlation analyze with the cognitive function tests.Results1.A sample size of 135 subjects were estimated,and at the end of intervention period,3 subjects dropped out,8 lost to follow-up,15 refused to accept the cognitive function evaluation.As a result,109 subjects were included in the Per-Protocol set.2.The baseline results showed that differences manifested between 3 groups on gender and body weight(P<0.05),while the global cognitive function,selective attention,sustained attention,divided attention,processing speed and other outcomes had no statistical differences between groups(P≥0.05).3.Per-Protocol analysis results showed that,after the intervention,the MoCA scores and the digit symbol test scores in the Baduanjin group were higher than those of the other 2 groups(P<0.05).The neutral correct numbers,consistent correct numbers,reverse correct numbers of Stroop test in the Baduanjin group were better than those of health education group(P<0.05).The correct number of auditory attention,reaction time of visual of divided attention test in brisk walk group were significant better than those of health education group(P<0.05).4.Intent-to-treat analysis results showed that,after the intervention,the MoCA scores of Baduanjin group were higher than those of the other 2 two groups(P<0.05).The consistent correct number in Baduanjin group was higher than that of health education group(P<0.05).The reverse correct number in Baduanjin group and brisk walk group were significant higher than that of health education group(P<0.05).5.Linear mixed models analysis results showed that MoCA scores in Baduanjin group were significantly higher than those of health education group(P<0.001),and significant group×time interaction effect existed(P=0.033).Neutral correct number,consistent correct number,reverse correct number in the Stroop test showed significant group effects(P<0.05),and those the Baduanjin group and the brisk walk group were significant higher than those of health education group.Reaction time from 10 to 15 minutes of sustained attention test had significant group effects(P=0.018),and that in Baduanjin group was significantly greater than brisk walk group.Digit symbol test showed significant group×time interaction effect(P=0.011),Baduanjin group was significantly higher than brisk walk group.6.The independent component analysis of the dorsal attention network results showed that,there were 60 people finished fMRI scans before and after the intervention.One-way ANOVA analysis showed that three groups had significant differences in 8 clusters,for example,the right temporal,superior temporal gyrus;right fusiform gyrus,parahippocampal gyrus;right rolandic operculum,insula,right supramarginal and angular gyrus.Using the Least-Significance-Difference method(LSD)for post-hoc comparisons,it showed that compaired with brisk walk group,Baduanjin group was significantly negatively activated in right middle temporal gyrus,right supramarginal,angular gyrius and right precuneus.Compaired with health education group,Baduanjin group was significantly negatively activated in left fusiform gyrus,left hippocampus,right rolandic operculum and insula.Compaired with health education group,brisk walk group was significantly activated in right middle temporal gyrus,right superior frontal gyrus and left precentral gyrus;but negatively activated in left insula.7.Correlation analysis between the differences of the DAN brain regions and cognitive function tests:reverse correct numbers of Stroop test were negatively correlated with the right fusiform gyrus and rolandic operculum.Consistent correct numbers were positively correlated with the right medial orbital superior frontal gyrus,but negatively correlated with the right supramarginal and angular gyrus.Reaction time from 0 to 5 minutes of the sustained attention test were negatively correlated with right precuneus;and correct numbers from 0 to 5 minutes of the sustained attention test were positively correlated with right precuneus(P<0.05).Conclusion1.Baduanjin exercisefor 6 months could improve the attention abilities of patients with MCI,and effects may be better than brisk walking;2.Baduanjin exercise for 6 months might change some brain regions function connectivity in the DAN of patients with MCI;3.Baduanjin exercise could improve the attention abilities,which are related with the changes of the DAN of the patients with MCI.