Memory training interventions for older adults: a meta-analysis

Training recollection in healthy older adults: clear improvements on the training task, but little evidence of transfer

Normal aging holds negative consequences for memory, in particular for the ability to recollect the precise details of an experience. With this in mind, Jennings and Jacoby (2003) developed a recollection training method using a single-probe recognition memory paradigm in which new items (i.e., foils) were repeated during the test phase at increasingly long intervals. In previous reports, this method has appeared to improve older adults’ performance on several non-trained cognitive tasks. We aimed to further examine potential transfer effects of this training paradigm and to determine which cognitive functions might predict training gains. Fifty-one older adults were assigned to either recollection training (n = 30) or an active control condition (n = 21) for six sessions over 2 weeks. Afterward, the recollection training group showed a greatly enhanced ability to reject the repeated foils. Surprisingly, however, the training and the control groups improved to the same degree in recognition accuracy (d′) on their respective training tasks. Further, despite the recollection group’s significant improvement in rejecting the repeated foils, we observed little evidence of transfer to non-trained tasks (including a temporal source memory test). Younger age and higher baseline scores on a measure of global cognitive function (as measured by the Montreal Cognitive Assessment tool) and working memory (as measured by Digit Span Backward) predicted gains made by the recollection training group members.

Computerized cognitive training in cognitively healthy older adults: a systematic review and meta-analysis of effect modifiers

BACKGROUND

New effective interventions to attenuate age-related cognitive decline are a global priority. Computerized cognitive training (CCT) is believed to be safe and can be inexpensive, but neither its efficacy in enhancing cognitive performance in healthy older adults nor the impact of design factors on such efficacy has been systematically analyzed. Our aim therefore was to quantitatively assess whether CCT programs can enhance cognition in healthy older adults, discriminate responsive from nonresponsive cognitive domains, and identify the most salient design factors.

METHODS AND FINDINGS

We systematically searched Medline, Embase, and PsycINFO for relevant studies from the databases' inception to 9 July 2014. Eligible studies were randomized controlled trials investigating the effects of ≥ 4 h of CCT on performance in neuropsychological tests in older adults without dementia or other cognitive impairment. Fifty-two studies encompassing 4,885 participants were eligible. Intervention designs varied considerably, but after removal of one outlier, heterogeneity across studies was small (I(2) = 29.92%). There was no systematic evidence of publication bias. The overall effect size (Hedges' g, random effects model) for CCT versus control was small and statistically significant, g = 0.22 (95% CI 0.15 to 0.29). Small to moderate effect sizes were found for nonverbal memory, g = 0.24 (95% CI 0.09 to 0.38); verbal memory, g = 0.08 (95% CI 0.01 to 0.15); working memory (WM), g = 0.22 (95% CI 0.09 to 0.35); processing speed, g = 0.31 (95% CI 0.11 to 0.50); and visuospatial skills, g = 0.30 (95% CI 0.07 to 0.54). No significant effects were found for executive functions and attention. Moderator analyses revealed that home-based administration was ineffective compared to group-based training, and that more than three training sessions per week was ineffective versus three or fewer. There was no evidence for the effectiveness of WM training, and only weak evidence for sessions less than 30 min. These results are limited to healthy older adults, and do not address the durability of training effects.

CONCLUSIONS

CCT is modestly effective at improving cognitive performance in healthy older adults, but efficacy varies across cognitive domains and is largely determined by design choices. Unsupervised at-home training and training more than three times per week are specifically ineffective. Further research is required to enhance efficacy of the intervention. Please see later in the article for the Editors' Summary.

Making working memory work: a meta-analysis of executive-control and working memory training in older adults

This meta-analysis examined the effects of process-based executive-function and working memory training (49 articles, 61 independent samples) in older adults (> 60 years). The interventions resulted in significant effects on performance on the trained task and near-transfer tasks; significant results were obtained for the net pretest-to-posttest gain relative to active and passive control groups and for the net effect at posttest relative to active and passive control groups. Far-transfer effects were smaller than near-transfer effects but were significant for the net pretest-to-posttest gain relative to passive control groups and for the net gain at posttest relative to both active and passive control groups. We detected marginally significant differences in training-induced improvements between working memory and executive-function training, but no differences between the training-induced improvements observed in older adults and younger adults, between the benefits associated with adaptive and nonadaptive training, or between the effects in active and passive control conditions. Gains did not vary with total training time.

Plasticity of brain and cognition in older adults

Aging is typically related to changes in brain and cognition, but the aging process is heterogeneous and differs between individuals. Recent research has started investigating the influence of cognitive and physical training on cognitive performance, functional brain activity, and brain structure in old age. The functional relevance of neural changes and the interactions among these changes following interventions is still a matter of debate. Here we selectively review research on structural and functional brain correlates of training-induced performance changes in healthy older adults and present exemplary longitudinal intervention studies sorted by the type of training applied (i.e., strategy-based training, process-specific training, and physical exercise). Although many training studies have been conducted recently, within each task domain, the number of studies that used comparable methods and techniques to assess behavioral and neural changes is limited. We suggest that future studies should include a multimodal approach to enhance the understanding of the relation between different levels of brain changes in aging and those changes that result from training. Investigating inter-individual differences in intervention-induced behavioral and neuronal changes would provide more information about who would benefit from a specific intervention and why. In addition, a more systematic examination of the time course of training-related structural and functional changes would improve the current level of knowledge about how learning is implemented in the brain and facilitate our understanding of contradictory results.

Cognitive bibliotherapy and memory training for older adults with depressive symptoms

OBJECTIVES

Substantial evidence indicates that depressed participants perform more poorly than nondepressed participants on a number of memory tasks. Cognitive deficits associated with depression (i.e., poor allocation of attention, poor encoding strategies), may help explain why depressed older adults are particularly prone to evidence poorer memory performance.

METHOD

The present study compared the impact of two self-administered treatment protocols, cognitive bibliotherapy for depression plus memory training (CBT + MT) and cognitive bibliotherapy alone (CBT), to a wait-list control condition on measures of memory functioning and depression in a group of older adults experiencing depressive symptoms and memory complaints.

RESULTS

Results provide partial support for CBT as a treatment for depressive symptoms; however, memory training augmentation did not produce improvements.

CONCLUSION

Suggestions for improving retention of older adults in self-administered treatments are discussed.

Facilitating change in health-related behaviors and intentions: a randomized controlled trial of a multidimensional memory program for older adults

OBJECTIVES

Many older adults are concerned about memory changes with age and consequently seek ways to optimize their memory function. Memory programs are known to be variably effective in improving memory knowledge, other aspects of metamemory, and/or objective memory, but little is known about their impact on implementing and sustaining lifestyle and healthcare-seeking intentions and behaviors.

METHODS

We evaluated a multidimensional, evidence-based intervention, the Memory and Aging Program, that provides education about memory and memory change, training in the use of practical memory strategies, and support for implementation of healthy lifestyle behavior changes. In a randomized controlled trial, 42 healthy older adults participated in a program (n = 21) or a waitlist control (n = 21) group.

RESULTS

Relative to the control group, participants in the program implemented more healthy lifestyle behaviors by the end of the program and maintained these changes 1 month later. Similarly, program participants reported a decreased intention to seek unnecessary medical attention for their memory immediately after the program and 1 month later.

CONCLUSIONS

Findings support the use of multidimensional memory programs to promote healthy lifestyles and influence healthcare-seeking behaviors. Discussion focuses on implications of these changes for maximizing cognitive health and minimizing impact on healthcare resources.

Prospective memory training in older adults and its relevance for successful aging

In research on cognitive plasticity, two training approaches have been established: (1) training of strategies to improve performance in a given task (e.g., encoding strategies to improve episodic memory performance) and (2) training of basic cognitive processes (e.g., working memory, inhibition) that underlie a range of more complex cognitive tasks (e.g., planning) to improve both the training target and the complex transfer tasks. Strategy training aims to compensate or circumvent limitations in underlying processes, while process training attempts to augment or to restore these processes. Although research on both approaches has produced some promising findings, results are still heterogeneous and the impact of most training regimes for everyday life is unknown. We, therefore, discuss recent proposals of training regimes aiming to improve prospective memory (i.e., forming and realizing delayed intentions) as this type of complex cognition is highly relevant for independent living. Furthermore, prospective memory is associated with working memory and executive functions and age-related decline is widely reported. We review initial evidence suggesting that both training regimes (i.e., strategy and/or process training) can successfully be applied to improve prospective memory. Conceptual and methodological implications of the findings for research on age-related prospective memory and for training research in general are discussed.

Does strategy training reduce age-related deficits in working memory?

BACKGROUND

Older adults typically perform worse on measures of working memory (WM) than do young adults; however, age-related differences in WM performance might be reduced if older adults use effective encoding strategies.

OBJECTIVE

The purpose of the current experiment was to evaluate WM performance after training individuals to use effective encoding strategies.

METHODS

Participants in the training group (older adults: n = 39; young adults: n = 41) were taught about various verbal encoding strategies and their differential effectiveness and were trained to use interactive imagery and sentence generation on a list-learning task. Participants in the control group (older: n = 37; young: n = 38) completed an equally engaging filler task. All participants completed a pre- and post-training reading span task, which included self-reported strategy use, as well as two transfer tasks that differed in the affordance to use the trained strategies - a paired-associate recall task and the self-ordered pointing task.

RESULTS

Both young and older adults were able to use the target strategies on the WM task and showed gains in WM performance after training. The age-related WM deficit was not greatly affected, however, and the training gains did not transfer to the other cognitive tasks. In fact, participants attempted to adapt the trained strategies for a paired-associate recall task, but the increased strategy use did not benefit their performance.

CONCLUSIONS

Strategy training can boost WM performance, and its benefits appear to arise from strategy-specific effects and not from domain-general gains in cognitive ability.

A rehabilitation tool designed for intensive web-based cognitive training: description and usability study

Background

Cognitive deficits are among the most disabling of neurological diseases and have a serious impact on the quality of life of patients and families. Cognitive training has been proven successful in improving or compensating for neuropsychological deficits after acute brain injury, but its efficacy highly depends on the intensity of treatment over an extended period of time. Therefore, cognitive training indicates expensive human resources and renders the rehabilitation process vulnerable to physical and economic barriers for the majority of patients.

Objective

The aim of this study was to develop and test a new Web-based rehabilitation tool that provides intensive cognitive training at home under clinical prescription and monitoring, at affordable costs.

Methods

From a pool of 60 original exercises, designed and used over the past 10 years for cognitive training at our center, we developed 27 exercises on a computer game format, with automatic increase or decrease of difficulty levels. These exercises were assembled in a clean, user-friendly design and covered various cognitive domains such as attention (n=4), memory (n=11), language (n=3), calculus (n=3), praxis (n=2), and executive functions (n=3). A Web 2.0 platform was also designed to provide medical prescription of cognitive training sessions, performed at the patient’s home. These sessions included continuous monitoring of compliance, performance, and evolution; algorithms for automatic adjustment and long-term learning through use, and database recording of all activities. The end-user interaction test included 80 patients from our memory clinic from several groups including subjective memory complaints (n=20), traumatic brain injury (n=20), stroke and other static brain lesions (n=20), and mild Alzheimer’s disease (n=20). During a 1-hour session, patients and their relatives were taught to use the system and allowed to practice using it. At the end of the session, they were asked to complete a questionnaire.

Results

A total of 48/80 patients (60%) attended the training session. The mean age of the patients was 60 years (SD 13.3, range 41-78), and the mean level of formal education was 6 years (range 4-16). Of all the participants, 32/48 patients (66%) have previously used a computer. All patients and their relatives made a positive evaluation of the cognitive training tool. Only 2/48 patients (4%) were not interested in performing the exercises at home; 19/48 patients (39%) mentioned the need for further coaching from a relative or health care professional. The patients who mentioned difficulties in performing the exercises have not used the computer earlier.

Conclusions

This new Web-based system was very well accepted by patients and their relatives, who showed high levels of motivation to use it on a daily basis at home. The simplicity of its use and comfort were especially outlined. This tool will have an important effect on human resource management, in increasing the patient access to specialized health care and improving the quality and national health system costs of rehabilitation programs.

The efficacy of a multifactorial memory training in older adults living in residential care settings

BACKGROUND

Several studies have shown an increase in memory performance after teaching mnemonic techniques to older participants. However, transfer effects to non-trained tasks are generally either very small, or not found.

METHODS

The present study investigates the efficacy of a multifactorial memory training program for older adults living in a residential care center. The program combines teaching of memory strategies with activities based on metacognitive (metamemory) and motivational aspects. Specific training-related gains in the Immediate list recall task (criterion task), as well as transfer effects on measures of short-term memory, long-term memory, working memory, motivational (need for cognition), and metacognitive aspects (subjective measure of one's memory) were examined. Maintenance of training benefits was assessed after seven months. Fifty-one older adults living in a residential care center, with no cognitive impairments, participated in the study. Participants were randomly assigned to two programs: the experimental group attended the training program, while the active control group was involved in a program in which different psychological issues were discussed.

RESULTS

A benefit in the criterion task and substantial general transfer effects were found for the trained group, but not for the active control, and they were maintained at the seven months follow-up.

CONCLUSION

Our results suggest that training procedures, which combine teaching of strategies with metacognitive-motivational aspects, can improve cognitive functioning and attitude toward cognitive activities in older adults.

The Contributions of Cognitive Trainings to the Stability of Cognitive, Everyday, and Brain Functioning across Adulthood

This review covers the contributions of cognitive trainings to stability in cognitive, everyday, and brain functioning across adulthood. For these functional domains, relevant types of empirical evidence were defined for training-induced enhancement in absolute, differential, and dimensional stability in the light of developmental decline. The state of research regarding these types of evidence is presented. Little data were generally available on the effects of cognitive trainings on the stability of everyday and brain functioning and across all covered domains for their contributions to differential stability. There was sound empirical support for training-induced enhancements of absolute and dimensional cognitive stability across adulthood. The theoretical, methodological, and practical implications of these findings are discussed.