1
|
Chiaravalloti ND, Costa SL, Armknecht C, Costanza K, Wallace S, Moore NB, DeLuca J. Speed of processing training to improve cognition in moderate to severe TBI: a randomized clinical trial. Front Neurol 2024; 15:1445560. [PMID: 39268073 PMCID: PMC11390365 DOI: 10.3389/fneur.2024.1445560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 08/16/2024] [Indexed: 09/15/2024] Open
Abstract
Background Moderate to severe traumatic brain injury (TBI) often results in cognitive deficits. Processing speed (PS) deficits are common, exerting a significant impact on daily life. Few studies have examined the efficacy of cognitive rehabilitation specifically for PS deficits in moderate to severe TBI. Objective Examine the efficacy of Speed of Processing Training (SOPT) in moderate to severe TBI. This protocol is a 10-session behavioral intervention for PS deficits that has been successfully used with other cognitively impaired populations. Methods This double-blind, placebo-controlled, randomized clinical trial included 46 participants with moderate to severe TBI, 22 randomly assigned to the treatment group and 24 to the placebo-control group. Baseline and follow-up measures included a task similar to the training task (UFOV), measures of near transfer (neuropsychological measures of processing speed: Symbol Digit Modalities Test (SDMT), Wechsler Adult Intelligence Scale-IV (WAIS-IV) Symbol Search, WAIS-IV Coding) and measures of far transfer [neuropsychological measures of learning and memory: the California Verbal Learning Test-II (CVLT-II), Memory Assessment Scales - Prose Memory (MAS-PM)]. Results Significant improvement from pre-to post-SOPT was observed on all subtests of the UFOV, which is similar to the training task. There was no significant difference on neuropsychological measures of PS or new learning and memory post-treatment. Neuropsychological assessment 6-months post-treatment showed no significant change in PS ability over time. Monthly booster sessions did not impact performance at the 6-month follow-up. Conclusion Consistent with the SOPT literature, SOPT improves PS ability as measured by the UFOV, a task similar to the training task, in moderate to severe TBI. However, neither near nor far transfer was noted. That is, no improvement was noted on neuropsychological measures of PS.
Collapse
Affiliation(s)
- Nancy D Chiaravalloti
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, East Hanover, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers -New Jersey Medical School, Newark, NJ, United States
| | - Silvana L Costa
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, East Hanover, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers -New Jersey Medical School, Newark, NJ, United States
| | - Caroline Armknecht
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, East Hanover, NJ, United States
| | - Kristin Costanza
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, East Hanover, NJ, United States
| | - Sean Wallace
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, East Hanover, NJ, United States
| | - Nancy B Moore
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, East Hanover, NJ, United States
| | - John DeLuca
- Kessler Foundation, Center for Neuropsychology and Neuroscience Research, East Hanover, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers -New Jersey Medical School, Newark, NJ, United States
- Department of Neurology and Neurosciences, Rutgers -New Jersey Medical School, Newark, NJ, United States
| |
Collapse
|
2
|
Huang AR, Rebok GW, Swenor BK, Deal JA. Vision and hearing difficulty and effects of cognitive training in older adults. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12537. [PMID: 38595912 PMCID: PMC11002773 DOI: 10.1002/dad2.12537] [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: 10/10/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 04/11/2024]
Abstract
BACKGROUND Cognitive training is delivered visually and aurally. It is unknown whether self-reported sensory difficulty modifies the effects of cognitive training on cognition. METHODS Participants (N = 2788) in the Advanced Cognitive Training for Independent and Vital Elderly Study were randomized to training in memory, reasoning, speed of processing, or control. Differences in the 10-year effect of cognitive training on cognition by self-reported vision and hearing difficulty were assessed using linear mixed effect models. RESULTS Benefit (intervention vs. control) of reasoning training was smaller among participants with versus without vision difficulty (difficulty: -0.25, 95% confidence interval: [-0.88, 0.39], no difficulty: 0.58 [0.28, 0.89]). Benefit of memory training was greater for participants with versus without hearing difficulty (difficulty: 0.17 [-0.37, 0.72], no difficulty: -0.20 [-0.65, 0.24]). DISCUSSION Older adults with sensory loss have increased risk for cognitive decline; benefits of cognitive training may be greater for these individuals. Sensory loss should be considered in training design. Highlights Memory training was more beneficial for participants with hearing loss.Participants with vision difficulties did not benefit as much from reasoning training.Low accessibility in design and learned compensation strategies may contribute.Consideration of sensory impairment in study design is needed.Inclusion of older adults with sensory impairment in cognitive training is needed.
Collapse
Affiliation(s)
- Alison R. Huang
- 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
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Bonnielin K. Swenor
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Disability Health Research CenterJohns Hopkins Bloomberg UniversityBaltimoreMarylandUSA
- The Wilmer Eye InstituteJohns 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
- Disability Health Research CenterJohns Hopkins Bloomberg UniversityBaltimoreMarylandUSA
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
An YW, Kim KM, DiTrani Lobacz A, Baumeister J, Higginson JS, Rosen J, Swanik CB. Cognitive Training Improves Joint Stiffness Regulation and Function in ACLR Patients Compared to Healthy Controls. Healthcare (Basel) 2023; 11:1875. [PMID: 37444709 DOI: 10.3390/healthcare11131875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
As cognitive function is critical for muscle coordination, cognitive training may also improve neuromuscular control strategy and knee function following an anterior cruciate ligament reconstruction (ACLR). The purpose of this case-control study was to examine the effects of cognitive training on joint stiffness regulation in response to negative visual stimuli and knee function following ACLR. A total of 20 ACLR patients and 20 healthy controls received four weeks of online cognitive training. Executive function, joint stiffness in response to emotionally evocative visual stimuli (neutral, fearful, knee injury related), and knee function outcomes before and after the intervention were compared. Both groups improved executive function following the intervention (p = 0.005). The ACLR group had greater mid-range stiffness in response to fearful (p = 0.024) and injury-related pictures (p = 0.017) than neutral contents before the intervention, while no post-intervention stiffness differences were observed among picture types. The ACLR group showed better single-legged hop for distance after cognitive training (p = 0.047), while the healthy group demonstrated no improvement. Cognitive training enhanced executive function, which may reduce joint stiffness dysregulation in response to emotionally arousing images and improve knee function in ACLR patients, presumably by facilitating neural processing necessary for neuromuscular control.
Collapse
Affiliation(s)
- Yong Woo An
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA 90621, USA
| | - Kyung-Min Kim
- Department of Sport Science, Sungkyunkwan University, Suwon-si 16419, Republic of Korea
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33146, USA
| | | | - Jochen Baumeister
- Department of Exercise & Health, Paderborn University, 33098 Paderborn, Germany
| | - Jill S Higginson
- Department of Mechanical Engineering, University of Delaware, Newark, DE 19716, USA
| | - Jeffrey Rosen
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, USA
| | - Charles Buz Swanik
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19716, USA
| |
Collapse
|
6
|
Michaels J, Chaumillon R, Mejia-Romero S, Bernardin D, Faubert J. Can Three-Dimensional Multiple Object Tracking Training Be Used to Improve Simulated Driving Performance? A Pilot Study in Young and Older Adults. JOURNAL OF COGNITIVE ENHANCEMENT 2023; 7:112-127. [PMID: 37351199 PMCID: PMC10123568 DOI: 10.1007/s41465-023-00260-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/27/2023] [Indexed: 06/24/2023]
Abstract
Driving ability has been shown to be dependent on perceptual-cognitive abilities such as visual attention and speed of processing. There is mixed evidence suggesting that training these abilities may improve aspects of driving performance. This preliminary study investigated the feasibility of training three-dimensional multiple object tracking (3D-MOT)-a dynamic, speeded tracking task soliciting selective, sustained and divided attention as well as speed of processing-to improve measures of simulated driving performance in older and younger adults. A sample of 20 young adults (23-33 years old) and 14 older adults (65-76 years old) were randomly assigned to either a 3D-MOT training group or an active control group trained on a perceptual discrimination task as well as 2048. Participants were tested on a driving scenario with skill-testing events previously identified as optimal for cross-sectional comparisons of driving ability. Results replicated previously identified differences in driving behaviour between age groups. A possible trend was observed for the 3D-MOT trained group, especially younger adults, to increase the distance at which they applied their maximum amount of braking in response to dangerous events. This measure was associated with less extreme braking during events, implying that these drivers may have been making more controlled stops. Limitations of sample size and task realism notwithstanding, the present experiment offers preliminary evidence that 3D-MOT training might transfer to driving performance through quicker detection of or reaction to dangerous events and provides a rationale for replication with a larger sample size.
Collapse
Affiliation(s)
- Jesse Michaels
- Faubert Laboratory, School of Optometry, Université de Montréal, Montréal, Québec Canada
| | - Romain Chaumillon
- Faubert Laboratory, School of Optometry, Université de Montréal, Montréal, Québec Canada
| | - Sergio Mejia-Romero
- Faubert Laboratory, School of Optometry, Université de Montréal, Montréal, Québec Canada
| | - Delphine Bernardin
- Faubert Laboratory, School of Optometry, Université de Montréal, Montréal, Québec Canada
- Essilor International, Research and Development Department, Paris, France
- Essilor Canada, Saint-Laurent, Canada
| | - Jocelyn Faubert
- Faubert Laboratory, School of Optometry, Université de Montréal, Montréal, Québec Canada
| |
Collapse
|
7
|
Sprague BN, Ross LA, Ball KK. Does Cognitive Training Reduce Falls across Ten Years?: Data from the ACTIVE Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4941. [PMID: 36981850 PMCID: PMC10048914 DOI: 10.3390/ijerph20064941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
The purpose of this study was to examine the effect of cognitive training on the risk of experiencing a fall across 10 years. The study used data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized controlled trial. Older adults aged 65-94 were randomly assigned to speed of processing, memory, or reasoning training or to a no-contact control group (n = 2802). The experience of a fall in the prior two months was assessed at baseline and at 1, 2, 3, 5, and 10 years posttest. Cox proportional hazards explored group differences in the total sample, as well as group differences for participants classified as low risk (n = 2360) and high risk (n = 442) for future falls. The data were censored at the first reported fall postbaseline. After baseline, 983 (35.08%) participants across the full sample reported a fall. There were no significant effects of the training in the full sample or in the low-risk sample of participants. However, the participants at greater risk for future falls in the speed of processing training group were 31% less likely (HR = 0.69; 95% CI = 0.48, 0.998, p = 0.049) to experience a subsequent fall across ten years compared to the control group. Reasoning and memory training did not reduce a future fall in the high-risk sample. The speed of processing training reduced the risk of future falls across ten years in the high-risk participants. Future work should examine moderators and mediators of training in at-risk samples.
Collapse
Affiliation(s)
- Briana N. Sprague
- Division of General Internal Medicine & Geriatrics, University of Indiana School of Medicine, Indianapolis, IN 46202, USA
- Center for Aging Research, Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Lesley A. Ross
- Department of Psychology, Clemson University, Clemson, SC 29634, USA
| | - Karlene K. Ball
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
da Silva TBL, Bratkauskas JS, Barbosa MEDC, da Silva GA, Zumkeller MG, de Moraes LC, Lessa PP, Cardoso NP, Ordonez TN, Brucki SMD. Long-term studies in cognitive training for older adults: a systematic review. Dement Neuropsychol 2022; 16:135-152. [PMID: 35720648 PMCID: PMC9173785 DOI: 10.1590/1980-5764-dn-2021-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 11/22/2022] Open
Abstract
Studies show that aging is accompanied by losses in cognitive functions and that interventions can increase performance and/or support the maintenance of cognitive skills in the elderly.
Collapse
Affiliation(s)
- Thais Bento Lima da Silva
- Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, São Paulo SP, Brazil.,Instituto Supera de Educação, São José dos Campos SP, Brazil
| | | | | | | | | | | | | | | | | | - Sonia Maria Dozzi Brucki
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Grupo de Neurologia Cognitiva e Comportamental, São Paulo SP, Brazil
| |
Collapse
|
10
|
Mendes L, Oliveira J, Barbosa F, Castelo-Branco M. A Conceptual View of Cognitive Intervention in Older Adults With and Without Cognitive Decline-A Systemic Review. FRONTIERS IN AGING 2022; 3:844725. [PMID: 35821828 PMCID: PMC9261456 DOI: 10.3389/fragi.2022.844725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/28/2022] [Indexed: 11/17/2022]
Abstract
Background: Dementia is the one of the most common and prominent disease in the elderly person that results in the Cognitive interventions. In this study, we aim to conceptualize the cognitive intervention for older adults with and without cognitive dysfunction and to clarify the heterogeneity existing in this literature field by determining the main variables implicated. Methods: We conducted a study analysis using previous literature highlighting the significant data reporting empirical results from cognitive intervention for healthy older adults and other seniors with different types of dementia. Each paper was reviewed in terms of compensatory cognitive training, cognitive remediation, enrichment, cognitive activation, brain training, cognitive stimulation, cognitive training, and cognitive rehabilitation. The research analysis was performed following rigorous inclusion and exclusion criteria with the purpose of collecting relevant answers to our research questions. Results: We included a total of 168 studies in our review. Our findings indicated heterogeneity regarding methods, concepts, and procedures. Additionally, the values were integrated using different information existing in this field. Conclusion: In conclusion, we highlighted that this is the first review that clarify the discrepancy of various existing definitions, methods, and procedures, as well as the overlapping information in the cognitive interventions.
Collapse
Affiliation(s)
- Liliana Mendes
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Joana Oliveira
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Fernando Barbosa
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| |
Collapse
|
11
|
Harrell ER, Roque NA, Boot WR, Charness N. Investigating message framing to improve adherence to technology-based cognitive interventions. Psychol Aging 2021; 36:974-982. [PMID: 34460281 PMCID: PMC8665007 DOI: 10.1037/pag0000629] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A cognitive intervention study was conducted with the purpose of exploring methods to improve adherence to a technology-based cognitive intervention and uncover individual differences that predict adherence (N = 120). The study was divided into two phases: Phase 1, in which participants were asked to follow a prescribed schedule of training that involved gamified neuropsychological tests administered via tablet, and Phase 2, in which participants were asked to play as frequently as they wished. Positive- and negative-framed messages about brain health were delivered via the software program, and measures of cognition, technology proficiency, self-efficacy, technology attitudes, and belief in the benefits of cognitive training were collected. Generalized linear mixed-effects models revealed that positive-framed messages encouraged greater adherence over negative-framed messages, but this effect was restricted to Phase 2 of the study in the absence of social pressure. Measures of memory and self-efficacy demonstrated some, but limited, ability to predict individual differences in adherence. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
|
12
|
Harrington K, Craven MP, Wilson ML, Landowska A. Using Patient and Public Involvement to Elicit Opinion on Cognitive Training Games and Assessment Technologies for Dementia (Preprint). JMIR Serious Games 2021; 10:e32489. [PMID: 35723912 PMCID: PMC9253969 DOI: 10.2196/32489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/22/2021] [Accepted: 02/17/2022] [Indexed: 11/28/2022] Open
Abstract
Background Cognitive training and assessment technologies offer the promise of dementia risk reduction and a more timely diagnosis of dementia, respectively. Cognitive training games may help reduce the lifetime risk of dementia by helping to build cognitive reserve, whereas cognitive assessment technologies offer the opportunity for a more convenient approach to early detection or screening. Objective This study aims to elicit perspectives of potential end users on factors related to the acceptability of cognitive training games and assessment technologies, including their opinions on the meaningfulness of measurement of cognition, barriers to and facilitators of adoption, motivations to use games, and interrelationships with existing health care infrastructure. Methods Four linked workshops were conducted with the same group, each focusing on a specific topic: meaningful improvement, learning and motivation, trust in digital diagnosis, and barriers to technology adoption. Participants in the workshops included local involvement team members acting as facilitators and those recruited via Join Dementia Research through a purposive selection and volunteer sampling method. Group activities were recorded, and transcripts were analyzed using thematic analysis with a combination of a priori and data-driven themes. Using a mixed methods approach, we investigated the relationships between the categories of the Capability, Opportunity, and Motivation–Behavior change model along with data-driven themes by measuring the φ coefficient between coded excerpts and ensuring the reliability of our coding scheme by using independent reviewers and assessing interrater reliability. Finally, we explored these themes and their relationships to address our research objectives. Results In addition to discussions around the capability, motivation, and opportunity categories, several important themes emerged during the workshops: family and friends, cognition and mood, work and hobbies, and technology. Group participants mentioned the importance of functional and objective measures of cognitive change, the social aspect of activities as a motivating factor, and the opportunities and potential shortcomings of digital health care provision. Our quantitative results indicated at least moderate agreement on all but one of the coding schemes and good independence of our coding categories. Positive and statistically significant φ coefficients were observed between several coding themes between categories, including a relatively strong positive φ coefficient between capability and cognition (0.468; P<.001). Conclusions The implications for researchers and technology developers include assessing how cognitive training and screening pathways would integrate into existing health care systems; however, further work needs to be undertaken to address barriers to adoption and the potential real-world impact of cognitive training and screening technologies. International Registered Report Identifier (IRRID) RR2-10.1007/978-3-030-49065-2_4
Collapse
Affiliation(s)
- Kyle Harrington
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, Nottingham, United Kingdom
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Michael P Craven
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
- Human Factors Research Group, Faculty of Engineering, University of Nottingham, Nottingham, United Kingdom
| | - Max L Wilson
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
- Mixed Reality Lab, School of Computer Science, University of Nottingham, Nottingham, United Kingdom
| | - Aleksandra Landowska
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
- Mixed Reality Lab, School of Computer Science, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
13
|
Yuan J, Crowson A, Richardson G, Feng J. Drive aware training: A computerized training program for older drivers' detection of road hazards. TRAFFIC INJURY PREVENTION 2021; 22:443-448. [PMID: 34124967 DOI: 10.1080/15389588.2021.1929944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Cognitive training for reducing crash rate can be delivered to older drivers via in-person on-road sessions, a driving simulator, or using computer-based cognitive methods. Despite established effectiveness, in-person on-road assessment and rehabilitation are expensive, and limited professional service may not be readily accessible; simulator-based training may not fit every driver due to simulator sickness. In comparison, computerized training is easier to implement and could be delivered with little cost to older drivers with computer access. Based on the Drive Aware Task, a validated measure of attentional processes in hazard detection, we developed a computerized cognitive training method with a focus on hazard detection. In this study, we examined the effectiveness of this newly-developed interactive training program in improving older drivers' detection of road hazards. METHODS Using a matched-pair design, nine triads of three older drivers (aged 65 or above) with matched pretest performance and gender were formed. For each triad, each participant was randomly allocated to one of the three groups: 1) active training group to receive the two training sessions (1.5-2.5h per session); 2) passive training group to receive two video-watching sessions (i.e., watch the video of training session performance from the corresponding paired participant); 3) no-contact control group. Older drivers' performances on hazard detection and simulated driving were measured before and after training. RESULTS The active training group showed significant training effects on the computerized hazard detection task and simulated driving performance, while there were only marginal effects in the passive training group and no effects in the no-contact control group. A post-training survey suggested older drivers were receptive to the Drive Aware training program. CONCLUSIONS The computerized Drive Aware training program has the potential to be used as a prevention and intervention tool to improve older drivers' hazard detection performance. Future studies should examine the effectiveness of this tool in more diverse samples and in long-term outcomes.
Collapse
Affiliation(s)
- Jing Yuan
- Department of Psychology, North Carolina State University, Raleigh, North Carolina
| | - Aaron Crowson
- Department of Psychology, North Carolina State University, Raleigh, North Carolina
| | - Geoffrey Richardson
- Department of Psychology, North Carolina State University, Raleigh, North Carolina
| | - Jing Feng
- Department of Psychology, North Carolina State University, Raleigh, North Carolina
| |
Collapse
|
14
|
Sprague BN, Phillips CB, Ross LA. Cognitive Training Attenuates Decline in Physical Function Across 10 Years. J Gerontol B Psychol Sci Soc Sci 2021; 76:1114-1124. [PMID: 32484891 DOI: 10.1093/geronb/gbaa072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Poor physical function is associated with negative health and cognitive outcomes. Although nine studies demonstrated that cognitive training reduces age-related declines in physical function, only one study has examined the effects beyond immediate posttest changes. The first aim of this study was to assess the impact of three cognitive training programs on physical function measures across 10 years and the second aim was to examine whether baseline cognitive self-efficacy or depressive symptoms moderated training effects. METHOD Using data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized controlled trial, older adults in a no-contact control condition (n = 698) were compared to those receiving processing speed (n = 702), memory (n = 703), or reasoning (n = 694) training. Intention-to-treat (ITT) and dosage analyses were conducted for grip strength and Turn 360. Participants were followed up to 10 years posttest. RESULTS There were no significant ITT effects of processing speed, memory, or reasoning training assignment to any physical function outcome (p > .05). Dosage models indicated that there were small age-related attenuation effects in Turn 360 decline with more processing speed training (b = -.011, p < .001), memory training (b = -.011, p < .001), and reasoning training (b = -.012, p < .001). There was no significant transfer to grip strength. These training gains were greater for those with more baseline depressive symptoms who received more processing speed training (b = -.001, p < .001). DISCUSSION This is the first study to demonstrate the effects of cognitive training to complex physical function across 10 years.
Collapse
Affiliation(s)
- Briana N Sprague
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park
| | | | - Lesley A Ross
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park.,Department of Psychology, Clemson University, South Carolina
| |
Collapse
|
15
|
Kirk HE, Spencer-Smith M, Wiley JF, Cornish KM. Gamified Attention Training in the Primary School Classroom: A Cluster-Randomized Controlled Trial. J Atten Disord 2021; 25:1146-1159. [PMID: 31718386 DOI: 10.1177/1087054719887435] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This randomized controlled trial evaluated the efficacy of attention training delivered in class on cognitive attention processes, inattention, hyperactivity, working memory, and numeracy in primary school children. Method: Eight classes (n = 98 children; 5-9 years) were cluster randomized to gamified attention training, a placebo program, or a no-contact control condition. Assessments were conducted at baseline, immediately after the 5-week intervention (posttraining), and 6 months later (follow-up). Results: Posttraining, attention training was associated with reduced inattention and hyperactivity within the classroom compared with controls, and reduced hyperactivity at home compared with the no-contact control. At follow-up, reduced hyperactivity within the classroom compared with the no-contact control persisted. No effects of training on cognitive attention processes, working memory, and numeracy were observed posttraining. Conclusion: Classroom-based attention training has select benefits in reducing inattention and hyperactivity, but may not promote gains in cognitive or academic skills in primary school children.
Collapse
|
16
|
Triebel K, Anderson J, Nakkina SR, Vance DE. Can Breast Cancer Survivors Benefit from Speed of Processing Training? A Perspective Article on Treatment and Research. NURSING: RESEARCH AND REVIEWS 2021. [DOI: 10.2147/nrr.s312214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
17
|
Shaffer J. Centenarians, Supercentenarians: We Must Develop New Measurements Suitable for Our Oldest Old. Front Psychol 2021; 12:655497. [PMID: 33897565 PMCID: PMC8058349 DOI: 10.3389/fpsyg.2021.655497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/11/2021] [Indexed: 12/22/2022] Open
Affiliation(s)
- Joyce Shaffer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| |
Collapse
|
18
|
Lima-Silva TB, Barbosa MEDC, Zumkeller MG, Verga CER, Prata PL, Cardoso NP, de Moraes LC, Brucki SMD. Cognitive training using the abacus: a literature review study on the benefits for different age groups. Dement Neuropsychol 2021; 15:256-266. [PMID: 34345368 PMCID: PMC8283869 DOI: 10.1590/1980-57642021dn15-020014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/07/2021] [Indexed: 11/30/2022] Open
Abstract
The literature indicates that cognitive stimulation interventions have shown promising results. Abacus represents a tool with great potential in such interventions.
Collapse
Affiliation(s)
- Thais Bento Lima-Silva
- Group of Cognitive and Behavioral Neurology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo, SP, Brazil
| | | | | | | | - Patrícia Lessa Prata
- Group of Cognitive and Behavioral Neurology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo, SP, Brazil
| | | | | | - Sonia Maria Dozzi Brucki
- Group of Cognitive and Behavioral Neurology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo, SP, Brazil
| |
Collapse
|
19
|
Lee HK, Kent JD, Wendel C, Wolinsky FD, Foster ED, Merzenich MM, Voss MW. Home-Based, Adaptive Cognitive Training for Cognitively Normal Older adults: Initial Efficacy Trial. J Gerontol B Psychol Sci Soc Sci 2021; 75:1144-1154. [PMID: 31140569 DOI: 10.1093/geronb/gbz073] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES We examined whether a home-based, adaptive cognitive training (CT) program would lead to cognitive performance changes on a neuropsychological test battery in cognitively normal older adults. METHOD Sixty-eight older adults (age = 70.0, SD = 3.74) were randomly assigned to either CT or an active control group (AC, casual computer games). Participants were instructed to train on their assigned programs for 42 min per day, 5 days per week, over 10 weeks (35 hr of total program usage). Participants completed tests of processing speed, working memory, and executive control before and after 10 weeks of training. RESULTS Training groups did not differ in performance before training. After training, CT participants out-performed AC participants in the overall cognitive composite score, driven by processing speed and working memory domains. DISCUSSION Our results show that a limited dose of home-based CT can drive cognitive improvements as measured with neuropsychological test battery, suggesting potential cognitive health maintenance implications for cognitively normal older adults.
Collapse
Affiliation(s)
- Hyun Kyu Lee
- Department of Research and Development, Posit Science Inc., San Francisco, California
| | - James D Kent
- Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa
| | - Christopher Wendel
- Department of Psychological and Brain Sciences, University of Iowa, Iowa
| | - Fredric D Wolinsky
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa
| | - Eric D Foster
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa
| | - Michael M Merzenich
- Department of Research and Development, Posit Science Inc., San Francisco, California
| | - Michelle W Voss
- Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa.,Department of Psychological and Brain Sciences, University of Iowa, Iowa
| |
Collapse
|
20
|
Computerized Cognitive Training: A Review of Mechanisms, Methodological Considerations, and Application to Research in Depression. JOURNAL OF COGNITIVE ENHANCEMENT 2021. [DOI: 10.1007/s41465-021-00209-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
21
|
Bonnechère B, Langley C, Sahakian BJ. The use of commercial computerised cognitive games in older adults: a meta-analysis. Sci Rep 2020; 10:15276. [PMID: 32943742 PMCID: PMC7498601 DOI: 10.1038/s41598-020-72281-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/28/2020] [Indexed: 11/09/2022] Open
Abstract
Brain training programs are currently one effective solution to prevent cognitive decline in healthy aging. We conducted a meta-analysis of randomized controlled trials assessing the use of commercially available computerised cognitive games to improve cognitive function in people aged above 60 years old without cognitive impairment. 1,543 participants from sixteen studies were included in the meta-analysis. Statistically significant improvements were observed for processing speed (SMD increased 0.40 [95% CI 0.20-0.60], p < 0.001), working memory (0.21 [95% CI 0.08-0.34], p = 0.001), executive function (0.21 [95% CI 0.06-0.35], p = 0.006), and for verbal memory (0.12 [95% CI 0.01-0.24, p = 0.031), but not for attention or visuospatial abilities. No relationship between the age of the participants and the amount of training was found. Commercially available computerised cognitive games are effective in improving cognitive function in participants without cognitive impairment aged over 60 years.
Collapse
Affiliation(s)
- Bruno Bonnechère
- Department of Psychiatry and Behavioural and Clinical Neurosciences, University of Cambridge, Herchel Smith Bldg, Robinson Way, Cambridge, CB2 0SZ, UK. .,Center for Research in Epidemiology, Biostatistics and Clinical Research - Public Health School, Université Libre de Bruxelles, Brussels, Belgium.
| | - Christelle Langley
- Department of Psychiatry and Behavioural and Clinical Neurosciences, University of Cambridge, Herchel Smith Bldg, Robinson Way, Cambridge, CB2 0SZ, UK
| | - Barbara Jacquelyn Sahakian
- Department of Psychiatry and Behavioural and Clinical Neurosciences, University of Cambridge, Herchel Smith Bldg, Robinson Way, Cambridge, CB2 0SZ, UK
| |
Collapse
|
22
|
Gates NJ, Rutjes AWS, Di Nisio M, Karim S, Chong L, March E, Martínez G, Vernooij RWM. Computerised cognitive training for 12 or more weeks for maintaining cognitive function in cognitively healthy people in late life. Cochrane Database Syst Rev 2020; 2:CD012277. [PMID: 32104914 PMCID: PMC7045394 DOI: 10.1002/14651858.cd012277.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Increasing age is associated with a natural decline in cognitive function and is the greatest risk factor for dementia. Cognitive decline and dementia are significant threats to independence and quality of life in older adults. Therefore, identifying interventions that help to maintain cognitive function in older adults or that reduce the risk of dementia is a research priority. Cognitive training uses repeated practice on standardised exercises targeting one or more cognitive domains and may be intended to improve or maintain optimal cognitive function. This review examines the effects of computerised cognitive training interventions lasting at least 12 weeks on the cognitive function of healthy adults aged 65 or older and has formed part of a wider project about modifying lifestyle to maintain cognitive function. We chose a minimum 12 weeks duration as a trade-off between adequate exposure to a sustainable intervention and feasibility in a trial setting. OBJECTIVES To evaluate the effects of computerised cognitive training interventions lasting at least 12 weeks on cognitive function in cognitively healthy people in late life. SEARCH METHODS We searched to 31 March 2018 in ALOIS (www.medicine.ox.ac.uk/alois), and we performed additional searches of MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov, and the WHO Portal/ICTRP (www.apps.who.int/trialsearch), to ensure that the search was as comprehensive and as up-to-date as possible to identify published, unpublished, and ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs, published or unpublished, reported in any language. Participants were cognitively healthy people, and at least 80% of the study population had to be aged 65 or older. Experimental interventions adhered to the following criteria: intervention was any form of interactive computerised cognitive intervention - including computer exercises, computer games, mobile devices, gaming console, and virtual reality - that involved repeated practice on standardised exercises of specified cognitive domain(s) for the purpose of enhancing cognitive function; the duration of the intervention was at least 12 weeks; cognitive outcomes were measured; and cognitive training interventions were compared with active or inactive control interventions. DATA COLLECTION AND ANALYSIS We performed preliminary screening of search results using a 'crowdsourcing' method to identify RCTs. At least two review authors working independently screened the remaining citations against inclusion criteria. At least two review authors also independently extracted data and assessed the risk of bias of included RCTs. Where appropriate, we synthesised data in random-effects meta-analyses, comparing computerised cognitive training (CCT) separately with active and inactive controls. We expressed treatment effects as standardised mean differences (SMDs) with 95% confidence intervals (CIs). We used GRADE methods to describe the overall quality of the evidence for each outcome. MAIN RESULTS We identified eight RCTs with a total of 1183 participants. The duration of the interventions ranged from 12 to 26 weeks; in five trials, the duration of intervention was 12 or 13 weeks. The included studies had moderate risk of bias, and the overall quality of evidence was low or very low for all outcomes. We compared CCT first against active control interventions, such as watching educational videos. Negative SMDs favour CCT over control. Trial results suggest slight improvement in global cognitive function at the end of the intervention period (12 weeks) (standardised mean difference (SMD) -0.31, 95% confidence interval (CI) -0.57 to -0.05; 232 participants; 2 studies; low-quality evidence). One of these trials also assessed global cognitive function 12 months after the end of the intervention; this trial provided no clear evidence of a persistent effect (SMD -0.21, 95% CI -0.66 to 0.24; 77 participants; 1 study; low-quality evidence). CCT may result in little or no difference at the end of the intervention period in episodic memory (12 to 17 weeks) (SMD 0.06, 95% CI -0.14 to 0.26; 439 participants; 4 studies; low-quality evidence) or working memory (12 to 16 weeks) (SMD -0.17, 95% CI -0.36 to 0.02; 392 participants; 3 studies; low-quality evidence). Because of the very low quality of the evidence, we are very uncertain about the effects of CCT on speed of processing and executive function. We also compared CCT to inactive control (no interventions). We found no data on our primary outcome of global cognitive function. At the end of the intervention, CCT may lead to slight improvement in episodic memory (6 months) (mean difference (MD) in Rivermead Behavioural Memory Test (RBMT) -0.90 points, 95% confidence interval (CI) -1.73 to -0.07; 150 participants; 1 study; low-quality evidence) but can have little or no effect on executive function (12 weeks to 6 months) (SMD -0.08, 95% CI -0.31 to 0.15; 292 participants; 2 studies; low-quality evidence), working memory (16 weeks) (MD -0.08, 95% CI -0.43 to 0.27; 60 participants; 1 study; low-quality evidence), or verbal fluency (6 months) (MD -0.11, 95% CI -1.58 to 1.36; 150 participants; 1 study; low-quality evidence). We could not determine any effects on speed of processing because the evidence was of very low quality. We found no evidence on quality of life, activities of daily living, or adverse effects in either comparison. AUTHORS' CONCLUSIONS We found low-quality evidence suggesting that immediately after completion of the intervention, small benefits of CCT may be seen for global cognitive function when compared with active controls, and for episodic memory when compared with an inactive control. These benefits are of uncertain clinical importance. We found no evidence that the effect on global cognitive function persisted 12 months later. Our confidence in the results was low, reflecting the overall quality of the evidence. In five of the eight trials, the duration of the intervention was just three months. The possibility that more extensive training could yield larger benefit remains to be more fully explored. We found substantial literature on cognitive training, and collating all available scientific information posed problems. Duration of treatment may not be the best way to categorise interventions for inclusion. As the primary interest of older people and of guideline writers and policymakers involves sustained cognitive benefit, an alternative would be to categorise by length of follow-up after selecting studies that assess longer-term effects.
Collapse
Affiliation(s)
- Nicola J Gates
- University of New South WalesCentre for Healthy Brain Ageing (CHeBA)Suite 407 185 Elizabeth StreetSydneyNSWAustralia2000
| | - Anne WS Rutjes
- University of BernInstitute of Social and Preventive Medicine (ISPM)Mittelstrasse 43BernBernSwitzerland3012
- University of BernInstitute of Primary Health Care (BIHAM)Mittelstrasse 43BernBernSwitzerland3012
| | - Marcello Di Nisio
- University "G. D'Annunzio" of Chieti‐PescaraDepartment of Medicine and Ageing SciencesVia dei Vestini 31Chieti ScaloItaly66013
| | - Salman Karim
- Lancashire Care NHS Foundation TrustPsychiatrySceptre Point, Sceptre WayPrestonUKPR5 6AW
| | | | - Evrim March
- St Vincent's Hospital (Melbourne)St Vincent's Adult Mental Health46 Nicholson StreetFitzroyVICAustralia3065
| | - Gabriel Martínez
- Universidad de AntofagastaFaculty of Medicine and DentistryAvenida Argentina 2000AntofagastaChile127001
| | - Robin WM Vernooij
- University Medical Center UtrechtDepartment of Nephrology and Hypertension and Julius Center for Health Sciences and Primary CareHeidelberglaan 100UtrechtNetherlands3584 CX
| | | |
Collapse
|
23
|
Structured Cognitive Training Yields Best Results in Healthy Older Adults, and Their ApoE4 State and Baseline Cognitive Level Predict Training Benefits. Cogn Behav Neurol 2020; 32:76-86. [PMID: 31205121 DOI: 10.1097/wnn.0000000000000195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cognitive training has been shown to improve cognitive functions in healthy older adults. However, little is known about which specific variables are responsible for the improvement. OBJECTIVE Our aim was to evaluate whether healthy older adults benefit more from a structured cognitive training program than an unstructured brain jogging program and to identify possible predictors for training success, including apolipoprotein E4 (apoE4). METHODS In a randomized controlled trial, participants completed either a 6-week structured cognitive training program (n=35) or a 6-week unstructured brain jogging program (n=35). A control group received no training and was not part of the randomization procedure (n=35). Overall, 105 participants were included in the training data analyses, focusing on verbal memory, attention, and executive functions. Data from an additional 45 previously trained, healthy older adults were used for the predictor analysis. RESULTS A significant Time×Training interaction in favor of the structured cognitive training program was found in verbal memory. Low baseline performance on neuropsychological tests was a significant predictor for benefits in verbal memory, attention, and executive functions. A subgroup analysis (n=35) revealed that only noncarriers of the apoE4 allele showed significant gains in long-term verbal memory and attention. CONCLUSIONS Our results support the greater effectiveness of structured cognitive training on verbal memory compared with brain jogging and no training. The success of this type of training program may be predicted by sociodemographic, cognitive, and genetic variables.
Collapse
|
24
|
Vo JB, Fazeli PL, Benz R, Bail JR, Triebel K, Vance DE, Meneses K. Effects of a speed of processing training intervention on self-reported health outcomes in breast cancer survivors. NURSING: RESEARCH AND REVIEWS 2019; 9:13-19. [PMID: 38037592 PMCID: PMC10688571 DOI: 10.2147/nrr.s199664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Purpose Cognitive deficits are a concern for breast cancer survivors, as these effects are prevalent and impact daily functioning and quality of life (QoL). The purpose of this study was to examine the effects of a speed of processing (SOP) training intervention on secondary, self-reported health outcomes in this population. Methods Sixty middle-aged and older adult women breast cancer survivors completed baseline assessments and were randomized to either a no-contact control group or an SOP training group, who completed 10 hrs of computerized SOP training online at home. Both conditions completed self-report surveys of sleep, QoL, cognitive difficulties, and depressive symptoms at six weeks and six months post study entry. Results There were no significant effects of the SOP training on self-reported health outcomes. Conclusion Future studies examining the effect of cognitive training on self-reported health outcomes are warranted that include individuals with baseline impairment in such indices in order to better determine efficacy, and longer follow-up time points may aid in examining the protective effects of this intervention in those without baseline impairment.
Collapse
Affiliation(s)
- Jacqueline B Vo
- Office of Research and Scholarship, School of Nursing, University of Alabama, Birmingham, AL 35294-1210, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama, Birmingham, AL, USA
- Center for Translational Research on Aging and Mobility, University of Alabama, Birmingham, AL, USA
| | - Rachel Benz
- Office of Research and Scholarship, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer R Bail
- Cancer Prevention and Control Training Program, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristen Triebel
- Department of Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David E Vance
- Center for Translational Research on Aging and Mobility, University of Alabama, Birmingham, AL, USA
- Office of Research and Scholarship, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karen Meneses
- Office of Research and Scholarship, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birminghan, AL, USA
| |
Collapse
|
25
|
The impact of behavioral interventions on cognitive function in healthy older adults: A systematic review. Ageing Res Rev 2019; 52:32-52. [PMID: 31002885 DOI: 10.1016/j.arr.2019.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 04/06/2019] [Accepted: 04/08/2019] [Indexed: 11/22/2022]
Abstract
Behavioral interventions to improve cognitive function in older adults are widespread and can vary from theater classes to cognitive training programs. However, the effectiveness in maintaining different cognitive domains varies greatly both across and within intervention types. To date, no systematic reviews have synthesized findings across more than a few types of interventions (e.g., cognitive vs. exercise). This systematic review examined 11 types of behavioral interventions and the respective transfer to 19 cognitive domains, as well as transfer to everyday function. Study inclusion criteria were: peer-reviewed articles in English, samples of healthy adults aged 65 and older, and randomized controlled trials of behavioral interventions with reported cognitive outcomes. The 2017 search yielded 75 eligible articles comprising cognitive training, exercise training, combination interventions, cognitively-stimulating activities, and action video games. In general, process- (n = 26) and strategy-based (n = 16) cognitive training improved the trained domains but had weak transfer to non-trained domains. Aerobic training (n = 13) most consistently improved executive function, and strength/resistance (n = 8) and aerobic/resistance combination training (n = 6) most consistently improved cognitive inhibition and visual working memory. Combination interventions (n = 15 nonfactorial, n = 3 factorial) showed promise in improving verbal delayed recall and executive function. Few studies examined cognitively-stimulating activities or action video games, leaving inconclusive results about their effect on cognitive function. Few studies examined everyday function (n = 9), however, process- and strategy-based training demonstrated notable long-term transfer. Recommendations for future research and practice are highlighted.
Collapse
|
26
|
Belleville S, Moussard A, Ansaldo AI, Belchior P, Bherer L, Bier N, Bohbot VD, Bruneau MA, Cuddy LL, Gilbert B, Jokel R, Mahalingam K, McGilton K, Murphy KJ, Naglie G, Rochon E, Troyer AK, Anderson ND. Rationale and protocol of the ENGAGE study: a double-blind randomized controlled preference trial using a comprehensive cohort design to measure the effect of a cognitive and leisure-based intervention in older adults with a memory complaint. Trials 2019; 20:282. [PMID: 31118095 PMCID: PMC6532200 DOI: 10.1186/s13063-019-3250-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 02/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leisure activities can be both enjoyable and cognitively stimulating, and participation in such activities has been associated with reduced age-related cognitive decline. Thus, integrating stimulating leisure activities in cognitive training programs may represent a powerful and innovative approach to promote cognition in older adults at risk of dementia. The ENGAGE study is a randomized controlled, double-blind preference trial with a comprehensive cohort design that will test the efficacy and long-term impact of an intervention that combines cognitive training and cognitively stimulating leisure activities. METHODS One hundred and forty-four older adults with a memory complaint will be recruited in Montreal and Toronto. A particular effort will be made to reach persons with low cognitive reserve. Participants will be randomly assigned to one of two conditions: cognitive + leisure training (ENGAGE-MUSIC/SPANISH) or active control (ENGAGE-DISCOVERY). The ENGAGE-MUSIC/SPANISH training will include teaching of mnemonic and attentional control strategies, casual videogames selected to train attention, and classes in music or Spanish as a second language. The ENGAGE-DISCOVERY condition will comprise psychoeducation on cognition and the brain, low-stimulating casual videogames and documentary viewing with discussions. To retain the leisure aspect of the activities, participants will be allowed to exclude either music or Spanish at study entry if they strongly dislike one of these activities. Participants randomized to ENGAGE-MUSIC/SPANISH who did not exclude any activity will be assigned to music or Spanish based on a second random assignment. Training will be provided in 24 2-h sessions over 4 months. Outcomes will be measured at baseline, at 4-month follow-up, and at 24-month follow-up. The primary outcome will be cognitive performance on a composite measure of episodic memory (delayed recall scores for words and face-name associations) measured at baseline and at the 4-month follow-up. Secondary outcomes will include a composite measure of attention (speed of processing, inhibition, dual tasking, and shifting), psychological health, activities of daily living, and brain structure and function and long-term maintenance measured at the 24-month follow-up. Information on cognitive reserve proxies (education and lifestyle questionnaires), sex and genotype (apolipoprotein (Apo)E4, brain-derived neurotrophic factor (BDNF), and catechol-O-methyltransferase (COMT)) will be collected and considered as moderators of training efficacy. DISCUSSION This study will test whether a program combining cognitive training with stimulating leisure activities can increase cognition and reduce cognitive decline in persons at risk of dementia. TRIAL REGISTRATION NCT03271190 . Registered on 5 September 2017.
Collapse
Affiliation(s)
- S Belleville
- Université de Montréal, Montreal, Canada. .,Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada.
| | - A Moussard
- Université de Montréal, Montreal, Canada.,Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - A I Ansaldo
- Université de Montréal, Montreal, Canada.,Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - P Belchior
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada.,McGill University, Montreal, Canada
| | - L Bherer
- Université de Montréal, Montreal, Canada.,Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - N Bier
- Université de Montréal, Montreal, Canada.,Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - V D Bohbot
- McGill University, Montreal, Canada.,Douglas Mental Health University Institute, Montreal, Canada
| | - M-A Bruneau
- Université de Montréal, Montreal, Canada.,Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - L L Cuddy
- Queen's University, Kingston, Canada
| | - B Gilbert
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - R Jokel
- University of Toronto, Toronto, Canada.,Baycrest Health Sciences, Toronto, Canada
| | | | - K McGilton
- University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute - the University Health Network, Toronto, Canada
| | - K J Murphy
- University of Toronto, Toronto, Canada.,Baycrest Health Sciences, Toronto, Canada
| | - G Naglie
- University of Toronto, Toronto, Canada.,Baycrest Health Sciences, Toronto, Canada
| | - E Rochon
- University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute - the University Health Network, Toronto, Canada
| | - A K Troyer
- University of Toronto, Toronto, Canada.,Baycrest Health Sciences, Toronto, Canada
| | - N D Anderson
- University of Toronto, Toronto, Canada.,Baycrest Health Sciences, Toronto, Canada
| |
Collapse
|
27
|
Curtin A, Ayaz H, Tang Y, Sun J, Wang J, Tong S. Enhancing neural efficiency of cognitive processing speed via training and neurostimulation: An fNIRS and TMS study. Neuroimage 2019; 198:73-82. [PMID: 31078636 DOI: 10.1016/j.neuroimage.2019.05.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 11/24/2022] Open
Abstract
Speed of Processing (SoP) represents a fundamental limiting step in cognitive performance which may underlie General Intelligence. The measure of SoP is particularly sensitive to aging, neurological or cognitive diseases, and has become a benchmark for diagnosis, cognitive remediation, and enhancement. Neural efficiency of the Dorsolateral Prefrontal Cortex (DLPFC) is proposed to account for individual differences in SoP. However, the mechanisms by which DLPFC efficiency is shaped by training and whether it can be enhanced remain elusive. To address this, we monitored the brain activity of sixteen healthy participants using functional Near Infrared Spectroscopy (fNIRS) while practicing a common SoP task (Symbol Digit Substitution Task) across 4 sessions. Furthermore, in each session, participants received counterbalanced excitatory repetitive transcranial magnetic stimulation (rTMS) during mid-session breaks. Results indicate a significant involvement of the left-DLPFC in SoP, whose neural efficiency is consistently increased through task practice. Active neurostimulation, but not Sham, significantly enhanced the neural efficiency. These findings suggest a common mechanism by which neurostimulation may aid to accelerate learning.
Collapse
Affiliation(s)
- Adrian Curtin
- Drexel University, School of Biomedical Engineering, Science and Health Systems, Philadelphia, PA, USA; Shanghai Jiao Tong University, School of Biomedical Engineering, Shanghai, China
| | - Hasan Ayaz
- Drexel University, School of Biomedical Engineering, Science and Health Systems, Philadelphia, PA, USA; University of Pennsylvania, Department of Family and Community Health, Philadelphia, PA, USA; Children's Hospital of Philadelphia, Center for Injury Research and Prevention, Philadelphia, PA, USA.
| | - Yingying Tang
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Junfeng Sun
- Shanghai Jiao Tong University, School of Biomedical Engineering, Shanghai, China
| | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Shanbao Tong
- Shanghai Jiao Tong University, School of Biomedical Engineering, Shanghai, China.
| |
Collapse
|
28
|
Nouchi R, Kobayashi A, Nouchi H, Kawashima R. Newly Developed TV-Based Cognitive Training Games Improve Car Driving Skills, Cognitive Functions, and Mood in Healthy Older Adults: Evidence From a Randomized Controlled Trial. Front Aging Neurosci 2019; 11:99. [PMID: 31133842 PMCID: PMC6513888 DOI: 10.3389/fnagi.2019.00099] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/10/2019] [Indexed: 01/26/2023] Open
Abstract
Background: Cognitive training in a laboratory improves car driving skills of older car drivers. However, it remains unclear whether other types of cognitive training at home have beneficial effects on driving skills. Using our developed cognitive training games that can be played on a television with a set-top box in a person's home, we investigated the effects of a 6-week cognitive training program on driving skills, which included on-road evaluation (primary outcome), and cognitive functions and emotional states (secondary outcome) in older people. Methods: In this double-blinded randomized control trial (RCT), 60 older licensed drivers were randomly assigned into one of the two groups: a cognitive training game for car driving (CTCD) group and an active control cognitive training game (ACT) group. Participants in the CTCD group played the CTCD (processing speed, dual attention, and speed prediction) for 20 min in five sessions per week for 6 weeks. Participants in the ACT group played the ACT (selecting the larger number; selecting a number from largest to smallest; play a game of rock, article, scissors) for 20 min in five sessions per week for 6 weeks. We measured driving skills, various cognitive functions, and emotional states before and after the 6-week intervention period. Results: Our main results showed that compared to the ACT group, the CTCD group demonstrated improved driving skills (adjusted p = 0.034). Moreover, the CTCD group demonstrated improved inhibition (stroop, adjusted p = 0.042: reverse Stroop, adjusted p = 0.043) and processing speed performance symbol search (SS), adjusted p = 0.049; digit symbol coding (adjusted p = 0.047), compared to the ACT group. The CTCD group scored higher on vigor-activity mood (adjusted p = 0.041) as measured using the Profile of Mood State. Discussion: This randomized controlled trial provides scientific evidence for the benefits of the 6-week CTCD program on driving skills and cognitive functions, such as processing speed, inhibition, and vigor-activity mood, in healthy older people. Our results suggest that cognitive training is useful to improve the driving skills of older adults. Trial registration: This trial was registered at The University Hospital Medical Information Network Clinical Trials Registry (UMIN 000029769). Registered 31 October 2017, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034010.
Collapse
Affiliation(s)
- Rui Nouchi
- Department of Cognitive Health Science, Institute of Development, Aging and Cancer (IDAC), Tohoku University, Sendai, Japan
- Smart Aging Research Center (S.A.R.C.), Tohoku University, Sendai, Japan
| | - Akiko Kobayashi
- Department of Functional Brain Imaging, Institute of Development, Aging and Cancer (IDAC), Tohoku University, Sendai, Japan
| | - Haruka Nouchi
- Department of Functional Brain Imaging, Institute of Development, Aging and Cancer (IDAC), Tohoku University, Sendai, Japan
| | - Ryuta Kawashima
- Smart Aging Research Center (S.A.R.C.), Tohoku University, Sendai, Japan
- Department of Functional Brain Imaging, Institute of Development, Aging and Cancer (IDAC), Tohoku University, Sendai, Japan
| |
Collapse
|
29
|
Gates NJ, Rutjes AWS, Di Nisio M, Karim S, Chong L, March E, Martínez G, Vernooij RWM. Computerised cognitive training for maintaining cognitive function in cognitively healthy people in late life. Cochrane Database Syst Rev 2019; 3:CD012277. [PMID: 30864187 PMCID: PMC6414816 DOI: 10.1002/14651858.cd012277.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Increasing age is associated with a natural decline in cognitive function and is also the greatest risk factor for dementia. Cognitive decline and dementia are significant threats to independence and quality of life in older adults. Therefore, identifying interventions that help to maintain cognitive function in older adults or to reduce the risk of dementia is a research priority. Cognitive training uses repeated practice on standardised exercises targeting one or more cognitive domains and is intended to maintain optimum cognitive function. This review examines the effect of computerised cognitive training interventions lasting at least 12 weeks on the cognitive function of healthy adults aged 65 or older. OBJECTIVES To evaluate the effects of computerised cognitive training interventions lasting at least 12 weeks for the maintenance or improvement of cognitive function in cognitively healthy people in late life. SEARCH METHODS We searched to 31 March 2018 in ALOIS (www.medicine.ox.ac.uk/alois) and performed additional searches of MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov, and the WHO Portal/ICTRP (www.apps.who.int/trialsearch) to ensure that the search was as comprehensive and as up-to-date as possible, to identify published, unpublished, and ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs, published or unpublished, reported in any language. Participants were cognitively healthy people, and at least 80% of the study population had to be aged 65 or older. Experimental interventions adhered to the following criteria: intervention was any form of interactive computerised cognitive intervention - including computer exercises, computer games, mobile devices, gaming console, and virtual reality - that involved repeated practice on standardised exercises of specified cognitive domain(s) for the purpose of enhancing cognitive function; duration of the intervention was at least 12 weeks; cognitive outcomes were measured; and cognitive training interventions were compared with active or inactive control interventions. DATA COLLECTION AND ANALYSIS We performed preliminary screening of search results using a 'crowdsourcing' method to identify RCTs. At least two review authors working independently screened the remaining citations against inclusion criteria. At least two review authors also independently extracted data and assessed the risk of bias of included RCTs. Where appropriate, we synthesised data in random-effect meta-analyses, comparing computerised cognitive training (CCT) separately with active and inactive controls. We expressed treatment effects as standardised mean differences (SMDs) with 95% confidence intervals (CIs). We used GRADE methods to describe the overall quality of the evidence for each outcome. MAIN RESULTS We identified eight RCTs with a total of 1183 participants. Researchers provided interventions over 12 to 26 weeks; in five trials, the duration of intervention was 12 or 13 weeks. The included studies had a moderate risk of bias. Review authors noted a lot of inconsistency between trial results. The overall quality of evidence was low or very low for all outcomes.We compared CCT first against active control interventions, such as watching educational videos. Because of the very low quality of the evidence, we were unable to determine any effect of CCT on our primary outcome of global cognitive function or on secondary outcomes of episodic memory, speed of processing, executive function, and working memory.We also compared CCT versus inactive control (no interventions). Negative SMDs favour CCT over control. We found no studies on our primary outcome of global cognitive function. In terms of our secondary outcomes, trial results suggest slight improvement in episodic memory (mean difference (MD) -0.90, 95% confidence interval (CI) -1.73 to -0.07; 150 participants; 1 study; low-quality evidence) and no effect on executive function (SMD -0.08, 95% CI -0.31 to 0.15; 292 participants; 2 studies; low-quality evidence), working memory (MD -0.08, 95% CI -0.43 to 0.27; 60 participants; 1 study; low-quality evidence), or verbal fluency (MD -0.11, 95% CI -1.58 to 1.36; 150 participants; 1 study; low-quality evidence). We could not determine any effects on speed of processing at trial endpoints because the evidence was of very low quality.We found no evidence on quality of life, activities of daily living, or adverse effects in either comparison. AUTHORS' CONCLUSIONS We found little evidence from the included studies to suggest that 12 or more weeks of CCT improves cognition in healthy older adults. However, our limited confidence in the results reflects the overall quality of the evidence. Inconsistency between trials was a major limitation. In five of the eight trials, the duration of intervention was just three months. The possibility that longer periods of training could be beneficial remains to be more fully explored.
Collapse
Affiliation(s)
- Nicola J Gates
- University of New South WalesCentre for Healthy Brain Ageing (CHeBA)Suite 407 185 Elizabeth StreetSydneyNSWAustralia2000
| | - Anne WS Rutjes
- University of BernInstitute of Social and Preventive Medicine (ISPM)Mittelstrasse 43BernBernSwitzerland3012
- University of BernInstitute of Primary Health Care (BIHAM)Mittelstrasse 43BernBernSwitzerland3012
| | - Marcello Di Nisio
- University "G. D'Annunzio" of Chieti‐PescaraDepartment of Medicine and Ageing SciencesVia dei Vestini 31Chieti ScaloItaly66013
| | - Salman Karim
- Lancashire Care NHS Foundation TrustPsychiatrySceptre Point, Sceptre WayPrestonUKPR5 6AW
| | | | - Evrim March
- St Vincent's Hospital (Melbourne)St Vincent's Adult Mental Health46 Nicholson StreetFitzroyVICAustralia3065
| | - Gabriel Martínez
- Universidad de AntofagastaFaculty of Medicine and DentistryAvenida Argentina 2000AntofagastaChile127001
| | - Robin WM Vernooij
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167BarcelonaBarcelonaSpain08025
| | | |
Collapse
|
30
|
Gates NJ, Rutjes AWS, Di Nisio M, Karim S, Chong L, March E, Martínez G, Vernooij RWM. Computerised cognitive training for maintaining cognitive function in cognitively healthy people in midlife. Cochrane Database Syst Rev 2019; 3:CD012278. [PMID: 30864746 PMCID: PMC6415131 DOI: 10.1002/14651858.cd012278.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Normal aging is associated with changes in cognitive function that are non-pathological and are not necessarily indicative of future neurocognitive disease. Low cognitive and brain reserve and limited cognitive stimulation are associated with increased risk of dementia. Emerging evidence now suggests that subtle cognitive changes, detectable years before criteria for mild cognitive impairment are met, may be predictive of future dementia. Important for intervention and reduction in disease risk, research also suggests that engaging in stimulating mental activity throughout adulthood builds cognitive and brain reserve and reduces dementia risk. Therefore, midlife (defined here as 40 to 65 years) may be a suitable time to introduce cognitive interventions for maintaining cognitive function and, in the longer term, possibly preventing or delaying the onset of clinical dementia. OBJECTIVES To evaluate the effects of computerised cognitive training interventions lasting at least 12 weeks for maintaining or improving cognitive function in cognitively healthy people in midlife. SEARCH METHODS We searched up to 31 March 2018 in ALOIS (www.medicine.ox.ac.uk/alois), the specialised register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG). We ran additional searches in MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov, and the WHO Portal/ICTRP at www.apps.who.int/trialsearch, to ensure that the search was as comprehensive and as up-to-date as possible, to identify published, unpublished, and ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs, published or unpublished, reported in any language. Participants were cognitively healthy people between 40 and 65 years of age (80% of study population within this age range). Experimental interventions adhered to the following criteria: intervention was any form of interactive computerised cognitive intervention - including computer exercises, computer games, mobile devices, gaming console, and virtual reality - that involved repeated practice on standardised exercises of specified cognitive domain(s) for the purpose of enhancing cognitive function; duration of the intervention was at least 12 weeks; cognitive outcomes were measured; and cognitive training interventions were compared with active or inactive control interventions. DATA COLLECTION AND ANALYSIS For preliminary screening of search results, we used a 'crowd' method to identify RCTs. At least two review authors working independently screened remaining citations against inclusion criteria; independently extracted data; and assessed the quality of the included trial, using the Cochrane risk of bias assessment tool. We used GRADE to describe the overall quality of the evidence. MAIN RESULTS We identified one eligible study that examined the effect of computerised cognitive training (CCT) in 6742 participants over 50 years of age, with training and follow-up duration of six months. We considered the study to be at high risk of attrition bias and the overall quality of the evidence to be low.Researchers provided no data on our primary outcome. Results indicate that there may be a small advantage for the CCT group for executive function (mean difference (MD) -1.57, 95% confidence interval (CI) -1.85 to -1.29; participants = 3994; low-quality evidence) and a very small advantage for the control group for working memory (MD 0.09, 95% CI 0.03 to 0.15; participants = 5831; low-quality evidence). The intervention may have had little or no effect on episodic memory (MD -0.03, 95% CI -0.10 to 0.04; participants = 3090; low-quality evidence). AUTHORS' CONCLUSIONS We found low-quality evidence from only one study. We are unable to determine whether computerised cognitive training is effective in maintaining global cognitive function among healthy adults in midlife. We strongly recommend that high-quality studies be undertaken to investigate the effectiveness and acceptability of cognitive training in midlife, using interventions that last long enough that they may have enduring effects on cognitive and brain reserve, and with investigators following up long enough to assess effects on clinically important outcomes in later life.
Collapse
Affiliation(s)
- Nicola J Gates
- University of New South WalesCentre for Healthy Brain Ageing (CHeBA)Suite 407 185 Elizabeth StreetSydneyAustralia2000
| | | | - Marcello Di Nisio
- University "G. D'Annunzio" of Chieti‐PescaraDepartment of Medicine and Ageing SciencesVia dei Vestini 31Chieti ScaloItaly66013
| | - Salman Karim
- Lancashire Care NHS Foundation TrustPsychiatrySceptre Point, Sceptre WayPrestonUKPR5 6AW
| | | | - Evrim March
- St Vincent's Hospital (Melbourne)St Vincent's Adult Mental Health46 Nicholson StreetFitzroyAustralia3065
| | - Gabriel Martínez
- Universidad de AntofagastaFaculty of Medicine and DentistryAvenida Argentina 2000AntofagastaChile127001
| | - Robin WM Vernooij
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167BarcelonaSpain08025
| |
Collapse
|
31
|
Gates NJ, Vernooij RWM, Di Nisio M, Karim S, March E, Martínez G, Rutjes AWS. Computerised cognitive training for preventing dementia in people with mild cognitive impairment. Cochrane Database Syst Rev 2019; 3:CD012279. [PMID: 30864747 PMCID: PMC6415132 DOI: 10.1002/14651858.cd012279.pub2] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The number of people living with dementia is increasing rapidly. Clinical dementia does not develop suddenly, but rather is preceded by a period of cognitive decline beyond normal age-related change. People at this intermediate stage between normal cognitive function and clinical dementia are often described as having mild cognitive impairment (MCI). Considerable research and clinical efforts have been directed toward finding disease-modifying interventions that may prevent or delay progression from MCI to clinical dementia. OBJECTIVES To evaluate the effects of at least 12 weeks of computerised cognitive training (CCT) on maintaining or improving cognitive function and preventing dementia in people with mild cognitive impairment. SEARCH METHODS We searched to 31 May 2018 in ALOIS (www.medicine.ox.ac.uk/alois) and ran additional searches in MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov, and the WHO portal/ICTRP (www.apps.who.int/trialsearch) to identify published, unpublished, and ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs in which cognitive training via interactive computerised technology was compared with an active or inactive control intervention. Experimental computerised cognitive training (CCT) interventions had to adhere to the following criteria: minimum intervention duration of 12 weeks; any form of interactive computerised cognitive training, including computer exercises, computer games, mobile devices, gaming console, and virtual reality. Participants were adults with a diagnosis of mild cognitive impairment (MCI) or mild neurocognitive disorder (MND), or otherwise at high risk of cognitive decline. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias of the included RCTs. We expressed treatment effects as mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes and as risk ratios (RRs) for dichotomous outcomes. We used the GRADE approach to describe the overall quality of evidence for each outcome. MAIN RESULTS Eight RCTs with a total of 660 participants met review inclusion criteria. Duration of the included trials varied from 12 weeks to 18 months. Only one trial used an inactive control. Most studies were at unclear or high risk of bias in several domains. Overall, our ability to draw conclusions was hampered by very low-quality evidence. Almost all results were very imprecise; there were also problems related to risk of bias, inconsistency between trials, and indirectness of the evidence.No trial provided data on incident dementia. For comparisons of CCT with both active and inactive controls, the quality of evidence on our other primary outcome of global cognitive function immediately after the intervention period was very low. Therefore, we were unable to draw any conclusions about this outcome.Due to very low quality of evidence, we were also unable to determine whether there was any effect of CCT compared to active control on our secondary outcomes of episodic memory, working memory, executive function, depression, functional performance, and mortality. We found low-quality evidence suggesting that there is probably no effect on speed of processing (SMD 0.20, 95% confidence interval (CI) -0.16 to 0.56; 2 studies; 119 participants), verbal fluency (SMD -0.16, 95% CI -0.76 to 0.44; 3 studies; 150 participants), or quality of life (mean difference (MD) 0.40, 95% CI -1.85 to 2.65; 1 study; 19 participants).When CCT was compared with inactive control, we obtained data on five secondary outcomes, including episodic memory, executive function, verbal fluency, depression, and functional performance. We found very low-quality evidence; therefore, we were unable to draw any conclusions about these outcomes. AUTHORS' CONCLUSIONS Currently available evidence does not allow us to determine whether or not computerised cognitive training will prevent clinical dementia or improve or maintain cognitive function in those who already have evidence of cognitive impairment. Small numbers of trials, small samples, risk of bias, inconsistency between trials, and highly imprecise results mean that it is not possible to derive any implications for clinical practice, despite some observed large effect sizes from individual studies. Direct adverse events are unlikely to occur, although the time and sometimes the money involved in computerised cognitive training programmes may represent significant burdens. Further research is necessary and should concentrate on improving methodological rigour, selecting suitable outcomes measures, and assessing generalisability and persistence of any effects. Trials with long-term follow-up are needed to determine the potential of this intervention to reduce the risk of dementia.
Collapse
Affiliation(s)
- Nicola J Gates
- University of New South WalesCentre for Healthy Brain Ageing (CHeBA)Suite 407 185 Elizabeth StreetSydneyAustralia2000
| | - Robin WM Vernooij
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167BarcelonaSpain08025
| | - Marcello Di Nisio
- University "G. D'Annunzio" of Chieti‐PescaraDepartment of Medicine and Ageing SciencesVia dei Vestini 31Chieti ScaloItaly66013
| | - Salman Karim
- Lancashire Care NHS Foundation TrustPsychiatrySceptre Point, Sceptre WayPrestonUKPR5 6AW
| | - Evrim March
- St Vincent's Hospital (Melbourne)St Vincent's Adult Mental Health46 Nicholson StreetFitzroyAustralia3065
| | - Gabriel Martínez
- Universidad de AntofagastaFaculty of Medicine and DentistryAvenida Argentina 2000AntofagastaChile127001
| | | |
Collapse
|
32
|
Hsu HC, Kuo T, Lin JP, Hsu WC, Yu CW, Chen YC, Xie WZ, Hsu WC, Hsu YL, Yu MT. A Cross-Disciplinary Successful Aging Intervention and Evaluation: Comparison of Person-to-Person and Digital-Assisted Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E913. [PMID: 29734674 PMCID: PMC5981952 DOI: 10.3390/ijerph15050913] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 04/29/2018] [Accepted: 05/02/2018] [Indexed: 01/23/2023]
Abstract
Background: Successful aging has been the paradigm of old-age life. The purpose of this study was to implement and evaluate a cross-disciplinary intervention program using two approaches for community-based older adults in Taichung, Taiwan. Methods: The content of the intervention included successful aging concepts and preparation, physical activity, chronic disease and health management, dietary and nutrition information, cognitive training, emotional awareness and coping skills, family relationship and resilience, legal concepts regarding financial protection, and Internet use. The traditional person-to-person (P2P) intervention approach was implemented among participants at urban centers, and the personal-and-digital (P&D) intervention approach was implemented among participants at rural centers; before the P&D group received the intervention, participants were assessed as the control group for comparison. Results: Healthy behavior and nutrition improved for the P2P group, although not significantly. Strategies for adapting to old age and reducing ineffective coping were significantly improved in the P2P group. The ability to search for health information improved in the P&D group, and knowledge of finance-related law increased in the P2P group. Conclusion: A continuous, well-designed and evidence-based intervention program is beneficial for improving the health of older adults, or at least delaying its decline.
Collapse
Affiliation(s)
- Hui-Chuan Hsu
- Department of Health Care Administration, Asia University, Taichung 41354, Taiwan.
| | - Tsuann Kuo
- Department of Medical Sociology and Social Work, Chung Shang Medical University, Taichung 40201, Taiwan.
| | - Ju-Ping Lin
- Department of Human Development and Family Studies, National Taiwan Normal University, Taipei 10610, Taiwan.
| | - Wei-Chung Hsu
- Department of Radiation Oncology, Chung-Kang Branch, Cheng-Ching General Hospital, Taichung 40764, Taiwan.
| | - Chia-Wen Yu
- Department of Human Development and Family Studies, National Taiwan Normal University, Taipei 10610, Taiwan.
| | - Yen-Cheng Chen
- Department of Health Care Administration, Asia University, Taichung 41354, Taiwan.
| | - Wan-Zhen Xie
- Department of Health Care Administration, Asia University, Taichung 41354, Taiwan.
| | - Wei-Chiang Hsu
- Department of Health Care Administration, Asia University, Taichung 41354, Taiwan.
| | - Ya-Lan Hsu
- Department of Health Care Administration, Asia University, Taichung 41354, Taiwan.
| | - Mu-Ting Yu
- Department of Health Care Administration, Asia University, Taichung 41354, Taiwan.
| |
Collapse
|
33
|
Neural Correlates of Selective Attention With Hearing Aid Use Followed by ReadMyQuips Auditory Training Program. Ear Hear 2018; 38:28-41. [PMID: 27556531 DOI: 10.1097/aud.0000000000000348] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this study were to investigate the effects of hearing aid use and the effectiveness of ReadMyQuips (RMQ), an auditory training program, on speech perception performance and auditory selective attention using electrophysiological measures. RMQ is an audiovisual training program designed to improve speech perception in everyday noisy listening environments. DESIGN Participants were adults with mild to moderate hearing loss who were first-time hearing aid users. After 4 weeks of hearing aid use, the experimental group completed RMQ training in 4 weeks, and the control group received listening practice on audiobooks during the same period. Cortical late event-related potentials (ERPs) and the Hearing in Noise Test (HINT) were administered at prefitting, pretraining, and post-training to assess effects of hearing aid use and RMQ training. An oddball paradigm allowed tracking of changes in P3a and P3b ERPs to distractors and targets, respectively. Behavioral measures were also obtained while ERPs were recorded from participants. RESULTS After 4 weeks of hearing aid use but before auditory training, HINT results did not show a statistically significant change, but there was a significant P3a reduction. This reduction in P3a was correlated with improvement in d prime (d') in the selective attention task. Increased P3b amplitudes were also correlated with improvement in d' in the selective attention task. After training, this correlation between P3b and d' remained in the experimental group, but not in the control group. Similarly, HINT testing showed improved speech perception post training only in the experimental group. The criterion calculated in the auditory selective attention task showed a reduction only in the experimental group after training. ERP measures in the auditory selective attention task did not show any changes related to training. CONCLUSIONS Hearing aid use was associated with a decrement in involuntary attention switch to distractors in the auditory selective attention task. RMQ training led to gains in speech perception in noise and improved listener confidence in the auditory selective attention task.
Collapse
|
34
|
Gross AL, Payne BR, Casanova R, Davoudzadeh P, Dzierzewski JM, Farias S, Giovannetti T, Ip EH, Marsiske M, Rebok GW, Schaie KW, Thomas K, Willis S, Jones RN. The ACTIVE conceptual framework as a structural equation model. Exp Aging Res 2018; 44:1-17. [PMID: 29303475 PMCID: PMC5793899 DOI: 10.1080/0361073x.2017.1398802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background/Study Context: Conceptual frameworks are analytic models at a high level of abstraction. Their operationalization can inform randomized trial design and sample size considerations. METHODS The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) conceptual framework was empirically tested using structural equation modeling (N=2,802). ACTIVE was guided by a conceptual framework for cognitive training in which proximal cognitive abilities (memory, inductive reasoning, speed of processing) mediate treatment-related improvement in primary outcomes (everyday problem-solving, difficulty with activities of daily living, everyday speed, driving difficulty), which in turn lead to improved secondary outcomes (health-related quality of life, health service utilization, mobility). Measurement models for each proximal, primary, and secondary outcome were developed and tested using baseline data. Each construct was then combined in one model to evaluate fit (RMSEA, CFI, normalized residuals of each indicator). To expand the conceptual model and potentially inform future trials, evidence of modification of structural model parameters was evaluated by age, years of education, sex, race, and self-rated health status. RESULTS Preconceived measurement models for memory, reasoning, speed of processing, everyday problem-solving, instrumental activities of daily living (IADL) difficulty, everyday speed, driving difficulty, and health-related quality of life each fit well to the data (all RMSEA < .05; all CFI > .95). Fit of the full model was excellent (RMSEA = .038; CFI = .924). In contrast with previous findings from ACTIVE regarding who benefits from training, interaction testing revealed associations between proximal abilities and primary outcomes are stronger on average by nonwhite race, worse health, older age, and less education (p < .005). CONCLUSIONS Empirical data confirm the hypothesized ACTIVE conceptual model. Findings suggest that the types of people who show intervention effects on cognitive performance potentially may be different from those with the greatest chance of transfer to real-world activities.
Collapse
Affiliation(s)
- Alden L. Gross
- Departments of Epidemiology, Johns Hopkins Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Departments of Mental Health, Johns Hopkins Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brennan R. Payne
- Department of Psychology and The Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana-Champaign, Illinois, USA
| | - Ramon Casanova
- Departments of Biostatistical Sciences, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
- Departments of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Pega Davoudzadeh
- Department of Psychology, University of California, Davis, California, USA
| | | | - Sarah Farias
- Department of Neurology, University of California, Davis Medical Center, Sacramento, California, USA
| | - Tania Giovannetti
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Edward H. Ip
- Departments of Biostatistical Sciences, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
- Departments of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - George W. Rebok
- Departments of Mental Health, Johns Hopkins Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - K. Warner Schaie
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA; Department of Radiology, Integrated Brain Imaging Center (IBIC), University of Washington, Seattle, WA
| | - Kelsey Thomas
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Sherry Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA; Department of Radiology, Integrated Brain Imaging Center (IBIC), University of Washington, Seattle, WA
| | - Richard N. Jones
- Departments of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Departments of Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| |
Collapse
|
35
|
Edwards JD, Fausto BA, Tetlow AM, Corona RT, Valdés EG. Systematic review and meta-analyses of useful field of view cognitive training. Neurosci Biobehav Rev 2018; 84:72-91. [DOI: 10.1016/j.neubiorev.2017.11.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 12/30/2022]
|
36
|
Speed of processing training in middle-aged and older breast cancer survivors (SOAR): results of a randomized controlled pilot. Breast Cancer Res Treat 2017; 168:259-267. [PMID: 29128897 PMCID: PMC5823754 DOI: 10.1007/s10549-017-4564-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/01/2017] [Indexed: 10/29/2022]
Abstract
PURPOSE Cognitive changes are common among breast cancer survivors. There is limited evidence to guide management of cognitive changes. This randomized controlled pilot evaluated the preliminary efficacy of a speed of processing (SOP) training among middle-aged and older breast cancer survivors. METHODS Sixty breast cancer survivors with self-reported cognitive changes were recruited to the SOAR study. Participants were randomized to either a home-based SOP training (n = 30) or no-contact control group (n = 30). Primary outcomes were SOP (Useful Field of View Test®), and executive function (NIH Toolbox Cognition Battery). Neuropsychological assessments were completed at baseline, 6 weeks, and 6 months post study entry. Data were analyzed using repeated measures t tests, analysis of covariance, and sensitivity analyses. RESULTS SOP training resulted in improvement in objective measures of SOP and executive function. Immediate (6 week) posttest and 6-month follow-up demonstrated large SOP training effects over time. Large representation of African American women (51.2%) and 96% retention in the SOAR study add to study strengths. CONCLUSION Home-based SOP training shows promise for remediating cognitive changes following breast cancer treatment, particularly improved SOP, and executive function.
Collapse
|
37
|
Edwards JD, Xu H, Clark DO, Guey LT, Ross LA, Unverzagt FW. Speed of processing training results in lower risk of dementia. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2017; 3:603-611. [PMID: 29201994 PMCID: PMC5700828 DOI: 10.1016/j.trci.2017.09.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Cognitive training improves cognitive performance and delays functional impairment, but its effects on dementia are not known. We examined whether three different types of cognitive training lowered the risk of dementia across 10 years of follow-up relative to control and if greater number of training sessions attended was associated with lower dementia risk. METHODS The Advanced Cognitive Training in Vital Elderly (NCT00298558) study was a randomized controlled trial (N = 2802) among initially healthy older adults, which examined the efficacy of three cognitive training programs (memory, reasoning, or speed of processing) relative to a no-contact control condition. Up to 10 training sessions were delivered over 6 weeks with up to four sessions of booster training delivered at 11 months and a second set of up to four booster sessions at 35 months. Outcome assessments were taken immediately after intervention and at intervals over 10 years. Dementia was defined using a combination of interview- and performance-based methods. RESULTS A total of 260 cases of dementia were identified during the follow-up. Speed training resulted in reduced risk of dementia (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.50-0.998, P = .049) compared to control, but memory and reasoning training did not (HR 0.79, 95% CI 0.57-1.11, P = .177 and HR 0.79, 95% CI 0.56-1.10, P = .163, respectively). Each additional speed training session was associated with a 10% lower hazard for dementia (unadjusted HR, 0.90; 95% CI, 0.85-0.95, P < .001). DISCUSSION Initially, healthy older adults randomized to speed of processing cognitive training had a 29% reduction in their risk of dementia after 10 years of follow-up compared to the untreated control group.
Collapse
Affiliation(s)
- Jerri D. Edwards
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | - Huiping Xu
- Department of Biostatistics, The Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Daniel O. Clark
- Department of Medicine, Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA
| | | | - Lesley A. Ross
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | | |
Collapse
|
38
|
Eramudugolla R, Kiely KM, Chopra S, Anstey KJ. Effect of Speed of Processing Training on Older Driver Screening Measures. Front Aging Neurosci 2017; 9:338. [PMID: 29089888 PMCID: PMC5651014 DOI: 10.3389/fnagi.2017.00338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 10/03/2017] [Indexed: 11/23/2022] Open
Abstract
Objective: Computerized training for cognitive enhancement is of great public interest, however, there is inconsistent evidence for the transfer of training gains to every day activity. Several large trials have focused on speed of processing (SOP) training with some promising findings for long-term effects on daily activity, but no immediate transfer to other cognitive tests. Here, we examine the transfer of SOP training gains to cognitive measures that are known predictors of driving safety in older adults. Methods: Fifty-three adults aged 65-87 years who were current drivers participated in a two group non-randomized design with repeated measures and a no-contact matched control group. The Intervention group completed an average of 7.9 (SD = 3.0) hours of self-administered online SOP training at home. Control group was matched on age, gender and test-re-test interval. Measures included the Useful Field of View (UFOV) test, a Hazard Perception test, choice reaction time (Cars RT), Trail Making Test B, a Maze test, visual motion threshold, as well as road craft and road knowledge tests. Results: Speed of processing training resulted in significant improvement in processing speed on the UFOV test relative to controls, with an average change of -45.8 ms (SE = 14.5), and effect size of ω2 = 0.21. Performance on the Maze test also improved, but significant slowing on the Hazard Perception test was observed after SOP training. Training effects on the UFOV task was associated with similar effects on the Cars RT, but not the Hazard Perception and Maze tests, suggesting transfer to some but not all driving related measures. There were no effects of training on any of the other measures examined. Conclusion: Speed of processing training effects on the UFOV task can be achieved with self-administered, online training at home, with some transfer to other cognitive tests. However, differential effects of training may be observed for tasks requiring goal-directed search strategies rather than diffuse attention.
Collapse
Affiliation(s)
- Ranmalee Eramudugolla
- Centre for Research on Ageing Health and Wellbeing, Australian National University, Canberra, ACT, Australia
| | | | | | - Kaarin J. Anstey
- Centre for Research on Ageing Health and Wellbeing, Australian National University, Canberra, ACT, Australia
| |
Collapse
|
39
|
Ross LA, Freed SA, Edwards JD, Phillips CB, Ball K. The Impact of Three Cognitive Training Programs on Driving Cessation Across 10 Years: A Randomized Controlled Trial. THE GERONTOLOGIST 2017; 57:838-846. [PMID: 28329859 PMCID: PMC5881723 DOI: 10.1093/geront/gnw143] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/27/2016] [Indexed: 11/12/2022] Open
Abstract
Purpose of the Study Driving is important for older adults' health and well-being, yet little research has examined interventions to maintain driving mobility. As fluid cognitive abilities are strongly linked to driving, targeted cognitive training interventions may impact driving mobility longitudinally. This study assessed the effects of three different cognitive training programs (reasoning, speed of processing, and memory) on driving cessation in older adults across 10 years (n = 2,390). Design and Methods Cox regression analyses evaluated the impact of each program relative to a no-contact control group with intent-to-treat (ITT) analyses. The effects of randomization to additional booster sessions were also examined. Subsample analyses repeated these models in participants who were at-risk for driving mobility declines. Results There were no training (n = 2,390) or booster training (n = 1,540) effects on driving cessation with ITT analyses. Individuals at-risk for future mobility declines were 49% (Hazard Ratio (HR) = 0.51, 95% confidence interval [CI]: 0.28, 0.94; n = 336) less likely to cease driving after speed of processing training and 55% (HR = 0.45, 95% CI: 0.24, 0.86; n = 324) less likely to quit driving subsequent to reasoning training. Additional booster sessions for speed of processing training resulted in a 70% reduction of driving cessation (HR = 0.30, 95% CI: 0.11, 0.82; n = 252) in the subsample analyses. There were no significant effects of memory training. Implications Some cognitive interventions transfer to maintained driving among those at-risk for mobility declines due to cognitive impairment. Future research should identify moderators and mediators of training and transfer effects.
Collapse
Affiliation(s)
- Lesley A Ross
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park
| | - Sara A Freed
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park
| | - Jerri D Edwards
- School of Aging Studies, University of South Florida, Tampa, Florida
| | - Christine B Phillips
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park
| | - Karlene Ball
- Department of Psychology, University of Alabama at Birmingham
| |
Collapse
|
40
|
Valdés EG, O’Connor ML, Uc EY, Hauser RA, Andel R, Edwards JD. Use, maintenance and dose effects of cognitive speed of processing training in Parkinson's disease. Int J Neurosci 2017; 127:841-848. [PMID: 27919204 PMCID: PMC8284743 DOI: 10.1080/00207454.2016.1269088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Recent research indicated that cognitive speed of processing training (SPT) improved Useful Field of View (UFOV) among individuals with Parkinson's disease (PD). The effects of SPT in PD have not been further examined. The objectives of the current study were to investigate use, maintenance and dose effects of SPT among individuals with PD. METHODS Participants who were randomized to SPT or a delayed control group completed the UFOV at a six-month follow-up visit. Use of SPT was monitored across the six-month study period. Regression explored factors affecting SPT use. Mixed effect models were conducted to examine the durability of training gains among those randomized to SPT (n = 44), and training dose effects among the entire sample (n = 87). RESULTS The majority of participants chose to continue to use SPT (52%). Those randomized to SPT maintained improvements in UFOV performance. A significant dose effect of SPT was evident such that more hours of training were associated with greater UFOV performance improvements. The cognitive benefits derived from SPT in PD may be maintained for up to three months. CONCLUSION Future research should determine how long gains endure and explore if such training gains transfer.
Collapse
Affiliation(s)
- Elise G. Valdés
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Melissa L. O’Connor
- Department of Human Development and Family Science, North Dakota State University, Fargo, ND, USA
| | - Ergun Y. Uc
- Department of Neurology, University of Iowa, Iowa City, IA, USA
- Neurology Service, Veterans Affairs Medical Center, Iowa City, IA, USA
| | - Robert A. Hauser
- Department of Neurology, University of South Florida, Tampa, FL, USA
| | - Ross Andel
- School of Aging Studies, University of South Florida, Tampa, FL, USA
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic
| | - Jerri D. Edwards
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| |
Collapse
|
41
|
Cognitive behavioral therapy (CBT) for preventing Alzheimer's disease. Behav Brain Res 2017; 334:163-177. [PMID: 28743599 DOI: 10.1016/j.bbr.2017.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/15/2017] [Accepted: 07/18/2017] [Indexed: 12/13/2022]
Abstract
This review provides the rationale for implementing cognitive behavioral therapy (CBT) for the prevention of Alzheimer's disease (AD). There are known risk factors associated with the development of AD, some of which may be ameliorated with CBT. We posit that treating the risk factors of inactivity, poor diet, hyposmia and anosmia, sleep disorders and lack of regularly engaged challenging cognitive activity will modify the physiology of the brain sufficiently to avoid the accumulation of excess proteins, including amyloid beta, causal events in the development of AD. Further, the successful treatment of the listed risk factors is well within our technology to do so and, even further, it is cost effective. Also, there is considerable scientific literature to support the proposition that, if implemented by well-established practices, CBT will be effective and will be engaged by those of retirement age. That is, we present a biologically informed CBT for the prevention of the development of AD, i.e., an aspect of applied behavioral neuroscience.
Collapse
|
42
|
Intradialytic Cognitive and Exercise Training May Preserve Cognitive Function. Kidney Int Rep 2017; 3:81-88. [PMID: 29340317 PMCID: PMC5762950 DOI: 10.1016/j.ekir.2017.08.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/12/2017] [Accepted: 08/14/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction Cognitive decline is common and increases mortality risk in hemodialysis patients. Intradialytic interventions like cognitive training (CT) and exercise training (ET) may preserve cognitive function. Methods We conducted a pilot randomized controlled trial of 20 hemodialysis patients to study the impact of 3 months of intradialytic CT (tablet-based brain games) (n = 7), ET (foot peddlers) (n = 6), or standard of care (SC) (n = 7) on cognitive function. Global cognitive function was measured by the Modified Mini Mental Status Exam (3MS), psychomotor speed was measured by Trail Making Tests A and B (TMTA and TMTB), and executive function was assessed by subtracting (TMTB − TMTA). Lower 3MS scores and slower TMTA and TMTB times reflected worse cognitive function. P values for differences were generated using analysis of variance, and 95% confidence intervals (CIs) and P values were generated from linear regression. Results Patients with SC experienced a decrease in psychomotor speed and executive function by 3 months (TMTA: 15 seconds; P = 0.055; TMTB: 47.4 seconds; P = 0.006; TMTB − TMTA; 31.7 seconds; P = 0.052); this decline was not seen among those with CT or ET (all P > 0.05). Compared with SC, the difference in the mean change in 3MS score was −3.29 points (95% CI: −11.70 to 5.12; P = 0.42) for CT and 4.48 points (95% CI: −4.27 to 13.22; P = 0.30) for ET. Compared with SC, the difference in mean change for TMTA was −15.13 seconds (95% CI: −37.64 to 7.39; P = 0.17) for CT and −17.48 seconds (95% CI: −41.18 to 6.22; P = 0.14) for ET, for TMTB, the difference was −46.72 seconds (95% CI: −91.12 to −2.31; P = 0.04) for CT and −56.21 seconds (95% CI: −105.86 to −6.56; P = 0.03) for ET, and for TMTB – TMTA, the difference was −30.88 seconds (95% CI: −76.05 to 14.28; P = 0.16) for CT and −34.93 seconds (95% CI: −85.43 to 15.56; P = 0.16) for ET. Conclusion Preliminary findings of our pilot study suggested that cognitive decline in psychomotor speed and executive function is possibly prevented by intradialytic CT and ET. These preliminary pilot findings should be replicated.
Collapse
|
43
|
Vance D, Fazeli P, Shacka J, Nicholson W, McKie P, Raper J, Azuero A, Wadley V, Ball K. Testing a Computerized Cognitive Training Protocol in Adults Aging With HIV-Associated Neurocognitive Disorders: Randomized Controlled Trial Rationale and Protocol. JMIR Res Protoc 2017; 6:e68. [PMID: 28446421 PMCID: PMC5422019 DOI: 10.2196/resprot.6625] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/20/2016] [Accepted: 10/22/2016] [Indexed: 12/26/2022] Open
Abstract
Background HIV-associated neurocognitive disorders occur in nearly 50% of adults with HIV. Such disorders can interfere with everyday functioning such as driving and medication adherence. Therefore, cognitive interventions are needed to address such neurocognitive disorders as well as improve everyday functioning, especially as people age with HIV. Objective This article reports and discusses the overall rationale and development of speed of processing training, a computerized Internet cognitive training program, to improve this specific neurocognitive ability as well as everyday functioning and quality of life in adults aging with HIV. Although this protocol has been shown to improve speed of processing, everyday functioning, and quality of life in healthy, community-dwelling older adults in the advanced cognitive training in vital elderly (ACTIVE) study, its efficacy in adults aging with HIV has not been established. Nevertheless, such a cognitive intervention is particularly germane as 52%-59% of adults with HIV experience HIV-associated neurocognitive disorders (HAND), and both the frequency and severity of such disorders may increase with advancing age. Methods The description of this longitudinal randomized controlled trial covers the following: (1) rationale for speed of processing training in this clinical population, (2) overview of overall study design, (3) eligibility criteria and HAND, (4) intervention dosage, (5) assessment battery, and (6) examination of biomarkers. Results The project was funded in April 2016 and enrolment is on-going. The first results are expected to be submitted for publication in 2020. Conclusions Similar novel cognitive intervention approaches are suggested as they may be of value to those with HAND and may utilize similar features of this current randomized controlled trial (RCT) protocol to examine their therapeutic efficacy. Trial Registration ClinicalTrials.gov NCT02758093; https://clinicaltrials.gov/ct2/show/NCT02758093 (Archived by Webcite at http://www.webcitation.org/6p8C5fBCX)
Collapse
Affiliation(s)
- David Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Pariya Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - John Shacka
- Department of Pharmacology & Toxicology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - William Nicholson
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Peggy McKie
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James Raper
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Virginia Wadley
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Karlene Ball
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| |
Collapse
|
44
|
Shah TM, Weinborn M, Verdile G, Sohrabi HR, Martins RN. Enhancing Cognitive Functioning in Healthly Older Adults: a Systematic Review of the Clinical Significance of Commercially Available Computerized Cognitive Training in Preventing Cognitive Decline. Neuropsychol Rev 2017; 27:62-80. [PMID: 28092015 DOI: 10.1007/s11065-016-9338-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/07/2016] [Indexed: 02/01/2023]
Abstract
Successfully assisting older adults to maintain or improve cognitive function, particularly when they are dealing with neurodegenerative disorders such as Alzheimer's disease (AD), remains a major challenge. Cognitive training may stimulate neuroplasticity thereby increasing cognitive and brain reserve. Commercial brain training programs are computerized, readily-available, easy-to-administer and adaptive but often lack supportive data and their clinical validation literature has not been previously reviewed. Therefore, in this review, we report the characteristics of commercially available brain training programs, critically assess the number and quality of studies evaluating the empirical evidence of these programs for promoting brain health in healthy older adults, and discuss underlying causal mechanisms. We searched PubMed, Google Scholar and each program's website for relevant studies reporting the effects of computerized cognitive training on cognitively healthy older adults. The evidence for each program was assessed via the number and quality (PEDro score) of studies, including Randomized Control Trials (RCTs). Programs with clinical studies were subsequently classified as possessing Level I, II or III evidence. Out of 18 identified programs, 7 programs were investigated in 26 studies including follow-ups. Two programs were identified as possessing Level I evidence, three programs demonstrated Level II evidence and an additional two programs demonstrated Level III evidence. Overall, studies showed generally high methodological quality (average PEDro score = 7.05). Although caution must be taken regarding any potential bias due to selective reporting, current evidence supports that at least some commercially available computerized brain training products can assist in promoting healthy brain aging.
Collapse
Affiliation(s)
- Tejal M Shah
- McCusker Alzheimer's Research Foundation, Hollywood Medical Centre, Nedlands, WA, Australia, 6009
- Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, Australia, 6027
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, WA, Australia, 6009
| | - Michael Weinborn
- McCusker Alzheimer's Research Foundation, Hollywood Medical Centre, Nedlands, WA, Australia, 6009
- Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, Australia, 6027
- School of Psychology, University of Western Australia, Crawley, WA, Australia, 6009
| | - Giuseppe Verdile
- McCusker Alzheimer's Research Foundation, Hollywood Medical Centre, Nedlands, WA, Australia, 6009
- Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, Australia, 6027
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, WA, Australia, 6009
- School of Biomedical Sciences, CHIRI Biosciences, Curtin University, Bentley, WA, Australia, 6102
| | - Hamid R Sohrabi
- McCusker Alzheimer's Research Foundation, Hollywood Medical Centre, Nedlands, WA, Australia, 6009
- Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, Australia, 6027
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, WA, Australia, 6009
| | - Ralph N Martins
- McCusker Alzheimer's Research Foundation, Hollywood Medical Centre, Nedlands, WA, Australia, 6009.
- Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, Australia, 6027.
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, WA, Australia, 6009.
| |
Collapse
|
45
|
Bureš V, Čech P, Mikulecká J, Ponce D, Kuca K. The effect of cognitive training on the subjective perception of well-being in older adults. PeerJ 2016; 4:e2785. [PMID: 28028465 PMCID: PMC5180580 DOI: 10.7717/peerj.2785] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 11/11/2016] [Indexed: 02/03/2023] Open
Abstract
Background There is a growing number of studies indicating the major consequences of the subjective perception of well-being on mental health and healthcare use. However, most of the cognitive training research focuses more on the preservation of cognitive function than on the implications of the state of well-being. This secondary analysis of data from a randomised controlled trial investigated the effects of individualised television-based cognitive training on self-rated well-being using the WHO-5 index while considering gender and education as influencing factors. The effects of cognitive training were compared with leisure activities that the elderly could be engaged in to pass time. Methods Cognitively healthy participants aged 60 years or above screened using the Mini-Mental State Examination (MMSE) and Major Depression Inventory (MDI) were randomly allocated to a cognitive training group or to an active control group in a single-blind controlled two-group design and underwent 24 training sessions. Data acquired from the WHO-5 questionnaire administered before and after intervention were statistically analysed using a mixed design model for repeated measures. The effect of individualised cognitive training was compared with leisure activities while the impact of gender and education was explored using estimated marginal means. Results A total of 81 participants aged 67.9 ± 5.59 [60–84] without cognitive impairments and absent of depression symptoms underwent the study. Participants with leisure time activities declared significantly higher scores compared to participants with cognitive training M = 73.48 ± 2.88, 95% CI [67.74–79.22] vs M = 64.13 ± 3.034, 95% CI [58.09–70.17] WHO-5 score. Gender and education were found to moderate the effect of cognitive training on well-being when compared to leisure activities. Females engaged in leisure activities in the control group reported higher by M = 9.77 ± 5.4, 95% CI [−0.99–20.54] WHO-5 scores than females with the cognitive training regimen. Participants with high school education declared leisure activities to increase WHO-5 scores by M = 14.59 ± 5.39, 95% CI [3.85–25.34] compared to individualised cognitive training. Discussion The findings revealed that individualised cognitive training was not directly associated with improvements in well-being. Changes in the control group indicated that involvement in leisure time activities, in which participants were partly free to choose from, represented more favourable stimulation to a self-perceived sense of well-being than individualised cognitive training. Results also supported the fact that gender and education moderated the effect of cognitive training on well-being. Females and participants with high school education were found to be negatively impacted in well-being when performance connected with cognitive training was expected.
Collapse
Affiliation(s)
- Vladimír Bureš
- Faculty of Informatics and Management, University of Hradec Kralove , Hradec Kralove , Czech Republic
| | - Pavel Čech
- Faculty of Informatics and Management, University of Hradec Kralove , Hradec Kralove , Czech Republic
| | - Jaroslava Mikulecká
- Faculty of Informatics and Management, University of Hradec Kralove , Hradec Kralove , Czech Republic
| | - Daniela Ponce
- Faculty of Informatics and Management, University of Hradec Kralove , Hradec Kralove , Czech Republic
| | - Kamil Kuca
- Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic; Biomedical Research Centre, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| |
Collapse
|
46
|
Shaffer J. Neuroplasticity and Clinical Practice: Building Brain Power for Health. Front Psychol 2016; 7:1118. [PMID: 27507957 PMCID: PMC4960264 DOI: 10.3389/fpsyg.2016.01118] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/12/2016] [Indexed: 01/26/2023] Open
Abstract
The focus of this review is on driving neuroplasticity in a positive direction using evidence-based interventions that also have the potential to improve general health. One goal is to provide an overview of the many ways new neuroscience can inform treatment protocols to empower and motivate clients to make the lifestyle choices that could help build brain power and could increase adherence to healthy lifestyle changes that have also been associated with simultaneously enhancing vigorous longevity, health, happiness, and wellness. Another goal is to explore the use of a focus in clinical practice on helping clients appreciate this new evidence and use evolving neuroscience in establishing individualized goals, designing strategies for achieving them and increasing treatment compliance. The timing is urgent for such interventions with goals of enhancing brain health across the lifespan and improving statistics on dementia worldwide.
Collapse
Affiliation(s)
- Joyce Shaffer
- Department of Psychiatry and Behavioral Sciences, University of Washington Seattle, WA, USA
| |
Collapse
|
47
|
Clark DO, Xu H, Unverzagt FW, Hendrie H. Does targeted cognitive training reduce educational disparities in cognitive function among cognitively normal older adults? Int J Geriatr Psychiatry 2016; 31:809-17. [PMID: 26644115 PMCID: PMC5300706 DOI: 10.1002/gps.4395] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to investigate educational differences in treatment responses to memory, reasoning, and speed of processing cognitive training relative to no-contact control. METHODS Secondary analyses of the Advanced Cognitive Training for Independent and Vital Elderly trial were conducted. Two thousand eight hundred older adults were randomized to memory, reasoning, or speed of processing training or no-contact control. A repeated-measures mixed-effects model was used to investigate immediate post-training and 1-year outcomes with sensitivity analyses out to 10 years. Outcomes were as follows: (1) memory composite of Hopkins Verbal Learning Test, Rey Auditory Verbal Learning Test, and Rivermead Behavioral Memory Test; (2) reasoning composite of letter series, letter sets, and word series; and (3) speed of processing measured using three trials of useful field of view and the digit symbol substitution test. RESULTS The effects of reasoning and memory training did not differ by educational attainment. The effect of speed of processing training did. Those with fewer than 12 years of education experienced a 50% greater effect on the useful field of view test compared with those with 16 or more years of education. The training advantage for those with fewer than 12 years of education was maintained to 3 years post-training. CONCLUSION Older adults with less than a secondary education are at elevated risk of dementia, including Alzheimer's disease. The analyses here indicate that speed of processing training is effective in older adults with low educational attainment.
Collapse
Affiliation(s)
- Daniel O Clark
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Huiping Xu
- Department of Biostatistics, Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Frederick W Unverzagt
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Department of Psychiatry, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hugh Hendrie
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| |
Collapse
|
48
|
Bamidis PD, Fissler P, Papageorgiou SG, Zilidou V, Konstantinidis EI, Billis AS, Romanopoulou E, Karagianni M, Beratis I, Tsapanou A, Tsilikopoulou G, Grigoriadou E, Ladas A, Kyrillidou A, Tsolaki A, Frantzidis C, Sidiropoulos E, Siountas A, Matsi S, Papatriantafyllou J, Margioti E, Nika A, Schlee W, Elbert T, Tsolaki M, Vivas AB, Kolassa IT. Gains in cognition through combined cognitive and physical training: the role of training dosage and severity of neurocognitive disorder. Front Aging Neurosci 2015; 7:152. [PMID: 26300772 PMCID: PMC4528297 DOI: 10.3389/fnagi.2015.00152] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 07/24/2015] [Indexed: 01/06/2023] Open
Abstract
Physical as well as cognitive training interventions improve specific cognitive functions but effects barely generalize on global cognition. Combined physical and cognitive training may overcome this shortcoming as physical training may facilitate the neuroplastic potential which, in turn, may be guided by cognitive training. This study aimed at investigating the benefits of combined training on global cognition while assessing the effect of training dosage and exploring the role of several potential effect modifiers. In this multi-center study, 322 older adults with or without neurocognitive disorders (NCDs) were allocated to a computerized, game-based, combined physical and cognitive training group (n = 237) or a passive control group (n = 85). Training group participants were allocated to different training dosages ranging from 24 to 110 potential sessions. In a pre-post-test design, global cognition was assessed by averaging standardized performance in working memory, episodic memory and executive function tests. The intervention group increased in global cognition compared to the control group, p = 0.002, Cohen’s d = 0.31. Exploratory analysis revealed a trend for less benefits in participants with more severe NCD, p = 0.08 (cognitively healthy: d = 0.54; mild cognitive impairment: d = 0.19; dementia: d = 0.04). In participants without dementia, we found a dose-response effect of the potential number and of the completed number of training sessions on global cognition, p = 0.008 and p = 0.04, respectively. The results indicate that combined physical and cognitive training improves global cognition in a dose-responsive manner but these benefits may be less pronounced in older adults with more severe NCD. The long-lasting impact of combined training on the incidence and trajectory of NCDs in relation to its severity should be assessed in future long-term trials.
Collapse
Affiliation(s)
- Panagiotis D Bamidis
- Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Patrick Fissler
- Institute of Psychology and Pedagogy, Clinical and Biological Psychology, Ulm University, Ulm Germany
| | - Sokratis G Papageorgiou
- Behavioral Neurology and Neuropsychology Unit, 1st and 2nd Department of Neurology, Medical School, National Kapodistrian University of Athens Athens, Greece
| | - Vasiliki Zilidou
- Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Evdokimos I Konstantinidis
- Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Antonis S Billis
- Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Evangelia Romanopoulou
- Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Maria Karagianni
- Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece ; Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki Greece
| | - Ion Beratis
- Behavioral Neurology and Neuropsychology Unit, 1st and 2nd Department of Neurology, Medical School, National Kapodistrian University of Athens Athens, Greece
| | - Angeliki Tsapanou
- Behavioral Neurology and Neuropsychology Unit, 1st and 2nd Department of Neurology, Medical School, National Kapodistrian University of Athens Athens, Greece
| | - Georgia Tsilikopoulou
- Behavioral Neurology and Neuropsychology Unit, 1st and 2nd Department of Neurology, Medical School, National Kapodistrian University of Athens Athens, Greece
| | - Eirini Grigoriadou
- Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece ; Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki Greece
| | - Aristea Ladas
- Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece ; Cognitive Psychology and Neuropsychology Lab, Department of Psychology, City College, The University of Sheffield International Faculty, Thessaloniki Greece
| | - Athina Kyrillidou
- Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece ; Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki Greece
| | - Anthoula Tsolaki
- Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece ; Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki Greece
| | - Christos Frantzidis
- Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Efstathios Sidiropoulos
- Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Anastasios Siountas
- Laboratory of Medical Physics, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Stavroula Matsi
- Behavioral Neurology and Neuropsychology Unit, 1st and 2nd Department of Neurology, Medical School, National Kapodistrian University of Athens Athens, Greece
| | - John Papatriantafyllou
- Behavioral Neurology and Neuropsychology Unit, 1st and 2nd Department of Neurology, Medical School, National Kapodistrian University of Athens Athens, Greece
| | - Eleni Margioti
- Behavioral Neurology and Neuropsychology Unit, 1st and 2nd Department of Neurology, Medical School, National Kapodistrian University of Athens Athens, Greece
| | - Aspasia Nika
- Behavioral Neurology and Neuropsychology Unit, 1st and 2nd Department of Neurology, Medical School, National Kapodistrian University of Athens Athens, Greece
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg Regensburg, Germany
| | - Thomas Elbert
- Clinical Psychology and Clinical Neuropsychology, University of Konstanz Konstanz, Germany
| | - Magda Tsolaki
- Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki Greece ; 3rd Department of Neurology, Medical School, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Ana B Vivas
- Cognitive Psychology and Neuropsychology Lab, Department of Psychology, City College, The University of Sheffield International Faculty, Thessaloniki Greece
| | - Iris-Tatjana Kolassa
- Institute of Psychology and Pedagogy, Clinical and Biological Psychology, Ulm University, Ulm Germany
| |
Collapse
|
49
|
Zahodne LB, Meyer OL, Choi E, Thomas ML, Willis SL, Marsiske M, Gross AL, Rebok GW, Parisi JM. External locus of control contributes to racial disparities in memory and reasoning training gains in ACTIVE. Psychol Aging 2015; 30:561-72. [PMID: 26237116 DOI: 10.1037/pag0000042] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Racial disparities in cognitive outcomes may be partly explained by differences in locus of control. African Americans report more external locus of control than non-Hispanic Whites, and external locus of control is associated with poorer health and cognition. The aims of this study were to compare cognitive training gains between African American and non-Hispanic White participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study and determine whether racial differences in training gains are mediated by locus of control. The sample comprised 2,062 (26% African American) adults aged 65 and older who participated in memory, reasoning, or speed training. Latent growth curve models evaluated predictors of 10-year cognitive trajectories separately by training group. Multiple group modeling examined associations between training gains and locus of control across racial groups. Compared to non-Hispanic Whites, African Americans evidenced less improvement in memory and reasoning performance after training. These effects were partially mediated by locus of control, controlling for age, sex, education, health, depression, testing site, and initial cognitive ability. African Americans reported more external locus of control, which was associated with smaller training gains. External locus of control also had a stronger negative association with reasoning training gain for African Americans than for Whites. No racial difference in training gain was identified for speed training. Future intervention research with African Americans should test whether explicitly targeting external locus of control leads to greater cognitive improvement following cognitive training.
Collapse
Affiliation(s)
- Laura B Zahodne
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University
| | - Oanh L Meyer
- Alzheimer's Disease Center, Department of Neurology, University of California, Davis
| | - Eunhee Choi
- School of Social Work, Health and Human Sciences, Colorado State University
| | | | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida
| | - Alden L Gross
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | | | | |
Collapse
|
50
|
Ross LA, Edwards JD, O'Connor ML, Ball KK, Wadley VG, Vance DE. The Transfer of Cognitive Speed of Processing Training to Older Adults' Driving Mobility Across 5 Years. J Gerontol B Psychol Sci Soc Sci 2015; 71:87-97. [PMID: 25878053 DOI: 10.1093/geronb/gbv022] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 03/02/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Multilevel models assessed the effects of cognitive speed of processing training (SPT) on older adults' self-reported driving using intention-to-treat (ITT, randomization to training or control conditions) and dosage (treatment-received via number of training sessions) analyses across 5 years. METHOD Participants randomized to SPT (n = 598) were compared with those randomized to either the no-contact control (n = 598) or memory training, which served as an active control (n = 610). Driving mobility (frequency, exposure, and space) was assessed over time. RESULTS No significant effects were found within the ITT analyses. However, number of SPT sessions did affect driving mobility outcomes. In the full sample (N = 1,806), higher SPT doses were associated with maintained driving frequency as compared with both control groups, but no effects were found for driving exposure or space. Subsample analyses (n = 315) revealed that persons at-risk for mobility declines (i.e., poor initial processing speed) who received additional booster SPT sessions reported greater maintenance of both driving frequency and exposure over time as compared with the no-contact and active control groups. DISCUSSION These results and prior research indicate that cognitive SPT transfers to prolonged driving mobility among older adults. Future research should investigate the mechanisms behind transfer effects to real-world activities, such as driving.
Collapse
Affiliation(s)
- Lesley A Ross
- The Department of Human Development and Family Studies, The Pennsylvania State University, University Park.
| | | | - Melissa L O'Connor
- Department of Human Development and Family Studies, North Dakota State University, Fargo
| | | | | | | |
Collapse
|