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Ferguson L, Sain D, Kürüm E, Strickland-Hughes CM, Rebok GW, Wu R. One-year cognitive outcomes from a multiple real-world skill learning intervention with older adults. Aging Ment Health 2023; 27:2134-2143. [PMID: 37059695 DOI: 10.1080/13607863.2023.2197847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 03/21/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES Novel skill learning has been shown to have cognitive benefits in the short-term (up to a few months). Two studies expanded on prior research by investigating whether learning multiple novel real-world skills simultaneously (e.g. Spanish, drawing, music composition), for a minimum of six hours a week, would yield 1-year cognitive gains. METHOD Following a 3-month multi-skill learning intervention, Study 1 (N = 6, Mage = 66 years, SDage = 6.41) and Study 2 (N = 27, Mage = 69 years, SDage = 7.12) participants completed follow-up cognitive assessments 3 months, 6 months, and one year after the intervention period. Cognitive assessments tested executive function (working memory and cognitive control) and verbal episodic memory. RESULTS Linear mixed-effects models revealed improvements in multiple cognitive outcomes from before the intervention to the follow-up timepoints. Specifically, executive function increased from pre-test to the 1-year follow-up for both studies (an effect driven mostly by cognitive control scores). DISCUSSION Our findings provide evidence that simultaneously learning real-world skills can lead to long-term improvements in cognition during older adulthood. Future work with diverse samples could investigate individual differences in gains. Overall, our findings promote the benefits of lifelong learning, namely, to improve cognitive abilities in older adulthood.
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Affiliation(s)
- Leah Ferguson
- Department of Psychology, UC Riverside, Riverside, CA, USA
| | - Debaleena Sain
- Department of Statistics, UC Riverside, Riverside, CA, USA
| | - Esra Kürüm
- Department of Statistics, UC Riverside, Riverside, CA, USA
| | | | - George W Rebok
- Bloomberg School of Public Health and Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Wu
- Department of Psychology, UC Riverside, Riverside, CA, USA
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Rebok GW, Gellert A, Coe NB, Clay OJ, Wallace G, Parisi JM, Aiken-Morgan AT, Crowe M, Ball K, Thorpe RJ, Marsiske M, Zahodne LB, Felix C, Willis SL. Effects of Cognitive Training on Alzheimer's Disease and Related Dementias: The Moderating Role of Social Determinants of Health. J Aging Health 2023; 35:40S-50S. [PMID: 37994850 DOI: 10.1177/08982643231203755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Objective: We examined whether social determinants of health (SDoH) are associated with Alzheimer's disease and related dementias (ADRD) risk and the effects of cognitive training over a 20-year follow-up period. Methods: Data were obtained from 1605 participants in ACTIVE. SDoH measures were created using baseline data at the individual and neighborhood level. Incident ADRD was defined using administrative claims data (1999-2019). Cause-specific hazard models estimated associations between SDoH and claims-based diagnosed ADRD. Results: Higher scores on neighborhood and built environment were associated with lower ADRD risk. Trained participants obtained a greater degree of protection from ADRD when they had higher scores for SDoH domains associated with health care and education access. However, there were fewer significant SDoH moderation effects on cognitive training than expected. Discussion: Future work should continue to explore culturally tailored cognitive training interventions to reduce ADRD risk associated with SDoH that disproportionately affects racially diverse aging populations.
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Affiliation(s)
- George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Norma B Coe
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gail Wallace
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins University, Baltimore, MD, USA
| | - Jeanine M Parisi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins University, Baltimore, MD, USA
| | | | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karlene Ball
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roland J Thorpe
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Cynthia Felix
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Rebok GW, Clay OJ, Thorpe RJ, Willis SL. The ACTIVE Study: Association of Race and Social Determinants of Health (SDoH) with Long-Term Outcomes and Cognitive Training Effects. J Aging Health 2023; 35:3S-10S. [PMID: 37994854 DOI: 10.1177/08982643231204931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Objective: The purpose of this article is to introduce a special issue on the ACTIVE project examining the association between race and social determinants of health (SDoH) and long-term participant outcomes and training effectiveness for older Black/African Americans and Whites in the ACTIVE (for Advanced Cognitive Training for Independent and Vital Elderly) Trial on cognitive abilities, everyday functioning, and incidence of dementia. The ACTIVE study is the largest randomized clinical trial (N = 2802) of the efficacy of three types of cognitive training (memory, reasoning, speed of processing) in improving cognitive and everyday functioning in normal older adults, with follow-ups extending through 5 and 10 years post-intervention. Method: We provide background and context for studying the multiple domains of SDoH in understanding long-term participant outcomes in the ACTIVE trial and racial disparities in the efficacy of cognitive training and summarize the 11 articles in this special issue. Results: Articles in this special issue address several cross-cutting themes. These include 1) a focus on SDoH and race in relation to three cognitive abilities and driving; 2) cognitive training outcomes in older Black/African Americans (B/AA); 3) race differences in everyday function; and 4) associations of various risk factors (e.g., cardiovascular disease, obesity, depression) and protective factors (e.g., occupational complexity) for cognitive decline with health disparities in incident dementia and mortality. Conclusion: In cognitive training studies with cognitively healthy older adults, it is important to consider how factors such as race and SDoH relate to long-term participant outcomes and how they moderate intervention effects.
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Affiliation(s)
- George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, Birmingham, AL, USA
- UAB Alzheimer's Disease Research Center, Birmingham, AL, USA
| | - Roland J Thorpe
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Rodriguez TM, Sheffler P, Ferguson LE, Rebok GW, Wu R. Cognitive and Functional Improvement via Novel Skill Learning for Low-Income Minoritized Middle-Aged and Older Adults. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:926-935. [PMID: 35895188 DOI: 10.1007/s11121-022-01413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/25/2022]
Abstract
Prior research has demonstrated beneficial outcomes for learning new skills in older adulthood, including increased cognitive and functional abilities, which help prevent age-related declines and foster healthy aging. However, these studies largely have included participants not typically considered at risk for cognitive and functional decline (i.e., White, highly educated, higher income). Cognitive and functional disparities exist among minoritized racial and ethnic individuals, particularly Black and Latinx populations, because of a lifetime of inequalities associated with low socioeconomic status, low education, and discrimination. This theoretical paper proposes a potential pathway in which such disparities could be mitigated by increasing cognitive and functional abilities via novel skill learning in these at-risk populations in middle and later life to prevent decline. We also discuss indirect barriers (e.g., financial and health issues), direct barriers (e.g., limited learning opportunities), and motivational barriers (e.g., self-beliefs, values) that these adults may encounter. We further highlight that addressing these barriers to novel skill learning by providing appropriate resources is necessary to maximize the feasibility and potential effectiveness of this pathway. Lastly, we encourage future research to test this pathway and help inform policymakers and existing learning programs to implement better ways of promoting lifelong learning in an inclusive and equitable manner to prevent decline.
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Affiliation(s)
| | - Pamela Sheffler
- Department of Psychology, University of California, Riverside, USA
| | - Leah E Ferguson
- Department of Psychology, University of California, Riverside, USA
| | - George W Rebok
- Department of Mental Health, Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, USA
- Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, USA
| | - Rachel Wu
- Department of Psychology, University of California, Riverside, USA
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Marino FR, Jiang K, Smith JR, Chen D, Tzuang M, Reed NS, Swenor BK, Deal JA, Rebok GW, Huang A. Inclusion of hearing and vision impairments in cognitive training interventions. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12374. [PMID: 36873925 PMCID: PMC9983145 DOI: 10.1002/trc2.12374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 02/23/2023]
Abstract
Introduction Cognitive training can potentially reduce risk of cognitive decline and dementia in older adults. To support implementation of cognitive training in the broader population of older adults, it is critical to evaluate intervention implementation and efficacy among representative samples, particularly those at highest risk of cognitive decline. Hearing and vision impairments are highly prevalent among older adults and confer increased risk of cognitive decline/dementia. Whether cognitive training interventions enroll and are designed to include this important subgroup is unknown. Methods A scoping review of PubMed and PsycINFO was conducted to examine the inclusion of older adults with hearing and vision impairment in cognitive training interventions. Two independent reviewers completed a full-text review of eligible articles. Eligible articles included cognitive training and multimodal randomized controlled trials and a study population that was cognitively unimpaired, aged ≥55-years, and community dwelling. Articles were primary outcome papers published in English. Results Among the 130 articles included in the review, 103 were cognitive training interventions (79%) and 27 were multimodal interventions (21%). More than half the trials systematically excluded participants with hearing and/or vision impairment (n = 60, 58%). Few studies reported hearing and vision measurement (cognitive: n = 16, 16%; multimodal: n = 3, 11%) or incorporated universal design and accessibility into intervention design (cognitive: n = 7, 7%; multimodal: n = 0, 0%). Discussion Older adults with hearing and vision impairment are underrepresented in cognitive training interventions. Reporting of hearing and vision measurement, proper justification of exclusions, and inclusion of accessibility and universal intervention design are also lacking. These findings raise concerns about whether current trial findings apply to those with hearing and vision impairment and generalize to the broader population of older adults. It is critical to include more diverse study populations and integrate accessibility into intervention design to include and better represent older adults with hearing and vision impairment. Highlights Cognitive training interventions underrepresent hearing and vision impairment.Sensory measurement and proper justification of exclusions are rarely reported.Interventions lack inclusion of accessibility and universal intervention design.More diverse study populations are needed in cognitive training interventions.Integration of accessibility into cognitive training intervention design is needed.
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Affiliation(s)
- Francesca R. Marino
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Kening Jiang
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Jason R. Smith
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Diefei Chen
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Center on Aging and HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Marian Tzuang
- Department of Community Health SystemsSchool of NursingUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Nicholas S. Reed
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Bonnielin K. Swenor
- The Wilmer Eye InstituteJohns Hopkins UniversityBaltimoreMarylandUSA
- Johns Hopkins Disability Health Research CenterJohns Hopkins UniversityBaltimoreMarylandUSA
- Johns Hopkins School of NursingBaltimoreMarylandUSA
| | - Jennifer A. Deal
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - George W. Rebok
- Center on Aging and HealthJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Alison Huang
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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Sheffler P, Rodriguez TM, Cheung CS, Wu R. Cognitive and metacognitive, motivational, and resource considerations for learning new skills across the lifespan. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2021; 13:e1585. [PMID: 34783458 DOI: 10.1002/wcs.1585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/09/2021] [Accepted: 10/15/2021] [Indexed: 01/09/2023]
Abstract
Across the lifespan, learners have to tackle the challenges of learning new skills. These skills can range from abilities needed for survival, such as learning languages, learning to walk during infancy, and learning new software for a job in adulthood, to abilities related to leisure and hobbies. As the learner progresses through novice to expert stages, there are cognitive and metacognitive, motivational, and resource considerations for learning new skills. In terms of cognitive considerations, fluid and crystallized abilities as well as executive functions interact to help the learner process and retain information related to the skills. In terms of metacognitive considerations, knowing what to learn and how to learn are important for novel skill learning. In terms of motivational considerations, changes in individuals' intrinsic and extrinsic motivation throughout the lifespan impact their pursuit of novel skill learning, and declines in motivation can be buffered through the cultivation of grit, growth mindset, self-efficacy, and other personal factors. In terms of resource considerations, there are many tools that learners can use to acquire new skills, but allocation and availability of these resources differ based on life stage and socioeconomic status. Taken together, these considerations may provide learners with the best chance at acquiring new skills across the lifespan. Further research investigating these three factors, particularly among older adult learners, and their interactive effects could help increase our understanding of their impacts on skill learning and inform future cognitive interventions that can be tailored to learners' unique needs. This article is categorized under: Cognitive Biology > Cognitive Development Psychology > Development and Aging Psychology > Learning.
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Affiliation(s)
- Pamela Sheffler
- Department of Psychology, University of California, Riverside, California, USA
| | - Tania M Rodriguez
- Department of Psychology, University of California, Riverside, California, USA
| | - Cecilia S Cheung
- Department of Psychology, University of California, Riverside, California, USA
| | - Rachel Wu
- Department of Psychology, University of California, Riverside, California, USA
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7
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Dotson VM, Duarte A. The importance of diversity in cognitive neuroscience. Ann N Y Acad Sci 2020; 1464:181-191. [DOI: 10.1111/nyas.14268] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/17/2019] [Accepted: 10/16/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Vonetta M. Dotson
- Department of Psychology and the Gerontology InstituteGeorgia State University Atlanta Georgia
| | - Audrey Duarte
- Department of PsychologyGeorgia Institute of Technology Atlanta Georgia
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McDougall GJ, McDonough IM, LaRocca M. Memory training for adults with probable mild cognitive impairment: a pilot study. Aging Ment Health 2019; 23:1433-1441. [PMID: 30303394 PMCID: PMC6458094 DOI: 10.1080/13607863.2018.1484884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background & Objectives: This pilot study aimed to evaluate the efficacy of memory training and health training intervention over a 24-month period in people with probable mild cognitive impairment (MCI). Research Design & Methods: Based on the accepted criteria, and the neuropsychiatric measures used in the trial, MCI was defined as a subjective change in cognition, impairment in episodic memory, preservation of independence of functional abilities, and no dementia. Without a neurological assessment, laboratory tests, and psychometric evaluation combined, some of our participants may have had dementia that we were unable to detect through neuropsychological testing. Of the 263 total participants, 39 met criteria for a diagnosis of MCI. There were 19 adults in the memory and 20 in health training conditions. Both groups received twenty hours of classroom content that included eight hours of booster sessions at three months post intervention. Hierarchical linear models (HLM) and standardized regression-based (SBR) analyses were used to test the efficacy of the intervention on immediate recall, delayed recall, subjective memory complaints, and memory self-efficacy. Age, education, depression, racial group, ethnic group, MMSE score, and baseline performance were included as covariates. Results: Over 24 months, the MCI group in the memory training condition showed better objective and subjective memory outcomes compared with the MCI group in the health training condition. Conclusions: Senior WISE Memory training delivered to individuals with MCI was able to forestall the participants' declining cognitive ability and sustain the benefit over two years in both subjective and objective memory function.
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Affiliation(s)
| | | | - Michael LaRocca
- Veterans Administration Palo Alto Health Care System, War Related Illness and Injury Study Center
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Yoon JS, Roque NA, Andringa R, Harrell ER, Lewis KG, Vitale T, Charness N, Boot WR. Intervention Comparative Effectiveness for Adult Cognitive Training (ICE-ACT) Trial: Rationale, design, and baseline characteristics. Contemp Clin Trials 2019; 78:76-87. [PMID: 30711665 PMCID: PMC6485952 DOI: 10.1016/j.cct.2019.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/20/2019] [Accepted: 01/30/2019] [Indexed: 11/17/2022]
Abstract
Age-related perceptual and cognitive declines are associated with difficulties performing everyday tasks required to remain independent. Encouraging improvements in cognitive abilities have been shown for various short-term interventions but there is little evidence for direct impact on independence. This project compares the effect of broad and directed (narrow) technology-based training on basic perceptual and cognitive abilities in older adults and on the performance of simulated tasks of daily living including driving and fraud avoidance. Participants (N = 230, Mean age = 72) were randomly assigned to one of four training conditions: broad training using either (1) a web-based brain game suite, Brain HQ, or (2) a strategy video game, Rise of Nations, or to directed training for (3) Instrumental Activities of Daily Living (IADL) training using web-based programs for both driving and fraud avoidance training, or (4) to an active control condition of puzzle solving. Training took approximately 15-20 h for each intervention condition across four weeks. Before training began, participants received baseline ability tests of perception, attention, memory, cognition, and IADL, including a driving simulator test for hazard perception, and a financial fraud recognition test. They were tested again on these measures following training completion (post-test). A one-year follow-up from training completion is also scheduled. The baseline results support that randomization was successful across the intervention conditions. We discuss challenges and potential solutions for using technology-based interventions with older adults. We also discuss how the current trial addressed methodological limitations of previous intervention studies. TRIAL REGISTRATION NUMBER: NCT03141281.
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Affiliation(s)
- Jong-Sung Yoon
- Florida State University, Department of Psychology, Tallahassee, FL, United States.
| | - Nelson A Roque
- Penn State University, Center for Healthy Aging, University Park, PA, United States
| | - Ronald Andringa
- Florida State University, Department of Psychology, Tallahassee, FL, United States
| | - Erin R Harrell
- Florida State University, Department of Psychology, Tallahassee, FL, United States
| | - Katharine G Lewis
- Florida State University, Department of Psychology, Tallahassee, FL, United States
| | - Thomas Vitale
- Florida State University, Department of Psychology, Tallahassee, FL, United States
| | - Neil Charness
- Florida State University, Department of Psychology, Tallahassee, FL, United States
| | - Walter R Boot
- Florida State University, Department of Psychology, Tallahassee, FL, United States
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Croff RL, Witter IV P, Walker ML, Francois E, Quinn C, Riley TC, Sharma NF, Kaye JA. Things Are Changing so Fast: Integrative Technology for Preserving Cognitive Health and Community History. THE GERONTOLOGIST 2019; 59:147-157. [PMID: 29961887 PMCID: PMC6326255 DOI: 10.1093/geront/gny069] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Indexed: 12/17/2022] Open
Abstract
Background and Objectives Multimodal interventions are increasingly targeting multiple cognitive decline risk factors. However, technology remains mostly adjunctive, largely prioritizes age relevancy over cultural relevancy, and often targets individual health without lasting, community-wide deliverables. Meanwhile, African Americans remain overburdened by cognitive risk factors yet underrepresented in cognitive health and technology studies. The Sharing History through Active Reminiscence and Photo-imagery (SHARP) program increases physical, social, and cognitive activity within a culturally meaningful context that produces community deliverables-an oral history archive and cognitive health education. Design and Methods The SHARP application was tested with 19 African Americans ≥55 years, aiming for an easy, integrative, and culturally meaningful experience. The application guided triads in walks 3 times weekly for 6 months in Portland, Oregon's historically Black neighborhoods; local historical images prompted recorded conversational reminiscence. Focus groups evaluated factors influencing technology acceptance-attitudes about technology, usefulness, usability, and relevance to integrating program goals. Thematic analysis guided qualitative interpretation. Results Technology acceptance was influenced by group learning, paper-copy replicas for reluctant users, ease of navigation, usefulness for integrating and engaging in health behaviors, relevance to integrating individual benefit and the community priority of preserving history amidst gentrification, and flexibility in how the community uses deliverables. Perceived community benefits sustained acceptance despite intermittent technology failure. Discussion and Implications We offer applicable considerations for brain health technology design, implementation, and deliverables that integrate modalities, age, and cultural relevance, and individual and community benefit for more meaningful, and thus more motivated community engagement.
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Affiliation(s)
- Raina L Croff
- NIA-Layton Aging and Alzheimer’s Disease Center, Oregon Health & Science University, Portland
| | - Phelps Witter IV
- Oregon Center for Aging and Technology, Oregon Health & Science University, Portland
| | - Miya L Walker
- Department of Health Studies, OHSU-PSU School of Public Health, College of Urban and Public Affairs, Portland, Oregon
| | - Edline Francois
- NIA-Layton Aging and Alzheimer’s Disease Center, Oregon Health & Science University, Portland
| | - Charlie Quinn
- Oregon Center for Aging and Technology, Oregon Health & Science University, Portland
| | - Thomas C Riley
- Oregon Center for Aging and Technology, Oregon Health & Science University, Portland
| | - Nicole F Sharma
- Oregon Center for Aging and Technology, Oregon Health & Science University, Portland
| | - Jeffrey A Kaye
- NIA-Layton Aging and Alzheimer’s Disease Center, Oregon Health & Science University, Portland
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Cognitive Interventions for Cognitively Healthy, Mildly Impaired, and Mixed Samples of Older Adults: A Systematic Review and Meta-Analysis of Randomized-Controlled Trials. Neuropsychol Rev 2017; 27:403-439. [PMID: 28726168 DOI: 10.1007/s11065-017-9350-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 05/15/2017] [Indexed: 01/09/2023]
Abstract
Cognitive interventions may improve cognition, delay age-related cognitive declines, and improve quality of life for older adults. The current meta-analysis was conducted to update and expand previous work on the efficacy of cognitive interventions for older adults and to examine the impact of key demographic and methodological variables. EBSCOhost and Embase online databases and reference lists were searched to identify relevant randomized-controlled trials (RCTs) of cognitive interventions for cognitively healthy or mildly impaired (MCI) older adults (60+ years). Interventions trained a single cognitive domain (e.g., memory) or were multi-domain training, and outcomes were assessed immediately post-intervention using standard neuropsychological tests. In total, 279 effects from 97 studies were pooled based on a random-effects model and expressed as Hedges' g (unbiased). Overall, results indicated that cognitive interventions produce a small, but significant, improvement in the cognitive functioning of older adults, relative to active and passive control groups (g = 0.298, p < .001, 95% CI = 0.248-0.347). These results were confirmed using multi-level analyses adjusting for nesting of effect sizes within studies (g = 0.362, p < .001, 95% CI = 0.275, 0.449). Age, education, and cognitive status (healthy vs. MCI) were not significant moderators. Working memory interventions proved most effective (g = 0.479), though memory, processing speed, and multi-domain interventions also significantly improved cognition. Effects were larger for directly trained outcomes but were also significant for non-trained outcomes (i.e., "transfer effects"). Implications for future research and clinical practice are discussed. This project was pre-registered with PROSPERO (#42016038386).
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