Randomized controlled trials of non-pharmacological interventions for healthy seniors: Effects on cognitive decline, brain plasticity and activities of daily living-A 23-year scoping review

Little is known about the simultaneous effects of non-pharmacological interventions (NPI) on healthy older adults' behavior and brain plasticity, as measured by psychometric instruments and magnetic resonance imaging (MRI). The purpose of this scoping review was to compile an extensive list of randomized controlled trials published from January 1, 2000, to August 31, 2023, of NPI for mitigating and countervailing age-related physical and cognitive decline and associated cerebral degeneration in healthy elderly populations with a mean age of 55 and over. After inventorying the NPI that met our criteria, we divided them into six classes: single-domain cognitive, multi-domain cognitive, physical aerobic, physical non-aerobic, combined cognitive and physical aerobic, and combined cognitive and physical non-aerobic. The ultimate purpose of these NPI was to enhance individual autonomy and well-being by bolstering functional capacity that might transfer to activities of daily living. The insights from this study can be a starting point for new research and inform social, public health, and economic policies. The PRISMA extension for scoping reviews (PRISMA-ScR) checklist served as the framework for this scoping review, which includes 70 studies. Results indicate that medium- and long-term interventions combining non-aerobic physical exercise and multi-domain cognitive interventions best stimulate neuroplasticity and protect against age-related decline and that outcomes may transfer to activities of daily living.

Cognitive enrichment through art: a randomized controlled trial on the effect of music or visual arts group practice on cognitive and brain development of young children

BACKGROUND

The optimal stimulation for brain development in the early academic years remains unclear. Current research suggests that musical training has a more profound impact on children's executive functions (EF) compared to other art forms. What is crucially lacking is a large-scale, long-term genuine randomized controlled trial (RCT) in cognitive neuroscience, comparing musical instrumental training (MIP) to another art form, and a control group (CG). This study aims to fill this gap by using machine learning to develop a multivariate model that tracks the interconnected brain and EF development during the academic years, with or without music or other art training.

METHODS

The study plans to enroll 150 children aged 6-8 years and randomly assign them to three groups: Orchestra in Class (OC), Visual Arts (VA), and a control group (CG). Anticipating a 30% attrition rate, each group aims to retain at least 35 participants. The research consists of three analytical stages: 1) baseline analysis correlating EF, brain data, age, gender, and socioeconomic status, 2) comparison between groups and over time of EF brain and behavioral development and their interactions, including hypothesis testing, and 3) exploratory analysis combining behavioral and brain data. The intervention includes intensive art classes once a week, and incremental home training over two years, with the CG receiving six annual cultural outings.

DISCUSSION

This study examines the potential benefits of intensive group arts education, especially contrasting music with visual arts, on EF development in children. It will investigate how artistic enrichment potentially influences the presumed typical transition from a more unified to a more multifaceted EF structure around age eight, comparing these findings against a minimally enriched active control group. This research could significantly influence the incorporation of intensive art interventions in standard curricula.

TRIAL REGISTRATION

The project was accepted after peer-review by the Swiss National Science Foundation (SNSF no. 100014_214977) on March 29, 2023. The study protocol received approval from the Cantonal Commission for Ethics in Human Research of Geneva (CCER, BASEC-ID 2023-01016), which is part of Swiss ethics, on October 25, 2023. The study is registered at clinicaltrials.gov (NCT05912270).

Adversity specificity and life period exposure on cognitive aging

This study set out to examine the role of different adversities experienced at different life course stages on cognitive aging (i.e., level and change). Data from the longitudinal study: Survey of Health, Ageing, and Retirement in Europe (SHARE) with the selection of participants over 60 years were used (N = 2662, Mdnage = 68, SDage = 5.39) in a Structural Equation Modeling. In early life, the experience of hunger predicted lower delayed recall (β = - 0.10, p < 0.001) and verbal fluency (β = - 0.06, p = 0.001) performance in older age, whereas financial hardship predicted lower verbal fluency (β = - 0.06, p = 0.005) performance and steeper decline in delayed recall (β = - 0.11, p < 0.001). In early adulthood, financial hardship and stress predicted better delayed recall (financial hardship: β = 0.08, p = 0.001; stress: β = 0.07, p = 0.003) and verbal fluency performance (financial hardship: β = 0.08, p = 0.001; stress β = 0.10, p < 0.001), but no adversities were associated with a change in cognitive performance. In middle adulthood, no adversities were associated with the level of cognitive performance, but financial hardship predicted lower decline in delayed recall (β = 0.07, p = 0.048). This study highlights the importance of disentangling the period effect from the specific effect of the adversity experienced in the association between adversity and cognition in older age. Moreover, differential results for delayed recall and verbal fluency measures suggest that it is also important to consider the cognitive outcome domains examined.

Aging and time-based prospective memory in the laboratory: a meta-analysis on age-related differences and possible explanatory factors

In older adults' everyday life, time-based prospective memory (TBPM) is relevant as health-related intentions are often part of daily activities. Nonetheless, it is still unclear which task-related factors can potentially moderate the magnitude of age-related differences, such as duration of the PM target time (the time-window within which an individual must complete a given TBPM task), the frequency of the TBPM tasks, and the criterion chosen to compute PM accuracy. The present meta-analysis aimed to quantify age-related differences in laboratory TBPM tasks, and to investigate how specific task-related factors potentially moderate the magnitude of age effects. The results showed that age effects consistently emerged among the studies, with older adults showing lower TBPM performance and checking the clock less often than younger adults, especially for shorter intervals (e.g., ≤ 4 min). Furthermore, the results indicated that the duration of the PM target time interacted with the frequency of the PM task, suggesting that learning effects may attenuate the magnitude of age differences in TBPM performance. The results are discussed in terms of potential implications about the possible cognitive processes involved in TBPM and aging, as well as in terms of robustness of the TBPM laboratory paradigm in aging research.

Do executive functions explain older adults' health-related quality of life beyond event-based prospective memory?

Previous work has shown that event-based prospective memory (EBPM) predicted health-related quality of life (HrQoL). In the present study, we aimed to examine whether the relationship between EBPM and HrQoL extended to life satisfaction, and whether it persisted after controlling for other cognitive functions related to EBPM, namely executive functions and retrospective memory. We tested two models using structural equation modeling with latent variables in a sample of older adults. In the first model, we assessed whether EBPM predicted life satisfaction and HrQoL; in the second model, we controlled for retrospective memory and executive functions. The first model indicated that EBPM was related to HrQoL. However, in the second model, this relationship was eliminated by executive functions; life satisfaction was not related to any of the cognitive variables. Findings corroborated the link between HrQoL and EBPM, suggesting that such relationship stems from executive functions rather than retrospective memory.

Musical and psychomotor interventions for cognitive, sensorimotor, and cerebral decline in patients with Mild Cognitive Impairment (COPE): a study protocol for a multicentric randomized controlled study

BACKGROUND

Regular cognitive training can boost or maintain cognitive and brain functions known to decline with age. Most studies administered such cognitive training on a computer and in a lab setting. However, everyday life activities, like musical practice or physical exercise that are complex and variable, might be more successful at inducing transfer effects to different cognitive domains and maintaining motivation. "Body-mind exercises", like Tai Chi or psychomotor exercise, may also positively affect cognitive functioning in the elderly. We will compare the influence of active music practice and psychomotor training over 6 months in Mild Cognitive Impairment patients from university hospital memory clinics on cognitive and sensorimotor performance and brain plasticity. The acronym of the study is COPE (Countervail cOgnitive imPairmEnt), illustrating the aim of the study: learning to better "cope" with cognitive decline.

METHODS

We aim to conduct a randomized controlled multicenter intervention study on 32 Mild Cognitive Impairment (MCI) patients (60-80 years), divided over 2 experimental groups: 1) Music practice; 2) Psychomotor treatment. Controls will consist of a passive test-retest group of 16 age, gender and education level matched healthy volunteers. The training regimens take place twice a week for 45 min over 6 months in small groups, provided by professionals, and patients should exercise daily at home. Data collection takes place at baseline (before the interventions), 3, and 6 months after training onset, on cognitive and sensorimotor capacities, subjective well-being, daily living activities, and via functional and structural neuroimaging. Considering the current constraints of the COVID-19 pandemic, recruitment and data collection takes place in 3 waves.

DISCUSSION

We will investigate whether musical practice contrasted to psychomotor exercise in small groups can improve cognitive, sensorimotor and brain functioning in MCI patients, and therefore provoke specific benefits for their daily life functioning and well-being.

TRIAL REGISTRATION

The full protocol was approved by the Commission cantonale d'éthique de la recherche sur l'être humain de Genève (CCER, no. 2020-00510) on 04.05.2020, and an amendment by the CCER and the Commission cantonale d'éthique de la recherche sur l'être humain de Vaud (CER-VD) on 03.08.2021. The protocol was registered at clinicaltrials.gov (20.09.2020, no. NCT04546451).

The Geneva Space Cruiser: a fully self-administered online tool to assess prospective memory across the adult lifespan

The current study aimed to examine whether the Geneva Space Cruiser - a new online adaptation of the Cruiser - represents a valid, reliable and useful tool to assess prospective memory (PM) across the adult lifespan via fully self-administered online testing. Therefore, an adult lifespan sample of 252 adults (19-86 years old) performed the Geneva Space Cruiser in the laboratory and online, at home, and also performed a more traditional laboratory PM task. A second sample of 224 young adults (19-35 years old) participated in a test-retest online assessment of the Geneva Space Cruiser. Bayesian analyses showed that the Geneva Space Cruiser yielded similar results when administered in the laboratory versus online, both in terms of data distribution as well as of key outcome measures (i.e., PM performance and monitoring). Results further showed very good test-retest reliability and acceptable construct validity. Finally, the online tool was sensitive for detecting age-differences similar to those typically observed in laboratory studies. Together, our findings suggest that the Geneva Space Cruiser represents a rather valid, moderately to highly reliable, and generally useful tool to assess PM in online testing across wide ranges of the adult lifespan, with certain limitations for the oldest participants and for women.

Investigating prospective memory via eye tracking: No evidence for a monitoring deficit in older adults

Prospective memory (PM) refers to remembering to perform intended actions in the future. Older adults in particular have been shown to be negatively affected by PM tasks that require a high amount of attentional resources (i.e., nonfocal tasks). This age-related PM deficit has been attributed to reduced target monitoring in this age group older adults. However, this conclusion was based on indirect measures of monitoring, such as costs of the ongoing task. The present study set out to 1) investigate older adults' PM target monitoring by, for the first time, employing a direct measure (i.e., eye tracking), 2) assess differences in monitoring between PM tasks that differ in their focality, and 3) examine whether differences in PM monitoring can indeed explain older adults' reduced PM performance in nonfocal tasks. Results demonstrate that while older, but not younger adults, showed reduced performance in a nonfocal PM task, overt monitoring (eye movements) of these groups did not differ between focality conditions. Further analyses showed that older adults' performance was still reduced on the strategically more demanding task after controlling for overt target monitoring (i.e., including only trials in which the participant monitored). In contrast to indirect measures of cue monitoring, our findings illustrate that older adults' deficits on nonfocal PM tasks cannot (exclusively) be explained by reduced monitoring. Instead, processing that takes place after target monitoring are discussed as possible mechanisms underlying older adults' reduced PM performance in nonfocal tasks.

ADVERSE CHILDHOOD EXPERIENCES ARE ASSOCIATED WITH FRAILTY IN OLD AGE

With an increasing life expectancy, frailty is becoming an important outcome reflecting lower chances of healthy ageing. However, research on long-term risk factors of frailty is lacking. We aimed to assess associations of adverse childhood experiences (ACE) with frailty trajectories at older age, and to examine whether this link can be broken by the person’s life course socioeconomic trajectory. Data was used of 13,283 women and 10,591 men aged 50 years and over included in the Survey of Health, Ageing, and Retirement in Europe, who were followed from 2004 to the latest wave. ACE (from 0 to 15 years) were measured with six indicators; not living with biological parents, death of parents, period of hunger, property taken away, adolescent parenthood, stillborn child in adolescence. Frailty was operationalized according to Fried’s phenotype, presenting either weakness, shrinking, exhaustion, slowness, or low activity. Confounder-adjusted multilevel logistic regression models were used to analyse associations of ACE with frailty trajectories. Risk of frailty increased through age and with ageing. ACE was associated with risk of frailty among women and men. Among men only, ACE was associated with an accelerated increase of the risk of frailty. For both sexes, the ACE and frailty association was not mediated by the person’s life course socioeconomic trajectory. Experiencing adverse events in childhood is linked with frailty at older age. Such an unfavourable start in life is not compensated by the person’s life course socioeconomic trajectory. Men’s frailty with ageing is more sensitive to ACE compared to women.

Intraindividual reaction time variability predicts prospective memory failures in older adults

This study investigated the relationship between intraindividual variability (IIV) in reaction time and prospective memory errors in older adults using data from the Zurich Longitudinal Study of Cognitive Aging (n = 336 individuals aged 66-81 years). The results indicated that increased IIV measured from independent tasks was associated with a greater proportion of prospective memory errors. These significant findings were not influenced by age and did not vary according to prospective memory cue type. Variability is thought to reflect fluctuations in attentional and executive control and these attentional processes may also impact on prospective memory through failure to detect the target cue. The findings suggest, therefore, that measures of variability may have some potential in the identification of older persons who are more vulnerable to everyday errors such as prospective memory failures.

Continuous subcutaneous insulin infusion leads to immediate, stable and long-term changes in metabolic control

BACKGROUND

Evaluations of continuous subcutaneous insulin infusion (CSII) usually focus on one pre- and one post-CSII measurement to assess metabolic therapy outcome.

AIM

Extending this research, the aim of the present study was to provide a more fine-grained analysis of achieved glycaemic control.

METHODS

In 52 patients with type 1 diabetes (mean age of 37.85 years at CSII begin; s.d. +/- 12.41), haemoglobin A(1c) (HbA(1c)) levels were assessed every 3 months over a period of 5 years (1 year before and 4 years after the introduction of CSII). Mixed models were utilized to describe changes in glycaemic control.

RESULTS

The pre-post course showed that already in the first quarter, a statistically significant lower HbA(1c) level was obtained [7.30%, in contrast to 8.21% at the last quarter with intensified conventional therapy (ICT)]. In the following 15 quarters, the mean HbA(1c) levels remained constantly lower than that with ICT. Overall, the aggregated mean HbA(1c) level of patients with CSII therapy was 7.19%, in contrast to 8.08% with ICT; thus, an overall decrease by 11% was achieved. In addition, individual differences in blood glucose level and age of diabetes onset as a predictor for therapy success were analysed.

CONCLUSIONS

The data show an immediate, stable and long-term effect of CSII on HbA(1c). In addition, a significant relationship between metabolic control and age of diabetes onset was found, as well as a reduction of variance in HbA(1c) levels between subjects after change to CSII.

Planning and realisation of complex intentions in patients with Parkinson's disease

BACKGROUND

There is some evidence that patients with Parkinson's disease may impaired in prospective memory performance (planning and self initiated realisation of delayed intentions). Little is known about the effect of the disease on distinct phases of prospective memory and the potential mechanisms underlying these effects.

OBJECTIVE

To investigate intention formation, intention retention, intention initiation, and intention execution of patients with Parkinson's disease and test for the mediating influence of working memory, inhibition, short term retrospective memory, and divided attention.

METHODS

16 patients with Parkinson's disease and 16 age and education matched normal controls were given a complex event based prospective memory task which differentiates four phases of prospective remembering. In addition, participants completed tasks assessing potential cognitive mediators.

RESULTS

On the prospective remembering task, Parkinson patients were impaired in the intention formation phase and showed a trend towards impairment in the intention initiation. In contrast, there were no impairments of retrospective intention retention or the fidelity with which the patients executed their previously developed plan. The group effects were related to interindividual differences in working memory span.

CONCLUSIONS

The results suggest that the planning phase of prospective remembering is specifically impaired in Parkinson's disease, and that the impairment is related to working memory deficit. In contrast, even when complex intentions have to be remembered, the retrospective storage of intentions to be performed is not impaired.

Life-long intellectual activities mediate the predictive effect of early education on cognitive impairment in centenarians: a retrospective study

The purpose of this study was to examine the hypothesis of whether early education and/or maintaining intellectual activities over the life-course have the power to protect against cognitive impairment even in extremely old adults. Ninety centenarians from the population-based Heidelberg Centenarian Study were assessed with a modified version of the Mini Mental State Exam (MMSE). Data about education, occupational status, and life-long intellectual activities in four selected domains were obtained. Results demonstrated that 52% of the sample showed mild-to-severe cognitive impairment. Analyzing the influence of early education, occupational status, and intellectual activities on cognitive status we applied several (logistic) regression analyses. Results revealed independent, significant and strong influence of both formal school education and intellectual activities on the cognitive status in very late life, even after controlling for occupational status. However, about one fourth of the effect of early education on cognitive status was exerted indirectly via the assessed intellectual activities. In summary, the present study provides first evidence for the conclusion that even with regard to cognitive performance in very old age, both early education and life-long intellectual activities seem to be of importance.

[Similarities and differences between self-rated and proxy-rated health in extreme old age]

Especially in old age, the global well-being of persons is strongly influenced by their health situation. Due to functional limitations, research on the development of persons in extreme old age often uses proxy ratings of health instead of self-ratings common in younger age groups. However, it is not known whether self- and proxy-ratings provide comparable information about the health status of extremely old persons. The current study with 53 centenarians and 53 proxies examines similarities and differences between self and proxy-ratings of health. The results indicate a high degree of similarity in some health ratings, an overestimation of ADL capacities by the centenarians, and that self-ratings to a large degree reflect the current mood levels of individuals. Findings are discussed with respect to the differences in the kind of information used for general health ratings.

Lernen im Alter: Die Bedeutung der selbstst�ndigen Strukturierung des Lernmaterials

The purpose of the present study was to assess the role of memory, inhibition efficiency and self-initiated structuring of learning material in predicting age-related effects in learning performance. 47 young ( M = 23.3; SD = 3.8) and 52 old adults ( M = 64.5; SD = 5.2) took part in the current study. Tests assessing memory span, inhibition efficiency and a recall test requiring the participants to structure their learning material were administered. The results reveal that most of the age-related variance in learning performance can be explained by inhibition efficiency, memory span and-particularly-by the quality of structuring learning material. Furthermore, the results indicate that in order to recall the content of categories it is important to remember the categories formed during the learning period. The study emphasizes the importance of teaching strategies for organizing learning material in the context of cognitive trainings for the elderly.

Funktionale Kompetenz und Pflegebedürftigkeit nach SGB XI bei Hundertjährigen

The maintenance of autonomy and independence in the oldest old population is at high risk due to the inevitable aging process, which primarily affects functional and cognitive capacities. In this study, we investigate centenarians to assess the extent in which they have lost their ability to live independently. This is done with a classification system for dependency that considers both functional and cognitive limitations and determines the level of functional competence in this population. Based on this system, we evaluate the necessity for nursing care and investigate to which extent their actual needs are covered by the German Long-term Care Insurance. An important and relevant question is whether this system even addresses the evaluation of cognitive impairment. For this reason, 85 centenarians and their proxies were assessed with standardized instruments and the results show a severe loss of independence. The necessity for at least daily contact with nursing care was identified in 91 percent of the centenarians due to their dramatically limited capacities. Forty-four percent of the centenarians need more support than they actually receive from the German Long-term Care Insurance. Therefore, considering cognitive impairment is a crucial component in the evaluation, which would lead to more support by the official system in 20 percent of the centenarians. The considerable differences between the granted and the necessary nursing care demonstrate that co-operation from family members must be heavily relied upon.

[Executive functions and prospective memory performance in old age: an analysis of event-based and time-based prospective memory]

The goal of the present study was to examine the role of executive functions in age-related differences in prospective memory. Therefore, in a sample of 40 young ( M=24.8; SD=2.0) and 40 old adults ( M=69.3; SD=5.6), event- and time-based prospective memory as well as five executive functions were assessed. Results show that age differences in prospective memory performance depend largely on age-related individual differences in executive functions. Furthermore, the results indicate several executive functions to differentially predict prospective memory performance. The event-based prospective memory task requires inhibition to avoid distraction from irrelevant items. The time-based prospective memory task requires the flexible shifting of cognitive sets. Overall, the data support the assumption that age differences in prospective memory performance are closely related to executive functioning. In addition, time- and event-based prospective memory seem to rely on different executive processes.

[Heidelberg Centenarian Study: theoretical and methodological principles for social science research of the oldest old]

This paper addresses two important issues of oldest old research. First, we try to answer the question whether differences between extremely old persons are based on enduring aging processes of physical, social and psychological functions, or whether they are the result of selective survival weeding out the frail. Both trajectories predict low variability, but on different levels. Second, we investigate to which extent the variability of extremely old persons can be assessed by traditional psychosocial instruments. One hundred and fifty six centenarians were contacted, of whom 91 centenarians and 86 proxies participated in this study. The distribution of the cognitive status reveals a high amount of variability. In contrast, with respect to functional capacity 83% receive support from the German Statutory Insurance System for Long-Term Care. The higher variability in the psychological variable points to adaptive potential. We assume that in extreme old age various resources are used to maintain physical functioning above a critical threshold.

Varying the importance of a prospective memory task: differential effects across time- and event-based prospective memory

Only few studies have addressed the issue of task importance in prospective memory. Most of them, but not all, have shown that perceived task importance does improve prospective memory performance. However, there is little understanding of (1) the conditions under which importance of the prospective memory task makes a difference in performance and (2) the mechanisms by which perceived task importance has an effect on prospective memory performance. The present study reports two experiments that manipulate task importance in a time-based and an event-based prospective memory paradigm. Results show that importance has an effect on the time-based but not on the event-based task. Further analyses of the performance in the cover tasks as well as the monitoring behaviour indicate that importance improves prospective memory to the degree the task requires the strategic allocation of attentional resources.

Plan formation, retention, and execution in prospective memory: a new approach and age-related effects

Existing laboratory paradigms of prospective memory instruct subjects to remember to perform a single, isolated act at an appropriate point in the experiment. These paradigms do not completely capture many everyday complex prospective memory situations in which a series or set of delayed actions is planned to be executed in some subsequent period of time. We adapted a laboratory paradigm within which to study these prospective memory processes, and we investigated age-related influences on these prospective memory processes. Age-related declines were found in the planning, initiation, and execution of the set of tasks. In contrast, there were no age differences in plan retention or in the fidelity with which the plan was performed.