Does working memory training work? The promise and challenges of enhancing cognition by training working memory

Beyond social engagement: cognitive training leads to greater cognitive improvement in older adults

Aging is often accompanied by a decline in cognitive functions, with memory being particularly affected. Recent studies suggest that cognitive training sessions that teach memory strategies relevant to daily life may benefit seniors who live in the community. However, it is possible that the cognitive improvement observed in these programs results from the social encounters embedded in them. In this study, we aimed to investigate the effect of a social cognitive training group, which met regularly for an extended period, on enhancing cognitive indices compared to a control group that only received social engagement meetings without training. Sixty-six participants with a mean age of 78 took part in 12 sessions of a social engagement group, with or without strategy training. Cognitive performance was assessed before and after training using four memory tasks, two similar to the trained tasks (near-transfer tasks) and two novel (far-transfer tasks). Both groups showed a slight improvement in most of the evaluation tasks, but the cognitive training combined with social engagement group showed a significant improvement in the Word Recall and Verbal Fluency tests compared to the social engagement group without training. Our findings suggest that cognitive training sessions may be a useful tool in promoting cognitive improvement among older adults living in the community, even beyond the improvement obtained from the social engagement that occurs during the training sessions.Trial registration number:NCT05016336. Date of registration: 20 August 2021. Retrospectively registered.

Examining Conduct Problems in a Community Sample during Middle Childhood: The Role of Frontal EEG Asymmetry, Temperament, and Working Memory

Previous literature shows that aspects of temperament, executive functioning, and EEG frontal asymmetry are related to externalizing behaviors in children. We examined whether frontal EEG asymmetry measured at age 6 would moderate the impact of negative affectivity, attentional control, and working memory at age 6 on conduct problems at age 9. Behavioral tasks were given to assess children's attentional control and working memory. Parents completed questionnaires about their children's negative affectivity and conduct problems. Results showed that greater negative affectivity reported at age 6 predicted for more conduct problems reported at age 9, regardless of EEG frontal asymmetry. Lower levels of attentional control and working memory at age 6 predicted for more conduct problems reported at age 9 when children also exhibited greater left EEG frontal asymmetry, which has been linked to approach motivation. These findings illustrate the importance of assessing multiple intrinsic factors, both independent and interactive, that contribute to children's conduct problems.

Rehabilitation of working memory after acquired brain injury and multiple sclerosis: A systematic review

The objective is to study the effectiveness of working memory (WM) rehabilitation after Acquired brain injury (ABI) and multiple sclerosis (MS). A systematic database search of published studies, following PRISMA recommendations, with assessment of methodological quality and risk of bias, was conducted. The results were analysed according to the rehabilitation method used. 31 studies (including 14 class I) were included, and 11 different training programs were identified. Despite great variability in training methodology and outcome measures, the results were positive overall. However, only three rehabilitation programs showed a transfer effect to WM (near) and daily life with long-term maintenance. The results were more variable for protocols limited to the use of computerized n-back training tasks. Overall, the current evidence supports multi-task WM training rather than single-task-limited program. It also supports early and long duration training, with some therapist support. However, it is not possible, to date, to make strong recommendations regarding the rehabilitation program to be used preferentially. Although results are encouraging, level of evidence remains modest, particularly regarding the maintenance of the therapeutic effect after the end of training, and the transfer to everyday life skills. The influence of rehabilitation parameters (training duration, therapist involvement … ) remains difficult to assess.

Can we enhance working memory? Bias and effectiveness in cognitive training studies

Meta-analyses have found that working memory (WM) can be improved with cognitive training; however, some authors have suggested that these improvements are mostly driven by biases in the measurement of WM, especially the use of similar tasks for assessment and training. In the present meta-analysis, we investigated whether WM, fluid intelligence, executive functions, and short-term memory can be improved by cognitive training and evaluated the impact of possible sources of bias. We performed a risk of bias assessment of the included studies and took special care in controlling for practice effects. Data from 52 independent comparisons were analyzed, including cognitive training aimed at different cognitive functions. Our results show small improvements in WM after training (SMD = 0.18). Much larger effects were observed when the analysis was restricted to assessment tasks similar to those used for training (SMD = 1.15). Fluid intelligence was not found to improve as a result of training, and improvements in WM were not related to changes in fluid intelligence. Our analyses did however indicate that cognitive training can improve specific executive functions. Contrary to expectations, a set of meta-regressions indicated that characteristics of the training programme, such as dosage and type of training, do not have an impact on the effectiveness of training. The risk of bias assessment revealed some concerns in the randomization process and possible selective reporting among studies. Overall, our results identified various potential sources of bias, with the most significant being the choice of assessment tasks.

Virtual reality working memory training improves cognitive performance of acute and remitted patients with major depressive disorder

BACKGROUND

Cognitive training is effective in treating neuropsychological impairment in patients with major depressive disorder (MDD), and virtual reality (VR) is a promising tool to provide such training. However, studies using VR-based working memory (WM) training in treating depressed patients' cognitive impairment are extremely scarce and how it affects cognitive performance remains unclear. Therefore, we aimed to determine the efficacy of VR-WM training in acute and remitted depressed patients and try to investigate its potential mechanisms.

METHODS

Forty-two patients with MDD (22 acute patients and 20 remitted patients) received 20-session VR-WM training, while 22 healthy controls (HC) received no intervention. WM and other cognitive domains' performance were assessed by the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ) and the MATRICS Consensus Cognitive Battery (MCCB) before and after the intervention. Depressive symptoms were assessed by the 24-item Hamilton Depression Rating Scale (24-HDRS) at the same time points.

RESULTS

Acute and remitted MDD patients both exhibited significant improvements from pre- to post-training in WM, processing speed, visual learning, reasoning and problem-solving, and total cognition (all p < 0.05). Significant groups-by-time interactions were observed for the 24-HDRS score (p < 0.05). Mediation analysis showed that 24-HDRS score partially mediated the association between the effect of VR-WM training on WM and total cognition performance in total depressive samples.

CONCLUSIONS

VR-WM training effectively improved WM and other cognitive domains' performance in both acute and remitted MDD patients. Besides, VR-WM training improves WM and total cognition performance in MDD patients partially via the enhancement of depressive symptoms.

Validation of a mobile fNIRS device for measuring working memory load in the prefrontal cortex

Functional near-infrared spectroscopy (fNIRS) is a neuroimaging technique that measures cortical blood flow to infer neural activation. Traditionally limited to laboratory settings due to high costs and complex operation, recent advancements have introduced mobile fNIRS devices, significantly broadening the scope of potential research participants. This study validates the use of the Mendi, a two-channel mobile fNIRS system, for measuring prefrontal oxyhemoglobin concentration changes during an n-back task. We manipulated task difficulty through different n-back levels (one-back versus three-back), revealing increased oxyhemoglobin concentrations in the prefrontal cortex during the more demanding three-back task compared to the one-back task. This finding demonstrates the Mendi's ability to distinguish between low and high cognitive task loads. Behavioural data, showing a decrease in accuracy under high load conditions, further corroborates these neuroimaging findings. Our study validates the Mendi mobile fNIRS system as an effective tool for assessing working memory load and underscores its potential in enhancing neuroscientific research accessibility. The user-friendly and cost-effective nature of mobile fNIRS systems like the Mendi opens up neuroscientific research to a diverse set of participants, enabling the investigation of neural processes in real-world environments across a variety of demographic groups.

Virtual reality and cognitive rehabilitation for older adults with mild cognitive impairment: A systematic review

Virtual Reality (VR) has been gaining increasing attention as a potential ecological and effective intervention system for treating Mild Cognitive Impairment (MCI). However, it remains unclear the efficacy and effectiveness of VR-based cognitive rehabilitation therapy (VR-CRT) in comparison with cognitive rehabilitation therapy (CRT). Consequently, a systematic review on Pubmed, Scopus, PsycInfo, and Web Of Science was conducted to assess the state of the art of the literature published between 2003 and April 2023. Only articles that adopted CRT as control group and that included some measure of at least one domain among overall cognitive function, executive function and functional status were included. Participants needed to be older adults aged 65 or over with a diagnosis of MCI. The risk of bias and the quality of evidence were assessed using the Version 2 of the Cochrane risk-of-bias tool for randomized trials. Initially, 6503 records were considered and screened after removing duplicates (n = 1321). Subsequently, 81 full texts were assessed for eligibility. Four articles met the inclusion criteria but 2 of them were merged as they were describing different outcomes of the same research project. Consequently, 3 overall studies with a total of 130 participants were included in the final analysis. Due to the high heterogeneity in the methodology and outcome measures employed, it was not possible to conduct a meta-analysis. Included studies used semi-immersive (k = 2) and full-immersive (k = 1) VR systems in their research. Two articles evaluated overall cognitive function through the MoCA together with specific tests for executive functions (n = 69), while one study adopted a comprehensive neuropsychological battery to evaluate both cognitive function and executive function (n = 61). Finally, one study evaluated functional status through instrumental activities of daily living (n = 34). A However, the limited number of studies, the small sample size, and the potential issues with the quality and methodology of these studies that emerged from the risk of bias assessment may raise doubts about the reliability of their results. Nevertheless, although scarce, results of the present review suggest that VR-CRT may be paramount in treating MCI for its additional ecological and adaptive advantages, as all of the studies highlighted that it was at least as effective as conventional CRT for all the outcome measures. Therefore, more rigorous research that compares VR-CRT and CRT is needed to understand the degree to which VR-CRT is effective with older adults with MCI and the potential role of immersion to influence its efficacy. Indeed, these preliminary findings highlight the need for the development of standardized VR protocols, as the integration of such technology into clinical practice may help improve the quality of life and cognitive outcomes for this growing demographic.

Digital Cognitive Assessment Tests for Older Adults: Systematic Literature Review

BACKGROUND

The global health pandemic has affected the increasing older adult population, especially those with mental illnesses. It is necessary to prevent cases of cognitive impairment in adults early on, and this requires the support of information and communication technologies for evaluating and training cognitive functions. This can be achieved through computer applications designed for cognitive assessment.

OBJECTIVE

In this review, we aimed to assess the state of the art of the current platforms and digital test applications for cognitive evaluation, with a focus on older adults.

METHODS

A systematic literature search was conducted on 3 databases (Web of Science, PubMed, and Scopus) to retrieve recent articles on the applications of digital tests for cognitive assessment and analyze them based on the methodology used. Four research questions were considered. Through the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, following the application of inclusion and exclusion criteria, a total of 20 articles were finally reviewed.

RESULTS

Some gaps and trends were identified regarding the types of digital applications and technologies used, the evaluated effects on cognitive domains, and the psychometric parameters and personal characteristics considered for validation.

CONCLUSIONS

Computerized tests (similar to paper-and-pencil tests) and test batteries (on computers, tablets, or web platforms) were the predominant types of assessments. Initial studies with simulators, virtual environments, and daily-life activity games were also conducted. Diverse validation methods and psychometric properties were observed; however, there was a lack of evaluations that involved specific populations with diverse education levels, cultures, and degrees of technology acceptance. In addition, these evaluations should consider emotional and usability aspects.

Training in new forms of human-AI interaction improves complex working memory and switching skills of language professionals

AI-related technologies used in the language industry, including automatic speech recognition (ASR) and machine translation (MT), are designed to improve human efficiency. However, humans are still in the loop for accuracy and quality, creating a working environment based on Human-AI Interaction (HAII). Very little is known about these newly-created working environments and their effects on cognition. The present study focused on a novel practice, interlingual respeaking (IRSP), where real-time subtitles in another language are created through the interaction between a human and ASR software. To this end, we set up an experiment that included a purpose-made training course on IRSP over 5 weeks, investigating its effects on cognition, and focusing on executive functioning (EF) and working memory (WM). We compared the cognitive performance of 51 language professionals before and after the course. Our variables were reading span (a complex WM measure), switching skills, and sustained attention. IRSP training course improved complex WM and switching skills but not sustained attention. However, the participants were slower after the training, indicating increased vigilance with the sustained attention tasks. Finally, complex WM was confirmed as the primary competence in IRSP. The reasons and implications of these findings will be discussed.

How Do Executive Functions Influence Children's Reasoning About Counterintuitive Concepts in Mathematics and Science?

Many scientific and mathematical concepts are counterintuitive because they conflict with misleading perceptual cues or incorrect naive theories that we build from our everyday experiences of the world. Executive functions (EFs) influence mathematics and science achievement, and inhibitory control (IC), in particular, might facilitate counterintuitive reasoning. Stop & Think (S&T) is a computerised learning activity that trains IC skills. It has been found effective in improving primary children's mathematics and science academic performance in a large scale RCT trial (Palak et al., 2019; Wilkinson et al., Journal of Cognitive Enhancement, 4, 296-314, 2020). The current study aimed to investigate the role of EFs and the moderating effects of S&T training on counterintuitive mathematics and science reasoning. A sample of 372 children in school Years 3 (7- to 8-year-olds) and 5 (9- to 10-year-olds) were allocated to S&T, active control or teaching as usual conditions, and completed tasks assessing verbal and visuospatial working memory (WM), IC, IQ, and counterintuitive reasoning, before and after training. Cross-sectional associations between counterintuitive reasoning and EF were found in Year 5 children, with evidence of a specific role of verbal WM. The intervention benefited counterintuitive reasoning in Year 3 children only and EF measures were not found to predict which children would most benefit from the intervention. Combined with previous research, these results suggest that individual differences in EF play a lesser role in counterintuitive reasoning in younger children, while older children show a greater association between EFs and counterintuitive reasoning and are able to apply the strategies developed during the S&T training to mathematics and science subjects. This work contributes to understanding why specifically the S&T intervention is effective. This work was preregistered with the ISRCTN registry (TRN: 54726482) on 10/10/2017.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41465-023-00271-0.

The Processing Mechanism of Repetitive Practice Affecting Time-Based Prospective Memory

Time-based prospective memory (TBPM) refers to performing intended actions at a specific time in the future. The TBPM task is very common in daily life, and whether it can be successfully completed can affect our quality of life. Repeated behavior training can usually improve social cognitive performance, and this study focused on exploring whether TBPM performance could improve with repeated behavior training. Meanwhile, we also focused on whether behavior training could reduce attention consumption, both internal and external, attention on TBPM tasks. In this study, a single-factor between-subject design was adopted. Seventy-three undergraduates were assigned to three groups: the control group, the baseline group, and the experimental group. The baseline group only needs to perform ongoing tasks, so the ongoing task performance of the control group will not be affected by TBPM tasks. The control group needs to perform both ongoing and TBPM tasks without practice. The experimental group needs to perform both ongoing and TBPM tasks after 30 exercises. The ongoing task is a typical working memory task. The TBPM task was to press a "1" button every 1 min. The results showed that the performance of ongoing tasks in the baseline group, experimental group, and control group decreased sequentially, and the experimental group had less time monitoring than the control group. The results indicated that behavior training could reduce attention consumption in both internal attention and external attention, but it could not reach the level of automatic processing.

Computerized working memory training in males with Duchenne muscular dystrophy: A single case experimental design study

Learning disabilities (LDs) and working memory problems (WM) are common brain-related comorbidities in Duchenne muscular dystrophy (DMD). Despite growing evidence on the efficacy of computerized WM training in children with LDs, research in DMD is lacking. This exploratory study assessed whether training (1) improves dystrophin-associated WM problems in DMD, (2) effects are present at post-intervention, 3 and 8 months follow-up, and (3) improves problems that arise from their LDs. A single case non-concurrent multiple baseline across patients design evaluated the target behaviour i.e. parental reports of WM problems of four DMD participants with LDs. Additionally, participants completed cognitive tests of verbal and visual WM, academics, attention, processing speed and fluid reasoning. Parents and teachers completed behavioural questionnaires. Testing and questionnaires were administered at baseline, post-intervention (T2), 3 (T3) and 8 (T4) months follow-up. Positive effects on target behaviour were found for three of four participants, but parental bias cannot be ruled out. Short and long-term, near-and far transfer effects were found for verbal and visual WM (T2:n = 2, T3&T4:n = 1), reading (T2:n = 4,T3:n = 3,T4:n = 2), arithmetic (all T:n = 1), processing speed (all T:n = 4) and fluid reasoning (T2:n = 1,T3&T4:n = 2). Behavioural questionnaires displayed minimal changes (T2:n = 1,T3&T4:n = 2). Promising WM training results are shown in DMD that merit further research.

Fostering cognitive performance in older adults with a process- and a strategy-based cognitive training

       The present study investigates the impact of process-based and strategy-based cognitive training to boost performance in healthy older adults. Three groups trained with either a dichotic listening training (process-based training, n = 25), an implementation intention strategy training (strategy-based training, n = 23), or served as a non-contact control group (n = 30). Our results demonstrated that training participants improved their performance in the trained tasks (process-based training: d = 3.01, strategy-based training: d = 2.6). For untrained tasks, the process-based training group showed significant working memory (d = .58) as well as episodic memory task improvement (d = 1.19) compared to the strategy-based training and to the non-contact control group (all d < .03). In contrast, in the strategy-based training group there was a tendency towards some performance gain in a fluid intelligence test (d = .92). These results indicate that cognitive training can be tailored to improve specific cognitive abilities.

Working Memory Training in Norwegian Children with Cerebral Palsy (CP) Show Minimal Evidence of Near and No Far Transfer Effects

In children with cerebral palsy (CP), learning disabilities are well documented, and impairments in executive functions, such as attention, inhibition, shifting and working memory, represent significant burdens on patients, their families and the society. The aim of this study was to evaluate whether Cogmed RM working memory training could improve working memory in children with CP and investigate whether increased working memory capacity would generalize to other cognitive functions. Twenty-eight children completed the training and the results were compared to a waitlist control group (n = 32). The results yielded three main findings. First, children with CP improved with practice on trained working memory tasks. Second, the intervention group showed minimal near transfer effects to non-trained working memory tasks. Third, no effects on cognitive and behavioral far transfer measures were found.

Mechanisms of Cognitive Change: Training Improves the Quality But Not the Quantity of Visual Working Memory Representations

As of yet, visual working memory (WM) training has failed to yield consistent cognitive benefits to performance in untrained tasks, despite large improvements in trained tasks. Investigating the mechanisms underlying training effects can help explain these inconsistencies. In this pre-registered, pre-test/post-test online training study, we examined how training affects the quantity and quality of representations in visual WM using continuous-reproduction tasks. N = 64 young healthy adults were randomly assigned to an experimental group or an active control group to complete four training sessions of practce in an orientation-reproduction or a visual search task, respectively. We observed that, in the trained task, only the quality, but not the quantity, of visual WM representations significantly increased in the experimental group relative to the control group. These improvements did not generalise to untrained stimuli or paradigms. Therefore, our findings suggest that training gains are not driven by enhanced capacity. Instead, gains in the quality of visual WM representations that are tied to specific stimuli and paradigms may reflect enhanced efficiency in using the existing visual WM capacity.

Generalization of Skill for a Working Memory Recognition Procedure in Children: The Benefit of Starting with Easy Materials

When children practice a new task, they need to learn both the task procedure and the materials tested. It is often unclear if improvements with practice reflect learning of the task procedure or familiarity with the materials. We sought to examine learning of the task procedure by switching from one set of materials to another in a working memory recognition task. We recruited 70 children (34 female, M = 11.27 years, SD = 0.62, ranging from 10.08 to 12.39) in the United States who were to remember sequences of orientations and of shapes for recognition immediately following the list. Half of the children began with orientation, an easier task, and the other half began with difficult-to-name shapes, a harder task. When children began with the easier task, the acquisition of the recognition task skill in the easy condition transferred to the more difficult task, optimizing the mean performance across tasks. Transfer was less potent when children began with the more difficult task. The results showed that sufficient practice is crucial to avoid poor initial performance, which might be important for the student’s rate of progress and task engagement.

Are facet-specific task trainings efficient in improving children's executive functions and why (they might not be)? A multi-facet latent change score approach

It currently remains unclear how facet-specific trainings of three core modules of executive function (EF; updating, switching, and inhibition) directly compare regarding efficacy, whether improvements on trained tasks transfer to nontrained EF tasks, and which factors predict children's improvements. The current study systematically investigated three separate EF trainings in 6- to 11-year-old children (N = 229) using EF-specific trainings that were similar in structure, design, and intensity. Children participated in pre- and posttest assessments of the three EFs and were randomly allocated to one of three EF trainings or to an active or passive control group. Multivariate latent change score models revealed that only the updating group showed training-specific improvements in task performance that were larger compared with active controls as well as passive controls. In contrast, there were no training-specific benefits of training switching or inhibition. Latent changes in the three EF tasks were largely independent, and there was no evidence of transfer effects to nontrained EF tasks. Lower baseline performance and older age predicted larger changes in EF performance. These seemingly opposing effects support compensation accounts as well as developmental theories of EF, and they highlight the importance of simultaneously accounting for multiple predictors within one model. In line with recent theoretical proposals of EF development, we provide new systematic evidence that questions whether modular task trainings represent an efficient approach to improve performance in narrow or in broader indicators of EF. Thereby, this evidence ultimately highlights the need for more comprehensive assessments of EF and, subsequently, the development of new training approaches.

Training and asymmetrical transfer effects of working memory and inhibitory control in primary school children

Working memory (WM) and inhibitory control (IC) are two fundamental and supportive components of executive function (EF) that are critical for school-age children. However, the direct comparison of the training and transfer effects of WM and IC training in school-age children still needs to be improved. This study adopted a "pre-, post-, and delayed posttest" design to compare the training, near-transfer, and far-transfer effects of WM and IC in school-age children. A total of 60 children aged 8 to 10 years were randomly assigned to the WM training group, IC training group, or control group. Children in the WM and IC training groups completed 12 sessions of multiple adaptive training tasks tapping different subcomponents of WM (visual-spatial and verbal WM) and IC (interference control and response inhibition) separately. In the pretraining, posttraining, and 6-month follow-up stages, we used WM and IC tasks to evaluate training and near-transfer effects and used analogical reasoning tasks to evaluate far-transfer effects. Results showed significant training effects on visual-spatial and verbal WM, near-transfer effects on response inhibition, and far-transfer effects on analogical reasoning for WM training in the posttraining stage. The improvements in verbal WM and analogical reasoning were maintained for 6 months, whereas for IC training only the training effects on response inhibition and the far-transfer effects on analogical reasoning were observed in the posttraining stage and only the training effects on response inhibition were maintained for 6 months. Results suggested positive training and asymmetrical transfer effects of WM and IC training, which provide new evidence for the effectiveness of WM and IC training in school-age children.

The mechanisms of far transfer from cognitive training: specifying the role of distraction suppression

Cognitive training aims to produce a durable transfer to untrained abilities (i.e., far transfer). However, designing effective programs is difficult, because far transfer mechanisms are not well understood. Greenwood and Parasuraman (Neuropsychol 30(6):742-755. https://doi.org/10.1037/neu0000235 , 2016) proposed that the ability to ignore distractions is key in promoting far transfer. While the authors identified working-memory training based on the N-back task as an effective way to train distraction suppression, a recent meta-analysis concluded that this form of training rarely produces far transfer. Such inconsistency casts doubt onto the importance of distraction suppression in far transfer and calls for further examination of the role of this ability in cognitive training effectiveness. We propose here to conceptualize distraction suppression in the light of the load theory of attention, which distinguishes two mechanisms of distractor rejection depending on the level and type of information load involved: perceptual selection and cognitive control. From that standpoint, N-back training engages a single suppression mechanism, namely cognitive control, because it mainly involves low perceptual load. In the present study, we compared the efficacy of N-back training in producing far transfer to that of a new response-competition training paradigm that solicits both distraction suppression mechanisms. Response-competition training was the only one to produce far transfer effects relative to an active control training. These findings provided further support to Greenwood and Parasuraman's hypothesis and suggest that both selection perception and cognitive control need to be engaged during training to increase the ability to suppress distraction, hence to promote far transfer.

Effects of working memory training on cognitive and academic abilities in typically developing school-age children

Process-based working memory (WM) training in typically developing children usually leads to short- and long-term improvements on untrained WM tasks. However, results are mixed regarding far transfer to academic and cognitive abilities. Moreover, there is a lack of studies jointly evaluating the different types of transfer, using an adequate design and considering motivational factors. In addition, evidence is needed about how pre-training performance is related to individual differences in training-induced transfer. Therefore, this study aimed to implement and evaluate the efficacy of a computerized process-based WM training in typically developing school-age children. Near and far transfer effects were evaluated both immediately after training and after 6 months, as well as individual differences in training-induced transfer. The sample was composed of 89 typically developing children aged 9-10 years (M = 9.52, SD = 0.30), who were randomized to a WM training group or an active control group. They were evaluated at pre-training, post-training, and follow-up phases with measures of visuospatial and verbal WM, reading comprehension, math computation, and fluid intelligence. Results showed that the training group significantly improved performance in verbal WM and fluid intelligence compared to the active control group, immediately after training and after 6 months. Trained children with lower initial performance in verbal WM or fluid intelligence showed greater transfer gains. No group differences were found in motivational factors. Findings of this study suggest that process-based WM training may promote transfer to cognitive abilities and lead to compensation effects of individual differences in typically developing school-age children.

Atypical development of social and nonsocial working memory capacity among preschoolers with autism spectrum disorders

Individuals with autism spectrum disorders (ASD) have shown impaired performance in canonical and nonsocial working memory (WM). However, no study has investigated social WM and its early development. Using biological motion stimuli, our study assessed the development of social and nonsocial WM capacity among children with or without ASD across the age span between 4 and 6 (N = 150). While typically developing (TD) children show a rapid development from age 5 to 6, children with ASD showed a delayed development for both social and nonsocial WM capacity, reaching a significant group difference at age 6. Furthermore, we found a negative correlation between social (but not nonsocial) WM capacity and the severity of autistic symptoms among children with ASD. In contrast, there is a positive correlation between both types of WM capacity and intelligence among TD children but not among children with ASD. Our findings thus indicate that individuals with ASD miss the rapid development of WM capacity in early childhood and, particularly, their delayed social WM development might contribute to core symptoms that critically depend on social information processing.

Training Programs for Improving Speech Perception in Noise: A Review

Understanding speech in the presence of noise is difficult and challenging, even for people with normal hearing. Accurate pitch perception, coding and decoding of temporal and intensity cues, and cognitive factors are involved in speech perception in noise (SPIN); disruption in any of these can be a barrier to SPIN. Because the physiological representations of sounds can be corrected by exercises, training methods for any impairment can be used to improve speech perception. This study describes the various types of bottom-up training methods: pitch training based on fundamental frequency (F0) and harmonics; spatial, temporal, and phoneme training; and top-down training methods, such as cognitive training of functional memory. This study also discusses music training that affects both bottom-up and top-down components and speech training in noise. Given the effectiveness of all these training methods, we recommend identifying the defects underlying SPIN disorders and selecting the best training approach.

Intra-individual variability in task performance after cognitive training is associated with long-term outcomes in children

The potential benefits and mechanistic effects of working memory training (WMT) in children are the subject of much research and debate. We show that after five weeks of school-based, adaptive WMT 6-9 year-old primary school children had greater activity in prefrontal and striatal brain regions, higher task accuracy, and reduced intra-individual variability in response times compared to controls. Using a sequential sampling decision model, we demonstrate that this reduction in intra-individual variability can be explained by changes to the evidence accumulation rates and thresholds. Critically, intra-individual variability is useful in quantifying the immediate impact of cognitive training interventions, being a better predictor of academic skills and well-being 6-12 months after the end of training than task accuracy. Taken together, our results suggest that attention control is the initial mechanism that leads to the long-run benefits from adaptive WMT. Selective and sustained attention abilities may serve as a scaffold for subsequent changes in higher cognitive processes, academic skills, and general well-being. Furthermore, these results highlight that the selection of outcome measures and the timing of the assessments play a crucial role in detecting training efficacy. Thus, evaluating intra-individual variability, during or directly after training could allow for the early tailoring of training interventions in terms of duration or content to maximise their impact.

The effect of computerized working memory training on working memory and emotion perception for patients with chronic schizophrenia and normal cognition

BACKGROUND

Cognitive impairment and affective symptoms are hallmark features of patients with schizophrenia. This study determines whether a computerized working memory training program improves the patient's working memory and affective perception.

METHODS

Thirty-nine male patients with schizophrenia, aged 25-65, participated in this study. The study uses a single-blind randomized controlled design. Twenty subjects were assigned to the experimental group and received an eight-week working memory computerized training course comprising four modules of the CogniPlus system. Nineteen subjects were assigned to the control group and received treatment as usual. All subjects received the same assessments twice, including the Mini-Mental Status Examination (MMSE), Working Memory Index (WMI) of Wechsler Adult Intelligence Scale-Third Edition, and the subjective rating of pictures of the International affective picture system by Self-Assessment Manikin (SAM).

RESULTS

This study shows that computerized working memory training improves WMI and the score for MMSE and produces a significant increase in the pleasure score for S.A.M. for negative pictures, between the pretest and post-test for the experimental group.

CONCLUSIONS

Working memory training improves working memory and emotion perception for patients with chronic schizophrenia and normal cognition. The limitations of this study and suggestions for future study are also discussed.

Framing cognitive offloading in terms of gains or losses: achieving a more optimal use of reminders

Nowadays individuals can readily set reminders to offload intentions onto external resources, such as smartphone alerts, rather than using internal memory. Individuals tend to be biased, setting more reminders than would be optimal. We address the question whether the reminder bias depends on offloading scenarios being framed as either gains or losses, both between-participants (Experiment 1) and within-participants (Experiment 2). In both experiments, framing of reminders in terms of gains resulted in participants employing a risk-averse strategy and using more reminders than would be optimal. Importantly, however, participants used reminders more optimally and were more willing to choose the risk-seeking option of remembering internally when reminders implied a loss. Based on metacognitive measures in Experiment 2, the reminder bias increased the more underconfident participants were about their memory abilities in both framing scenarios. Framing did not alter this relationship between erroneous metacognitive underconfidence and reminder bias but provides an additional influence. We conclude that emphasizing the losses (costs) associated with external reminders helps in achieving more optimal decisions in offloading situations, and that in addition to cognitive effort and metacognitive judgments, framing needs to be considered in improving individuals’ offloading behavior.

Effects of virtual reality working memory training on event-based prospective memory in patients with major depressive disorder

BACKGROUND

Event-based prospective memory (EBPM) refers to remembering to perform delayed intention when specific events occur. EBPM deficit is present in patients with major depressive disorder (MDD) and hinders recovery from the illness. Working memory training (WMT) has been reported to enhance EBPM but its effect on EBPM in MDD remains unclear. We investigated whether virtual reality (VR)-based WMT can improve EBPM in MDD patients.

METHODS

Forty-six MDD patients and 41 healthy controls (HC) were recruited. Among the former ones, the first 23 consecutive patients were allocated to the experimental group (MDD-VR) and the next 23 consecutive patients to the waitlist control group (MDD-W). EBPM accuracy was used to assess EBPM performance. Hamilton Depression Rating Scale (HDRS) and Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ) were employed to assess the cognitive functions and the depressive symptoms.

RESULTS

At baseline, EBPM accuracy did not significantly differ between MDD-VR and MDD-W but was lower in both of these two groups than in HC (both p < 0.001). Group-by-time interactions on EBPM accuracy (F = 4.614, p = 0.031) and CPFQ score (F = 5.754, p = 0.021) were present, whereas no significant group-by-time interaction or group effects were observed for HDRS score (both p > 0.05). After VR intervention, MDD-VR showed an increase in EBPM accuracy (Cohen's d = 1.20 [95% CI: 0.53, 1.86], p = 0.001).

CONCLUSIONS

Our results demonstrated that VR-based WMT could improve EBPM deficits in MDD patients. Large-scale studies of a VR-based WMT program are indicated.

Teacher perceptions of working memory and executive function improvements following school-day cognitive training

Considerable research has documented the impact of teacher perceptions on students’ academic-related outcomes (e.g., classroom performance). This body of literature clearly shows that teacher perceptions (resulting from direct interactions with students) can have both positive and negative effects with respect to student behaviors and experiences in the classroom. What remains unclear is whether teachers perceive changes that result from interventions administered outside of their classrooms. The purpose of this study was to examine changes in teacher perceptions of working memory and executive function concerns (two important predictors of academic success) among students who participated in a computerized cognitive training program designed to enhance working memory skills. The current results indicate that teachers perceived fewer concerns following students’ participation in the training; this outcome was supplemented with significant improvements in the students’ working memory capabilities following the training program. These findings have important implications given the literature highlighting the relation between teacher perceptions and student outcomes as a function of a school-based computerized cognitive training intervention.

Effect of horticultural activities on quality of life, perceived stress, and working memory of community-dwelling older adults

This study sampled 86 community-dwelling older adults to investigate the effect of horticultural activities on their quality of life, perceived stress, and working memory. The results demonstrated that after 8 weeks of horticultural activities, the effect sizes (Cohen's d) of their quality of life, perceived stress, and working memory were 0.92, -1.32, and 0.62, respectively. Among the four domains of quality of life, the social relationships domain improved the most. For perceived stress, the score of the experimental group decreased from 1.70 (0.48) to 1.29 (0.58). For working memory, the score increased from 3.43 (1.13) to 4.14 (1.27), whereas the score of the control group did not change substantially. Statistical analysis conducted using a generalized estimating equation revealed a significant interaction effect between group and time (P < 0.001). This study provides a reference for improving the quality of life, perceived stress, and working memory in older people.

Possible evidence of near transfer effects after adaptive working memory training in persons with multiple sclerosis

BACKGROUND

Cognitive deficits, especially in working memory (WM) and information processing (IP) efficiency, are common in people with multiple sclerosis (PwMS). Few studies have examined the efficacy of n-back training in improving these two cognitive functions in PwMS. In the present study, we examined the effects of an intensive n-back training program by measuring the gains on the trained task (2- and 3-back tasks), but we also studied possible near transfer effects to other tests that assess WM and IP, as well as far transfer effects or improvements in other cognitive functions.

METHODS

A sample consisting of 35 PwMS with different cognitive statuses. All the participants underwent an adaptive n-back training for 10 days (60 min/day), and they were neuropsychologically assessed at baseline (D1) and after training (D10). The effectiveness of the training was tested: (1) by using mean-based comparisons and Cohen's d values; (2) by estimating and comparing the quartile values of the D1 and D10 distributions. Two indexes of improvement in individual performance were calculated, the net score improvement index (NSI) and the percent of maximum possible individualized improvement (PMPI).

RESULTS

Repeat practice improves 2- and 3-back performance, showing more correct responses (CR) and lower reaction times (RT) on D10 compared to D1. These results were corroborated by the NSI and PMPI scores, but the gains after training were more statistically significant for the 3-back (observing higher CR and lower RT after training) than for the 2-back (observing gains in CR, but not in RT). We also observed a possible transference of this improvement on the n-back task to other WM/IPS tests. Specifically, statistically significant pre-post training differences were found in the values in three quartiles of the Paced Auditory Serial Addition Test (PASAT; q25, p < 0.03; q50, p < 0.001; q75, p < 0.002) and of the Symbol Digit Modalities Test (SDMT; q25, p < 0.03; q50, p < 0.001; q75, p < 0.001) as well as in two quartiles of the Letter-Number Sequencing Task (LNST; q50, p < 0.004; q75 p < 0.001), and in one quartile of the Digit Backwards Span Test (DSBT; q75, p < 0.001). Reliable change analyses confirmed these performance improvements on the PASAT, SDMT, and LNST.

CONCLUSIONS

This study confirmed that the intensive and adaptive n-back training produced improvements in the trained task in PwMS with different cognitive statuses. Furthermore, these gains were not only observed on the trained task, but they seemed to be also transferred to other tests that measured WM and IP functions.

Effectiveness of a process-based executive function intervention on arithmetic knowledge of children with Developmental Dyscalculia

BACKGROUND

Arithmetic knowledge has long been known as an essential factor for educational and vocational success.

AIMS

This study aims to explore the effectiveness of a process-based Executive Function (EF) intervention program on the improvement of components of arithmetic.

METHODS AND PROCEDURE

A goal-directed sampling method was applied in this study. Participants were assigned into active control and experimental groups. Semi-experimental design with pre-test, post-test and follow-up was utilized in this research. Participants were included in this study based on their WISC-IV and Key-Math test performance. 30 male students aged 8-10 years with a formal diagnosis of Developmental Dyscalculia (DD), selected from a learning disability center in Ahvaz, Iran, participated in the study. The pre-test took 1 month, the intervention including 17 sessions, took two months and the post-test took 1 month. All the students' arithmetic knowledge were tested in pre-test, post-test, and 3 months after post-test to test the longevity of the intervention effects. Repeated measure Univariate Analysis of Variance was conducted in this study.

OUTCOMES AND RESULTS

The results indicate that the students who attended the intervention, outperformed control group in the components of factual and procedural arithmetic in post-test and follow-up, however; the performance of two groups in conceptual knowledge was not different. This study contributes to the emerging evidence that EF intervention may improve factual and procedural arithmetic knowledge in children with DD.

CONCLUSIONS AND IMPLICATIONS

Process-based EF interventions can improve arithmetic knowledge of students with DD, which can contribute to the literature of this area WHAT THIS PAPER ADDS?: The current research helps cognitive science to present a more meticulous theoretical and conceptual pattern for EF components and math, using process-based EF intervention programs with arithmetic content. Furthermore, this research allows for specification of cognitive fundamentals of arithmetic development and understanding the mechanisms underlying the transfer effect of EF intervention to math. The findings of this research can contribute to evidence-based EF intervention studies and help educational psychologists in preparation of appropriate curricula based on the fundamental components of arithmetic development in preschool and primary school.

The effects of implementation intentions on prospective memory in young and older adults

Prospective memory (PM) is the ability to perform a planned action at a future time, while carrying on with other unrelated tasks. Implementation Intentions (II) is a promising metacognitive strategy for improving PM in older adults, though its generalization and longer-term effects are not well-understood. We examined the effects of II on PM in 48 community-dwelling older adults (77% female, M_age = 71.52) and 59 young adults (75% female, M_age = 19.86). Participants were randomly allocated to a conventional instruction or II group and administered a laboratory-based PM task in the first session. In the second session, participants returned to complete a similar but new laboratory-based PM task and an ecological PM task without prompts to use a strategy. We found strong age effects on PM performance whereby older adults performed worse than young adults across all PM tasks. While the overall facilitation effect of II was not statistically significant, there was a trend that this strategy facilitated PM performance on the laboratory-based PM task in the first session for older adults with a medium sized effect (d = 0.37). The generalization and longer-term effect of II were not significant for either the similar laboratory-based or the ecological PM task. These results suggest that a single-session II intervention may not be sufficient to elicit transfer to other similar new PM tasks in healthy populations.

Considerations for Selecting Cognitive Endpoints and Psychological Patient-Reported Outcomes for Clinical Trials in Pediatric Patients With Sickle Cell Disease

Pediatric patients with sickle cell disease (SCD) experience a range of medical complications that result in significant morbidity and mortality. Recent advances in prophylactic and curative treatment approaches have highlighted the need for sensitive and clinically-meaningful trial endpoints. The detrimental effects of cognitive and psychological difficulties on social and economic mobility are well described. Although numerous reviews have assessed cognitive outcomes in other rare genetic disorders, SCD has not received the same focus. This review describes the cognitive (i.e., executive function and processing speed) and psychological domains (i.e., depression and anxiety) that are consistently associated with SCD pathology and, therefore, may be of particular interest as clinical trial endpoints. We then discuss corresponding well-validated and reliable cognitive tests and patient-reported outcomes (PROs) that may be appropriate for clinical trials given their robust psychometric properties, ease of administration, and previous use in the SCD population. Further, we provide a discussion of potential pitfalls and considerations to guide endpoint selection. In line with the move toward patient-centered medicine, we identify specific tests (e.g., NIH Toolbox Cognition Module, Wechsler Cancellation Test) and psychological PROs (e.g., PROMIS depression and anxiety scales) that are sensitive to SCD morbidity and have the potential to capture changes that are clinically meaningful in the context of patients' day to day lives. In particularly vulnerable cognitive domains, such as executive function, we highlight the advantages of composite over single-test scores within the context of trials. We also identify general (i.e., practice effects, disease heterogeneity) and SCD-specific considerations (i.e., genotype, treatment course, and disease course, including degree of neurologic, pain, and sleep morbidity) for trial measures. Executive function composites hold particular promise as trial endpoints that are clinically meaningful, amenable to change, relatively easy to collect, and can be incorporated into the routine care of patients with SCD in various settings and countries.

Effect of Single Bout of Moderate and High Intensity Interval Exercise on Brain Derived Neurotrophic Factor and Working Memory in Young Adult Females

Objectives: The objectives of the study were to determine the effect of moderate-intensity exercise (MIE) and high-intensity interval exercise (HIIE) on serum brain-derived neurotrophic factor (BDNF) levels and working memory (WM) in young adult females. Methodology: This study was conducted in the Physiology Department, Khyber Girls Medical College Peshawar. Young adult females (n = 22), with a mean age of 20±2 years were recruited for two experimental sessions of MIE and HIIE, respectively. Baseline and post exercise blood samples were taken for determination of serum BDNF level and backward digit span test (BDST) for assessment of working memory in both sessions. Results: Serum BDNF levels pre and post MIE were 707±448 pg/ml and 829±476 pg/ml (p = 0.006) respectively while pre and post HIIE were 785±329 pg /ml and 1116±379 pg/ml (p <  0.001) respectively. BDST scores were significantly high at post intervention for both MIE (p = 0.05) and HIIE (p 0.001). Conclusions: Altogether our findings showed that both MIE and HIIE significantly increased serum BDNF levels and working memory in young adult females.

What Is Targeted When We Train Working Memory? Evidence From a Meta-Analysis of the Neural Correlates of Working Memory Training Using Activation Likelihood Estimation

Working memory (WM) is the system responsible for maintaining and manipulating information, in the face of ongoing distraction. In turn, WM span is perceived to be an individual-differences construct reflecting the limited capacity of this system. Recently, however, there has been some evidence to suggest that WM capacity can increase through training, raising the possibility that training can functionally alter the neural structures supporting WM. To address the hypothesis that the neural substrates underlying WM are targeted by training, we conducted a meta-analysis of functional magnetic resonance imaging (fMRI) studies of WM training using Activation Likelihood Estimation (ALE). Our results demonstrate that WM training is associated exclusively with decreases in blood oxygenation level-dependent (BOLD) responses in clusters within the fronto-parietal system that underlie WM, including the bilateral inferior parietal lobule (BA 39/40), middle (BA 9) and superior (BA 6) frontal gyri, and medial frontal gyrus bordering on the cingulate gyrus (BA 8/32). We discuss the various psychological and physiological mechanisms that could be responsible for the observed reductions in the BOLD signal in relation to WM training, and consider their implications for the construct of WM span as a limited resource.

Brief Strategy Training in Aging: Near Transfer Effects and Mediation of Gains by Improved Self-Regulation

A common approach to cognitive intervention for adults is memory strategy training, but limited work of this type has examined intervention effects in relation to self-regulation (e.g., strategy usage, memory beliefs) and few have established near transfer (training-related performance gain on untrained tasks related to the target task). The present research, Everyday Memory Clinic—Revised (EMC-R), examined whether relatively brief face-name association training, offering elements focused on self-regulation, can improve name recall, enhance memory self-regulation, and lead to near transfer. Participants were 122 healthy, well-educated middle-aged and older adults (51–90 years old) randomly assigned to a strategy training program (SO), a comparable program with a theoretical self-regulatory boost (SB), or a waitlist control group. Compared to the waitlist group, both groups of trainees demonstrated higher pretest-posttest improvements in name recall (target task), memory self-efficacy, and effective strategy use, as well as the near transfer of gains to nontrained associative tasks, a rare finding in strategy training research. Furthermore, changes in memory self-efficacy and strategy use fully mediated the effect of training on name recall. This innovative approach for brief memory intervention offers a model for successful training that can be easily disseminated via community centers and lifelong learning programs.

Higher white matter hyperintensity load adversely affects pre-post proximal cognitive training performance in healthy older adults

Cognitive training has shown promise for improving cognition in older adults. Age-related neuroanatomical changes may affect cognitive training outcomes. White matter hyperintensities are one common brain change in aging reflecting decreased white matter integrity. The current study assessed (1) proximal cognitive training performance following a 3-month randomized control trial and (2) the contribution of baseline whole-brain white matter hyperintensity load, or total lesion volume (TLV), on pre-post proximal training change. Sixty-two healthy older adults were randomized to either adaptive cognitive training or educational training control interventions. Repeated-measures analysis of covariance revealed two-way group × time interactions such that those assigned cognitive training demonstrated greater improvement on proximal composite (total training composite) and sub-composite (processing speed training composite, working memory training composite) measures compared to education training counterparts. Multiple linear regression showed higher baseline TLV associated with lower pre-post change on processing speed training sub-composite (β = -0.19, p = 0.04), but not other composite measures. These findings demonstrate the utility of cognitive training for improving post-intervention proximal performance in older adults. Additionally, pre-post proximal processing speed training change appears to be particularly sensitive to white matter hyperintensity load versus working memory training change. These data suggest that TLV may serve as an important factor for consideration when planning processing speed-based cognitive training interventions for remediation of cognitive decline in older adults.

Working memory development: A 50-year assessment of research and underlying theories

The author has thought about working memory, not always by that name, since 1969 and has conducted research on its infant and child development since the same year that the seminal work of Baddeley and Hitch (1974) was published. The present article assesses how the field of working memory development has been influenced since those years by major theoretical perspectives: empiricism (along with behaviorism), nativism (along with modularity), cognitivism (along with constructivism), and dynamic systems theory. The field has not fully discussed the point that these theoretical perspectives have helped to shape different kinds of proposed working memory systems, which in turn have deeply influenced what is researched and how it is researched. Here I discuss that mapping of theoretical viewpoints onto assumptions about working memory and trace the influence of this mapping on the field of working memory development. I illustrate where these influences have led in my own developmental research program over the years.

Mental-Imagery-Based Mnemonic Training: A New Kind of Cognitive Training

We investigated the immediate and maintenance effects of mental-imagery-based mnemonic training on improving youths’ working memory, long-term memory, arithmetic and spatial abilities, and fluid intelligence. In Experiment 1, 26 Chinese participants (15 boys, 11 girls) aged 10–16 years were divided into an experimental group that received 8 days of mental-imagery-based mnemonic training and a no-contact control group. Participants completed pre-, post-, and three follow-up tests (3, 6, and 12 months after the pre-test). In Experiment 2, 54 Chinese children (28 boys, 26 girls), all 12 years old, were divided into experimental and control groups. Participants completed pre-, post-, and follow-up tests (three months after the pre-test). Results showed that the training significantly affected long-term memory-related task performance but no effects were observed on working memory, arithmetic or spatial ability, or fluid intelligence-related tasks. Moreover, the effect of the training on long-term memory lasted up to one year; the more frequently the training was used, the more effective it was. A content analysis of the feedback submitted by parents of participants in Experiment 2 three months after the training showed that the children used the strategy more for memorizing content such as Chinese and English, as well as for musical scores. Furthermore, there was also the possibility that the training improved abilities and academic performance such as concentration and math performance. Our results provide a basis for the further exploration of mental-imagery-based mnemonic training as a novel training modality.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Feasibility of a Home-Based Task-Switching Training in Middle-Aged Caregivers

The current study aimed at investigating feasibility of a self-administered task-switching training in a middle-aged working population. Eighty-one caregivers (41–62 years old) were instructed to train at home 8 times either within a 7- or 14-day interval. Only 56.7% performed more than 50% of the instructed number of training sessions. However, compliant caregivers (who completed more than 4 training sessions) showed significant training gains and transfer to an untrained task-switching task. Although transfer effects to other cognitive tasks were not found, trained participants tended to report fewer everyday memory failures than a control group. In conclusion, the implementation of a home-based task-switching training in everyday life of caregivers is possible. However, there is only limited evidence for generalization of results of previous laboratory studies. Adherence and transfer to other cognitive tasks are discussed as important challenges in conveying laboratory findings into real life.

The Pursuit of Effective Working Memory Training: a Pre-registered Randomised Controlled Trial with a Novel Varied Training Protocol

Working memory (WM) training, typically entailing repetitive practice with one or two tasks, has mostly yielded only limited task-specific transfer effects. We developed and tested a new WM training approach where the task paradigm, stimulus type, and predictability of the stimulus sequence were constantly altered during the 4-week training period. We expected that this varied training protocol would generate more extensive transfer by facilitating the use of more general strategies that could be applied to a range of WM tasks. Pre-post transfer effects following varied training (VT group, n = 60) were compared against traditional training (TT group, training a single adaptive WM task, n = 63), and active controls (AC, n = 65). As expected, TT evidenced strong task-specific near transfer as compared to AC. In turn, VT exhibited task-specific near transfer only on one of the measures, and only as compared to the TT group. Critically, no evidence for task-general near transfer or far transfer effects was observed. In sum, the present form of VT failed to demonstrate broader transfer. Nevertheless, as VT has met with success in other cognitive domains, future studies should probe if and how it would be possible to design WM training protocols that promote structural learning where common features of specific tasks would be identified and utilised when selecting strategies for novel memory tasks.

Substance use disorder and obesogenic eating: Does working memory training strengthen ability to abstain from unwanted behaviors? A systematic review

INTRODUCTION

Abstaining from unwanted behaviors requires a sufficient balance between the executive and impulsive cognitive systems. Working memory (WM) is a vital component of both systems, identified in a wide range of research as the central and dominant component of executive function. WM potentially modulates the desires, tendencies, and behaviors specific to and seen in individuals with substance use disorder (SUD) and obesogenic eating (OE). Compared to healthy populations, research has shown individuals with SUD, as well as those who display OE, to have some degree of executive dysfunction, and both conditions have far-reaching health care implications. Additionally, these deficits are associated with impulsive behavior. Research has proposed that impulsive and so-called reward-driven responses could be altered through cognitive therapy and that both SUD and OE could benefit from working memory training (WMT).

METHOD

In this narrative review, we systematically align extant empirical reasoning and evidence with these assumptions. Our main aim is to ascertain and summarize the value of WMT for the treatment of both SUD and food reward consummatory behaviors. As a means to include detailed narrative accounts of all papers of potential value, our thresholds for meaningful improvements in both WM and unwanted behaviors are broad.

RESULTS

The results from the eleven qualifying studies are as follows: Nine of ten studies show a significant positive training effect of WMT on one or more components of WM capacity; three of six eligible papers (two on alcohol and one on opioid addiction) deliver notable improvements in SUD in response to WMT. One of two suitable studies showed WMT to be a moderately efficacious form of therapy for OE. Conversely, WMT appears to have negligible therapeutic benefit for cognitive function deficits or psychopathology unrelated to WM, suggesting that WMT has unique treatment efficacy for impulsive human behaviors.

CONCLUSION

In conclusion, more rigorous and uniform studies on WMT and impulsive harmful behaviors are required to give proof of the benefits of this potential useful treatment.

The effectiveness of affective compared to neutral working memory training in university students with test anxiety

BACKGROUND

Test anxiety (TA), defined as the emotional, physiological, and behavioural responses surrounding situations involving formal evaluation of performance, is a relatively common occurrence, and, when present, can be a disruptive factor in students' academic careers. Research indicates that working memory, in particular, affective working memory, is impaired in individuals with TA. The current study therefore explored whether training the application of working memory in affective contexts could reduce TA and associated cognitive and affective impairments.

METHOD

60 Iranian university students (50% female; 19-22 years) with TA symptoms were randomized to receive 20 sessions of affective working memory training (aWMT), neutral working memory training (nWMT) or to a no-training control group. Prior and immediately after training, all participants completed measures of TA, working memory, cognitive control, and emotion regulation.

RESULTS

Compared to the control group, both the aWMT and the nWMT groups demonstrated improved cognitive and affective functioning from pre-to post-training. However, the reduction in TA symptoms and improvement in emotion regulation was greater in the aWMT group compared to the nWMT group.

CONCLUSION

aWMT may be an effective means of not only reducing TA, but also enhancing cognitive and affective functioning. These preliminary findings are promising given the potential for free and easy dissemination of aWMT in schools and online settings, including low- and middle-income countries.

Transcranial Magnetic Stimulation and Working Memory Training to Address Language Impairments in Aphasia: A Case Study

BACKGROUND

Traditionally, people with aphasia (PWA) are treated with impairment-based language therapy to improve receptive and expressive language skills. In addition to language deficits, PWA are often affected by some level of working memory (WM) impairments. Both language and working memory impairments combined have a negative impact on PWA's quality of life. The aim of this study was to investigate whether the application of intermittent theta-burst stimulation (iTBS) combined with computerized WM training will result in near-ransfer effects (i.e., trained WM) and far-transfer effects (i.e., untrained language tasks) and have a positive effect on the quality of life of PWA.

METHODS

The participant was a 63-year-old Greek-Cypriot male who presented with mild receptive aphasia and short-term memory difficulties. Treatment was carried out using a multiple baseline (MB) design composed of a pretherapy or baseline testing phase, a therapy phase, and a posttherapy/follow-up phase. The treatment program involved iTBS application to the left dorsolateral prefrontal cortex (DLPFC), an area responsible for WM, for 10 consecutive sessions. The participant received a 3-minute iTBS application followed by 30-minute computer-assisted WM training. Outcome measures included a WM screening test, a standardized aphasia test, a nonverbal intelligence test, story-telling speech samples, a procedural discourse task, and a questionnaire addressing quality of life. These measures were performed three times before the treatment, immediately upon completion of the treatment, and once during follow-up testing at 3 months posttreatment.

RESULTS

We found a beneficial effect of iTBS and WM training on naming, reading, WM, reasoning, narrative, communication efficiency, and quality of life (QoL). Implications for Rehabilitation. Noninvasive brain stimulation combined with computerized WM training may be used in aphasia rehabilitation to improve WM and generalize to language improvement.

Cogmed Training Does Not Generalize to Real-World Benefits for Adult Hearing Aid Users: Results of a Blinded, Active-Controlled Randomized Trial

Objectives:

Performance on working memory tasks is positively associated with speech-in-noise perception performance, particularly where auditory inputs are degraded. It is suggested that interventions designed to improve working memory capacity may improve domain-general working memory performance for people with hearing loss, to benefit their real-world listening. We examined whether a 5-week training program that primarily targets the storage component of working memory (Cogmed RM, adaptive) could improve cognition, speech-in-noise perception and self-reported hearing in a randomized controlled trial of adult hearing aid users with mild to moderate hearing loss, compared with an active control (Cogmed RM, nonadaptive) group of adults from the same population.

Design:

A preregistered randomized controlled trial of 57 adult hearing aid users (n = 27 experimental, n = 30 active control), recruited from a dedicated database of research volunteers, examined on-task learning and generalized improvements in measures of trained and untrained cognition, untrained speech-in-noise perception and self-reported hearing abilities, pre- to post-training. Participants and the outcome assessor were both blinded to intervention allocation. Retention of training-related improvements was examined at a 6-month follow-up assessment.

Results:

Per-protocol analyses showed improvements in trained tasks (Cogmed Index Improvement) that transferred to improvements in a trained working memory task tested outside of the training software (Backward Digit Span) and a small improvement in self-reported hearing ability (Glasgow Hearing Aid Benefit Profile, Initial Disability subscale). Both of these improvements were maintained 6-month post-training. There was no transfer of learning shown to untrained measures of cognition (working memory or attention), speech-in-noise perception, or self-reported hearing in everyday life. An assessment of individual differences showed that participants with better baseline working memory performance achieved greater learning on the trained tasks. Post-training performance for untrained outcomes was largely predicted by individuals’ pretraining performance on those measures.

Conclusions:

Despite significant on-task learning, generalized improvements of working memory training in this trial were limited to (a) improvements for a trained working memory task tested outside of the training software and (b) a small improvement in self-reported hearing ability for those in the experimental group, compared with active controls. We found no evidence to suggest that training which primarily targets storage aspects of working memory can result in domain-general improvements that benefit everyday communication for adult hearing aid users. These findings are consistent with a significant body of evidence showing that Cogmed training only improves performance for tasks that resemble Cogmed training. Future research should focus on the benefits of interventions that enhance cognition in the context in which it is employed within everyday communication, such as training that targets dynamic aspects of cognitive control important for successful speech-in-noise perception.

The Effects of Exercise Interventions on Executive Functions in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review and Meta-analysis

BACKGROUND

Both chronic and acute exercise interventions have reported positive effects on executive functions (EFs) in general populations. However, data on changes in EFs in children and adolescents with autism spectrum disorder (ASD) in response to exercise interventions are still unclear.

OBJECTIVE

This systematic review and meta-analysis aimed to synthesize available empirical studies concerning the effects of exercise interventions on EFs in children and adolescents with ASD.

METHODS

In accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines, the electronic databases CINAHL Complete (via EBSCOhost), SPORTDiscus with Full Text (via EBSCOhost), MEDLINE (via EBSCOhost), Web of Science, ProQuest, and Education Resources Information Center (ERIC; via EBSCOhost) were searched from inception to January 2021. Two authors independently extracted data and conducted a risk-of-bias analysis using the Physiotherapy Evidence Database scale. Randomized controlled trials/quasi-experimental designs that used acute or chronic exercise interventions and assessed EFs through neurocognitive tasks or questionnaires among children and adolescents with ASD were included. In total, 259 articles were identified, of which 15 full texts were independently assessed for eligibility by two authors. In total, 14 articles underwent systematic review, and seven were selected for meta-analysis.

RESULTS

Overall, chronic exercise interventions had a small to moderate positive effect on overall EFs in children and adolescents with ASD (g = 0.342; 95% confidence interval [CI] 0.084-0.600; p < 0.01). Regarding domain-specific EFs, chronic exercise interventions had a small to moderate positive effect on cognitive flexibility (g = 0.312; 95% CI 0.053-0.570; p < 0.01) and inhibitory control (g = 0.492; 95% CI 0.188-0.796; p < 0.01). However, our review found a non-significant effect size (g = 0.212; 95% CI - 0.088 to 0.512) on working memory.

CONCLUSIONS

Chronic exercise interventions appear to have beneficial effects on overall EFs in children and adolescents with ASD, particularly in relation to cognitive flexibility and inhibitory control.

Pilot Study of an Attention and Executive Function Cognitive Intervention in Children with Autism Spectrum Disorders

This pilot study investigated the efficacy of a game-based cognitive training program (Caribbean Quest; CQ) for improving attention and executive function (EF) in school-aged children with Autism Spectrum Disorder (ASD). CQ is a 'serious game' that uses a hybrid process-specific/compensatory approach to remediate attention and EF abilities through repetitive, hierarchically graded exercises delivered in an adaptive format. Game-play is accompanied by instruction in metacognitive strategies delivered by an adult trainer. Twenty children diagnosed with ASD (ages 6-12 years) completed 12 h of intervention in schools over 8-10 weeks that was facilitated by a trained Research Assistant. Pre-post testing indicated near transfer gains for visual working memory and selective attention and far transfer effects for math fluency. Exit interviews with parents and school staff indicated anecdotal gains in attention, EF, emotion-regulation, flexibility, communication, and social skills. Overall, this study provides preliminary support for the feasibility and potential efficacy of the CQ when delivered in schools to children with ASD.

Improving cognitive control: Is theta neurofeedback training associated with proactive rather than reactive control enhancement?

Frontal-midline (FM) theta activity (4-8 Hz) is proposed to reflect a mechanism for cognitive control that is needed for working memory retention, manipulation, and interference resolution. Modulation of FM theta activity via neurofeedback training (NFT) demonstrated transfer to some but not all types of cognitive control. Therefore, the present study investigated whether FM theta NFT enhances performance and modulates underlying EEG characteristics in a delayed match to sample (DMTS) task requiring mainly proactive control and a color Stroop task requiring mainly reactive control. Moreover, temporal characteristics of transfer were explored over two posttests. Across seven 30-min NFT sessions, an FM theta training group exhibited a larger FM theta increase compared to an active control group who upregulated randomly chosen frequency bands. In a posttest performed 13 days after the last training session, the training group showed better retention performance in the DMTS task. Furthermore, manipulation performance was associated with NFT theta increase for the training but not the control group. Contrarily, behavioral group differences and their relation to FM theta change were not significant in the Stroop task, suggesting that NFT is associated with proactive but not reactive control enhancement. Transfer to both tasks at a posttest one day after training was not significant. Behavioral improvements were not accompanied by changes in FM theta activity, indicating no training-induced modulation of EEG characteristics. Together, these findings suggest that NFT supports transfer to cognitive control that manifests late after training but that other training-unspecific factors may also contribute to performance enhancement.