{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T05:02:02Z","timestamp":1784523722329,"version":"3.55.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Dement."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Latin America and the Caribbean are experiencing rapid population aging, accompanied by rising dementia prevalence. Risk is heightened by social inequalities, low education, and limited healthcare resources. While pharmacological treatments for dementia prevention offer only modest benefits, non-pharmacological multimodal interventions have shown promise for maintaining cognition. However, such programs have not yet been evaluated in Panama. This pilot study examined the feasibility and effects of a multimodal physical and cognitive intervention program on cognition, depressive symptoms, and physical performance in community-dwelling older adults in Panama.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Forty-three sedentary adults aged 60\u201380 were divided into three groups: combined cognitive\u2013physical intervention group (CG;\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f15), a physical intervention group (PG;\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f15), or an active control group (AG;\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f13) for 4\u202fmonths. Outcomes included cognition (Montreal Cognitive Assessment, MoCA), depressive symptoms (Geriatric Depression Scale, GDS-15), and physical performance (Short Physical Performance Battery, SPPB), assessed pre- and post-intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mixed-model ANCOVAs, adjusted for age and education, revealed no significant group-by-time interactions for MoCA, GDS-15, or SPPB. Nonetheless, descriptive analyses indicated the greatest numerical improvements in the CG (MoCA: +3.4 points; GDS-15: \u22121.1 points). Repeated-measures ANOVAs showed significant overall gains in cognition [\n                      <jats:italic>F<\/jats:italic>\n                      (1,40)\u202f=\u202f4.733,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.036] and small improvements in SPPB [\n                      <jats:italic>F<\/jats:italic>\n                      (1,40)\u202f=\u202f4.254,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.046], though pairwise differences in SPPB were nonsignificant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This study demonstrates the feasibility of delivering multimodal interventions in Panama. Preliminary trends suggest potential cognitive and emotional benefits of combined approaches. Larger, longer trials are needed to confirm efficacy and optimize intervention design.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frdem.2026.1805165","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T04:20:30Z","timestamp":1784521230000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A feasibility pilot study on the effects of a combined cognitive and physical intervention program in older adults in Panama"],"prefix":"10.3389","volume":"5","author":[{"given":"Elianne","family":"Pauli-Quiros","sequence":"first","affiliation":[{"name":"Instituto de Investigaciones Cient\u00edficas y Servicios de Alta Tecnolog\u00eda (INDICASAT-AIP)","place":["Panama City, Panama"]},{"name":"School of Psychology, Universidad Santa Maria La Antigua (USMA)","place":["Panama City, Panama"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Lammie","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones Cient\u00edficas y Servicios de Alta Tecnolog\u00eda (INDICASAT-AIP)","place":["Panama City, Panama"]},{"name":"School of Psychology, Universidad Latina de Panam\u00e1","place":["Panama City, Panama"]},{"name":"Centro de Vacunaci\u00f3n e Investigaci\u00f3n (CEVAXIN)","place":["Panama City, Panama"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Fernanda","family":"Martinez","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones Cient\u00edficas y Servicios de Alta Tecnolog\u00eda (INDICASAT-AIP)","place":["Panama City, Panama"]},{"name":"Faculty of Psychology, Universidad de Panam\u00e1 (UP)","place":["Panama City, Panama"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam E.","family":"Tratner","sequence":"additional","affiliation":[{"name":"Sistema Nacional de Investigaci\u00f3n (SNI)","place":["Panama City, Panama"]},{"name":"Florida State University (FSU)","place":["Panama City, Panama"]},{"name":"Center of Population Sciences for Health Empowerment, Florida State University (FSU)","place":["Tallahassee, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sof\u00eda","family":"Rodr\u00edguez-Ara\u00f1a","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones Cient\u00edficas y Servicios de Alta Tecnolog\u00eda (INDICASAT-AIP)","place":["Panama City, Panama"]},{"name":"School of Psychology, Universidad Santa Maria La Antigua (USMA)","place":["Panama City, Panama"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giselle A.","family":"Rangel","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones Cient\u00edficas y Servicios de Alta Tecnolog\u00eda 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Social (CSS)","place":["Panama City, Panama"]},{"name":"Centro Psicol\u00f3gico Especializado","place":["Panama City, Panama"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hjalmar","family":"Jones","sequence":"additional","affiliation":[{"name":"School of Psychology, Universidad Santa Maria La Antigua (USMA)","place":["Panama City, Panama"]},{"name":"Faculty of Psychology, Universidad de Panam\u00e1 (UP)","place":["Panama City, Panama"]},{"name":"Centro Neuropsic","place":["Panama City, Panama"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle B.","family":"Britton","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones Cient\u00edficas y Servicios de Alta Tecnolog\u00eda (INDICASAT-AIP)","place":["Panama City, Panama"]},{"name":"Centro de Vacunaci\u00f3n e Investigaci\u00f3n (CEVAXIN)","place":["Panama City, Panama"]},{"name":"Sistema Nacional de Investigaci\u00f3n (SNI)","place":["Panama City, 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Argentina"},{"key":"ref9003","volume-title":"Opportunities for Boosting Output","author":"L\u00f3pez Marmolejo","year":"2023"},{"key":"ref9004","doi-asserted-by":"publisher","first-page":"1513","DOI":"10.1377\/hlthaff.2015.1366","article-title":"Gaps in primary care and health system performance in six Latin American and Caribbean countries","volume":"35","author":"Macinko","year":"2016","journal-title":"Health Affairs"},{"key":"ref25","volume-title":"Envejecimiento en Am\u00e9rica Latina y el Caribe: inclusi\u00f3n y derechos de las personas mayores","year":"2022"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"2255","DOI":"10.1016\/S0140-6736(15)60461-5","article-title":"A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial","volume":"385","author":"Ngandu","year":"2015","journal-title":"Lancet"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"e105","DOI":"10.1016\/S2468-2667(21)00249-8","article-title":"Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the global burden of disease study 2019","volume":"7","author":"Nichols","year":"2022","journal-title":"Lancet Public Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1136\/bjsports-2016-096587","article-title":"Exercise interventions for cognitive function in adults older than 50","volume":"52","author":"Northey","year":"2018","journal-title":"Br. 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Sport"},{"key":"ref44","author":"Villar Liste","year":"2025"},{"key":"ref45","volume-title":"Risk Reduction of Cognitive Decline and Dementia: WHO Guidelines","year":"2020"},{"key":"ref9005","article-title":"Macro Poverty Outlook for Panama: April 2026","year":"2026"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.3389\/fneur.2018.01058","article-title":"The multidisciplinary approach to Alzheimer\u2019s disease and dementia. A narrative review of non-pharmacological treatment","volume":"9","author":"Zucchella","year":"2018","journal-title":"Front. 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