Moving Yourself in Space and Time: MYSTIC

The Four Square Step Test (FSST) assesses mechanisms underlying motor-cognitive integration. FSST requires participants to step clockwise, then counterclockwise, into four squares created by rods arranged on the ground in a cross. Participants are instructed to perform FSST "as quickly and as safely as you can," not to touch the rods, and to make both feet contact the floor in each square. Timing begins when the participant initiates movement and stops when both feet are back in the starting square after completing the sequence. Trials will be repeated if the participant does not understand the instructions, fails to complete the sequence accurately, loses balance, or touches a rod. Three successful trials will be recorded, and the fastest time selected for analysis. Lower scores are better.

Gait speed testing (Forward/Backwards/Fast): How quickly a person can walk within a specific distance forward and Backwards using GAITRite. GAITRite is a pressure-sensitive walkway that can assess gait anomalies. Lower scores are better.

Body Position Spatial Task (BPST) is a validated visuospatial memory task. The BPST incorporates spatial memory and navigational skills while maintaining posture. The examiner verbally and visually shows a series of side, forward, and turning steps, which the examinee repeats. If the examinee repeats the entire pattern correctly, they are scored as 1; any incorrect parts of the pattern result in a score of 0. Participants complete up to 8 different sequences and have up to 2 tries to perform the sequence correctly. Total scores can range from 0 to 8, with higher values indicating more sequences correctly performed and better.

The number of sit-to-stand maneuvers completed in 30 seconds is used to measure leg strength and endurance. A higher score is better.

The number of steps the participant takes to turn around in a complete circle. Lower number of steps is better.

The time it takes the participants to turn around in a complete circle. Lower times are better.

Measures the time it takes to rise from a chair, walk 3 meters, turn around, and return to the chair in the simple condition. In the Cognitive condition, one is required to simultaneously count backward by 3s from a number between 20 and 100; in the Manual condition, one is required to simultaneously pick up a cup of water and carry it while completing the task. A lower score is a better outcome.

The SF12 evaluates the level of activity and perceived physical and mental quality of life.

The SF-12 uses a standardized system with scores ranging from 0 to 100, where the general population's average is 50, with higher scores indicating better health. Because it measures relative deviation, the numbers represent the following health levels:

Above 50: Better than average health. Exactly 50: Average health status. 40 to 50: Below average health (mild disability or impairment). 30 to 40: Moderate disability or impairment. Below 40: Severe impairment or disability.

The Activities-specific Balance Confidence (ABC) Scale is a 16-item self-report questionnaire used to measure an individual's confidence in performing daily activities without losing their balance or feeling unsteady. Participants rate their self-confidence on a percentage scale from 0% (no confidence) to 100% (completely confident) for 16 specific tasks.

The total score is added for all 16 items and divided by 16 to get the average percentage score.

≥ 80%: Indicates a high level of physical functioning and balance confidence. 50% to 80%: Indicates a moderate level of physical functioning. < 50%: Indicates a low level of physical functioning.

Higher scores indicate a higher level of functioning and a lower risk of falling, while lower scores (below 67%) often indicate a higher risk of falling.

The BDI-II is a 21-item self-report measure that taps major depression symptoms according to diagnostic criteria listed in the Diagnostic and Statistical Manual for Mental Disorders. Each item is scored 0-3, and clinicians sum all 21 scores to calculate a total between 0 and 63. Items are summed to create a total score, with lower scores indicating a lower level of depression and higher scores indicating higher levels of depression.

Total BDI-II scores are generally interpreted using these cutoff ranges:

0 to 13: Minimal depression

14 to 19: Mild depression

20 to 28: Moderate depression

29 to 63: Severe depression

The PASE score combines information on leisure, household, and occupational activity. The PASE assesses the types of activities typically chosen by older adults (walking, recreational activities, exercise, housework, yard work, and caring for others. It uses frequency, duration, and intensity level of activity over the previous week to assign a score, ranging from 0 to 793, with higher scores indicating greater physical activity.

The MSPSS has 12 items that assess how social support factors are perceived by individuals. This scale has three subscales to evaluate support by family, friends, and significant others. Respondents rate statements on a scale of 1 (very strongly disagree) to 7 (very strongly agree).

Total scores range from 12 to 84, with higher scores being better and indicating an increased perception of social support.

The Patient Health Questionnaire (PHQ-9) is a 9-item, validated measure of depression severity in dementia. Respondents indicate how bothered by problems they are on a scale from 0 (not at all) to 3 (nearly every day). Total scores range from 0 to 27, where higher scores indicate more severe depression.

Scores fall into bands:

0 to 4 (none), 5 to 9 (mild), 10 to 14 (moderate), 15 to 19 (moderately severe), and 20 to 27 (severe)

The CDR is designed to reflect the level of cognitive impairment based on a semi-structured interview with an informant and a separate mental status exam with the patient. The clinician rates each of the six general domains involving memory, orientation, judgment and problem-solving, community affairs, home and hobbies, and personal care.

A global rating is then generated, ranging from 0 = no impairment to 3 = severe impairment. Lower scores=better outcome.

0: Normal 0.5: Very Mild Dementia

• Mild Dementia
• Moderate Dementia
• Severe Dementia

The 6-minute walk test (6MWT) assesses distance, in meters, walked over 6 minutes as a sub-maximal test of aerobic capacity and endurance. A higher score indicates a better outcome.

Normal range: A healthy adult typically walks between 400 m and 700 m in 6 minutes.

Impaired capacity: Walking less than 350 m to 300 m is associated with a poor prognosis and indicates significantly reduced functional capacity in conditions like chronic obstructive pulmonary disease (COPD) or heart failure.

Improvement: An increase in your distance by ≥ 30 m overtime typically indicates a positive response to treatment.

Pulse wave activity (PWA) will be used to measure the arterial stiffness and will be measured using a SphygmoCor system before and after the intervention. A lower PWA(slower speed) indicates healthy, flexible arteries, whereas a higher PWA (faster speed) indicates stiff, less elastic arteries.

Satisfaction will be assessed post-intervention only with an Exit Questionnaire with two focus groups, balanced for gender and race. Participants will rate (extremely easy/very easy) and their overall satisfaction with the intervention. A higher score indicates better satisfaction.

Number of participants (Retention rate) retained in each group after enrollment throughout study participation.