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Woolf C, Lampit A, Shahnawaz Z, Sabates J, Norrie LM, Burke D, Naismith SL, Mowszowski L. A Systematic Review and Meta-Analysis of Cognitive Training in Adults with Major Depressive Disorder. Neuropsychol Rev 2021; 32:419-437. [PMID: 33913064 DOI: 10.1007/s11065-021-09487-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/11/2021] [Indexed: 11/24/2022]
Abstract
Major Depressive Disorder (MDD) is common and disabling, and is linked to functional impairment and increased mortality. While current treatments for MDD are moderately effective, ultimately, up to one third of patients do not achieve full remission. Interestingly, while affective symptoms of major depression typically resolve with the depressive episode, cognitive impairment frequently persists, and has been identified as one of the most prominent predictors of illness recurrence. Additionally, MDD is well-recognised as a key risk factor for further cognitive decline and dementia. Yet, available treatments for MDD do not typically address cognitive impairment. Cognitive training, represents a promising and novel therapeutic intervention in this regard. This review systematically identified and evaluated the evidence for cognitive training in adults with MDD. Following PRISMA guidelines, eligible studies were selected according to pre-defined criteria delineating our target population (adults with clinically defined MDD), parameters for cognitive training interventions (computer-or strategy-based, clinician-facilitated), and study design (controlled trials including pre-post cognitive and psychological or functional outcome data). Of 448 studies identified, nine studies met inclusion criteria. These studies were evaluated for methodological quality and risk of bias. Despite heterogeneity, qualitative and meta-analytic synthesis of study findings revealed significant improvements in cognitive and affective outcomes following cognitive training, with moderate pooled effect sizes. Unfortunately, very few studies investigated 'far transfer' to broader domains of everyday functioning. Overall, given the strong evidence for the efficacy and value of cognitive training in this context, cognitive training should be considered as a primary therapeutic intervention in the treatment of MDD.
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Affiliation(s)
- C Woolf
- Older People's Mental Health Service, St Vincent's Hospital, Sydney, Australia. .,Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia. .,School of Psychology, The University of Sydney, Camperdown, NSW, Australia.
| | - A Lampit
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Z Shahnawaz
- Older People's Mental Health Service, St Vincent's Hospital, Sydney, Australia
| | - J Sabates
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - L M Norrie
- Older People's Mental Health Service, St Vincent's Hospital, Sydney, Australia.,School of Psychiatry, University of New South Wales, Randwick, Australia
| | - D Burke
- Older People's Mental Health Service, St Vincent's Hospital, Sydney, Australia.,Discipline of Psychiatry, University of Notre Dame, Sydney, Australia.,Department of Psychiatry, Trinity College, Dublin, Ireland
| | - S L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - L Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
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Bahar-Fuchs A, Barendse MEA, Bloom R, Ravona-Springer R, Heymann A, Dabush H, Bar L, Slater-Barkan S, Rassovsky Y, Schnaider Beeri M. Computerized Cognitive Training for Older Adults at Higher Dementia Risk due to Diabetes: Findings From a Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2020; 75:747-754. [PMID: 30868154 PMCID: PMC7931965 DOI: 10.1093/gerona/glz073] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To evaluate the effects of adaptive and tailored computerized cognitive training on cognition and disease self-management in older adults with diabetes. METHODS This was a single-blind trial. Eighty-four community-dwelling older adults with diabetes were randomized into a tailored and adaptive computerized cognitive training or a generic, non-tailored or adaptive computerized cognitive training condition. Both groups trained for 8 weeks on the commercially available CogniFit program and were supported by a range of behavior change techniques. Participants in each condition were further randomized into a global or cognition-specific self-efficacy intervention, or to a no self-efficacy condition. The primary outcome was global cognition immediately following the intervention. Secondary outcomes included diabetes self-management, meta-memory, mood, and self-efficacy. Assessments were conducted at baseline, immediately after the training, and at a 6-month follow-up. RESULTS Adherence and retention were lower in the generic computerized cognitive training condition, but the self-efficacy intervention was not associated with adherence. Moderate improvements in performance on a global cognitive composite at the posttreatment assessments were observed in both cognitive training conditions, with further small improvement observed at the 6-month follow-up. Results for diabetes self-management showed a modest improvement on self-rated diabetes care for both intervention conditions following the treatment, which was maintained at the 6-month follow-up. CONCLUSIONS Our findings suggest that older adults at higher dementia risk due to diabetes can show improvements in both cognition and disease self-management following home-based multidomain computerized cognitive training. These findings also suggest that adaptive difficulty and individual task tailoring may not be critical components of such interventions. TRIAL REGISTRATION NCT02709629.
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Affiliation(s)
- Alex Bahar-Fuchs
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Victoria, Australia
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Center for Research on Aging, Health, and Wellbeing, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Marjolein E A Barendse
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Victoria, Australia
| | - Rachel Bloom
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Department of Psychology, Bar-Ilan University, Ramat Gan
| | - Ramit Ravona-Springer
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University
| | - Anthony Heymann
- Sackler School of Medicine, Tel-Aviv University
- Maccabi Healthcare Services, Tel-Aviv
| | - Hai Dabush
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Lior Bar
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | | | - Yuri Rassovsky
- Department of Psychology, Bar-Ilan University, Ramat Gan
- Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA)
| | - Michal Schnaider Beeri
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York
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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.
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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
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Park JM, Kim MW, Shim HY. Effects of a Multicomponent Cognitive Stimulation Program on Cognitive Function Improvement Among Elderly Women. Asian Nurs Res (Korean Soc Nurs Sci) 2019; 13:306-312. [PMID: 31707059 DOI: 10.1016/j.anr.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 11/03/2019] [Accepted: 11/03/2019] [Indexed: 02/06/2023] Open
Abstract
PURPOSE This study was conducted to identify the effect of a multicomponent cognitive stimulation program (MCSP) on the improvement of older people's cognitive abilities. It also aimed to determine whether the effectiveness of the MCSP is related to age. METHODS A one-group pretest-posttest design was used. The program was conducted once a week for 10 weeks. The Korean-Montreal Cognitive Assessment (K-MoCA) was used to measure cognitive functions before and after the MCSP. Participants included 37 people aged over 65 years with normal cognitive functions and living in I city. A paired t-test was used to compare K-MoCA scores before and after the MCSP, and a two-way analysis of variance was performed to confirm whether there is an interaction between the MCSP and age. RESULTS It was found that the MCSP had a significant effect on improving cognitive functions (t = -5.15, p < .001). Regarding the subdomains, visuospatial/executive ability, recall, naming, and language ability showed significant effects; however, abstractive ability-which was not a focus of the program-showed no significant effect. There were differences in visuospatial/executive functions, language skills, and memory between the 65-79 years age group and the aged over 80 group. Further, regarding the relationship between the MCSP and age, it was found that their interaction was significant only with regard to visuospatial/executive ability. CONCLUSION The MCSP helps to improve the cognitive functions of the elderly; however, its effect differs between the young-old group and the old-old group. Therefore, age should be considered when developing MCSPs.
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Affiliation(s)
- Jeong-Mo Park
- Department of Nursing Science, Kyungin Women's University, Incheon, Republic of Korea
| | - Mi-Won Kim
- Department of Nursing Science, Sangmyung University, Cheonan, Republic of Korea.
| | - Hee-Young Shim
- Center for Dementia, Gyeyang-gu, Incheon, Republic of Korea
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5
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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: 28] [Impact Index Per Article: 5.6] [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.
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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
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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.
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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
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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.
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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
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8
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Walton CC, Lampit A, Boulamatsis C, Hallock H, Barr P, Ginige JA, Brodaty H, Chau T, Heffernan M, Sachdev PS, Fiatarone Singh MA, Valenzuela M. Design and Development of the Brain Training System for the Digital "Maintain Your Brain" Dementia Prevention Trial. JMIR Aging 2019; 2:e13135. [PMID: 31518277 PMCID: PMC6715098 DOI: 10.2196/13135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 12/20/2022] Open
Abstract
Background Dementia is the leading cause of disability worldwide, and interventions aimed at reducing the prevalence and burden of the disease are urgently needed. Maintain Your Brain (MYB) is a randomized controlled trial of a multimodal digital health intervention targeting modifiable dementia risk factors to combat cognitive decline and potentially prevent dementia. In addition to behavioral modules targeting mood, nutrition, and physical exercise, a new Brain Training System (BTS) will deliver computerized cognitive training (CCT) throughout the trial to provide systematic, challenging, and personally adaptive cognitive activity. Objective This paper aimed to describe the design and development of BTS. Methods BTS has been designed with a central focus on the end user. Raw training content is provided by our partner NeuroNation and delivered in several innovative ways. A baseline cognitive profile directs selection and sequencing of exercises within and between sessions and is updated during the 10-week 30-session module. Online trainers are available to provide supervision at different levels of engagement, including face-to-face share-screen coaching, a key implementation resource that is triaged by a “red flag” system for automatic tracking of user adherence and engagement, or through user-initiated help requests. Individualized and comparative feedback is provided to aid motivation and, for the first time, establish a social support network for the user based on their real-world circle of friends and family. Results The MYB pilot was performed from November 2017 to March 2018. We are currently analyzing data from this pilot trial (n=100), which will make up a separate research paper. The main trial was launched in June 2018. Process and implementation data from the first training module (September to November 2018) are expected to be reported in 2019 and final trial outcomes are anticipated in 2022. Conclusions The BTS implemented in MYB is focused on maximizing adherence and engagement with CCT over the short and long term in the setting of a fully digital trial, which, if successful, could be delivered economically at scale. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12618000851268; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=370631&isReview=true
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Affiliation(s)
- Courtney Campbell Walton
- School of Psychology, University of Queensland, Brisbane, Australia.,Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Amit Lampit
- Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne, Australia.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christos Boulamatsis
- Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,School of Computing, Engineering and Mathematics, Western Sydney University, Sydney, Australia
| | - Harry Hallock
- Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Polly Barr
- Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Jeewani Anupama Ginige
- School of Computing, Engineering and Mathematics, Western Sydney University, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.,Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Tiffany Chau
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Megan Heffernan
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Perminder Singh Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.,Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, Australia
| | - Maria A Fiatarone Singh
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Health Sciences, Sydney Medical School, University of Sydney, Sydney, Australia.,Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States.,Hebrew Senior Life, Boston, MA, United States
| | - Michael Valenzuela
- Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
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9
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Tzuang M, Owusu JT, Spira AP, Albert MS, Rebok GW. Cognitive Training for Ethnic Minority Older Adults in the United States: A Review. THE GERONTOLOGIST 2019; 58:e311-e324. [PMID: 28575230 DOI: 10.1093/geront/gnw260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Indexed: 11/14/2022] Open
Abstract
Purpose of the Study Interest in cognitive training for healthy older adults to reduce cognitive decline has grown considerably over the past few decades. Given the shift toward a more diverse society, the purpose of this review is to examine the extent of race/ethnic minority participation in cognitive training studies and characteristics of studies that included race/ethnic minority participants. Design and Methods This review considered peer-reviewed studies reporting cognitive training studies for cognitively healthy, community-dwelling older adults (age 55+) in the United States published in English before December 31, 2015. A total of 31 articles published between 1986 and 2015 meeting inclusion criteria were identified and included in the review. Results A total of 6,432 participants were recruited across all of the studies, and ranged in age from 55 to 99 years. Across all studies examined, 39% reported racial/ethnic background information. Only 3 of these studies included a substantial number of minorities (26.7% in the ACTIVE study; 28.4% in the SeniorWISE study; 22.7% in the TEAM study). Race/ethnic minority older adults were disproportionately underrepresented in cognitive training studies. Implications Further research should aim to enroll participants representative of various race/ethnic minority populations. Strategies for recruitment and retention of ethnic minority participants in cognitive training research are discussed, which could lead to the development of more culturally appropriate and perhaps more effective cognitive interventions.
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Affiliation(s)
- Marian Tzuang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jocelynn T Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | - Marilyn S Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
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10
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Walton CC, Keegan RJ, Martin M, Hallock H. The Potential Role for Cognitive Training in Sport: More Research Needed. Front Psychol 2018; 9:1121. [PMID: 30018585 PMCID: PMC6037849 DOI: 10.3389/fpsyg.2018.01121] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 06/12/2018] [Indexed: 01/20/2023] Open
Abstract
Sports performance at the highest level requires a wealth of cognitive functions such as attention, decision making, and working memory to be functioning at optimal levels in stressful and demanding environments. Whilst a substantial research base exists focusing on psychological skills for performance (e.g., imagery) or therapeutic techniques for emotion regulation (e.g., cognitive behavioral therapy), there is a scarcity of research examining whether the enhancement of core cognitive abilities leads to improved performance in sport. Cognitive training is a highly researched method of enhancing cognitive skills through repetitive and targeted exercises. In this article, we outline the potential use of cognitive training (CT) in athlete populations with a view to supporting athletic performance. We propose how such an intervention could be used in the future, drawing on evidence from other fields where this technique is more fruitfully researched, and provide recommendations for both researchers and practitioners working in the field.
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Affiliation(s)
- Courtney C Walton
- School of Psychology, University of Queensland, Brisbane, QLD, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Richard J Keegan
- University of Canberra Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Mike Martin
- New South Wales Institute of Sport, Sydney, NSW, Australia
| | - Harry Hallock
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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11
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Lussier M, Brouillard P, Bherer L. Limited Benefits of Heterogeneous Dual-Task Training on Transfer Effects in Older Adults. J Gerontol B Psychol Sci Soc Sci 2017; 72:801-812. [PMID: 26603017 DOI: 10.1093/geronb/gbv105] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/19/2015] [Indexed: 01/20/2023] Open
Abstract
Objectives It has often been reported that cognitive training has limited transfer effects. The present study addresses training context variability as a factor that could increase transfer effects, as well as the manifestation through time of transfer effects. Method Fifty-eight older adults were assigned to an active placebo or two dual-task training conditions, one in which the training context varies between sessions (heterogeneous training) and the other in a fixed training context (homogeneous training). Transfer was assessed with near and far-modality transfer tasks. Results Results show that heterogeneous and homogeneous training led to larger near-modality transfer effects than an active placebo (computer lessons). Transfer effects were roughly comparable in both training groups, but heterogeneous training led to a steeper improvement of the dual-task coordination learning curve within training sessions. Also, results indicated that dual-task cost did not improve in the active placebo group from the pre- to the post-training sessions. Discussion Heterogeneous training showed modest advantages over homogeneous training. Results also suggest that transfer effects on dual-task cost induced by training take place early on in the post-training session. These findings provide valuable insights on benefits arising from variability in the training protocol for maximizing transfer effects.
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Affiliation(s)
- Maxime Lussier
- Department of Psychology, Université du Québec à Montréal, Quebec, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Quebec, Canada
| | - Philippe Brouillard
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Quebec, Canada.,Department of Mathematics and Statistics, Université de Montréal, Quebec, Canada
| | - Louis Bherer
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Quebec, Canada.,PERFORM Centre and Department of Psychology, Concordia University, Montreal, Quebec, Canada
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12
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Payne BR, Stine-Morrow EAL. The Effects of Home-Based Cognitive Training on Verbal Working Memory and Language Comprehension in Older Adulthood. Front Aging Neurosci 2017; 9:256. [PMID: 28848421 PMCID: PMC5550674 DOI: 10.3389/fnagi.2017.00256] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 07/19/2017] [Indexed: 11/13/2022] Open
Abstract
Effective language understanding is crucial to maintaining cognitive abilities and learning new information through adulthood. However, age-related declines in working memory (WM) have a robust negative influence on multiple aspects of language comprehension and use, potentially limiting communicative competence. In the current study (N = 41), we examined the effects of a novel home-based computerized cognitive training program targeting verbal WM on changes in verbal WM and language comprehension in healthy older adults relative to an active component-control group. Participants in the WM training group showed non-linear improvements in performance on trained verbal WM tasks. Relative to the active control group, WM training participants also showed improvements on untrained verbal WM tasks and selective improvements across untrained dimensions of language, including sentence memory, verbal fluency, and comprehension of syntactically ambiguous sentences. Though the current study is preliminary in nature, it does provide initial promising evidence that WM training may influence components of language comprehension in adulthood and suggests that home-based training of WM may be a viable option for probing the scope and limits of cognitive plasticity in older adults.
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Affiliation(s)
- Brennan R Payne
- The Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, UrbanaIL, United States.,Department of Psychology, University of Utah, Salt Lake CityUT, United States
| | - Elizabeth A L Stine-Morrow
- The Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, UrbanaIL, United States.,Department of Educational Psychology, University of Illinois at Urbana-Champaign, UrbanaIL, United States
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13
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Walton CC, Naismith SL, Lampit A, Mowszowski L, Lewis SJG. Cognitive Training in Parkinson’s Disease. Neurorehabil Neural Repair 2016; 31:207-216. [DOI: 10.1177/1545968316680489] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Courtney C. Walton
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
- Healthy Brain Ageing Program, School of Psychology; Brain and Mind Centre & The Charles Perkins Centre,University of Sydney, NSW, Australia
- Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Sharon L. Naismith
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
- Healthy Brain Ageing Program, School of Psychology; Brain and Mind Centre & The Charles Perkins Centre,University of Sydney, NSW, Australia
| | - Amit Lampit
- Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Loren Mowszowski
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
- Healthy Brain Ageing Program, School of Psychology; Brain and Mind Centre & The Charles Perkins Centre,University of Sydney, NSW, Australia
| | - Simon J. G. Lewis
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
- Healthy Brain Ageing Program, School of Psychology; Brain and Mind Centre & The Charles Perkins Centre,University of Sydney, NSW, Australia
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14
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Strategy-Based Cognitive Training for Improving Executive Functions in Older Adults: a Systematic Review. Neuropsychol Rev 2016; 26:252-270. [DOI: 10.1007/s11065-016-9329-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/18/2016] [Indexed: 02/04/2023]
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15
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Cognitive Training in Parkinson's Disease: A Review of Studies from 2000 to 2014. PARKINSONS DISEASE 2016; 2016:9291713. [PMID: 27688923 PMCID: PMC5027302 DOI: 10.1155/2016/9291713] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/03/2016] [Indexed: 01/05/2023]
Abstract
Cognitive deficits are prevalent among patients with Parkinson's disease (PD), in both early and late stages of the disease. These deficits are associated with lower quality of life, loss of independence, and institutionalization. To date, there is no effective pharmacological treatment for the range of cognitive impairments presented in PD. Cognitive training (CT) has been explored as an alternative approach to remediating cognition in PD. In this review we present a detailed summary of 13 studies of CT that have been conducted between 2000 and 2014 and a critical examination of the evidence for the effectiveness and applicability of CT in PD. Although the evidence shows that CT leads to short-term, moderate improvements in some cognitive functions, methodological inconsistencies weaken these results. We discuss several key limitations of the literature to date, propose methods of addressing these questions, and outline the future directions that studies of CT in PD should pursue. Studies need to provide more detail about the cognitive profile of participants, include larger sample sizes, be hypothesis driven, and be clearer about the training interventions and the outcome measures.
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16
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Gates NJ, Karim S, Rutjes AWS, Ware J, Chong LY, March E, Vernooij RWM. Computerised cognition-based interventions for maintaining cognitive function in cognitively healthy people in midlife. Hippokratia 2016. [DOI: 10.1002/14651858.cd012278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nicola J Gates
- University of New South Wales; Centre for Healthy Brain Ageing (CHeBA); Suite 407 185 Elizabeth Street Sydney NSW Australia 2000
| | - Salman Karim
- Lancashire Care NHS Foundation Trust; Memory Assessment Service; Charnley Fold, Cottage Lane Preston UK PR5 6YA
| | - Anne WS Rutjes
- Fondazione "Università G. D'Annunzio"; Centre for Systematic Reviews; Via dei Vestini 31 Chieti Chieti Italy 66100
- University of Bern; CTU Bern; Bern Bern Switzerland 3012
- University of Bern; Institute of Social and Preventive Medicine (ISPM); Finkenhubelweg 11 Bern Bern Switzerland 3012
| | - Jennifer Ware
- University of Oxford; Cochrane Dementia and Cognitive Improvement Group; Oxford UK OX3 9DU
| | | | - Evrim March
- St Vincent's Hospital (Melbourne); St Vincent's Adult Mental Health; 46 Nicholson Street Fitzroy VIC Australia 3065
| | - Robin WM Vernooij
- Iberoamerican Cochrane Centre; C/ Sant Antoni Maria Claret 167 Barcelona Barcelona Spain 08025
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17
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Gates NJ, Karim S, Rutjes AWS, Ware J, Chong LY, March E, Vernooij RWM. Computerised cognition-based interventions for maintaining cognitive function in cognitively healthy people in late life. Hippokratia 2016. [DOI: 10.1002/14651858.cd012277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nicola J Gates
- University of New South Wales; Centre for Healthy Brain Ageing (CHeBA); Suite 407 185 Elizabeth Street Sydney NSW Australia 2000
| | - Salman Karim
- Lancashire Care NHS Foundation Trust; Memory Assessment Service; Charnley Fold, Cottage Lane Preston UK PR5 6YA
| | - Anne WS Rutjes
- Fondazione "Università G. D'Annunzio"; Centre for Systematic Reviews; Via dei Vestini 31 Chieti Chieti Italy 66100
- University of Bern; CTU Bern; Bern Bern Switzerland 3012
- University of Bern; Institute of Social and Preventive Medicine (ISPM); Finkenhubelweg 11 Bern Bern Switzerland 3012
| | - Jennifer Ware
- University of Oxford; Cochrane Dementia and Cognitive Improvement Group; Oxford UK OX3 9DU
| | | | - Evrim March
- St Vincent's Hospital (Melbourne); St Vincent's Adult Mental Health; 46 Nicholson Street Fitzroy VIC Australia 3065
| | - Robin WM Vernooij
- Iberoamerican Cochrane Centre; C/ Sant Antoni Maria Claret 167 Barcelona Barcelona Spain 08025
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18
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Gates NJ, Karim S, Rutjes AWS, Ware J, March E, Vernooij RWM. Computerised cognition-based interventions for preventing dementia in people with mild cognitive impairment. Hippokratia 2016. [DOI: 10.1002/14651858.cd012279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Nicola J Gates
- University of New South Wales; Centre for Healthy Brain Ageing (CHeBA); Suite 407 185 Elizabeth Street Sydney NSW Australia 2000
| | - Salman Karim
- Lancashire Care NHS Foundation Trust; Memory Assessment Service; Charnley Fold, Cottage Lane Preston UK PR5 6YA
| | - Anne WS Rutjes
- Fondazione "Università G. D'Annunzio"; Centre for Systematic Reviews; Via dei Vestini 31 Chieti Chieti Italy 66100
- University of Bern; CTU Bern; Bern Bern Switzerland 3012
- University of Bern; Institute of Social and Preventive Medicine (ISPM); Finkenhubelweg 11 Bern Bern Switzerland 3012
| | - Jennifer Ware
- University of Oxford; Cochrane Dementia and Cognitive Improvement Group; Oxford UK OX3 9DU
| | - Evrim March
- St Vincent's Hospital (Melbourne); St Vincent's Adult Mental Health; 46 Nicholson Street Fitzroy VIC Australia 3065
| | - Robin WM Vernooij
- Iberoamerican Cochrane Centre; C/ Sant Antoni Maria Claret 167 Barcelona Barcelona Spain 08025
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19
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Song YW, Lee JS, Song AY. Meta-analysis about cognitive intervention effect applied to dementia patients. NeuroRehabilitation 2016; 39:319-27. [PMID: 27372367 DOI: 10.3233/nre-161363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The study tries to explore what effects multiple cognitive intervention, computer-based intervention, and memory training program had on dementia patients through meta-analysis. METHOD Data was collected using an overseas search engine and 13 pieces of research published from January 2001 to April 2015 were selected. On papers that fit the selection criteria qualitative evaluation was conducted using Jadad evaluation and using pre-post average, standard deviation, and sample size of cognitive function, meta-analysis was conducted. RESULTS The 13 studies selected included 6 multiple interventions, 4 computer-based interventions, and 3 memory training programs. In the Jadad evaluation all had 3 points or higher and there were 474 research participants and in the result of effect size analysis memory training intervention was found to be 'large effect size', computer-based intervention 'medium effect size', and multiple cognitive intervention 'small effect size'. All three intervention methods were all statistically significant (p < 0.05). CONCLUSION It was found that the effect on dementia patients was in the order of memory training intervention, computer-based intervention, and multiple cognitive intervention. Clinically, this can be objective basis for treatment method for cognitive intervention of dementia patients.
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20
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Szeto JYY, Lewis SJG. Current Treatment Options for Alzheimer's Disease and Parkinson's Disease Dementia. Curr Neuropharmacol 2016; 14:326-38. [PMID: 26644155 PMCID: PMC4876589 DOI: 10.2174/1570159x14666151208112754] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 07/16/2015] [Accepted: 10/09/2015] [Indexed: 12/30/2022] Open
Abstract
Alzheimer's disease (AD) and Parkinson's disease (PD) are the two most common neurodegenerative disorders encountered in clinical practice. Whilst dementia has long been synonymous with AD, it is becoming more widely accepted as part of the clinical spectrum in PD (PDD). Neuropsychiatric complications, including psychosis, mood and anxiety disorders, and sleep disorders also frequently co-exist with cognitive dysfunctions in AD and PDD patients. The incidence of such symptoms is often a significant source of disability, and may aggravate pre-existing cognitive deficits. Management of AD and PDD involves both pharmacological and non-pharmacological measures. Although research on pharmacological therapies for AD and PDD has so far had some success in terms of developing symptomatic treatments, the benefits are often marginal and non-sustained. These shortcomings have led to the investigation of non-pharmacological and novel treatments for both AD and PD. Furthermore, in light of the diverse constellation of other neuropsychiatric, physical, and behavioural symptoms that often occur in AD and PD, consideration needs to be given to the potential side effects of pharmacological treatments where improving one symptom may lead to the worsening of another, rendering the clinical management of these patients challenging. Therefore, the present article will critically review the evidence for both pharmacological and non-pharmacological treatments for cognitive impairment in AD and PD patients. Treatment options for other concomitant neuropsychiatric and behavioural symptoms, as well as novel treatment strategies will also be discussed.
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Affiliation(s)
| | - Simon J G Lewis
- Brain & Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, New South Wales, Australia.
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21
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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.
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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
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22
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Affiliation(s)
- Ju Kang Lee
- Department of Physical Medicine and Rehabilitation, Gachon University School of Medicine, Korea
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23
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Walton CC, Kavanagh A, Downey LA, Lomas J, Camfield DA, Stough C. Online cognitive training in healthy older adults: a preliminary study on the effects of single versus multi-domain training. Transl Neurosci 2014; 6:13-19. [PMID: 28123787 PMCID: PMC4936611 DOI: 10.1515/tnsci-2015-0003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/23/2014] [Indexed: 02/03/2023] Open
Abstract
It has been argued that cognitive training may be effective in improving cognitive performance in healthy older adults. However, inappropriate active control groups often hinder the validity of these claims. Additionally there are relatively few independent empirical studies on popular commercially available cognitive training programs. The current research extends on previous work to explore cognitive training employing a more robust control group. Twenty-eight healthy older adults (age: M = 64.18, SD = 6.9) completed either a multi-faceted online computerised cognitive training program or trained on a simple reaction time task for 20 minutes a day over a 28 day period. Both groups significantly improved performance in multiple measures of processing speed. Only the treatment group displayed improved performance for measures of memory accuracy. These results suggest improvements in processing speed and visual working memory may be obtained over a short period of computerized cognitive training. However, gains over this time appear only to show near transfer. The use of similar active control groups in future research are needed in order to better understand changes in cognition after cognitive training.
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Affiliation(s)
- Courtney C Walton
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia; Brain & Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra Kavanagh
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Luke A Downey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia; Department of Psychology, Swansea University, Swansea, Wales, United Kingdom
| | - Justine Lomas
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - David A Camfield
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia; School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Con Stough
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia
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24
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Walton CC, Shine JM, Hall JM, O'Callaghan C, Mowszowski L, Gilat M, Szeto JYY, Naismith SL, Lewis SJG. The major impact of freezing of gait on quality of life in Parkinson's disease. J Neurol 2014; 262:108-15. [PMID: 25319020 DOI: 10.1007/s00415-014-7524-3] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/08/2014] [Accepted: 09/30/2014] [Indexed: 11/24/2022]
Abstract
Freezing of gait (FOG) is a disabling motor symptom experienced by a large proportion of patients with Parkinson's disease (PD). While it is known that FOG contributes to lower health-related quality of life (HRQoL), previous studies have not accounted for other important factors when measuring the specific impact of this symptom. The aim of this study was to examine FOG and HRQoL while controlling for other factors that are known to impact patient well-being, including cognition, motor severity, sleep disturbance and mood. Two hundred and three patients with idiopathic PD (86 with FOG) were included in the study. All patients were between Hoehn and Yahr stages I-III. A forced entry multiple regression model evaluating the relative contribution of all symptoms was conducted, controlling for time since diagnosis and current dopaminergic treatment. Entering all significantly correlated variables into the regression model accounted for the majority of variance exploring HRQoL. Self-reported sleep-wake disturbances, depressive and anxious symptoms and FOG were individually significant predictors. FOG accounted for the highest amount of unique variance. While sleep-wake disturbance and mood have a significant negative impact on HRQoL in PD, the emergence of FOG represents the most substantial predictor among patients in the earlier clinical stages of disease. This finding presumably reflects the disabling loss of independence and fear of injury associated with FOG and underlines the importance of efforts to reduce this common symptom.
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Affiliation(s)
- Courtney C Walton
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia
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