Table 36: Overall Conclusions on Patient-Directed Initiatives.

Intervention	Target Population	1° or 2° Prevention	Conclusion	Overall Quality (GRADE)
Physical exercise	Seniors with mild to moderate dementia	2°	Physical exercise is effective for improving physical functioning in patients with dementia.	Moderate
Physical exercise	Seniors with good cognitive functioning (no dementia)	1°	Long-term outcomes Regular leisure time physical activity in midlife is associated with a reduced risk of dementia in later life (mean follow-up 21 years)	Moderate
			Short-term outcomes Regular physical activity in seniors is associated with a reduced risk of cognitive decline (mean follow-up 2 years) Regular physical activity in seniors is associated with a reduced risk of dementia (mean follow-up 6–7 years)	High/Moderate High/Moderate
Nonpharmacol ogic and nonexercise interventions	Seniors with mild to moderate dementia	2°	Previous systematic review indicated that “cognitive training” is not effective in patients with dementia. Recent RCT suggests CST (up to 7 weeks) is effective for improving cognitive function and quality of life in patients with dementia.	Low
Nonpharmacol ogic and nonexercise interventions	Seniors with good cognitive functioning (no dementia)	1°	For seniors with good cognitive and physical functioning: Evidence that cognitive training for specific functions (memory, reasoning, and speed of processing) produces improvements in these specific domains Limited inconclusive evidence that cognitive training can offset deterioration in the performance of self-reported IADL scores and performance assessments	Low

^*CST indicates cognitive stimulation therapy; IADL, instrumental activities of daily living, RCT, randomized controlled trial.