Cognitive rehabilitation in the elderly: overview and future directions

Strategy-training post-stroke via tele-rehabilitation: a pilot randomized controlled trial

PURPOSE

Long-term limitations in social participation are common after stroke. Whether these can be attenuated through a tele-rehabilitation approach is unknown. We were particularly interested in examining transfer of learning effects which could result in broader improvements in social participation.

METHODS

We adapted a strategy training rehabilitation approach (tele-CO-OP) for remote delivery. Participants with chronic stroke were randomized to receive the intervention (EXPT) or to a wait list (Control). Feasibility and acceptability were measured via attendance scores, satisfaction with the training and therapist evaluation of engagement with the training. The primary outcome measure was the Canadian Occupational Performance Measure (COPM), a standardized semi-structured interview which elicits difficulties in day-to-day life.

RESULTS

Seventeen participants were randomized. Tele-CO-OP was found to be feasible and acceptable: participants reported high satisfaction and engagement, and missed few sessions. Large effect sizes for transfer of learning effects were observed in favor of receiving tele-CO-OP vs being waitlisted. Significant benefits were also conferred to the Control group following receipt of tele-CO-OP. The intervention also appeared to improve mood.

CONCLUSIONS

This exploratory study demonstrates the feasibility and acceptability of tele-CO-OP and provides preliminary evidence for transfer of learning effects to untrained everyday social participation activities. Trial registration number: NCT02724813.

Multicomponent Training Prevents Memory Deficit Related to Amyloid-β Protein-Induced Neurotoxicity

BACKGROUND

Alzheimer's disease (AD) is characterized by the accumulation of the amyloid-β peptide in the brain, leading to early oxidative stress and neurotoxicity. It has been suggested that physical exercise could be beneficial in preventing AD, but studies with multicomponent training are scanty.

OBJECTIVE

Verify the effects of multicomponent exercise training to prevent deficits in recognition memory related to Aβ neurotoxicity.

METHODS

We subjected Wistar rats to multicomponent training (including aerobic and anaerobic physical exercise and cognitive exercise) and then infused amyloid-β peptide into their hippocampus.

RESULTS

We show that long-term multicomponent training prevents the amyloid-β-associated neurotoxicity in the hippocampus. It reduces hippocampal lipid peroxidation, restores antioxidant capacity, and increases glutathione levels, finally preventing recognition memory deficits.

CONCLUSION

Multicomponent training avoids memory deficits related to amyloid-β neurotoxicity on an animal model.

A study protocol for MindMoves: A lifestyle physical activity and cognitive training intervention to prevent cognitive impairment in older women with cardiovascular disease

INTRODUCTION

Cognitive impairment (CI) and cardiovascular disease (CVD) disproportionately affect women compared to men, and CVD increases risk of CI. Physical activity and cognitive training can improve cognition in older adults and may have additive or synergistic effects. However, no combined intervention has targeted women with CVD or utilized a sustainable lifestyle approach. The purpose of the trial is to evaluate efficacy of MindMoves, a 24-week multimodal physical activity and cognitive training intervention, on cognition and serum biomarkers in older women with CVD. Three serum biomarkers (brain-derived neurotrophic factor [BDNF], vascular endothelial growth factor [VEGF], and insulin-like growth factor 1 [IGF-1]) were selected as a priori hypothesized indicators of the effects of physical activity and/or cognitive training on cognition.

METHODS

The study design is a randomized controlled trial with a 2 × 2 factorial design, to determine independent and combined efficacies of Mind (tablet-based cognitive training) and Move (lifestyle physical activity with goal-setting and group meetings) on change in cognition (primary outcome) and serum biomarkers (secondary outcomes). We will recruit 254 women aged ≥65 years with CVD and without CI from cardiology clinics. Women will be randomized to one of four conditions: (1) Mind, (2) Move, (3) MindMoves, or (4) usual care. Data will be obtained from participants at baseline, 24, 48, and 72 weeks.

DISCUSSION

This study will test efficacy of a lifestyle-focused intervention to prevent or delay cognitive impairment in older women with CVD and may identify relevant serum biomarkers that could be used as early indicators of intervention response.

Computer-based cognitive rehabilitation program GRADIOR for mild dementia and mild cognitive impairment: new features

BACKGROUND

The growing number of older people and, with it, the increase of neurological impairments such as dementia has led to the implementation of the use of computer programs for cognitive rehabilitation in people with dementia. For 20 years, we have been developing the GRADIOR cognitive rehabilitation program and conducted several studies associated with its usability and effectiveness. This paper describes the development of the latest version of the GRADIOR computer-based cognitive rehabilitation program for people with different neurological etiologies, especially mild cognitive impairment and mild dementia.

RESULTS

GRADIOR is a program that allows cognitive evaluation and rehabilitation of people affected by cognitive impairment. The new version of GRADIOR is characterized by a structure that is dynamic and flexible for both user and therapist, consisting of: Clinical Manager, Clinical History Manager, Treatment Manager and Report Manager. As a structure based on specific requirements, GRADIOR includes a series of modalities and sub-modalities, each modality comprising a series of exercises with different difficulty levels.

DISCUSSION

Previous studies associated with earlier versions of GRADIOR have allowed the development of a new version of GRADIOR. Taking into account aspects associated with user experience, usability and effectiveness. Aspects that have made it possible to achieve a program that can meet the needs of older people with dementia.

The Reversal of Memory Deficits in an Alzheimer's Disease Model Using Physical and Cognitive Exercise

Alzheimer’s disease (AD) is the leading cause of dementia in the world, accounting for 50–75% of cases. Currently, there is limited treatment for AD. The current pharmacological therapy minimizes symptom progression but does not reverse brain damage. Studies focused on nonpharmacological treatment for AD have been developed to act on brain plasticity and minimize the neurotoxicity caused by the amyloid-beta (Aβ) peptide. Using a neurotoxicity model induced by Aβ in rats, the present study shows that physical (PE) and cognitive exercise (CE) reverse recognition memory deficits (with a prominent effect of long-term object recognition memory), decrease hippocampal lipid peroxidation, restore the acetylcholinesterase activity altered by Aβ neurotoxicity, and seems to reverse, at least partially, hippocampal tissue disorganization.

Cognitive Health Promotion Program for Community-Dwelling Seniors: Who Are We Reaching?

This exploratory study examines the reach of Jog Your Mind, a multifactorial community-based program promoting cognitive vitality among seniors with no known cognitive impairment. The aim was to determine whether the program successfully reached its target population and to compare the characteristics of participants (sociodemographic, health, lifestyle, attitudes, and cognitive profile) with the general population of seniors. Twenty-three community organizations recruited 294 community-dwelling seniors willing to participate in the program. Descriptive analyses revealed that the participants were mostly Canadian-born educated women living alone. Participants' health profile and lifestyle behaviors were fairly similar to those of seniors in Québec and Canada. A large proportion of the participants were concerned about their memory. These results suggest that the program did not attract many hard-to-reach members of the population and reached seniors who may have had some cognitive challenges. Cues to action for improving the reach of cognitive health promotion programs are discussed.

The effect of cognitive-based training for the healthy older people: A meta-analysis of randomized controlled trials

Background

From the perspective of disease prevention, the enhancement of cognitive function among the healthy older people has become an important issue in many countries lately. This study aim to investigate the effect of cognitive-based training on the overall cognitive function, memory, attention, executive function, and visual-spatial ability of the healthy older people.

Methods

Cochrane, PubMed, EMBASE, MEDLINE, PsycINFO, and CINAHL of selected randomized controlled trials (RCTs), and previous systematic reviews were searched for eligible studies. The population focused on this study were healthy older people who participated in randomized controlled trials that investigated the effectiveness of cognitive-based training. The outcomes including change in overall cognitive function, memory, attention, executive function, and visual-spatial ability.

Results

We collected a total of 31 RCTs, the results showed that cognitive-based training has a moderate effect on overall cognitive function (g = 0.419; 95%CI = 0.205–0.634) and executive function (g = 0.420; 95%CI = 0.239–0.602), and a small effect on the memory (g = 0.354; 95%CI = 0.244–0.465), attention (g = 0.218; 95%CI = 0.125–0.311), and visual-spatial ability (g = 0.183;95%CI = 0.015–0.352) in healthy older people. Subgroup analysis indicated the intervention characteristics of ≧3 times each week (p = 0.042), ≧8 total training weeks (p = 0.003) and ≧24 total training sessions (p = 0.040) yields a greater effect size.

Conclusions

Cognitive-based training is effective for the healthy older people. This improvement can represent a clinically important benefit, provide information about the use of cognitive-based training in healthy older people, and help the healthy older people obtain the greatest possible benefit in health promotion and disease prevention.

Attitudes and lifestyle changes following Jog your Mind: results from a multi-factorial community-based program promoting cognitive vitality among seniors

This study examined the effects on attitudes and lifestyle behavior of Jog your Mind, a multi-factorial community-based program promoting cognitive vitality among seniors with no known cognitive impairment. A quasi-experimental study was conducted. Twenty-three community organizations were assigned either to the experimental group (offering the program) or to the control group (creating a waiting list). They recruited 294 community-dwelling seniors. The aims of the study were to verify the effects of the program on attitudes and behaviors related to cognitive vitality and to explore its effects on cognitive vitality. Data was collected at baseline and after the program. Regression analyses revealed that, following their participation in the program, experimental group participants reported: (i) in terms of attitudes, having a greater feeling of control concerning their cognitive capacities, (ii) in terms of behaviors, using significantly more memory strategies and practicing more physical activity and stimulating activities than control group participants. However, the program had no significant effects on measures of cognitive vitality. This study supports the fact that a multi-factorial community-based program can have significant effects on seniors' attitudes and lifestyle behaviors related to cognitive vitality but at short term, no effects on cognitive vitality it-self were found.

Multi-domain training in healthy old age: Hotel Plastisse as an iPad-based serious game to systematically compare multi-domain and single-domain training

Finding effective training interventions for declining cognitive abilities in healthy aging is of great relevance, especially in view of the demographic development. Since it is assumed that transfer from the trained to untrained domains is more likely to occur when training conditions and transfer measures share a common underlying process, multi-domain training of several cognitive functions should increase the likelihood of such an overlap. In the first part, we give an overview of the literature showing that cognitive training using complex tasks, such as video games, leisure activities, or practicing a series of cognitive tasks, has shown promising results regarding transfer to a number of cognitive functions. These studies, however, do not allow direct inference about the underlying functions targeted by these training regimes. Custom-designed serious games allow to design training regimes according to specific cognitive functions and a target population's need. In the second part, we introduce the serious game Hotel Plastisse as an iPad-based training tool for older adults that allows the comparison of the simultaneous training of spatial navigation, visuomotor function, and inhibition to the training of each of these functions separately. Hotel Plastisse not only defines the cognitive functions of the multi-domain training clearly, but also implements training in an interesting learning environment including adaptive difficulty and feedback. We propose this novel training tool with the goal of furthering our understanding of how training regimes should be designed in order to affect cognitive functioning of older adults most broadly.

Restoring large-scale brain networks in PTSD and related disorders: a proposal for neuroscientifically-informed treatment interventions

BACKGROUND

Three intrinsic connectivity networks in the brain, namely the central executive, salience, and default mode networks, have been identified as crucial to the understanding of higher cognitive functioning, and the functioning of these networks has been suggested to be impaired in psychopathology, including posttraumatic stress disorder (PTSD).

OBJECTIVE

1) To describe three main large-scale networks of the human brain; 2) to discuss the functioning of these neural networks in PTSD and related symptoms; and 3) to offer hypotheses for neuroscientifically-informed interventions based on treating the abnormalities observed in these neural networks in PTSD and related disorders.

METHODS

Literature relevant to this commentary was reviewed.

RESULTS

Increasing evidence for altered functioning of the central executive, salience, and default mode networks in PTSD has been demonstrated. We suggest that each network is associated with specific clinical symptoms observed in PTSD, including cognitive dysfunction (central executive network), increased and decreased arousal/interoception (salience network), and an altered sense of self (default mode network). Specific testable neuroscientifically-informed treatments aimed to restore each of these neural networks and related clinical dysfunction are proposed.

CONCLUSIONS

Neuroscientifically-informed treatment interventions will be essential to future research agendas aimed at targeting specific PTSD and related symptoms.

Posture and cognition in the elderly: interaction and contribution to the rehabilitation strategies

In this paper we review the effects of aging on sensory systems and their impact on posture, balance and gait. We also address cognitive aging and attempt to specify which altered cognitive functions negatively impact balance and walking. The role of cognition in postural control is tested with dual-task experiments. This situation results in deleterious effects due to an attentional overload. Given the human cognitive system has limited capacities, we propose that simultaneously performing two tasks depends on the capacity of each individual to perform these tasks on a continuum between automatic execution to highly controlled performance. A level of maximum control exceeds the subject's attentional capacity, which makes it impossible to perform both tasks simultaneously. The subject therefore prioritizes one of the tasks. We use representative dual-task studies from the literature to illustrate the relationship between the different cognitive components and their impact on the control of posture and gait in elderly subjects with altered cognitive capacities and with elderly subjects who are fallers or who have altered sensory-motor capacities. Recently this postural-cognitive relationship was addressed with a new approach. We report how cognitive training can improve dual-task management and we attempt to define the cognitive mechanisms that may be responsible for better postural balance.

Distraction can reduce age-related forgetting

In three experiments, we assessed whether older adults' generally greater tendency to process distracting information can be used to minimize widely reported age-related differences in forgetting. Younger and older adults studied and recalled a list of words on an initial test and again on a surprise test after a 15-min delay. In the middle (Experiments 1a and 2) or at the end (Experiment 3) of the delay, participants completed a 1-back task in which half of the studied words appeared as distractors. Across all experiments, older adults reliably forgot unrepeated words; however, older adults rarely or never forgot the words that had appeared as distractors, whereas younger adults forgot words in both categories. Exposure to distraction may serve as a rehearsal episode for older adults, and thus as a method by which general distractibility may be co-opted to boost memory.

Multistrategic memory training with the metamemory concept in healthy older adults

OBJECTIVE

According to the increase of older people, the need for effective methods to maintain or improve cognitive functions in the elderly has increased. These cognitive enhancing methods may contribute to the prevention of elderly cognitive decline by aging and dementing illness as well. This study aimed to examine the effectiveness of multistrategic memory training with the metamemory concept on cognitive functions in the normal health elderly in Korea.

METHODS

The program used in this study was developed by psychiatrists and psychologists in accordance with Korean situations. We applied the training program to the community-dwelling elderly with subjective memory complaints. Twenty participants were randomly received the intervention with 20 non-treatment controls. This program consisted of 10 sessions and was administered once a week. We examined the effects of this memory training for verbal memory, visuospatial memory, working memory, and verbal fluency ability by repeated ANOVA.

RESULTS

There were significant improvements in Word List Short-term Delayed Free and Cued Recall, Word list Long-term Delayed Free and Cued Recall and visuospatial recognition memory. Performance improvements in visuospatial span forwards and the Categorical Fluency Test were also significant. These improvements were still significant after adjusting for depression improvement exact categorical fluency.

CONCLUSION

This study shows that multistrategic memory training with the metamemory concept may improve memory ability and other cognitive functions which are not trained and that these improvements may be achieved by pure cognitive training effects.

Nurse-Enhanced Memory Intervention in Heart Failure: the MEMOIR study

BACKGROUND

Many patients with heart failure (HF) have cognitive deficits, including memory loss.

OBJECTIVES

The aim of this study was to evaluate the efficacy of a cognitive training intervention on memory (primary outcome), working memory, psychomotor speed, executive function, and performance of cognitive activities and instrumental activities of daily living (IADLs).

METHODS AND RESULTS

Forty patients with HF were randomly assigned to the computerized plasticity-based cognitive training intervention called Brain Fitness or to the health education active control intervention. Advanced practice nurses made weekly home visits to assess symptoms and monitor intervention adherence. Patients completed demographic and clinical data (baseline), neuropsychologic tests (baseline and 8 and 12 weeks), and measures of cognitive and IADLs performance (baseline and 12 weeks) and satisfaction (12 weeks). Linear mixed models analyses indicated a significant group by time interaction for delayed recall memory (P = .032) and a significant time effect for total (list learning) (P < .001) and delayed (P = .015) recall memory, psychomotor speed (P = .029), and performance of IADLs (P = .006). Intervention adherence and patient satisfaction were high.

CONCLUSIONS

To our knowledge, this was the first test of Brain Fitness in HF. Although it was a preliminary study with limitations, results support the need for a larger randomized controlled trial to determine whether the memory loss of HF is amenable to plasticity-based interventions.

Ecologically-oriented neurorehabilitation of memory: robustness of outcome across diagnosis and severity

PRIMARY OBJECTIVE

The current study looked for a differential response to memory rehabilitation, testing the hypotheses that outcome would vary significantly as a function of patient diagnosis and severity of memory impairment.

RESEARCH DESIGN

Unblinded, open-label, pre/post-treatment comparison of memory rehabilitation in patients stratified by diagnosis (brain injury, n = 15; stroke, n = 12; other neurological condition, n = 6) and memory impairment severity.

METHODS AND PROCEDURES

Patients underwent an ecologically-oriented, strategy-based intervention for memory impairment and were evaluated pre- and post-treatment on seven simulations (four with alternate forms, randomized to the pre- or post-test) of everyday declarative or prospective memory tasks.

MAIN OUTCOMES AND RESULTS

Patients at all levels of severity and in all three diagnostic groups showed equivalent, statistically significant improvement in memory performance. Neither practice effects from repeat test administration nor spontaneous recovery accounted for the improvement in memory performance.

CONCLUSIONS

The current study provided evidence of improved performance in everyday memory content domains with compensatory-based cognitive rehabilitation. Comparable improvement was seen across diagnostic groups and severity ranges. Additional case series and randomized clinical trials are needed to evaluate further the efficacy of compensation-based approaches to cognitive rehabilitation.

Early intervention for cognitive decline: can cognitive training be used as a selective prevention technique?

BACKGROUND

Cognitive training (CT) may be effective as a therapeutic strategy to prevent cognitive decline in older adults. This review evaluates CT as a preventive tool at various stages of a prevention hierarchy with specific reference to healthy older adults, "at risk" and clinical populations. It also considers the underlying mechanism of CT, namely that which suggests that CT acts via promoting neuroplasticity.

METHODS

Evidence for CT in healthy, "at risk" and clinical populations has been systematically reviewed elsewhere. This review re-examines several studies in each group to clarify the potential of CT as a preventive technique, with a key focus on the secondary level of prevention.

RESULTS

Studies in healthy older adults and those with mild cognitive impairment are largely positive and suggest that CT has the potential to improve cognition. However, findings in relation to Alzheimer's disease are mixed. Limitations of existing research include diverse methodologies and CT programs, small samples, insufficient focus on functional outcomes, sustainability and generalization of effects and the need for imaging data to delineate mechanisms of change. Additionally, there is limited data on those with late-life depression, despite this being an independent risk factor for dementia.

CONCLUSIONS

CT offers promise as a preventive therapeutic technique in healthy older adults and particularly as a secondary prevention method for "at risk" groups. Future investigations need to focus on methodological constraints and delineating possible neuroplastic mechanisms of action. Nonetheless, CT programs may represent a viable, non-pharmacological early intervention strategy, as they are easily-implemented, engaging and promote social interaction in group settings.

Aging, training, and the brain: a review and future directions

As the population ages, the need for effective methods to maintain or even improve older adults' cognitive performance becomes increasingly pressing. Here we provide a brief review of the major intervention approaches that have been the focus of past research with healthy older adults (strategy training, multi-modal interventions, cardiovascular exercise, and process-based training), and new approaches that incorporate neuroimaging. As outcome measures, neuroimaging data on intervention-related changes in volume, structural integrity; and functional activation can provide important insights into the nature and duration of an intervention's effects. Perhaps even more intriguingly, several recent studies have used neuroimaging data as a guide to identify core cognitive processes that can be trained in one task with effective transfer to other tasks that share the same underlying processes. Although many open questions remain, this research has greatly increased our understanding of how to promote successful aging of cognition and the brain.

Strategy instruction in Parkinson's disease: influence on cognitive performance

OBJECTIVES

Though strategic deficits are extensively investigated in Parkinson's disease (PD), little is known about the effects of instruction for PD patients. Thus, we compared the ability to internally generate a cognitive strategy with the ability to use a strategy after elaborate strategy instruction.

METHODS

Patients with PD (n=14) and matched healthy controls (n=22) were administered a Numerosity Judgement task in which they had to determine different numerosities of blocks presented in a square grid. In more complex task configurations, healthy participants tend to use a subtraction strategy. Participants in our study were confronted with a counting condition (A), a strategy initiation condition without instruction (B), and a strategy elaboration and strategy training condition (C).

RESULTS

Patients and controls were comparable with respect to basic cognitive measures. PD patients and controls performed equivalently within the counting condition (A), but patients needed significantly more trials to initiate the subtraction strategy. With the exception of 1 PD patient, all patients were able to internally initiate the strategy (condition B). In condition C, both groups increased reaction times, but patients were significantly slower than controls. Moreover, only patients significantly increased error rates after strategy instruction.

CONCLUSION

As long as sufficient time is provided for solving the task, results do not show a general deficit in the ability to internally generate a cognitive strategy in PD. Failures in strategy utilization strongly depend on cognitive load (working memory, executive functions). This bears important implications for the neuropsychological rehabilitation of PD patients.

Cognitive training in older adults with Mild Cognitive Impairment: Impact on cognitive and functional performance

Aging is associated with cognitive decline, yet this does not prevent older adults from finding ways to compensate for age-related deficits. Earlier studies have shown that cognitively unimpaired older adults can benefit from training programs. The efficacy of cognitive interventions among older adults without dementia but with cognitive decline (mild cognitive impairment, MCI) has not yet been widely tested.

OBJECTIVES

To evaluate the impact of 8-session cognitive training on the cognitive and functional performance of older adults with MCI.

METHODS

16 older adults diagnosed with MCI received cognitive training (18 participated as controls). All participants were assessed pre and post intervention using the Short Cognitive Test (SKT), Direct Assessment of Functional Scale Revised (DAFS-R), Geriatric Depression Scale (GDS), and Clock Drawing Test (CDT).

RESULTS

A significant improvement was observed in the study group between pre and post-test in attention (SKT), time orientation, shopping skills and dealing with finances (DAFS-R) along with reduced depressive symptoms (GDS).

CONCLUSION

These results indicate the importance of non-pharmacological interventions for older adults with MCI to help compensate for cognitive decline.

Far transfer in cognitive training of older adults

PURPOSE

This article reviews the literature on far transfer effects in training of older adults.

METHODS

Adapting a taxonomy of transfer developed by Barnett and Ceci (2002), to rehabilitation or enhancement of existing cognitive skills; results of studies assessing transfer effects from training of memory, reasoning, UFOV, dual task performance, and complex training are classified.

RESULTS

Comparisons of the transfer outcomes of both strategy training and extended practice approaches suggest that far transfer has been observed.

CONCLUSIONS

Outcomes for strategy studies training memory have had less success than extended practice studies in obtaining far transfer. Reasons for this are discussed, as are suggestions for improved assessment of transfer outcomes.

Can training in a real-time strategy video game attenuate cognitive decline in older adults?

Declines in various cognitive abilities, particularly executive control functions, are observed in older adults. An important goal of cognitive training is to slow or reverse these age-related declines. However, opinion is divided in the literature regarding whether cognitive training can engender transfer to a variety of cognitive skills in older adults. In the current study, the authors trained older adults in a real-time strategy video game for 23.5 hr in an effort to improve their executive functions. A battery of cognitive tasks, including tasks of executive control and visuospatial skills, were assessed before, during, and after video-game training. The trainees improved significantly in the measures of game performance. They also improved significantly more than the control participants in executive control functions, such as task switching, working memory, visual short-term memory, and reasoning. Individual differences in changes in game performance were correlated with improvements in task switching. The study has implications for the enhancement of executive control processes of older adults.

Exercising your brain: a review of human brain plasticity and training-induced learning

Human beings have an amazing capacity to learn new skills and adapt to new environments. However, several obstacles remain to be overcome in designing paradigms to broadly improve quality of life. Arguably, the most notable impediment to this goal is that learning tends to be quite specific to the trained regimen and does not transfer to even qualitatively similar tasks. This severely limits the potential benefits of learning to daily life. This review discusses training regimens that lead to the acquisition of new knowledge and strategies that can be used flexibly across a range of tasks and contexts. Possible characteristics of training regimens are proposed that may be responsible for augmented learning, including the manner in which task difficulty is progressed, the motivational state of the learner, and the type of feedback the training provides. When maximally implemented in rehabilitative paradigms, these characteristics may greatly increase the efficacy of training.

Environmental enrichment alters dentate granule cell morphology in oldest-old rat

The hippocampus of aged rats shows marked age-related morphological changes that could cause memory deficits. Experimental evidence has established that environmental enrichment attenuates memory deficits in aged rats. We therefore studied whether environmental enrichment produces morphological changes on the dentate granule cells of aged rats. Fifteen male Sprague-Dawley rats, 24 months of age, were randomly distributed in two groups that were housed under standard (n = 7) or enriched (n = 8) environmental conditions for 26 days. Quantitative data of dendritic morphology from dentate gyrus granule cells were obtained on Golgi-Cox stained sections. Environmental enrichment significantly increased the complexity and size of dendritic tree (total number of segments increased by 61% and length by 116%), and spine density (88% increase). There were large interindividual differences within the enriched group, indicating differential individual responses to environmental stimulation. Previous studies in young animals have shown changes produced by environmental enrichment in the morphology of dentate gyrus granule cells. The results of the present study show that environmental enrichment can also produce changes in dentate granule cell morphology in the senescent brain. In conclusion, the hippocampus retains its neuroplastic capacity during aging, and enriched environmental housing conditions can attenuate age-related dendritic regression and synaptic loss, thus preserving memory functions.

Cognitive rehabilitation of neuropsychological deficits and mild cognitive impairment: a review of the literature

Neuropsychological rehabilitation is related to the treatment or optimization of disabilities, handicaps and cognitive deficiencies including emotional, behavioral and personality alterations, aiming at the best cognitive, neurobiological and social re-adaptation.

Objective

The main aim of this paper is to review scientific studies published over the last five years on cognitive training with rehabilitation, focusing on elderly subjects with cognitive complaints and patients diagnosed with MCI.

Methods

Data were generated from Medline, PsychoInfo and EMBASE including publications from 2002 to 2007 using the search terms "Mild Cognitive Impairment", "Cognitive Complaints", "Rehabilitation" and "Intervention Studies". Data collection criteria were restricted to the quality of evidence Class I.

Results

Eight articles out of sixty eight previously selected were chosen because of their randomized studies, including techniques of cognitive rehabilitation in patients with cognitive complaints, MCI and neuropsychological training.

Conclusions

The studies showing generalization of rehabilitation techniques to practical real life situations and use of an errorless learning approach were considered more effective in terms of maintaining treatment follow up, although further studies are recommended.

Cognitive rehabilitation in the elderly: effects on strategic behavior in relation to goal management

Executive functions are highly sensitive to the effects of aging and other conditions affecting frontal lobe function. Yet there are few validated interventions specifically designed to address executive functions, and, to our knowledge, none validated in a healthy aging sample. As part of a large-scale cognitive rehabilitation randomized trial in 49 healthy older adults, a modified Goal Management Training program was included to address the real-life deficits caused by executive dysfunction. This program emphasized periodic suspension of ongoing activity to establish goal hierarchies and monitor behavioral output. Tabletop simulated real-life tasks (SRLTs) were developed to measure the processes targeted by this intervention. Participants were randomized to two groups, one of which received the intervention immediately and the other of which was wait-listed prior to rehabilitation. Results indicated improvements in SRLT performance and self-rated executive deficits coinciding with the training in both groups. These gains were maintained at long-term follow-up. Future research will assess the specificity of these effects in patient groups.

Cognitive rehabilitation in the elderly: an evaluation of psychosocial factors

In this study, we report changes in psychosocial function in two groups of older adults that participated in the experimental trial of our cognitive rehabilitation program. The results, based on tests that measured a range of psychosocial attributes, showed that, following training, participants improved in terms of overall well-being, as well as in specific areas that included perceived happiness, coping strategies, and quality of life. An important finding was that improvements were also observed in long-term follow-up testing. Both groups benefited from training, but the effect was greater in the group that received training before undergoing a control procedure. The results, which show that the benefits of our rehabilitation program extend into the psychosocial domain, underscore the potentially important relationship between psychosocial factors and cognitive performance in older adults.

Cognitive rehabilitation in the elderly: a randomized trial to evaluate a new protocol

This study provides an introduction to, and overview of, several papers that resulted from a randomized control trial that evaluated a new cognitive rehabilitation protocol. The program was designed to improve general strategic abilities in ways that would be expressed in a broad range of functional domains. The trial, which was conducted on a sample of older adults who had experienced normal age-related cognitive decline, assessed performance in the following domains: memory, goal management, and psychosocial status. The general rationale for the trial, the overall experimental design, and the approach to statistical analyses that are relevant to each paper are described here. The results for each functional domain are reported in separate papers in this series.