This pilot study investigates the effects of a music-based dance intervention on executive function and physical performance in middle-aged and older adults with cognitive impairment. Dance, as a form of dual-task training, integrates music, rhythmic movement, and cognitive-motor coordination. When combined with group interaction and partner-guided physical cues, it has the potential to enhance both cognitive and motor functions simultaneously.
The intervention features a simple, structured dance sequence designed to stimulate rhythm, attention, and coordination through music-based movement. This study aims to evaluate the feasibility and preliminary efficacy of this approach in improving executive function and lower limb physical performance among individuals with cognitive impairment.
Subjective Cognitive Decline (SCD) with a score ≥5 on the SCD-Q9 questionnaire, or Mild Behavioral Impairment (MBI) with a score ≥7 on the MBI-Checklist, with symptoms persisting for more than three months.
Ability to follow instructions.
Ability to stand unsupported or with assistive devices for at least 10 minutes.
Ability to walk at least 10 meters, either unsupported or with assistive devices.
Severe visual or hearing impairment.
Score <16 on the Montreal Cognitive Assessment (MoCA).
Emotional or anxiety symptoms caused by psychiatric medications that significantly impair the ability to perform study-related motor tasks.
Parallel
Music-based dance
BehavioralThe dance routines emphasized perceptual-motor training through mutual physical guidance, spatial coordination, and social interaction among participants. The intervention aimed to enhance executive function, balance, and lower limb mobility by incorporating dual-task elements that challenge memory, attention, and physical control in a dynamic, enjoyable setting.
Control
BehavioralThe training content is delivered through standardized, non-musical instructional videos. Participants in the control group follow fixed video demonstrations to perform functional lower limb exercises. The movement components include independent lower limb strength training and balance training.
Montreal Cognitive Assessment
The Montreal Cognitive Assessment (MoCA) is a widely used screening tool for detecting Mild Cognitive Impairment (MCI). It evaluates seven cognitive domains through 12 subtests, including: visuospatial and executive Function (e.g., cube copying and clock drawing), naming (e.g., visual confrontation naming), attention and Concentration (e.g., digit span, vigilance tasks), language (e.g., sentence repetition and verbal fluency), abstract Reasoning (e.g., similarity identification), memory (immediate and delayed recall), orientation (temporal and spatial). A total score of 26 or above is considered within the normal cognitive range. According to previous studies, a cut-off score of 24 offers optimal discrimination for MCI, with a reported sensitivity of 92% and specificity of 78%.
Four-Square Step Test
The FSST assesses motor-cognitive integration and fall risk. Participants are instructed to step rapidly and safely over four squares formed by crossed floor tape in a specified sequence. The test requires directional changes, weight shifting, and quick stepping, engaging both lower limb motor control and executive attention. FSST is widely used in populations with balance impairments, including older adults, individuals with stroke, Parkinson's disease, vestibular disorders, and limb amputations. Cut-off times indicating elevated fall risk vary by population: \>15 sec in older adults and stroke patients, \>9.68 sec in Parkinson's disease, \>12 sec in vestibular disorders, and \>24 sec in amputees. The FSST demonstrates excellent test-retest reliability (ICC = 0.98) and inter-rater reliability (ICC = 0.99)
Timed Up and Go - Cognitive
This test evaluates dual-task performance by measuring the time needed to stand up from a chair, walk 3 meters, turn, return, and sit down, while performing a cognitive task (counting backward by threes from a random number). It reflects motor-cognitive integration, especially executive function and attention. Times \>15 seconds suggest increased fall risk. One practice trial is provided for instruction comprehension. The test takes approximately 3 minutes and demonstrates excellent test-retest reliability (ICC = 0.96) and strong criterion validity (r = 0.86-0.92)
Functional Reach Test
The FRT evaluates stability by measuring the maximal forward reach distance while standing with arms extended at 90 degrees and feet shoulder-width apart. The final reach distance is calculated by subtracting the starting fingertip position (third metacarpophalangeal joint) from the furthest reach. Three trials are averaged. Distances \<15 cm indicate high fall risk. Normative values: 14-17 in (ages 20-40), 13-16 in (ages 41-69), and 10-13 in (ages 70-87). The FRT takes approximately 5 minutes to complete and demonstrates strong reliability (test-retest ICC = 0.90-0.95, inter-rater ICC = 0.89) and good face validity (r = 0.71)
Stroop Color and Word Test
The SCWT measures selective attention, cognitive flexibility, and inhibitory control. It includes three parts: (1) reading color words, (2) naming colored squares, and (3) naming the ink color of incongruent color words (e.g., the word "red" printed in blue ink should be answered as "blue"). Each part is timed for 45 seconds, and performance is scored by the number of correct responses. The test demonstrates high internal consistency (ICC = 0.91), indicating strong reliability
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