Basic forms of cognitive plasticity extended into the oldest-old: Retest learning, age, and cognitive functioning

Measuring Multidimensional Aspects of Health in the Oldest Old Using the NIH Toolbox: Results From the ARMADA Study

OBJECTIVE

The percentage of older adults living into their 80s and beyond is expanding rapidly. Characterization of typical cognitive performance in this population is complicated by a dearth of normative data for the oldest old. Additionally, little attention has been paid to other aspects of health, such as motor, sensory, and emotional functioning, that may interact with cognitive changes to predict quality of life and well-being. The current study used the NIH Toolbox (NIHTB) to determine age group differences between persons aged 65-84 and 85+ with normal cognition.

METHOD

Participants were recruited in two age bands (i.e., 65-84 and 85+). All participants completed the NIHTB Cognition, Motor, Sensation, and Emotion modules. Independent-samples t-tests determined age group differences with post-hoc adjustments using Bonferroni corrections. All subtest and composite scores were then regressed on age and other demographic covariates.

RESULTS

The 65-84 group obtained significantly higher scores than the 85+ group across all cognitive measures except oral reading, all motor measures except gait speed, and all sensation measures except pain interference. Age remained a significant predictor after controlling for covariates. Age was not significantly associated with differences in emotion scores.

CONCLUSIONS

Results support the use of the NIHTB in persons over 85 with normal cognition. As expected, fluid reasoning abilities and certain motor and sensory functions decreased with age in the oldest old. Inclusion of motor and sensation batteries is warranted when studying trajectories of aging in the oldest old to allow for multidimensional characterization of health.

Effect of Cognitive Rehabilitation by Auditory Stroop Training on Quality of Life of Individuals with Tinnitus

Background: Studies have shown that tinnitus patients have difficulties in cognitive function such as memory and attention. The Stroop task engages the attention network where one aspect of the stimulus is noticed while the other one is ignored. Thus, Stroop training can improve the patient's cognitive control and ability to ignore the tinnitus signal. Method: Thirty chronic tinnitus (> 6 months) patients were included in this study. They were distributed into two 15-member groups: intervention and control. Common audiometric, psychometric, and psychoacoustic evaluations of tinnitus were performed for two groups before intervention and after auditory Stroop training of group 1. Results: There was significant difference in the quality of life and THI scores, VAS of annoyance, and reaction time of Stroop task before and after intervention in group1. The decreased reaction time was positively correlated with improved quality of life, THI score, and VAS of annoyance. Conclusion: Cognitive rehabilitation using tasks such as auditory Stroop can be effective in controlling tinnitus by improving cognitive control.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-04011-w.

Evidence-based cognitive retraining in elderly depressives

Background

Aging is a normal biological process, and its dynamic changes are beyond the control of human beings. The role of depression, fear, and anxiety in old age is preoccupied with unhappy thoughts, and loneliness leads to early deterioration in their cognitive performance which makes it difficult to perform daily activities and hence affects their quality of life.

Aim

The present study was done to assess the effectiveness of cognitive retraining in elderly depressives and its effect on their quality of life.

Materials and Methods

The study was done on a sample of 20 depressive elderly patients with an age range above 60 years diagnosed with ICD-10 criteria. The study was pre- and post-intervention, and the sampling method was purposive. Firstly to screen handedness, Annet's hand preference battery was used, to assess the depression in elderly, the geriatric depression scale was done, and for attention and memory, Digit Span Test (WAIS-R) and Wechsler Memory Scale (WMS) were administered, respectively. WHO-QOL BREF was done to know the quality of life of the patient. After preassessment, cognitive retraining tasks were introduced to the patients. A total of 15 sessions were taken within three months of follow-up and after that to evaluate the efficacy of an outcome of the cognitive retraining, post-assessment was done.

Results

Improvement was noticed in elderly depressive patients in the area of cognitive domain, i.e., attention, recognition, shifting, fixedness, recall, and planning which showed improvement in quality of life and daily activities.

Conclusion

In the remediation of cognitive deficits, cognitive retraining plays a very important role, and it helps the elderly population to live their life healthily and hence enhance their coping skills.

Testing A Hypothesis: Tinnitus Control by Enhancing Physiological Inhibition

Background

Deficit in cognitive functions and central executive function is one of the popular hypotheses on the underlying cause of tinnitus. Some studies expressed the effect of tinnitus on the inhibitory cognitive tasks, referring to the slower inhibitory results such as in the Stroop task in the people suffering from tinnitus as compared to normal subjects. Since Stroop engages the network overlapping the attention and tinnitus distress networks, it seems likely that Stroop exercises can effectively contribute to controlling the tinnitus and its consequent distress through improvement of the cognitive function and increasing the physiological inhibition.

Method

A total of 25 patients with chronic tinnitus (> 6 months) were randomly divided into two groups: an intervention group of 15 patients and a control group of 10 patients. Both groups were subjected to initial evaluations including pure tone audiometry, psychoacoustic measurements, tinnitus handicap inventory (THI) survey, and visual analogue scale (VAS) of annoyance and loudness. The intervention group underwent a rehabilitation program consisting of 6 Stroop training sessions. The control group didn't receive any training. Afterwards, both groups were reevaluated and the results were compared to those of initial evaluations.

Results

Results of this study indicated significant differences in THI scores and VAS of annoyance, before and after Stroop training in the intervention group, although no significant difference was observed when it came to VAS of loudness.

Conclusion

Successive sessions of conflict processing training can improve the annoyance of tinnitus by enhancing the patient's inhibition control, making this task a safe practice for tinnitus treatment.

Between-person and within-person associations of sleep and working-memory in the everyday lives of old and very old adults: initial level, learning, and variability

STUDY OBJECTIVES

Sleep duration affects various aspects of cognitive performance, such as working-memory and learning, among children and adults. However, it remains open, whether similar or even stronger associations exist in old and very old age when changes in sleep and cognitive decrements are common.

METHODS

Using repeated daily-life assessments from a sample of 121 young-old (66-69 years old) and 39 old-old adults (84-90 years old), we assessed links between sleep duration and different aspects of working-memory (initial level, practice-related learning, and residualized variability) between and within persons. Participants reported their sleep durations every morning and performed a numerical working-memory updating task six times a day for seven consecutive days.

RESULTS

Both people who slept longer and those who slept shorter than the sample average showed lower initial performance levels, but a stronger increase of WM over time (i.e. larger learning effects), relative to people with average sleep. Sleep duration did not predict performance variability. Within-person associations were found for people sleeping relatively little on average: For them, working-memory performance was lower on days with shorter than average sleep, yet higher on days with longer than average sleep. Except for lower initial levels of working-memory in old-old adults, no differences between young-old and old-old adults were observed.

CONCLUSION

We conclude that sufficient sleep remains important for working-memory performance in older adults and that it is relevant to include different aspects of working-memory performance, because effects differed for initial performance and learning.

Cognition in Healthy Aging

The study of cognitive change across a life span, both in pathological and healthy samples, has been heavily influenced by developments in cognitive psychology as a theoretical paradigm, neuropsychology and other bio-medical fields; this alongside the increase in new longitudinal and cohort designs, complemented in the last decades by the evaluation of experimental interventions. Here, a review of aging databases was conducted, looking for the most relevant studies carried out on cognitive functioning in healthy older adults. The aim was to review not only longitudinal, cross-sectional or cohort studies, but also by intervention program evaluations. The most important studies, searching for long-term patterns of stability and change of cognitive measures across a life span and in old age, have shown a great range of inter-individual variability in cognitive functioning changes attributed to age. Furthermore, intellectual functioning in healthy individuals seems to decline rather late in life, if ever, as shown in longitudinal studies where age-related decline of cognitive functioning occurs later in life than indicated by cross-sectional studies. The longitudinal evidence and experimental trials have shown the benefits of aerobic physical exercise and an intellectually engaged lifestyle, suggesting that bio-psycho-socioenvironmental factors concurrently with age predict or determine both positive or negative change or stability in cognition in later life.

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.

Single-Trial EEG Responses Classified Using Latency Features

Covert attention has been repeatedly shown to impact on EEG responses after single and repeated practice sessions. Machine learning techniques are increasingly adopted to classify single-trial EEG responses thereby primarily relying on amplitude-based features instead of latency-based features. In this study, we investigated changes in EEG response signatures of nine healthy older subjects when performing 10 sessions of covert attention training. We show that, when we trained classifiers to distinguish recorded EEG patterns between the two experimental conditions (a target stimulus is “present” or “not present”), latency-based classifiers outperform the amplitude-based ones and that classification accuracy improved along with behavioral accuracy, providing supportive evidence of brain plasticity.

Effects of Cognitive Rehabilitation on Cognition, Apathy, Quality of Life, and Subjective Complaints in the Elderly: A Randomized Controlled Trial

OBJECTIVE

To determine the efficacy of a new-generation integrative cognitive rehabilitation (CR) program (Rehacop) on cognition, clinical symptoms, quality of life (QoL), and subjective complaints in the elderly.

DESIGN

A randomized controlled trial study with a cohort of elderly people over 55 years of age.

SETTING

Communities of the Basque Country (Spain).

PARTICIPANTS

A total of 124 elderly participants (aged 79.00 ± 8.85 years) were randomized in the Rehacop group (RG) (n = 62) and control group (CG) (n = 62).

INTERVENTION

The RG attended 39 CR sessions for 3 months (3 sessions/week, 60-minute/session) with the Rehacop program. The CG performed occupational tasks with the same frequency and duration as the RG.

METHODS

Participants underwent a neuropsychological assessment at baseline and post-treatment which included cognitive, clinical, and functional tests. In addition, participants and their formal caregivers completed a subjective complaints questionnaire. The data were analyzed according to the intention to treat analysis and with participants who completed the study. This study was registered at clinicaltrials.gov (NCT03435029).

RESULTS

The RG showed significant improvements compared to the CG in neurocognition (ANCOVA timexgroup interaction effect size (η_p²)=0.05, 90% confidence interval (CI) = 0.00-0.12). The RG also reduced apathy (η_p²=0.06, 90% CI = 0.01-0.15) and participants' subjective complaints (η_p²=0.11, 90% CI = 0.03-0.21) and improved QoL (η_p²=0.08, 90% CI = 0.01-0.17).

CONCLUSIONS

Participants who attended the intervention improved their cognition, QoL, and reduced apathy and subjective complaints after treatment. These findings provide a new understanding of the benefits of CR in the elderly.

Is Computerized Working Memory Training Effective in Healthy Older Adults? Evidence from a Multi-Site, Randomized Controlled Trial

BACKGROUND

Developing effective interventions to attenuate age-related cognitive decline and prevent or delay the onset of dementia are major public health goals. Computerized cognitive training (CCT) has been marketed increasingly to older adults, but its efficacy remains unclear. Working memory (WM), a key determinant of higher order cognitive abilities, is susceptible to age-related decline and a relevant target for CCT in elders.

OBJECTIVE

To evaluate the efficacy of CCT focused on WM compared to an active control condition in healthy older adults.

METHODS

Eighty-two cognitively normal adults from two sites (USA and Sweden) were randomly assigned to Cogmed Adaptive or Non-Adaptive (active control) CCT groups. Training was performed in participants' homes, five days per week over five weeks. Changes in the performance of the Cogmed trained tasks, and in five neuropsychological tests (Trail Making Test Part A and Part B, Digit Symbol, Controlled Oral Word Association Test and Semantic Fluency) were used as outcome measures.

RESULTS

The groups were comparable at baseline. The Adaptive group showed robust gains in the trained tasks, and there was a time-by-group interaction for the Digit Symbol test, with significant improvement only after Adaptive training. In addition, the magnitude of the intervention effect was similar at both sites.

CONCLUSION

Home-based CCT Adaptive WM training appears more effective than Non-Adaptive training in older adults from different cultural backgrounds. We present evidence of improvement in trained tasks and on a demanding untrained task dependent upon WM and processing speed. The benefits over the active control group suggest that the Adaptive CCT gains were linked to providing a continuously challenging level of WM difficulty.

N-back training and transfer effects revealed by behavioral responses and EEG

INTRODUCTION

Cognitive function performance decreases in older individuals compared to young adults. To curb this decline, cognitive training is applied, but it is not clear whether it improves only the trained task or also other cognitive functions. To investigate this, we considered an N-back working memory (WM) training task and verified whether it improves both trained WM and untrained cognitive functions.

METHODS

As EEG studies have noted task difficulty and age-related changes in time-locked EEG responses, called event-related potentials (ERPs), we focused on the relation between the P300 ERP component, task difficulty level, and behavior response accuracy and reaction time (RT) in young and older healthy adults. We used two groups of young and older healthy participants to assess the effect of N-back training: cognitive training group (CTG) and passive control group (PCG). Before and after training, cognitive tests were administered to both groups to evaluate transfer effects.

RESULTS

Despite the observed age-related differences in the P300 ERP component and in terms of RT and accuracy, our findings demonstrate a stronger improvement in the trained task for older CTGs compared to younger CTGs, larger near- and far-transfer effect to WM and fluid intelligence for both younger and older CTGs, and a far-transfer effect to attention but only for older adults. Significant differences in response accuracy were shown between young and older subjects in spatial memory and attention tests.

CONCLUSION

The application of a WM training is a promising tool for both healthy adults, and in particular for older subjects, as it showed physiological and behavioral differences in cognitive plasticity across life span and evidence of benefits in the trained task and near-/far-transfer effects to other cognitive functions.

Cognitive Plasticity in Young-Old Adults and Old-Old Adults and Its Relationship with Successful Aging

The general objective of this study was to analyze cognitive plasticity as a variable related to successful aging in a group of young-old adults and old-old adults using the Auditory Verbal Learning Test—Learning Potential (AVLT-LP). Method: A total of 569 persons, with mean age 76.67 years (379 between the ages of 65 and 80 years, and 190 older than age 80). They were assessed with a socio-health questionnaire, with the AVLT-LP, and with the Spanish version of the Mini Mental State Examination. Results: The results showed significant differences on the test, in favor of the younger group, while the over 80 group gave poorer performance and showed less cognitive plasticity. With relation to gender, slight differences appeared in favor of the women, on the first four test trials, but not on the last two, nor in delayed recall or cognitive plasticity. As for cognitive status, the results showed significantly better task performance levels in healthy elders, as well as greater plasticity. Nonetheless, certain persons with high plasticity were also found among those with cognitive impairment. Conclusions: The data obtained here offers evidence for the importance of cognitive plasticity in elders and its relation to longevity and successful aging. It also provides information about the influence of variables like age, gender and cognitive status on a verbal memory and plasticity assessment task that is in wide use today.

Cognitive Testing in Patients with CKD: The Problem of Missing Cases

BACKGROUND AND OBJECTIVES

Cognitive testing is only valid in individuals with sufficient visual and motor skills and motivation to participate. Patients on dialysis usually suffer from limitations, such as impaired vision, motor difficulties, and depression. Hence, it is doubtful that the true value of cognitive functioning can be measured without bias. Consequently, many patients are excluded from cognitive testing. We focused on reasons for exclusion and analyzed characteristics of nontestable patients.

DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS

Within the Choice of Renal Replacement Therapy Project (baseline survey: May 2014 to May 2015), n=767 patients on peritoneal dialysis (n=240) or hemodialysis (n=527) were tested with the Trail Making Test-B and the German d2-Revision Test and completed the Kidney Disease Quality of Life Short Form cognition subscale. We divided the sample into patients with missing cognitive testing data and patients with full cognitive testing data, analyzed reasons for nonfeasibility, and compared subsamples with regard to psychosocial and physical metrics. The exclusion categories were linked to patient characteristics potentially associated with missing data (age, comorbidity, depression, and education level) by calculation of λ-coefficient.

RESULTS

The subsamples consisted of n=366 (48%) patients with missing data (peritoneal dialysis =62, hemodialysis =304) and n=401 patients with full cognitive testing data (peritoneal dialysis =178, hemodialysis =223). Patients were excluded due to visual impairment (49%), lack of motivation (31%), and motor impairment (13%). The remaining 8% did not follow instructions, suffered from medical incidents, or had language difficulties. Compared with patients with full cognitive testing data, they were more likely to have depression; be treated with hemodialysis; be older, nonworking, or more comorbid; and experience poorer shared decision making. Reasons for exclusion were not related to levels of age, comorbidity score, depression score, or education level.

CONCLUSIONS

We excluded almost one half of eligible patients from cognitive testing due to visual, motivational, or motor difficulties. Our findings are consistent with exclusion categories reported from the literature. We should be aware that, because of disease-related limitations, conclusions about cognitive functioning in the CKD population may be biased. In the future, nonvisual and nonverbal cognitive testing can be a valuable resource.

Can training enhance face cognition abilities in middle-aged adults?

Face cognition is a crucial skill for social interaction and shows large individual differences in healthy adults, suggesting a possibility for improvement in some. We developed and tested specific training procedures for the accuracy of face memory and the speed of face cognition. Two groups each of 20 healthy middle-aged trainees practiced for 29 daily sessions of 15 minutes duration with different computerized home-based training procedures. In addition, 20 matched and 59 non-matched controls were included. Face cognition speed training enhanced performance during the training and transferred to the latent factor level as measured in a pre-post comparison. Persistence of the training effect was evidenced at the manifest level after three months. However, the training procedure influenced the speed of processing object stimuli to the same extent as face stimuli and therefore seems to have affected a more general ability of processing complex visual stimuli and not only faces. No effects of training on the accuracy of face memory were found. This study demonstrates that face-specific abilities may be hard to improve but also shows the plasticity of the speed of processing complex visual stimuli – for the first time in middle-aged, normal adults.

Cognitive reserve in young and old healthy subjects: differences and similarities in a testing-the-limits paradigm with DSST

Cognitive reserve (CR) is understood as capacity to cope with challenging conditions, e.g. after brain injury or in states of brain dysfunction, or age-related cognitive decline. CR in elderly subjects has attracted much research interest, but differences between healthy older and younger subjects have not been addressed in detail hitherto. Usually, one-time standard individual assessments are used to characterise CR. Here we observe CR as individual improvement in cognitive performance (gain) in a complex testing-the-limits paradigm, the digit symbol substitution test (DSST), with 10 repeated measurements, in 140 younger (20–30 yrs) and 140 older (57–74 yrs) healthy subjects. In addition, we assessed attention, memory and executive function, and mood and personality traits as potential influence factors for CR. We found that both, younger and older subjects showed significant gains, which were significantly correlated with speed of information processing, verbal short-term memory and visual problem solving in the older group only. Gender, personality traits and mood did not significantly influence gains in either group. Surprisingly about half of the older subjects performed at the level of the younger group, suggesting that interindividual differences in CR are possibly age-independent. We propose that these findings may also be understood as indication that one-time standard individual measurements do not allow assessment of CR, and that the use of DSST in a testing-the-limits paradigm is a valuable assessment method for CR in young and elderly subjects.

Cognitive Inconsistency and Practice-Related Learning in Older Adults

The current study examined predictors of individual differences in the magnitude of practice-related improvements achieved by 87 older adults (mean_age 63.52 years) over 18-weeks of cognitive practice. Cognitive inconsistency in both baseline trial-to-trial reaction times and week-to-week accuracy scores was included as predictors of practice-related gains in two measures of processing speed. Conditional growth models revealed that both reaction time and accuracy level and rate-of-change in functioning were related to inconsistency, even after controlling for mean-level, but that increased inconsistency was negatively associated with accuracy versus positively associated with reaction time improvement. Cognitive inconsistency may signal dysregulation in the ability to control cognitive performance or may be indicative of adaptive attempts at functioning.

Cognitive plasticity, cognitive functioning and quality of life (QoL) in a sample of young-old and old-old adults in southern Spain

BACKGROUND AND AIMS

The present study was designed to assess the differences in cognitive plasticity, cognitive functioning and quality of life (QoL) in young-old and old-old adults, and to determine whether variables related to QoL can predict cognitive plasticity in old age.

METHODS

The study population consisted of 215 people living in sheltered accommodation for elderly people in southern Spain. Participants were divided into two groups according to age: young-old aged (between 65 and 80 years) and old-old (81 and above). Participants were assessed by means of cognitive performance tests, a QoL questionnaire, and the auditory verbal learning test-learning potential (AVLT-LP) as a measure of cognitive plasticity.

RESULTS

No significant differences were found in cognitive plasticity between the young-old and old-old adults, although the former performed better on immediate and sustained verbal recall. Likewise, no significant inter-group differences arose in most of the QoL variables. However, differences in cognitive plasticity did appear as a function of the level of cognitive functioning of the old adults, and cognitive functioning has been shown to be the best predictor of cognitive plasticity in old age.

CONCLUSIONS

Differences in cognitive plasticity between young-old and old-old adults only appear when the cognitive functioning of individuals is taken into account, rather than their age group. The variables cognitive functioning, social integration and education level appear to be the best predictors of cognitive plasticity in old age.

Structural integrity of the corpus callosum predicts long-term transfer of fluid intelligence-related training gains in normal aging

Although cognitive training usually improves cognitive test performance, the capability to transfer these training gains into respective or functionally related cognitive domains varies significantly. Since most studies demonstrate rather limited transfer effects in older adults, aging might be an important factor in transfer capability differences. This study investigated the transfer capability of logical reasoning training gains to a measure of Fluid Intelligence (Gf) in relation to age, general intelligence, and brain structural integrity as measured by diffusion tensor imaging. In a group of 41 highly educated healthy elderly, 71% demonstrated successful transfer immediately after a 4-week training session (i.e. short-term transfer). In a subgroup of 22% of subjects transfer maintained over a 3-month follow-up period (i.e. long-term transfer). While short-term transfer was not related to structural integrity, long-term transfer was associated with increased structural integrity in corpus and genu of the corpus callosum. Since callosal structural integrity was also related to age (in the present and foregoing studies), previously observed associations between age and transfer might be moderated by the structural integrity. Surprisingly, age was not directly associated with transfer in this study which could be explained by the multi-dependency of the structural integrity (modulating factors beside age, e.g. genetics). In this highly educated sample, general intelligence was not related to transfer suggesting that high intelligence is not sufficient for transfer in normal aging. Further studies are needed to reveal the interaction of transfer, age, and structural integrity and delineate mechanisms of age-dependent transfer capabilities.

From Neuroplasticity to Scaffolding

This paper is a review of cognitive aging research centred on the Scaffolding Theory of Aging and Cognition (STAC), a theory which brings together much of the previous research into cognitive aging over the past century and suggests directions for future work. From Santiago Ramon y Cajal, with his microscope and talented drawings, to today’s researchers with psychological and neurobiological methods and technology, particularly neuroimaging techniques, such as fMRI, sMRI, PET, etc., enormous progress has been made, through cognitive reserve, dedifferentiation, compensation, hemispherical asymmetry, inhibition and neurotransmission, to the Scaffolding theory of aging and cognition and beyond. Prior to 1990, research was almost entirely behavioural, but the advent of neuroimaging has boosted research and given rise to a new domain known as cognitive neuroscience, combining behavioural and neurobiological approaches to investigate structural and functional changes in the aging brain. Having reviewed the existing literature on cognitive aging research, the author concludes that although the scaffolding theory brings together a significant body of work and ideas, it is not yet the single, unifying theory for researchers. However, it does represent a giant step toward that theory.

Cognitive plasticity in normal and pathological aging

The main goal of the present study is to examine to what extent age and cognitive impairment contribute to learning performance (cognitive plasticity, cognitive modifiability, or learning potential). To address this question, participants coming from four studies (Longitudinal Study of Active Aging, age range, 55–75 years, N = 458; Longitudinal Study in the very old [90+], age range, 90–102, N = 188, and Cognitive Plasticity within the Course of Cognitive Impairment, 97 “Normal”, 57 mild cognitive impairment [MCI], and 98 Alzheimer’s disease [AD] patients) were examined through a measure of verbal learning (developed from Rey). The results show that all age, MCI, and AD groups learned across the five learning trials of that test, but significant differences were found due to age, pathology, and education. The effects of pathology (MCI and AD) can be expressed in a metric of “years of normal decline by age”; specifically, being MCI means suffering an impairment in performance that is equivalent to the decline of a normal individual during 15 years, whereas the impact of AD is equivalent to 22.7 years. Likewise, the improvement associated with about 5 years of education is equivalent to about 1 year less of normal aging. Also, the two pathological groups significantly differed from “normal” groups in the delayed trial of the test. The most dramatic difference is that between the “normal” group and the AD patients, which shows relatively poorer performance for the AD group in the delayed trial than in the first learning trial. The potential role of this unique effect for quick detection purposes of AD is assessed (in the 75–89 years age range, sensitivity and specificity equal 0.813 and 0.917, respectively).

Developmental change and intraindividual variability: relating cognitive aging to cognitive plasticity, cardiovascular lability, and emotional diversity

Repeated assessments obtained over years can be used to measure individuals' developmental change, whereas repeated assessments obtained over a few weeks can be used to measure individuals' dynamic characteristics. Using data from a burst of measurement embedded in the Berlin Aging Study (BASE; Baltes & Mayer, 1999), we illustrate and examine how long-term changes in cognitive ability are related to short-term changes in cognitive performance, cardiovascular function, and emotional experience. Our findings suggest that "better" cognitive aging over approximately 13 years was associated with greater cognitive plasticity, less cardiovascular lability, and less emotional diversity over approximately 2 weeks at age 90 years. The study highlights the potential benefits of multi-time scale longitudinal designs for the study of individual function and development.

Practice-oriented retest learning as the basic form of cognitive plasticity of the aging brain

It has been well documented that aging is associated with declines in a variety of cognitive functions. A growing body of research shows that the age-related cognitive declines are reversible through cognitive training programs, suggesting maintained cognitive plasticity of the aging brain. Retest learning represents a basic form of cognitive plasticity. It has been consistently demonstrated for adults in young-old and old-old ages. Accumulated research indicates that retest learning is effective, robust, endurable and could occur at a more conceptual level beyond item-specific memorization. Recent studies also demonstrate promisingly broader transfer effects from retest practice of activities involving complex executive functioning to other untrained tasks. The results shed light on the development of self-guided mental exercise programs to improve cognitive performance and efficiency of the aging brain. The relevant studies were reviewed, and the findings were discussed in light of their limitations, implications, and future directions.

Differences in cognitive performance, level of dependency and quality of life (QoL), related to age and cognitive status in a sample of Spanish old adults under and over 80 years of age

The main objective of this study was to analyze the similarities and differences in cognitive performance, level of dependency, cognitive plasticity and QoL in a sample of young-old adults and old-old adults, bearing in mind both the age-group (under or over 80 years) and the cognitive status of the participants. The study population consisted of 220 people living in sheltered accommodation for elderly people in the South of Spain, with an average age of 80.75 years. Participants were evaluated by means of cognitive performance tests, a QoL questionnaire, a depression scale and a dependency assessment scale. The results indicate that the main differences in the variables analyzed are due to the cognitive status of the sample and not to the fact that the participants are under or over 80 years of age. The findings show that major inter-individual differences in this stage of life depend not only on age but also on cognitive status, which is thus an important factor to take into account when working with this sector of the population.

Long-term maintenance of retest learning in young old and oldest old adults

This study examined the maintenance of retest learning benefits in young old and oldest old adults over an 8-month period in 3 cognitive abilities: reasoning, perceptual-motor speed, and visual attention. Twenty-four young old (aged 70-79 years, M = 74.2) and 23 oldest old adults (aged 80-90 years, M = 83.6) who participated in a previously published study (Yang, L., Krampe, R. T., & Baltes, P. B. [2006]. Basic forms of cognitive plasticity extended into the oldest-old: Retest learning, age, and cognitive functioning. Psychology and Aging, 21, 372-378) returned after an 8-month delay to complete 2 follow-up retest sessions. The results demonstrated that both young old and oldest old groups maintained about 50% of the original retest learning benefits. This extends the earlier findings of substantial long-term cognitive training maintenance in young old adults to a context of retest learning with oldest old adults, and thus portrays a positive message for cognitive plasticity of the oldest old.

Preserving cognition through an integrated cognitive stimulation and training program

BACKGROUND

Cognitive decline leads to disability and increased health care expenditures.

METHODS

Effectiveness of an intervention to stimulate multiple cognitive domains was determined using a format combining traditional and computer-based activities (Integrated Cognitive Stimulation and Training Program), 45 minutes a day, 2 days a week, for 6 weeks. Nonimpaired, mildly, and moderately-impaired participants > age 65 (n = 32) were randomly allocated into a control or experimental group. Using a repeated measures design participants were tested again postintervention and at 8 weeks follow-up.

RESULTS

Statistically significant improvement on Dementia Rating Scale scores occurred for mildly and moderately impaired treatment participants (n = 15). Statistical significance was demonstrated on subscales of the WMS-III: Logical Memory I and Logical Memory II.

CONCLUSION

Blending computer-based with traditional cognitive stimulation activities shows promise in preserving cognitive function in elders. Future studies to explore efficacy in larger, more diverse samples are needed.

Age effects in prospective memory performance within older adults: the paradoxical impact of implementation intentions

This study investigated age effects in prospective memory performance within older adults. The first aim was to explore this issue by examining event- and time-based prospective memory performance in two age groups: young-old (60-75 years) and old-old adults (76-90 years). Moreover, this study for the first time investigated whether forming implementation intentions could be used to improve prospective memory in young-old and old-old adults. Results showed a general effect of age in prospective memory performance for both task types. In addition, no general effect of implementation intentions in prospective memory performance across both task types and age groups was found. However, testing implementation intention effects separately for both age groups revealed that the formation of implementation intentions enhanced prospective memory only for the young-old adults, but did not substantially affect the performance in the time-based task and even impaired it in the event-based task for the old-old adults. Findings indicate that the formation of implementation intentions might be a powerful memory strategy for young-old adults, but not for the very old.

Working memory and postural control: adult age differences in potential for improvement, task priority, and dual tasking

We investigate dynamic posture control and working memory (NBack) retest practice in young and older adults, focusing on older adults' potential for improvement in the component tasks but more importantly in dual-task performance. Participants performed the 2 tasks in 11 sessions under single- and dual-task conditions. Posture improvement was observed with retest practice for both groups. Increase in cognitive load after initial practice led to greater dual-task costs in both tasks in older adults and higher costs in memory in young adults. With continued practice, costs were reduced by both groups; however, the 2 groups focused improvement on different tasks: Older adults focused on posture but young adults on cognition. These results emphasize older adults' potential for improvement in dual-task performance and their flexibility to utilize the practice gains in posture to optimize cognitive performance.

Far transfer in cognitive training of older adults

PURPOSE

This article reviews the literature on far transfer effects in training of older adults.

METHODS

Adapting a taxonomy of transfer developed by Barnett and Ceci (2002), to rehabilitation or enhancement of existing cognitive skills; results of studies assessing transfer effects from training of memory, reasoning, UFOV, dual task performance, and complex training are classified.

RESULTS

Comparisons of the transfer outcomes of both strategy training and extended practice approaches suggest that far transfer has been observed.

CONCLUSIONS

Outcomes for strategy studies training memory have had less success than extended practice studies in obtaining far transfer. Reasons for this are discussed, as are suggestions for improved assessment of transfer outcomes.

Enrichment Effects on Adult Cognitive Development: Can the Functional Capacity of Older Adults Be Preserved and Enhanced?

In this monograph, we ask whether various kinds of intellectual, physical, and social activities produce cognitive enrichment effects-that is, whether they improve cognitive performance at different points of the adult life span, with a particular emphasis on old age. We begin with a theoretical framework that emphasizes the potential of behavior to influence levels of cognitive functioning. According to this framework, the undeniable presence of age-related decline in cognition does not invalidate the view that behavior can enhance cognitive functioning. Instead, the course of normal aging shapes a zone of possible functioning, which reflects person-specific endowments and age-related constraints. Individuals influence whether they function in the higher or lower ranges of this zone by engaging in or refraining from beneficial intellectual, physical, and social activities. From this point of view, the potential for positive change, or plasticity, is maintained in adult cognition. It is an argument that is supported by newer research in neuroscience showing neural plasticity in various aspects of central nervous system functioning, neurochemistry, and architecture. This view of human potential contrasts with static conceptions of cognition in old age, according to which decline in abilities is fixed and individuals cannot slow its course. Furthermore, any understanding of cognition as it occurs in everyday life must make a distinction between basic cognitive mechanisms and skills (such as working-memory capacity) and the functional use of cognition to achieve goals in specific situations. In practice, knowledge and expertise are critical for effective functioning, and the available evidence suggests that older adults effectively employ specific knowledge and expertise and can gain new knowledge when it is required. We conclude that, on balance, the available evidence favors the hypothesis that maintaining an intellectually engaged and physically active lifestyle promotes successful cognitive aging. First, cognitive-training studies have demonstrated that older adults can improve cognitive functioning when provided with intensive training in strategies that promote thinking and remembering. The early training literature suggested little transfer of function from specifically trained skills to new cognitive tasks; learning was highly specific to the cognitive processes targeted by training. Recently, however, a new generation of studies suggests that providing structured experience in situations demanding executive coordination of skills-such as complex video games, task-switching paradigms, and divided attention tasks-train strategic control over cognition that does show transfer to different task environments. These studies suggest that there is considerable reserve potential in older adults' cognition that can be enhanced through training. Second, a considerable number of studies indicate that maintaining a lifestyle that is intellectually stimulating predicts better maintenance of cognitive skills and is associated with a reduced risk of developing Alzheimer's disease in late life. Our review focuses on longitudinal evidence of a connection between an active lifestyle and enhanced cognition, because such evidence admits fewer rival explanations of observed effects (or lack of effects) than does cross-sectional evidence. The longitudinal evidence consistently shows that engaging in intellectually stimulating activities is associated with better cognitive functioning at later points in time. Other studies show that meaningful social engagement is also predictive of better maintenance of cognitive functioning in old age. These longitudinal findings are also open to important rival explanations, but overall, the available evidence suggests that activities can postpone decline, attenuate decline, or provide prosthetic benefit in the face of normative cognitive decline, while at the same time indicating that late-life cognitive changes can result in curtailment of activities. Given the complexity of the dynamic reciprocal relationships between stimulating activities and cognitive function in old age, additional research will be needed to address the extent to which observed effects validate a causal influence of an intellectually engaged lifestyle on cognition. Nevertheless, the hypothesis that an active lifestyle that requires cognitive effort has long-term benefits for older adults' cognition is at least consistent with the available data. Furthermore, new intervention research that involves multimodal interventions focusing on goal-directed action requiring cognition (such as reading to children) and social interaction will help to address whether an active lifestyle enhances cognitive function. Third, there is a parallel literature suggesting that physical activity, and aerobic exercise in particular, enhances older adults' cognitive function. Unlike the literature on an active lifestyle, there is already an impressive array of work with humans and animal populations showing that exercise interventions have substantial benefits for cognitive function, particularly for aspects of fluid intelligence and executive function. Recent neuroscience research on this topic indicates that exercise has substantial effects on brain morphology and function, representing a plausible brain substrate for the observed effects of aerobic exercise and other activities on cognition. Our review identifies a number of areas where additional research is needed to address critical questions. For example, there is considerable epidemiological evidence that stress and chronic psychological distress are negatively associated with changes in cognition. In contrast, less is known about how positive attributes, such as self-efficacy, a sense of control, and a sense of meaning in life, might contribute to preservation of cognitive function in old age. It is well known that certain personality characteristics such as conscientiousness predict adherence to an exercise regimen, but we do not know whether these attributes are also relevant to predicting maintenance of cognitive function or effective compensation for cognitive decline when it occurs. Likewise, more information is needed on the factors that encourage maintenance of an active lifestyle in old age in the face of elevated risk for physiological decline, mechanical wear and tear on the body, and incidence of diseases with disabling consequences, and whether efforts to maintain an active lifestyle are associated with successful aging, both in terms of cognitive function and psychological and emotional well-being. We also discuss briefly some interesting issues for society and public policy regarding cognitive-enrichment effects. For example, should efforts to enhance cognitive function be included as part of a general prevention model for enhancing health and vitality in old age? We also comment on the recent trend of business marketing interventions claimed to build brain power and prevent age-related cognitive decline, and the desirability of direct research evidence to back claims of effectiveness for specific products.