The effect of cognitive training in older adults: be aware of CRUNCH

Twelve weeks of combined physical and cognitive intradialytic training preserves alertness and improves gait speed: a randomized controlled trial

BACKGROUND

Hemodialysis (HD) patients often experience cognitive deficits and reduced mobility. While studies have shown promising results of physical and/or cognitive training in older adults, their effects in HD patients remain understudied.

AIMS

This study aimed to evaluate the impact of a 12-week intradialytic training program combining cognitive training with physical exercise on attention domains and spontaneous gait speed (SGS) in HD patients.

METHODS

Forty-four HD patients were randomly assigned to either intradialytic cognitive and physical exercise training (EXP group; n = 22) or a standard care control group (CON group; n = 22). The EXP group performed intradialytic cycling and tablet-based cognitive training three days per week for 12 weeks. The primary outcome of the study was performance on the computerized test battery 'Test of Attentional Performance.' Secondary study outcome was patient mobility assessed by the four-meter SGS. Outcomes were assessed pre- and post-intervention.

RESULTS

Significant group x time interaction was observed in alertness (F(1,41) = 6.15, p = 0.017) and SGS (F(1,41) = 18.33, p < 0.001) in favor of the EXP group. Within-group analysis revealed a significant pre-post decline in the CON group in alertness test (-26.7 s; p = 0.04) and an improvement of SGS in EXP group (+ 0.07 s; p < 0.001).

DISCUSSION

This original study demonstrated that a combined physical and cognitive intradialytic training intervention led to improvements in SGS and preservation in alertness compared to a deterioration in the CON group.

CONCLUSION

Findings suggest that the intervention may serve as an effective tool to prevent the physical and cognitive decline in this patient population.

Comparing the effect of individual and group cognitive-motor training on reconstructing subjective well-being and quality of life in older males, recovered from the COVID-19

While the message emanating from physiological and psychological research has extolled the general advantages of exercise in physical and cognitive health, the social distancing and the impossibility of group exercises have revealed more complex conditions. Therefore, we performed an experimental study comparing the effect of individual and group cognitive-motor training on reconstructing subjective well-being (SWB) and quality of life (QOL) in older males who recovered from COVID-19. The study's design is a single-blind, randomized controlled trial (RCT). The participants, 36 older men (65-80 yrs.) recovering from COVID-19, were randomly divided into (1) Group A (cognitive-motor training, G-CMT); (2) Group B (individual cognitive-motor training, I-CMT); and (3) Group C (control). Both training interventions involved performing a training protocol (cognitive-motor training) twice a week for four weeks. The outcomes included an assessment of the SWB and QOL of participants by SWB scale and world health organization QOL scale at baseline and two weeks after interventions. Except for the effect of age and number of children variables on QOL, other demographic variables had no significant effect on the results of SWB or WHOQOL of participants (P > 0.05). The SWB results in G-CMT were better than I-CMT and control groups in emotional and social well-being domains. Also, WHOQOL test results in G-CMT were better than control groups in domains of psychological and social relationships, whereas I-CMT performed better than G-CMT and control groups in domains of cognitive well-being, physical health, and environment. The results revealed that the mean test scores of SWB and WHOQOL in G-CMT and I-CMT were better than the control group (P ≤ 0.001). The positive effects of cognitive-motor training on reconstructing SWB and QOL are associated with the synchronicity of cognitive and motor components in these exercises. We suggest that the emotional, social, and psychological benefits of cognitive-motor training override cognitive, physical, and environmental changes. The future line of the present study will include pathophysiology and further clinical aspect of recovering from COVID-19.

Effects of Musical Mnemonics on Working Memory Performance in Cognitively Unimpaired Young and Older Adults

OBJECTIVE

To overcome memory decrements in healthy aging, compensation strategies and mnemonics have been found to be promising. The effects of musical mnemonics in aging have been scarcely studied.

METHODS

The present study examined the effects of musical presentation of digits (pitch sequences, rhythms, and their combinations) on working memory performance in young and older adults, as compared to spoken presentation.

RESULTS

A facilitating effect of rhythm was found in both groups, whereas pitch and melodic cues affected performance negatively in older adults only. Musical training did not moderate the effect of musical mnemonics.

DISCUSSION

To investigate whether persons with working memory impairment also benefit from musical mnemonics, follow-up research in older persons with, for instance, mild cognitive impairment or Alzheimer's dementia is recommended.

Development and Co-design of NeuroOrb: A Novel “Serious Gaming” System Targeting Cognitive Impairment in Parkinson’s Disease

Whilst Parkinson’s disease (PD) is typically thought of as a motor disease, a significant number of individuals also experience cognitive impairment (CI), ranging from mild-CI to dementia. One technique that may prove effective in delaying the onset of CI in PD is cognitive training (CT); however, evidence to date is variable. This may be due to the implementation of CT in this population, with the motor impairments of PD potentially hampering the ability to use standard equipment, such as pen-and-paper or a computer mouse. This may, in turn, promote negative attitudes toward the CT paradigm, which may correlate with poorer outcomes. Consequently, optimizing a system for the delivery of CT in the PD population may improve the accessibility of and engagement with the CT paradigm, subsequently leading to better outcomes. To achieve this, the NeuroOrb Gaming System was designed, coupling a novel accessible controller, specifically developed for use with people with motor impairments, with a “Serious Games” software suite, custom-designed to target the cognitive domains typically affected in PD. The aim of the current study was to evaluate the usability of the NeuroOrb through a reiterative co-design process, in order to optimize the system for future use in clinical trials of CT in individuals with PD. Individuals with PD (n = 13; mean age = 68.15 years; mean disease duration = 8 years) were recruited from the community and participated in three co-design loops. After implementation of key stakeholder feedback to make significant modifications to the system, system usability was improved and participant attitudes toward the NeuroOrb were very positive. Taken together, this provides rationale for moving forward with a future clinical trial investigating the utility of the NeuroOrb as a tool to deliver CT in PD.

Baseline capacities and motivation in executive control training of healthy older adults

OBJECTIVES

Normal aging involves progressive prefrontal declines and impairments in executive control. This study aimed to examine the efficacy of an executive-control training focusing on working memory and inhibition, in healthy older adults, and to explore the role of individual differences in baseline capacities and motivation in explaining training gains.

METHODS

Forty-four healthy older adults were randomly assigned to an experimental (training executive control) or active control group (training processing speed). Participants completed six online training sessions distributed across two weeks. Transfer effects to working memory (Operation Span test), response inhibition (Stop-Signal test), processing speed (Pattern Comparison) and reasoning (Raven's Advanced Progressive Matrices and Cattell Culture Fair test) were evaluated. Furthermore, we explored individual differences in baseline capacities and assessed motivation during and after the intervention.

RESULTS

The experimental group, but not the active control, showed significant transfer to response inhibition. Moreover, a general compensation effect was found: older adults with lower baseline capacities achieved higher levels of training improvement. Motivation was not related to training performance.

CONCLUSION

Our results encourage the use of executive control training to improve cognitive functions, reveal the importance of individual differences in training-related gains, and provide further support for cognitive plasticity during healthy aging.

The effectiveness of cognitive-motor training on reconstructing cognitive health components in older male adults, recovered from the COVID-19

Objective

The incidence of COVID-19 disease in the elderly can accelerate normal degenerative process of cognitive functions. Interactive cognitive-motor training (CMT) is an intervention that integrates cognitive and motor tasks to promote individuals’ physical and psychological health. The present study aimed to examine the effect of CMT on reconstructing cognitive health components in older men, who have recently recovered from COVID-19.

Materials and methods

This study is a quasi-experimental repeated measure (without control group). Participants were 42 elderly men (65–80 years) who recovered from the COVID-19 disease that individually participated in a 4-week CMT program twice a week. The cognitive health components of the participants were assessed by the General Health Questionnaire (GHQ-2) and the Mini-Mental State Examination (MMSE) at 3 stages before the beginning of the intervention (baseline assessment); 2 weeks after the intervention (short-term follow-up); and 3 months after the intervention (long-term follow-up).

Results

The results showed that the scores of depression, anxiety, physical symptoms, and social performance components and the overall GHQ score improved significantly in short-term follow-up (P < 0.05) and also in long-term follow-up compared to baseline assessment (P < 0.05). It was also found that attention and calculation, recall, lingual skill, and action performance components and the overall score of MMSE were also improved at three stages of assessments. Other components did not differ among stages.

Conclusions

This study adds to the research on the effectiveness of using CMT for reconstructing cognitive health components in older adults, recovered from the COVID-19, and supports CMT as a viable intervention practice.

Initial performance predicts improvements in computerized cognitive training: Evidence from a selective attention task

Computerized cognitive training (CCT) has been found to improve a range of skills such as attention, working memory, inhibition control, and decision making. However, the relationship between the initial performance, amount of improvement, time constant, and asymptotic performance level in CCT is still unclear. In the current study, we performed selective attention training on college students and addressed this issue by mathematically modeling the learning curve with an exponential function. Twenty-nine students completed approximately 10 days of CCT. Presentation time served as the dependent variable and was measured by three-down/one-up adaptive algorithms. We fitted an exponential function to the estimated block thresholds during CCT and obtained three learning parameters (amount of improvement, time constant, and asymptotic performance level) for all subjects. The initial performance was defined by the sum of the amount of improvement and the asymptotic performance level. Pearson correlation analyses were conducted between the initial performance and the three leaning parameters. The initial performance was positively correlated with the amount of improvement and asymptotic performance level, but was negatively correlated with the time constant. The time constant was negatively correlated with the amount of improvement and asymptotic performance level. Poorer initial performance was linked to a larger amount of improvement, shorter time constant, and higher asymptotic threshold, which supported the compensation account. Our results may help improve the present understanding of the nature of the CCT process and demonstrate the advantages of using a customized training protocol to enhance the efficiency of cognitive training in practical applications.

The neural basis of individual differences in memory performance in young and older adults: Using the encoding/retrieval flip account as framework

Aging is associated with cognitive decline, specifically in episodic memory. However, there are large individual differences in the extent of this decline and previous research suggests that these are associated with differences in executive functioning (EF). These EF differences, and associated differences in the encoding and retrieval of episodic information, have been linked to differences in the activation of particular brain regions. The "encoding/retrieval flip" (E/R flip) framework assumes deactivation and activation of specific brain regions during successful encoding and retrieval, respectively. The present study assessed whether this framework can be used to explain EF-based individual differences in memory performance of young and older participants. Young adults (N = 19) and older adults (N = 39) performed an incidental semantic encoding and memory recognition task in an fMRI setting, focusing on brain regions that show the E/R flip. The association between an index of EF and fMRI activity in brain regions showing the E/R flip was tested in each age group. EF predicted E/R flip activity in the older, but not young adults. These findings underscore the importance of individual differences in ageing research and provide empirical evidence for the association between EF and the E/R flip.