The impact of behavioral interventions on cognitive function in healthy older adults: A systematic review

Facilitation of working memory capacity by transcranial direct current stimulation: a secondary analysis from the augmenting cognitive training in older adults (ACT) study

Aging is a public health concern with an ever-increasing magnitude worldwide. An array of neuroscience-based approaches like transcranial direct current stimulation (tDCS) and cognitive training have garnered attention in the last decades to ameliorate the effects of cognitive aging in older adults. This study evaluated the effects of 3 months of bilateral tDCS over the frontal cortices with multimodal cognitive training on working memory capacity. Two hundred ninety-two older adults without dementia were allocated to active or sham tDCS paired with cognitive training. These participants received repeated sessions of bilateral tDCS over the bilateral frontal cortices, combined with multimodal cognitive training. Working memory capacity was assessed with the digit span forward, backward, and sequencing tests. No baseline differences between active and sham groups were observed. Multiple linear regressions indicated more improvement of the longest digit span backward from baseline to post-intervention (p = 0.021) and a trend towards greater improvement (p = 0.056) of the longest digit span backward from baseline to 1 year in the active tDCS group. No significant between-group changes were observed for digit span forward or digit span sequencing. The present results provide evidence for the potential for tDCS paired with cognitive training to remediate age-related declines in working memory capacity. These findings are sourced from secondary outcomes in a large randomized clinical trial and thus deserve future targeted investigation in older adult populations.

Changes in cardiovascular health and white matter integrity with aerobic exercise, cognitive and combined training in physically inactive healthy late-middle-aged adults: the "Projecte Moviment" randomized controlled trial

INTRODUCTION

This is a 12-weeks randomized controlled trial examining the effects of aerobic exercise (AE), computerized cognitive training (CCT) and their combination (COMB). We aim to investigate their impact on cardiovascular health and white matter (WM) integrity and how they contribute to the cognitive benefits.

METHODS

109 participants were recruited and 82 (62% female; age = 58.38 ± 5.47) finished the intervention with > 80% adherence. We report changes in cardiovascular risk factors and WM integrity (fractional anisotropy (FA); mean diffusivity (MD)), how they might be related to changes in physical activity, age and sex, and their potential role as mediators in cognitive improvements.

RESULTS

A decrease in BMI (SMD = - 0.32, p = 0.039), waist circumference (SMD = - 0.42, p = 0.003) and diastolic blood pressure (DBP) (SMD = - 0.42, p = 0.006) in the AE group and a decrease in BMI (SMD = - 0.34, p = 0.031) and DBP (SMD = - 0.32, p = 0.034) in the COMB group compared to the waitlist control group was observed. We also found decreased global MD in the CCT group (SMD = - 0.34; p = 0.032) and significant intervention-related changes in FA and MD in the frontal and temporal lobes in the COMB group.

CONCLUSIONS

We found changes in anthropometric measures that suggest initial benefits on cardiovascular health after only 12 weeks of AE and changes in WM microstructure in the CCT and COMB groups. These results add evidence of the clinical relevance of lifestyle interventions and the potential benefits when combining them.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov NCT031123900.

Cleavage and Noncleavage Chemistry in Reactive Oxygen Species (ROS)-Responsive Materials for Smart Drug Delivery

The design and development of advanced drug delivery systems targeting reactive oxygen species (ROS) have gained significant interest in recent years for treating various diseases, including cancer, psychiatric diseases, cardiovascular diseases, neurological diseases, metabolic diseases, and chronic inflammations. Integrating specific chemical bonds capable of effectively responding to ROS and triggering drug release into the delivery system is crucial. In this Review, we discuss commonly used conjugation linkers (chemical bonds) and categorize them into two groups: cleavable linkers and noncleavable linkers. Our goal is to clarify their unique drug release mechanisms from a chemical perspective and provide practical organic synthesis approaches for their efficient production. We showcase numerous significant examples to demonstrate their synthesis routes and diverse applications. Ultimately, we strive to present a comprehensive overview of cleavage and noncleavage chemistry, offering insights into the development of smart drug delivery systems that respond to ROS.

Community-Based Strategies to Reduce Alzheimer's Disease and Related Dementia Incidence Among Rural, Racially/Ethnically Diverse Older Adults

Purpose of Review

The purpose of this paper was to address the research question "What recent advances in Alzheimer's Disease and Related Dementias (ADRD) risk reduction strategies can be tailored for rural, racially/ethnically diverse populations?" A rural resident's life story that grounded the work is shared. Next, a brief description is provided regarding ADRD risk factors of importance in rural, multicultural settings. Gaps in U.S.-based research are highlighted. Policy actions and interventions that may make a difference in alleviating rural, ADRD-related disparities are offered.

Recent Findings

More than a dozen factors, including lack of built environment, periodontitis, poor air quality, and sensory loss, were identified that are of particular relevance to rural groups. Evidence of importance to underserved residents has also emerged regarding the harmful effects of ultra-processed foods on brain health, benefits of even minimal physical activity, and importance of social engagement, on brain health.

Summary

Resident-led initiatives will be key to creating change at the community level. Health providers are also called to assist in identifying and adapting culturally specific upstream approaches, in partnership with community stakeholders. These mechanisms are vital for decreasing ADRD burdens in underserved communities facing the largest disparities in preventive care.

Fostering cognitive performance in older adults with a process- and a strategy-based cognitive training

       The present study investigates the impact of process-based and strategy-based cognitive training to boost performance in healthy older adults. Three groups trained with either a dichotic listening training (process-based training, n = 25), an implementation intention strategy training (strategy-based training, n = 23), or served as a non-contact control group (n = 30). Our results demonstrated that training participants improved their performance in the trained tasks (process-based training: d = 3.01, strategy-based training: d = 2.6). For untrained tasks, the process-based training group showed significant working memory (d = .58) as well as episodic memory task improvement (d = 1.19) compared to the strategy-based training and to the non-contact control group (all d < .03). In contrast, in the strategy-based training group there was a tendency towards some performance gain in a fluid intelligence test (d = .92). These results indicate that cognitive training can be tailored to improve specific cognitive abilities.

A Combined Intervention of Aerobic Exercise and Video Game in Older Adults: The Efficacy and Neural Basis on Improving Mnemonic Discrimination

BACKGROUND

Mnemonic discrimination is very vulnerable to aging. Previous studies have reported that aerobic exercise and enriched cognitive stimulation (e.g., video games) could improve mnemonic discrimination in older adults. The animal model suggested that combining the 2 training methods could result in a larger improvement. However, there is limited evidence on the potential superior efficacy of combined intervention with human participants. Moreover, the neural basis of this potential superior is poorly understood.

METHODS

We conducted a 16-week intervention trial with 98 community-dwelling older adults assigned to one of the four groups (combined training, aerobic cycling alone, video game alone, or passive control). Mnemonic discrimination was measured as the primary behavioral outcome, hippocampal volume, and functional connectivity of the default mode network (DMN) were measured as neural indicators.

RESULTS

Participants receiving the combined intervention demonstrated the largest effect size of mnemonic discrimination improvement. Magnetic resonance image results indicated aerobic exercising increased left hippocampal volume, while video-game training counteracted the decline of DMN functional connectivity with aging. The synergy of hippocampal structural and functional plasticity observed in the combined training group explained why the largest intervention benefits were obtained by this group.

CONCLUSION

Despite the nonrandomized design (i.e., likely self-selection bias), our results provide new evidence that combined intervention of exercise and cognitive training is more effective than single intervention for older adults. Parallel to animal studies, aerobic exercise and the video game with enriched cognitive stimulation could induce hippocampal plasticity through separate structural and functional pathways.

CLINICAL TRIALS REGISTRATION NUMBER

ChiCTR1900022702.

The role of cognitive rehabilitation in people with type 2 diabetes: A study protocol for a randomized controlled trial

Today, the prevalence of cognitive dysfunction and the prevalence of diabetes are increasing. Research shows that diabetes increases cognitive impairment risk, and cognitive impairment makes diabetes self-management more challenging. Diabetes self-management, essential to good glycemic control, requires patients to assimilate knowledge about their complex disease and to engage in activities such as glucose self-monitoring and the management of their medications. To test a comprehensive cognitive rehabilitation intervention-the Memory, Attention, and Problem-Solving Skills for Persons with Diabetes (MAPSS-DM) program. Our central hypothesis is that participants who take part in the MAPSS-DM intervention will have improved memory and executive function, increased use of compensatory cognitive skills, and improved self-management. We will also explore the role of glucose variability in those changes. This is a randomized controlled trial. Sixty-six participants with cognitive concerns and type 2 diabetes will be assigned to either the full MAPSS-DM intervention or an active control. Participants will use continuous glucose monitoring pre- and post-intervention to identify changes in glycemic variability. All participants will also be evaluated systematically via questionnaires and neuropsychological tests at three timepoints: baseline, immediately post-intervention, and 3 months post-intervention. This study will fill an important gap by addressing cognitive function in the management of diabetes. Diabetes is related to accelerated cognitive aging, cognitive deficits are related to poorer self-management, and improvements in cognitive performance as a result of cognitive rehabilitation can translate into improved performance in everyday life and, potentially, diabetes self-management. The results of the proposed study will therefore potentially inform strategies to support cognitive function and diabetes self-management, as well as offer new mechanistic insights into cognitive function through the use of continuous glucose monitoring. Trial registration: This study has been registered at ClinicalTrials.gov (NCT04831775).

Inter-individual differences in baseline dynamic functional connectivity are linked to cognitive aftereffects of tDCS

Transcranial direct current stimulation (tDCS) has the potential to modulate cognitive training in healthy aging; however, results from various studies have been inconsistent. We hypothesized that inter-individual differences in baseline brain state may contribute to the varied results. We aimed to explore whether baseline resting-state dynamic functional connectivity (rs-dFC) and/or conventional resting-state static functional connectivity (rs-sFC) may be related to the magnitude of cognitive aftereffects of tDCS. To achieve this aim, we used data from our double-blind randomized sham-controlled cross-over tDCS trial in 25 healthy seniors in which bifrontal tDCS combined with cognitive training had induced significant behavioral aftereffects. We performed a backward regression analysis including rs-sFC/rs-dFC measures to explain the variability in the magnitude of tDCS-induced improvements in visual object-matching task (VOMT) accuracy. Rs-dFC analysis revealed four rs-dFC states. The occurrence rate of a rs-dFC state 4, characterized by a high correlation between the left fronto-parietal control network and the language network, was significantly associated with tDCS-induced VOMT accuracy changes. The rs-sFC measure was not significantly associated with the cognitive outcome. We show that flexibility of the brain state representing readiness for top-down control of object identification implicated in the studied task is linked to the tDCS-enhanced task accuracy.

Maintained and Delayed Benefits of Executive Function Training and Low-Intensity Aerobic Exercise Over a 3.5-Year Period in Older Adults

This is a follow-up study of our previous work, with a specific goal to examine whether older adults are able to maintain or show delayed cognitive and psychosocial benefits of executive function training and physical exercise over a period of 3.5 years on average. Thirty-four participants from the original training study (17 from the executive function training and 17 from the aerobic exercise group) returned and completed a single follow-up session on a set of cognitive and psychosocial outcome measures. The results of the returned follow-up sample showed some significant original training transfer effects in WCST-64 performance but failed to maintain these benefits at the follow-up session. Surprisingly, episodic memory performance showed some significant improvement at the follow-up relative to baseline, signaling delayed benefits. The findings add some novel implications for cognitive training schedule and highlight the possible importance of continuous engagement in long-term cognitive enhancement in healthy older adults.

Prospective Memory Training for Healthy Older Adults: A Systematic Review

OBJECTIVES

This review systematically synthesizes existing evidence of prospective memory training for healthy older adults (> 55 years). Existing prospective memory training include strategy-based, process-based and combined regimens. Strategy-based training focuses on different mnemonics to compensate for aging declines in prospective memory. Process-based training aims to restore related cognitive processes to support prospective memory. Combined training utilizes both strategy-based and process-based regimens to enhance prospective memory performance.

METHODS

A total of 349 studies were identified from the Cochrane Library, EBSCO, PsycINFO and PubMed databases.

RESULTS

Using predefined inclusion and exclusion criteria, 11 studies were included in the review. There were six studies of strategy-based training, two studies of process-based training and three studies of combined training.

CONCLUSIONS

Overall, strategy-based training appears to facilitate prospective memory for healthy older adults. However, it is impossible to draw conclusions for process-based and combined training due to the preliminary nature of current evidence.

CLINICAL IMPLICATIONS

Mental imagery or the use of external aids can be useful strategy-based approaches to facilitate prospective memory in older adults. Strategy-based training should target multiple prospective memory phases simultaneously to encourage transfers. Further studies will be required to draw conclusions on the effectiveness of process-based and combined training.

Molecular and Brain Volume Changes Following Aerobic Exercise, Cognitive and Combined Training in Physically Inactive Healthy Late-Middle-Aged Adults: The Projecte Moviment Randomized Controlled Trial

Behavioral interventions have shown promising neuroprotective effects, but the cascade of molecular, brain and behavioral changes involved in these benefits remains poorly understood. Projecte Moviment is a 12-week (5 days per week—45 min per day) multi-domain, single-blind, proof-of-concept randomized controlled trial examining the cognitive effect and underlying mechanisms of an aerobic exercise (AE), computerized cognitive training (CCT) and a combined (COMB) groups compared to a waitlist control group. Adherence was > 80% for 82/109 participants recruited (62% female; age = 58.38 ± 5.47). In this study we report intervention-related changes in plasma biomarkers (BDNF, TNF-α, HGF, ICAM-1, SDF1-α) and structural-MRI (brain volume) and how they related to changes in physical activity and individual variables (age and sex) and their potential role as mediators in the cognitive changes. Our results show that although there were no significant changes in molecular biomarker concentrations in any intervention group, changes in ICAM-1 and SDF1-α were negatively associated with changes in physical activity outcomes in AE and COMB groups. Brain volume changes were found in the CCT showing a significant increase in precuneus volume. Sex moderated the brain volume change in the AE and COMB groups, suggesting that men may benefit more than women. Changes in molecular biomarkers and brain volumes did not significantly mediate the cognitive-related benefits found previously for any group. This study shows crucial initial molecular and brain volume changes related to lifestyle interventions at early stages and highlights the value of examining activity parameters, individual difference characteristics and using a multi-level analysis approach to address these questions.

Mentally Challenging Occupations Are Associated With More Rapid Cognitive Decline at Later Stages of Cognitive Aging

OBJECTIVES

Engaging in mentally challenging activities is associated with reduced risk for cognitive impairment and dementia; however, its association with rates of cognitive decline has been inconsistent. The aim of this study is to test whether working in mentally challenging occupations is related to rates of cognitive change at later older adulthood.

METHOD

The sample consisted of 1,520 individuals (baseline mean age = 78.6 ± 5.1, range = 64-100) from the Einstein Aging Study. Occupation information of each participant was collected retrospectively and linked with the substantive complexity of work score from the Dictionary of Occupational Titles. Cognitive changes in memory, speed, and executive function (EF) domains were represented using two time metrics (i.e., time from retirement, time from study enrollment).

RESULTS

Results from mixed models showed that occupational complexity was associated with significantly faster rates of cognitive decline in speed and EF in the "time from retirement" model but not in the "time from baseline" model. Despite faster cognitive loss, the protective effect of occupational complexity persisted for decades after retirement due to higher initial levels of cognition.

DISCUSSION

The result suggests that protective factors for cognitive health may be associated with delayed onset but more rapid cognitive decline afterwards at later stages of cognitive aging.

Cognitive Stabilization Intervention during the Era of COVID-19

As COVID-19 halted traditional neuropsychological assessment due to infection risk, neuropsychologists considered alternative practice models. Cognitive stabilization intervention (CSI) via telehealth, was developed to stabilize cognition in advance of neuropsychological assessment. It incorporates elements of evidence-based treatments, including cognitive training, sleep training, and medication adherence training within a motivational interview framework. Two case vignettes are described. One vignette describes an elder man who received CSI to manage sleep difficulties, forgetfulness, and mood symptoms. Another vignette describes a woman who completed CSI following an autoimmune disorder episode to improve sleep, organization, and attention. The benefits and limitations of CSI are discussed.

Cognitive Training Attenuates Decline in Physical Function Across 10 Years

OBJECTIVES

Poor physical function is associated with negative health and cognitive outcomes. Although nine studies demonstrated that cognitive training reduces age-related declines in physical function, only one study has examined the effects beyond immediate posttest changes. The first aim of this study was to assess the impact of three cognitive training programs on physical function measures across 10 years and the second aim was to examine whether baseline cognitive self-efficacy or depressive symptoms moderated training effects.

METHOD

Using data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized controlled trial, older adults in a no-contact control condition (n = 698) were compared to those receiving processing speed (n = 702), memory (n = 703), or reasoning (n = 694) training. Intention-to-treat (ITT) and dosage analyses were conducted for grip strength and Turn 360. Participants were followed up to 10 years posttest.

RESULTS

There were no significant ITT effects of processing speed, memory, or reasoning training assignment to any physical function outcome (p > .05). Dosage models indicated that there were small age-related attenuation effects in Turn 360 decline with more processing speed training (b = -.011, p < .001), memory training (b = -.011, p < .001), and reasoning training (b = -.012, p < .001). There was no significant transfer to grip strength. These training gains were greater for those with more baseline depressive symptoms who received more processing speed training (b = -.001, p < .001).

DISCUSSION

This is the first study to demonstrate the effects of cognitive training to complex physical function across 10 years.

Effect of regular resistance training on memory in older adults: A systematic review

The purpose of this study was to evaluate the effect of regular resistance training on memory in older adults.

METHODS

Eight databases (PubMed, Cochrane Library, EMBASE, Web of Science, SinoMed, China National Knowledge Infrastructure (CNKI), China Science and Technology Periodical Database (VIP) and Wanfang) were searched from their inception to March 24, 2021. The data included in the study were analysed according to the Cochrane handbook using Review Manager 5.3 software.

RESULTS

Eighteen eligible randomized controlled trials (RCTs) with a total of 1365 older adults were identified that met the inclusion criteria for the systematic review. Compared with no specific exercise or a low intensity exercise control, regular resistance training significantly improved working memory (standardized mean difference (SMD): 0.27, 95% confidence interval (CI): 0.11, 0.42, P < 0.001), immediate memory (SMD: 0.27, 95% CI: 0.01, 0.54, P = 0.04), and short-term memory (SMD: 0.68, 95% CI: 0.23,1.14, P = 0.003) but had no significant impact on verbal memory (SMD: 0.15, 95% CI: -0.40, 0.71, P = 0.59) or delayed memory (SMD: 0.01, 95% CI: -0.39, 0.42, P = 0.18).

CONCLUSIONS

Regular resistance training has a positive beneficial effect on working memory, immediate memory and short-term memory in older adults. However, due to the limitations of the included studies, these findings should be interpreted cautiously.

Nurse-Talk Ratios as a Measure of Participation in a Cognitive Rehabilitation Intervention for People With Type 2 Diabetes

BACKGROUND

Comprehensive cognitive rehabilitation teaches strategies to enhance strengths and has been used by nurses to target cognitive problems in chronic conditions. However, to date, no evaluations of web-based cognitive rehabilitation, based in empowerment theory, specifically for people with type 2 diabetes (T2DM), have been done.

PURPOSE

The purpose of this study was to analyze a cognitive rehabilitation intervention for people with T2DM, using qualitative content analysis and 10-second event coding to determine to what extent the classes reflected empowerment theory.

METHODS

Nineteen adults with T2DM and two nurses participated in an 8-week intervention that combined webinar classes with online home-based computer training. Classes were audio recorded and 10-second event coding was used to calculate nurse-talk ratios. Transcripts were examined using content analysis and compared with the talk ratios.

RESULTS

Talk ratios ranged from 40% to 74% for each class. Qualitative themes included (a) importance of goal setting; (b) pairing cognitive strategies with diabetes self-management; (c) experience and information sharing; and (d) validation by healthcare providers. Positive participant outcomes related to empowerment were associated with low nurse-talk ratios in some classes. However, high nurse-talk ratios were associated with factual content that participants also considered valuable.

IMPLICATIONS FOR PRACTICE

Talk ratios did not completely reflect the communication skills of the nurse. The 10-second method should be applied to other educational interventions in combination with qualitative analysis. Future interventions should include components of discourse evaluation and examinations of relationships to adherence and clinical outcomes.

Effects of foreign language learning on executive functions in healthy older adults: study protocol for a randomised controlled trial

Background

With age, most cognitive functions decline. As the number of people aged 60 years and older is expected to rise rapidly within the next decades, identifying interventions that promote healthy cognitive ageing is of utmost importance. Promising research on bilingualism has led to the notion that learning a foreign language could protect against cognitive decline. Foreign language learning likely promotes executive functions, which are higher-order cognitive abilities particularly affected by age-related cognitive decline. However, evidence is still sparse and has produced contradictory results. This study aims to investigate the effects of short and intensive foreign language learning on executive functions in healthy older adults.

Methods

In a randomised controlled trial, we will assign 60 native German-speaking monolingual healthy older adults, aged 65–80 years, to either a foreign language learning or a waiting list control group. Language learners will attend a face-to-face, group-based Spanish course for beginners for 1.5 h a day, 5 days a week, for a total of 3 weeks. Cognitive performance in executive functions will be assessed before and after the intervention or after a waiting period of 3 weeks (waiting list control group). Participants will be tested again after 3 months to evaluate longitudinal effects of foreign language learning. The waiting list control group will receive Spanish lessons only after the final assessment and will be invited to an additional voluntary evaluation after completion of the course.

Discussion

To the best of our knowledge, we are conducting the first randomised controlled trial on the effects of short and intensive foreign language learning in older adulthood on executive functions. Enhanced cognitive performance after foreign language learning would indicate that learning a foreign language could enlarge cognitive reserve and thus promote healthy cognitive ageing in older adults.

Trial registration

German Clinical Trials Register DRKS00016552. Registered on 11 February 2019.

A systematic review and meta-analysis of older driver interventions

The purpose of this systematic review and meta-analysis was to summarize and quantify the effects of different driving interventions among older adults on outcomes of crashes, on-road driving performance, self-reported outcomes of errors and crashes, and driving simulator performance. Randomized controlled trials examining the effects of a driving intervention among older adults ≥ 50 years of age were included. Thirty-one studies were identified using a systematic literature review, and 26 were included in meta-analyses. The following types of driving interventions were identified: physical retraining/exercise (e.g., flexibility and coordination training); visual-perceptual training (e.g., improving figure-ground discrimination); cognitive training (e.g., Useful Field of View cognitive training); education (e.g., classroom driver refresher course); context-specific training (i.e., on-road training in car, driving simulator training); combined intervention approaches (e.g., education and context-specific training combined). Effect sizes were calculated for each driving intervention type relative to control groups using random-effects. Physical retraining/exercise, visual-perceptual training, and combined intervention approaches demonstrated medium to large effects on on-road driving performance, ds = 0.564-1.061, ps < .050. Cognitive training approaches reduced at-fault crashes by almost 30 %, OR = 0.729, 95 % CI [0.553, 0.962], p = .026. Education and context-specific approaches were not efficacious to improve driving safety outcomes, ps> .050. In summary, skill-specific interventions (physical retraining/exercise, visual-perceptual training, cognitive training) and combined intervention approaches improved on-road driving performance and reduced at-fault crashes. Optimizing interventions that target age-related functional declines and combined intervention approaches is recommended.

Feasibility and Engagement of Multi-domain Cognitive Training in Community-Dwelling Healthy Elderly in Shanghai

BACKGROUND

In recent years, cognitive training has been one of the important non-pharmaceutical treatment methods that could delay cognitive decline and improve quality of life in the elderly. In different types of cognitive training, both the cognitive domains focused on and their training methods widely vary. This study aimed to explore the feasibility and engagement of multidomain cognitive training in Chinese community-dwelling healthy elderly.

METHODS

Based on the cluster sampling method, a total of 151 healthy elderly, aged 70 or above, who lived in the neighborhoods in Shanghai met the inclusion criteria and agreed to participate in the study. Among them, 90 participants were assigned to the cognitive training group (intervention group), and 61 were assigned to the no cognitive training group (control group). Participants in the intervention group attended a 1-h multidomain cognitive training course twice a week for 12 weeks (total of 24 times), which targeted memory, reasoning, strategy-based problem-solving skills, etc. The control group did not receive any intervention.

RESULTS

There was a significant increase in test scores of story recall (t = -8.61, p = 0.00) and Raven's Standard Progressive Matrices (RSPM) (t = -10.60, p = 0.00) after in-class interventions. The overall completion of homework was 77.78%. Fifty percent of the 90 participants completed self-training. The top three self-training methods were physical exercise, reading books and newspapers, and watching TV. The overall attendance rate of the intervention group was 76.14%, and more than 50% of them had an attendance rate of 77.8%. The attendance rate was positively correlated with years of education and baseline SF-36 (physical functioning, general health, vitality, and mental health) scores, whereas it was negatively correlated with baseline disease index and fatalism of personality indicators (p < 0.05).

CONCLUSION

The elderly with higher educational levels and better physical and psychological conditions had a higher engagement in multidomain cognitive training. The training course proved to be rational, feasible, and effective for community-scale application.

The Role of Exercise in Management of Mental Health Disorders: An Integrative Review

A large and growing body of evidence suggests that physical activity (PA) may hold therapeutic promise in the management of mental health disorders. Most evidence linking PA to mental health outcomes has focused on the effects of aerobic exercise training on depression, although a growing body of work supports the efficacy of both aerobic and resistance exercise paradigms in the treatment of anxiety and post-traumatic stress disorder. Despite abundant evidence linking PA and mental health, use of exercise training as a mental health treatment remains limited due to three important sources of uncertainty: (a) large individual differences in response to exercise treatment within multiple mental health domains; (b) the critical importance of sustained PA engagement, not always achieved, for therapeutic benefit; and (c) disagreement regarding the relative importance of putative therapeutic mechanisms. Our review of treatment data on exercise interventions and mental health outcomes focuses primarily on depression and anxiety within a health neuroscience framework. Within this conceptual framework, neurobiological and behavioral mechanisms may have additiveor synergistic influences on key cognitive and behavioral processes that influence mental health outcomes. We therefore highlight sources of treatment heterogeneity by integrating the critical influences of (a) neurobiological mechanisms enhancing neuroplasticity and (b) behavioral learning of self-regulatory skills. Understanding the interrelationships between dynamic neurobiological and behavioral mechanisms may help inform personalized mental health treatments and clarify why, and for whom, exercise improves mental health outcomes. The review concludes with recommendations for future studies leveraging individual differences to refine treatment approaches to optimize mental health benefits.

The Effects of Acute Exercise on Driving and Executive Functions in Healthy Older Adults

The benefits of exercise on cognitive functioning in older adults are well recognized. One limitation of the current literature is that researchers have almost exclusively relied on well-controlled laboratory tasks to assess cognition. Moreover, the effects of a single bout of aerobic exercise in older adults have received limited attention. The proposed study addresses these limitations by assessing the effects of a single bout of exercise on a more ecologically valid task - driving. Seventy-one participants (M _age = 66.39 ± 4.70 years) were randomly allocated to 20min cycling at moderate intensity or sitting and watching driving videos. Participants were then tested on their driving performance using a driving simulator. Driving performance was measured with three different scenarios assessing decision making, driving errors, reaction time, and attention. On a subsequent session, all participants were tested on executive functioning before and after a fitness test. Non-significant effects of exercise were observed on driving performance. However, participants performed better on the Trail Making Test (Cohen's d = 0.25) and Stroop test (d = 0.50) after the fitness test compared to their baseline. These results suggest that post-exercise cognitive improvements do not transfer to improved driving performance among healthy older adults. This study also highlights the importance of assessing expectations as a possible moderator of the effects of acute exercise on activities of daily living. Future studies must examine other relevant ecologically valid tasks and ensure similar expectations between experimental and control groups to further advance the knowledge base in the field.

Cognitive and Psychosocial Outcomes of Self-Guided Executive Function Training and Low-Intensity Aerobic Exercise in Healthy Older Adults

OBJECTIVES

Prior work has demonstrated that executive function training or physical exercise can improve older adults' cognition. The current study takes an exploratory approach to compare the feasibility and efficacy of online executive function training and low-intensity aerobic exercise for improving cognitive and psychosocial functioning in healthy older adults.

METHOD

Following a standard pretest-training-posttest protocol, 40 older adults (aged 65 and above) were randomly assigned to an executive function or a physical training group. A battery of cognitive and psychosocial outcome measures were administered before and after training. During the 10 weeks of self-guided training at home (25-30 min/day, 4 days/week), the executive function training group practiced a set of adaptive online executive function tasks designed by Lumos Labs, whereas the physical training group completed an adaptive Digital Video Disc (DVD)-based low-intensity aerobic exercise program.

RESULTS

Training transfer effects were limited. Relative to low-intensity aerobic exercise, executive function training yielded cognitive improvement on the 64-card Wisconsin Card Sorting Task (WCST-64), a general executive function measure. Depression and stress levels dropped following both training programs, but this could be driven by decreased stress or excitement in performing the tasks over time.

DISCUSSION

The results revealed limited cognitive benefits of the online executive function training program, specifically to a near transfer test of general executive control. Importantly, the current study supports the feasibility of home-based self-guided executive function and low-intensity physical training with healthy older adults.

The Effects of a 5-Year Physical Exercise Intervention with Music in Community- Dwelling Normal Elderly People: The Mihama-Kiho Follow-Up Project

BACKGROUND

We previously reported the enhanced effects of physical exercise when combined with music (ExM) on cognitive function in community-dwelling normal elderly people compared to exercise alone. Following that study, participants voluntarily continued the ExM classes for 5 years.

OBJECTIVE

To identify the effects of a 5-year ExM intervention on cognitive function in normal elderly people.

METHODS

Fifty-four subjects continued the ExM classes once a week for 5 years (ExM group). Thirty-three subjects retired from the ExM class during the 5 years (Retired group). Twenty-one subjects never participated in any intervention over the 5 years (No-exercise group). Cognitive function and ADLs were assessed using neuropsychological batteries and the functional independence measure (FIM), respectively. The voxel-based specific regional analysis system for Alzheimer's disease (VSRAD) was used to investigate medial temporal lobe atrophy.

RESULTS

Analyses of the raw scores after the 5-year intervention showed significant differences between the ExM and No-exercise groups in their MMSE scores, Raven's colored progressive matrices (RCPM) time, logical memory (LM)-I, as well as the total and physical exercise sub-scores of the FIM. Analysis of subjects aged 70- 79 years at the beginning of this project showed significantly quicker performance on the RCPM in the ExM compared to No-exercise groups. The correlation coefficients between the total number of ExM sessions attended and the degree of changes in physical, neuropsychological, and VSRAD scores were significant for RCPM performance time and LM-I scores.

CONCLUSION

Long-term ExM intervention reinforces multifaceted cognitive function in normal elderly people, and is especially beneficial for psychomotor speed.

Effective implementation approaches for healthy ageing interventions for older people: A rapid review

BACKGROUND AND OBJECTIVES

Systematic reviews on healthy ageing interventions have primarily focused on assessing their effectiveness, not the implementation processes underpinning them, and the factors influencing program effectiveness. This has created a knowledge gap about what are effective implementation approaches, and how to scale up such interventions at the population level. Our aim in this rapid review was to synthesise the evidence on implementation of effective healthy ageing interventions, and to identify the factors that influence population-level implementation of these interventions.

DESIGN AND METHODS

Following the PRISMA checklist, we searched for papers in six databases: Ovid Medline, Ovid Embase, CENTRAL, CINAHL, PsycArticles and PsycINFO. A narrative synthesis was used to summarise the results.

RESULTS

Twenty-nine articles reporting on 21 healthy ageing interventions (studies) were included in the review. The findings show that a wide range of approaches to implementation were used including collaborative partnership, co-design, use of volunteers, person centred-care, and self-directed/professional-led approaches. The key implementation drivers were the use of behavioural change techniques, social interaction, tailoring of interventions, booster sessions, and multi-component and multi-professional team approach to intervention design and delivery.

CONCLUSION

The effectiveness of healthy ageing interventions is contingent on a number of factors including the type of implementation approaches used, the context in which programs are implemented, and the specific mechanisms that may be at play at the individual older adult level.

Do Musicians Have Better Mnemonic and Executive Performance Than Actors? Influence of Regular Musical or Theater Practice in Adults and in the Elderly

The effects of musical practice on cognition are well established yet rarely compared with other kinds of artistic training or expertise. This study aims to compare the possible effect of musical and theater regular practice on cognition across the lifespan. Both of these artistic activities require many hours of individual or collective training in order to reach an advanced level. This process requires the interaction between higher-order cognitive functions and several sensory modalities (auditory, verbal, visual and motor), as well as regular learning of new pieces. This study included participants with musical or theater practice, and healthy controls matched for age (18–84 years old) and education. The objective was to determine whether specific practice in these activities had an effect on cognition across the lifespan, and a protective influence against undesirable cognitive outcomes associated with aging. All participants underwent a battery of cognitive tasks that evaluated processing speed, executive function, fluency, working memory, verbal and visual long-term memories, and non-verbal reasoning abilities. Results showed that music and theater artistic practices were strongly associated with cognitive enhancements. Participants with musical practice were better in executive functioning, working memory and non-verbal reasoning, whereas participants with regular acting practice had better long-term verbal memory and fluency performance. Thus, taken together, results suggest a differential effect of these artistic practices on cognition across the lifespan. Advanced age did not seem to reduce the benefit, so future studies should focus on the hypothetical protective effects of artistic practice against cognitive decline.

Effects of combining exercise with long-chain polyunsaturated fatty acid supplementation on cognitive function in the elderly: a randomised controlled trial

Multifactorial lifestyle intervention is known to be more effective for ameliorating cognitive decline than single factor intervention; however, the effects of combining exercise with long-chain polyunsaturated fatty acids (LCPUFA) on the elderlies' cognitive function remain unclear. We conducted a randomised, single-masked placebo-controlled trial in non-demented elderly Japanese individuals. Participants were randomly allocated to the exercise with LCPUFA, placebo, or no exercise with placebo (control) groups. Participants in the exercise groups performed 150 min of exercise per week, comprised resistance and aerobic training, for 24 weeks with supplements of either LCPUFA (docosahexaenoic acid, 300 mg/day; eicosapentaenoic acid, 100 mg/day; arachidonic acid, 120 mg/day) or placebo. Cognitive functions were evaluated by neuropsychological tests prior to and following the intervention. The per-protocol set analysis (n = 76) revealed no significant differences between the exercise and the control groups in changes of neuropsychological tests. Subgroup analysis for participants with low skeletal muscle mass index (SMI) corresponding to sarcopenia cut-off value showed changes in selective attention, while working memory in the exercise with LCPUFA group was better than in the control group. These findings suggest that exercise with LCPUFA supplementation potentially improves attention and working memory in the elderly with low SMI.