How to enhance route learning and visuo-spatial working memory in aging: a training for residential care home residents

Cognitive rescue in aging through prior training in rats

Cognitive decline in spatial memory is seen in aging. Understanding affected processes in aging is vital for developing methods to improve wellbeing. Daily memory persistence can be influenced by events around the time of learning or by prior experiences in early life. Fading memories in young can last longer if a novel event is introduced around encoding, a process called behavioral tagging. Based on this principle, we asked what processes are affected in aging and if prior training can rescue them. Two groups of aged rats received training in an appetitive delayed matching-to-place task. One of the groups additionally received prior training of the same task in young and in mid-life, constituting a longitudinal study. The results showed long-term memory decline in late aging without prior training. This would reflect affected encoding and consolidation. On the other hand, short-term memory was preserved and novelty at memory reactivation and reconsolidation enabled memory maintenance in aging. Prior training improved cognition through facilitating task performance, strengthening short-term memory and intermediate memory, and enabling encoding-boosted long-term memory. Implication of these findings in understanding brain mechanisms in cognitive aging and in beneficial effects of prior training is discussed.

Anxiety-reducing effects of working memory training: A systematic review and meta-analysis

OBJECTIVE

To assess whether working memory training will relieve anxiety in participants.

METHODS

The PubMed, PsycINFO, Web of Science, and ProQuest databases were searched up to January 25, 2022. We included random controlled trials with low to moderate risk of bias in comparing working memory training with control condition as the only intervention in treating anxiety (PROSPERO ID: CRD42022300404). The language was restricted to English. Data extraction was independently carried out by two authors, following the PRISMA guideline for systematic reviews.

RESULTS

Of the 477 records identified, 19 studies (n = 1051) were included in the meta-analysis. The results showed that the post-training anxiety was reduced with a small but significant value (Hedge's g = -0.392, p = .009) by working memory training. Subgroup analyses confirmed that the moderating effect of anxiety type, anxiety measurement and training environment were significant.

LIMITATIONS

These results should be considered with caution for the heterogeneity of training paradigms, participant population and types of anxiety assessed between studies. Further research is required to support these results.

CONCLUSIONS

Working memory training is a promising intervention to relieve anxiety symptoms.

Successful wayfinding in age: A scoping review on spatial navigation training in healthy older adults

Introduction

Spatial navigation is a complex cognitive function that declines in older age. Finding one’s way around in familiar and new environments is crucial to live and function independently. However, the current literature illustrates the efficacy of spatial navigation interventions in rehabilitative contexts such as pathological aging and traumatic injury, but an overview of existing training studies for healthy older adults is missing. This scoping review aims to identify current evidence on existing spatial navigation interventions in healthy older adults and analyze their efficacy.

Methods

To identify spatial navigation interventions and assessments and investigate their effectiveness, four electronic databases were searched (Pubmed, Web of Science, CINAHL and EMBASE). Two independent reviewers conducted a screening of title, abstract and full-texts and performed a quality assessment. Studies were eligible if (1) published in English, (2) the full text was accessible, (3) at least one group of healthy older adults was included with (4) mean age of 65 years or older, (5) three or more spatial navigation-related training sessions were conducted and (6) at least one spatial ability outcome was reported.

Results

Ten studies were included (N = 1,003, age-range 20–95 years, 51.5% female), only healthy older adults (n = 368, mean age ≥ 65) were assessed further. Studies differed in sample size (n = 22–401), type of training, total intervention duration (100 min–50 h), and intervention period (1–16 weeks).

Conclusion

The spatial navigation abilities addressed and the measures applied to elicit intervention effects varied in quantity and methodology. Significant improvements were found for at least one spatial ability-related outcome in six of 10 interventions. Two interventions achieved a non-significant positive trend, another revealed no measurable post-training improvement, and one study did not report pre-post-differences. The results indicate that different types of spatial navigation interventions improve components of spatial abilities in healthy older adults. The existing body of research does not allow conclusions on transferability of the trained components on everyday life spatial navigation performance. Future research should focus on reproducing and extending the promising approaches of available evidence. From this, valuable insights on healthy aging could emerge.

Trial Registration

This scoping review was preregistered at Open Science Framework (https://osf.io/m9ab6).

Age and sex impact on visuospatial working memory (VSWM), mental rotation, and cognitive strategies during navigation

This study assessed the impact of sex and typical aging on visuospatial working memory (VSWM), mental rotations, and navigational strategies using behavioral information. Fifty healthy participants regrouped in older (OA) and young adults (YA) performed the Walking Corsi test (WalCT) and the Redrawn Mental Rotation Test (MRT) to explore mental rotation abilities. We recorded kinematic data such as locomotion trajectories, and spatial orientations during navigation. We created a new method of data analysis for the WalCT performances and compared it with the classical approach. This original method allowed us to identify cognitive strategies based on errors analysis. Our data suggested that VSWM and mental rotation capacities in locomotion were modulated by age (YA scored higher than OA), and sex (Young Adult Males (YA-M) having higher performance than Young Adult Females (YA-F). We observed a preferential use of cognitive strategies related to sex; YA-F relied more on egocentric strategies whereas YA-M relied more on allocentric strategies. The preferential use of cognitive strategies in the YA group was not observed in the OA group producing more random errors per sequence. The results suggest the effects that age and sex have on VSWM, cognitive strategies, and mental rotation during navigation and highlight the importance of navigational strategies training.

Can theory of mind of healthy older adults living in a nursing home be improved? A randomized controlled trial

BACKGROUND

Research in nursing homes mainly focused on interventions for residents affected by cognitive decline. Few studies have considered healthy older adults living in nursing homes, and this research targeted cognitive functioning.

AIMS

To evaluate whether socio-cognitive abilities can be improved by means of a theory of mind (ToM) training conducted by nursing home's operators.

METHODS

RESULTS: Results revealed that older adults benefitted from the ToM intervention in both practiced and non-practiced tasks, while the control group showed no change from pre- to post-test evaluation. Analyses on errors scores indicated that the ToM intervention led to a reduction of both excessive mentalizing and absence of mental states inference.

DISCUSSION

The conversation-based ToM intervention proved to be effective in improving socio-cognitive skills in cognitively healthy nursing home residents. Notably, older adults were able to transfer the skills acquired during the training to new material.

CONCLUSIONS

Promoting healthy resident's ToM ability could positively impact on their social cognition, consequently increasing their quality of life. Our findings showed that the intervention can be feasibly managed by health care assistants within the residential context.

Requirements of a cognitive-motor spatial orientation training for nursing home residents: an iterative feasibility study

A sedentary lifestyle in nursing home residents is often accompanied with reduced life space mobility and in turn affects satisfaction with life. One of the reasons for this may be limited ability to find one’s way around the care facility and its environment. However, spatial orientation exercises might reduce these problems if they are integrated into an adequate cognitive-motor training. Therefore, we integrated six novel and target group-specific spatial orientation exercises into an established multicomponent cognitive-motor group training for nursing home residents and evaluated its feasibility. Forty nursing home residents (mean age: 87.3 ± 7 years) participated in the spatial orientation cognitive motor training (45–60 min, twice a week over a period of 12 weeks). The main outcomes included the feasibility criteria (adherence, completion time, acceptance, instructions, motor performance, materials/set up, complexity) and first measurements of mobility and satisfaction with life (SPPB [Short Physical Performance Battery], SWLS [Satisfaction with Life Scale]). Adherence increased over time. The increase was associated with the adaptions and modifications of the spatial orientation exercises that were made to meet the participants’ requirements. A positive trend was discerned for mobility and life satisfaction, comparing pre- and posttraining data. In summary, the feasibility analysis revealed that future interventions should consider that (a) instructions of demanding spatial tasks should be accompanied by an example task, (b) trainers should be encouraged to adjust task complexity and materials on an individual basis, (c) acceptance of the training should be promoted among nursing staff, and (d) surroundings with as little disturbance as possible should be selected for training.

Cognitive Stimulation Therapy (CST) for older adults with mild-to-moderate dementia in Italy: effects on cognitive functioning and on emotional and neuropsychiatric symptoms

OBJECTIVES

Cognitive Stimulation Therapy (CST) is one of the most popular evidence-based interventions for people with dementia. The aim of the present study was to assess the effectiveness in the short and long term (on completing the treatment and 3 months later) of an Italian adaptation of the CST protocol (CST-IT).

METHOD

Older adults with mild-to-moderate dementia at 16 residential care homes were randomly assigned to a CST-IT group (N=123), or an active control group (N=102). The following domains were examined for potential benefits: general cognitive functioning (Mini-Mental State Examination [MMSE] and the Alzheimer's Disease Assessment Scale - Cognitive subscale [ADAS-Cog]), and language (Narrative Language Test); mood and behavior (Cornell scale and Neuropsychiatric Inventory); everyday life functioning (Disability Assessment for Dementia), and quality of life (Quality of Life - Alzheimer's Disease scale).

RESULTS

At both the short- and long-term assessments, the CST-IT group's MMSE scores remained stable, while the control group's scores decreased slightly from pre-test to post-test and follow-up. The CST-IT group also had short-term benefits in other cognitive measures (ADAS-Cog and Narrative Language Test), and mood and behavior measures, which were generally maintained at follow-up. No other differences were observed.

DISCUSSION

The effectiveness of CST in sustaining cognitive and emotional functioning, and counteracting the progression of behavioral/neuropsychiatric symptoms in people with dementia was confirmed, and a long-term benefit was demonstrated. CST is a promising option for the treatment of people with dementia in clinical practice.

Working memory training format in older adults: individual versus group sessions

Working memory (WM) training has been shown to increase the performance of participants in WM tasks and in other cognitive abilities, but there has been no study comparing directly the impact of training format (individual vs. group) using the same protocol. Therefore, the aim of this study was to compare the efficacy of the Borella et al. three session verbal WM training offered in two different formats on target and transfer tasks. This study was conducted in two waves. In the first wave, participants were randomized into individual training (n = 11) and individual control conditions (n = 15). In the second wave, participants were randomized into group training (n = 16) and group control conditions (n = 17). Training consisted of three sessions of WM exercises and participants in the active control condition responded to questionnaires during the same time. There was significant improvement for both training conditions at post-test and maintenance at follow-up for the target task, other WM tasks, processing speed, and executive functions tasks. The ANOVA results showed that the training gains did not depend on the WM training format. However, the effect size analyses suggested that this intervention can be more effective, at short term and follow-up, when provided individually. To conclude, this study showed that providing this training collectively or individually does not change the training benefits, which increases the possibilities of its use in different contexts.

Verbal working memory training in older adults: an investigation of dose response

The WM training protocol proposed by Borella et al. found specific and transfer effects among seniors, however, the studies were carried out in the same socio-cultural context and variations in the procedure were never tested. The present study aimed at analyzing the efficacy of Borella et al.'s training, in terms of short and long-term benefits, in a different socio-cultural context (Study 1), and the effect of change in the training's length (duplicating the number of sessions (Study 2). Participants were randomly assigned to a trained group (N = 18 for Study 1, and N = 23 for Study 2) and active control group (N = 28 for Study 1, and N = 27 for Study 2), and evaluated at pre, post-test and six-month follow-up for verbal WM task (criterion task), and for visuospatial and verbal WM, inhibition, processing speed, executive function, and fluid intelligence measures (transfer tasks). The trained groups had higher performance in all tasks when compared with active control groups after training and at 6 month follow-up. The longer training (Study 2) generated similar gains as the original protocol, with some advantage in far transfer tasks at post-test and follow-up. Study limitations include the small sample sizes. In conclusion, this training was effective in a different socio-cultural context and adding three sessions to the protocol did not significantly change training impact.

Virtual environments as memory training devices in navigational tasks for older adults

Cognitive training approaches using virtual environments (VEs) might counter age-related visuospatial memory decline and associated difficulties in wayfinding. However, the effects of the visual design of a VE in route learning are not fully understood. Therefore, we created a custom-designed VE optimized for route learning, with adjusted levels of realism and highlighted landmark locations (MixedVE). Herein we tested participants’ route recall performance in identifying direction of turn at the intersection with this MixedVE against two baseline alternatives (AbstractVE, RealisticVE). An older vs. a younger group solved the tasks in two stages (immediate vs. delayed recall by one week). Our results demonstrate that the MixedVE facilitates better recall accuracy than the other two VEs for both age groups. Importantly, this pattern persists a week later. Additionally, our older participants were mostly overconfident in their route recall performance, but the MixedVE moderated this potentially detrimental overconfidence. Before the experiment, participants clearly preferred the RealisticVE, whereas after the experiment, most of the younger, and many of the older participants, preferred the MixedVE. Taken together, our findings provide insights into the importance of tailoring visualization design in route learning with VEs. Furthermore, we demonstrate the great potential of the MixedVE and by extension, of similar VEs as memory training devices for route learning, especially for older participants.

The Aging Navigational System

The discovery of neuronal systems dedicated to computing spatial information, composed of functionally distinct cell types such as place and grid cells, combined with an extensive body of human-based behavioral and neuroimaging research has provided us with a detailed understanding of the brain's navigation circuit. In this review, we discuss emerging evidence from rodents, non-human primates, and humans that demonstrates how cognitive aging affects the navigational computations supported by these systems. Critically, we show 1) that navigational deficits cannot solely be explained by general deficits in learning and memory, 2) that there is no uniform decline across different navigational computations, and 3) that navigational deficits might be sensitive markers for impending pathological decline. Following an introduction to the mechanisms underlying spatial navigation and how they relate to general processes of learning and memory, the review discusses how aging affects the perception and integration of spatial information, the creation and storage of memory traces for spatial information, and the use of spatial information during navigational behavior. The closing section highlights the clinical potential of behavioral and neural markers of spatial navigation, with a particular emphasis on neurodegenerative disorders.