Beneficial effects of multisensory and cognitive stimulation in institutionalized elderly: 12-months follow-up

Figures & data

Table 1 The mini-mental state examination and language tests scores after multisensory and cognitive intervention in the institutionalized group

	After 48 sessions	2 mo	4 mo	6 mo	8 mo	12 mo
Mini-mental state examination	24.3±0.72	23.8±0.87	22.5±0.90	21.7±0.89	21.1±0.91	20.7±0.98
Boston naming test	12.8±0.74	12.2±0.80	11.4±0.73	10.6±0.73	10.3±0.71	9.6±0.74*
Semantic verbal fluency	14.1±0.88	13.3±0.77	11.7±0.70	10.9±0.85	10.9±0.91	9.7±0.90**,Δ
Phonological verbal fluency	8.3±0.95	7.8±0.83	6.9±0.84	5.9±0.79	5.3±0.80	4.9±0.75*
Test of narrative
Key concepts	3.0±0.33	2.8±0.31	2.3±0.30	1.9±0.33	1.9±0.30	1.6±0.32*
Narrative efficiency	1.7±0.18	1.6±0.17	0.5±0.16	0.6±0.16□	0.6±0.16	0.5±0.16ΔΔ
Information units	3.1±0.38	2.8±0.35	2.4±0.35	2.0±0.30	1.9±0.35	1.5±0.33*
Total number of words	44.7±5.12	43.2±4.30	40.9±3.85	37.0±3.72	36.6±3.67	35.2±3.74
Concision	0.06±0.00	0.06±0.00	0.05±0.00	0.05±0.00	0.04±0.00	0.03±0.00*
MoCA battery
Metaphors (explanation)	27.3±1.59	26.6±1.58	24.6±1.51	21.6±1.52	21.7±1.60	20.1±1.59*,Δ
Metaphors (alternatives)	14.5±0.92	14.1±0.92	14.3±0.79	11.8±0.88	11.1±0.88	10.1±0.86**,Δ
Direct speech acts (explanation)	14.5±0.65	14.0±0.72	12.4±0.74	10.6±0.62□□,••	9.6±0.65○○,††,■	5.8±0.53**,ΔΔ,⋄⋄
Direct speech acts (alternatives)	8.3±0.33	7.9±0.39	6.9±0.39	6.2±0.41□□,•	5.6±0.43○○,††	5.6±0.53**,ΔΔ
Indirect speech acts (explanation)	17.2±0.49	16.5±0.53	14.7±0.53×	13.9±0.51□□,•	13.3±0.61○○,††	12.2±0.55**,ΔΔ,⋄
Indirect speech acts (alternatives)	9.3±0.17	8.8±0.23	8.1±0.28	7.7±0.35□	7.5±0.34○	7.1±0.32*,Δ
Emotional prosody	6.7±0.50	6.3±0.37	5.7±0.41	4.8±0.49□	4.5±0.40○○	4.6±0.43*
Linguistic prosody	7.6±0.38	7.1±0.46	6.2±0.45	6.0±0.45	5.8±0.32○	5.1±0.41**,Δ
Partial retelling	12.2±0.78	11.7±0.66	10.4±0.64	8.9±0.69□	8.9±0.67○	8.4±0.73**,Δ
Total retelling	9.2±0.54	8.7±0.51	7.4±0.47	6.4±0.40□□,••	6.1±0.42○○,††	5.9±0.42**,ΔΔ
Comprehension	8.5±0.64	8.1±0.58	7.4±0.65	6.0±0.62□	5.5±0.60○○,†	5.5±0.55**,Δ

Notes: Average scores ± standard error are shown for the end of intervention (after 48 sessions) and at 2 mo, 4 mo, 6 mo, 8 mo, and 12-mo follow-up.

× After 48 sessions vs 4 mo, P<0.05;

□ after 48 sessions vs 6 mo, P<0.05;

□□ after 48 sessions vs 6 mo, P<0.01;

○ after 48 sessions vs 8 mo, P<0.05;

○○ after 48 sessions vs 8 mo, P<0.01;

* after 48 sessions vs 12 mo, P<0.05;

** after 48 sessions vs 12 mo, P<0.01;

• 2 mo vs 6 mo, P<0.05;

•• 2 mo vs 6 mo, P<0.01;

† 2 mo vs 8 mo, P<0.05,

†† 2 mo vs 8 mo, P<0.01;

Δ 2 mo vs 12 mo, P<0.05;

ΔΔ 2 mo vs 12 mo, P<0.01;

■ 4 mo vs 8 mo, P<0.05;

⋄ 4 mo vs 12 mo, P<0.05;

⋄⋄ 4 mo vs 12 mo, P<0.01, one-way ANOVA.

Abbreviations: mo, months; MoCA, Montréal cognitive assessment; ANOVA, analysis of variance.

Table 2 The mini-mental state examination and language tests scores after multisensory and cognitive intervention in the noninstitutionalized group

	After 48 sessions	2 mo	4 mo	6 mo	8 mo	12 mo
Mini-mental state examination	26.6±0.59	26.3±0.55	26.2±0.50	24.3±0.55	24.1±0.57○	23.9±0.58**,Δ
Boston naming test	13.2±0.44	13.3±0.38	12.7±0.46	12.6±0.54	11.9±0.46	11.9±0.41
Semantic verbal fluency	14.5±0.77	14.4±0.66	14.3±0.65	13.1±0.59	12.4±0.67	11.7±0.68*
Phonological verbal fluency	9.8±1.10	9.7±1.10	9.6±1.10	8.3±1.00	7.5±0.93	6.8±0.75
Narrative tests
Key concepts	3.6±0.38	3.5±0.30	3.3±0.30	2.9±0.29	2.3±0.21○	2.3±0.25*
Narrative efficiency	1.9±0.24	1.8±0.20	1.5±0.19	1.3±0.18	1.0±0.19○	1.1±0.18*
Information units	3.5±0.32	3.5±0.32	3.1±0.28	2.5±0.29	2.1±0.23○,†	2.1±0.23*,Δ
Total number of words	53.1±4.42	50.5±3.73	47.4±3.73	48.9±3.37	43.9±2.85	43.0±3.20
Concision	0.07±0.00	0.07±0.00	0.07±0.00	0.05±0.00	0.05±0.00	0.05±0.00
MoCA battery
Metaphors (explanation)	27.5±2.22	28.7±2.19	26.5±2.02	27.1±1.97	24.7±1.78	22.9±1.86
Metaphors (alternatives)	16.0±1.06	16.3±1.12	15.1±1.20	14.0±1.09	13.5±1.01	12.1±0.90
Direct speech acts (explanation)	13.1±0.98	13.1±0.99	12.9±0.97	11.9±0.93	10.6±0.77	10.5±0.86
Direct speech acts (alternatives)	7.4±0.71	8.0±0.51	7.2±0.55	6.1±0.63	5.9±0.64	5.5±0.47Δ
Indirect speech acts (explanation)	16.2±0.93	15.7±0.89	15.4±0.88	13.9±0.77	13.1±0.82	12.2±0.72*,Δ
Indirect speech acts (alternatives)	9.3±0.25	9.2±0.26	8.7±0.27	8.3±0.27	7.9±0.29○○,†	7.7±0.30**,ΔΔ
Emotional prosody	6.6±0.76	6.9±0.65	6.1±0.65	4.7±0.55	5.1±0.53	4.9±0.46
Linguistic prosody	9.0±0.55	8.9±0.63	8.3±0.64	7.6±0.72	7.3±0.50	6.9±0.52
Partial retelling	11.3±1.59	11.6±1.27	11.3±1.35	10.1±1.28	9.7±1.27	8.9±1.11
Total retelling	9.2±0.84	8.6±0.64	8.1±0.71	7.4±0.74	6.8±0.60	6.2±0.60*
Comprehension	9.0±0.80	8.0±0.70	7.8±0.74	7.5±0.68	6.6±0.77	6.8±0.61

Notes: Average scores ± standard error are shown for the end of intervention (after 48 sessions) and at 2 mo, 4 mo, 6 mo, 8 mo, and 12-mo follow-up.

○ After 48 sessions vs 8 mo, P<0.05;

○○ after 48 sessions vs 6 mo, P<0.01;

* after 48 sessions vs 12 mo, P<0.05;

** after 48 sessions vs 12 mo, P<0.01,

† 2 mo vs 8 mo, P<0.05;

Δ 2 mo vs 12 mo, P<0.05;

ΔΔ 2 mo vs 12 mo, P<0.01. One-way ANOVA.

Abbreviations: mo, months; MoCA, Montréal cognitive assessment; ANOVA, analysis of variance.

Figure 1 Graphical representations of the mean and standard errors of test scores on the MMSE and language tests in the institutionalized (blue bars) and noninstitutionalized (red bars) groups as a function of time.

Notes: (A) Test scores from the MMSE, Boston naming, and semantic verbal fluency. (B–E) Test scores from key concepts, total number of words, metaphors (explanation), and linguistic prosody. The columns represent the mean and the errors bars represent standard error values. The symbols *, **, *** indicate P-values =0.05, 0.001, and 0.0001 significant differences, respectively.
Abbreviations: MMSE, mini-mental state examination; mo, months; I, institutionalized; NI, noninstitutionalized.

Figure 2 Graphical representations of the mean and standard error of tests scores in the institutionalized (circles) and noninstitutionalized (squares) groups as a function of time to illustrate the influence of time and institutionalization on (A) mini-mental state examination (MMSE) and (B) linguistic prosody test score reduction.

Notes: The mean is plotted and the standard errors are indicated by error bars. The colors and the position of the symbols indicate the comparisons that were significantly different.
Abbreviations: I, institutionalized; NI, noninstitutionalized; mo, months.

Table 3 Cognitive scores on MMSE and language tests before stimulation workshops in institutionalized (I) and noninstitutionalized (NI) elderly

	Before stimulation		t-values	P-values
	I	NI
MMSE	20.70±0.8	23.4±0.5	MW	0.0157
Boston naming	10.8±0.5	12.2±0.4	−2.0953	0.0441
Semantic verbal fluency	10.2±0.7	12.2±0.6	MW	0.0514
Phonologic verbal fluency	4.3±0.5	6.9±0.8	−2.8077	0.0084
Narrative tests
Main concepts	2.0±0.4	3.2±0.3	MW	0.0278
Narrative efficiency	1.0±0.2	1.7±0.2	−2.47	0.0188
Information units	2.2±0.4	2.9±0.4	−1.2783	0.2100
Total number of words	38.7±5.0	51.9±5.9	−1.7093	0.097
Concision rate	0.05±0.01	0.07±0.01	−1.2714	0.2124
MoCA battery
Metaphors (explanation)	18.1±1.9	21.7±2.0	−1.2845	0.2078
Metaphors (alternatives)	11.7±1.2	13.3±1.2	−0.9757	0.3363
Direct speech acts (explanation)	8.8±0.9	10.7±0.7	−1.6259	0.1134
Direct speech acts (alternatives)	6.1±0.7	7.7±0.8	−1.5197	0.138
Indirect speech acts (explanation)	11.9±0.7	13.6±0.9	−1.4334	0.1614
Indirect speech acts (alternatives)	8.3±0.3	8.5±0.4	−0.3944	0.6959
Emotional prosody	4.2±0.4	5.0±0.3	−1.5734	0.1251
Linguistic prosody	5.9±0.5	6.4±0.6	−0.5985	0.5536
Partial retelling	8.0±0.8	10.3±1.2	−1.6421	0.11
Integral retelling	6.1±0.6	7.0±0.6	−1.07	0.2923
Comprehension	6.1±0.8	8.1±0.7	−1.7611	0.0874

Notes: Mean ± standard errors and P-values to indicate statistical significant differences between groups are exhibited. MW indicates nonparametric Mann–Whitney U-tests.

Abbreviations: MMSE, mini-mental state examination; MoCA, Montréal cognitive assessment.