Should One Use Medications in Combination With Cognitive Training? If So, Which Ones?

Effectiveness of multiple mnemonic strategies for improving verbal memory in older adults

BACKGROUND

Cognitive training is an evidence-based intervention for preserving memory in older adults. The effectiveness of cognitive training varies, depending on the approach used. This study examined the efficiency of cognitive training using multiple mnemonic strategies in older adults.

METHODS

This study adopted a pretest-posttest control group design, with all participants undergoing two neuropsychological assessments. The cognitive training program consisted of four 60-minute sessions over a month. In the interventions, participants practiced the mnemonic strategies of elaboration and self-reference. The effect of cognitive training was analyzed using both dependent and independent t tests.

RESULTS

The mean ages were 69.7 ± 12.0 for the control group (n = 23) and 70.7 ± 5.6 for the intervention group (n = 27), with educational attainment of 11.9 ± 3.2 and 12.1 ± 3.9 years, respectively. Both groups showed an overall improvement in memory tests, but only the intervention group's learning and delayed recall aspects of the verbal memory test remained statistically significant after adjusting for multiple comparisons ( p < 0.00625).

CONCLUSION

Our study demonstrates that multiple mnemonic strategy-based cognitive training effectively enhances memory function in older adults and should be regarded as an alternative intervention for older adults.

Using Virtual Reality to investigate multitasking ability in individuals with frontal lobe lesions

Individuals with lesions in the prefrontal cortex often show impairments with the organisation of their behaviour in everyday life. These difficulties can be hard to detect using structured formal tests. The objective of this study was to use Virtual Reality (VR) to explore the multitasking performance of individuals with focal frontal lobe lesions, specifically using the Jansari assessment of Executive Functions (JEF^©). Nineteen individuals with frontal lobe lesions were compared with 19 matched controls on the test and a group of commonly used clinical measures of neuropsychological functioning, as well as questionnaire measures of everyday activity, anxiety and depression. There was a significant difference between groups on the overall JEF^© score and on five of the eight individual constructs, namely the planning, creative thinking, adaptive thinking, event-based Prospective Memory (PM) and time-based PM constructs. There were no differences between groups on the non-VR EF individual measures apart from on one EF control measure, Trail Making A. These results demonstrate the potential clinical utility of the JEF^© and highlight the value of ecologically valid VR measures in detecting impairments in EF in individuals with frontal lobe lesions.

Memory training interventions for older adults: a meta-analysis

A systematic review and meta-analysis of memory training research was conducted to characterize the effect of memory strategies on memory performance among cognitively intact, community-dwelling older adults, and to identify characteristics of individuals and of programs associated with improved memory. The review identified 402 publications, of which 35 studies met criteria for inclusion. The overall effect size estimate, representing the mean standardized difference in pre-post change between memory-trained and control groups, was 0.31 standard deviations (SD; 95% confidence interval (CI): 0.22, 0.39). The pre-post training effect for memory-trained interventions was 0.43 SD (95% CI: 0.29, 0.57) and the practice effect for control groups was 0.06 SD (95% CI: 0.05, 0.16). Among 10 distinct memory strategies identified in studies, meta-analytic methods revealed that training multiple strategies was associated with larger training gains (p=0.04), although this association did not reach statistical significance after adjusting for multiple comparisons. Treatment gains among memory-trained individuals were not better after training in any particular strategy, or by the average age of participants, session length, or type of control condition. These findings can inform the design of future memory training programs for older adults.

The fate of the 0.5s: predictors of 2-year outcome in mild cognitive impairment

Impairments in executive cognition (EC) may be predictive of incident dementia in patients with mild cognitive impairment (MCI). The present study examined whether specific EC tests could predict which MCI individuals progress from a Clinical Dementia Rating (CDR) score of 0.5 to a score ≥1 over a 2-year period. Eighteen clinical and experimental EC measures were administered at baseline to 104 MCI patients (amnestic and non-amnestic, single- and multiple-domain) recruited from clinical and research settings. Demographic characteristics, screening cognitive measures and measures of everyday functioning at baseline were also considered as potential predictors. Over the 2-year period, 18% of the MCI individuals progressed to CDR ≥ 1, 73.1% remained stable (CDR = 0.5), and 4.5% reverted to normal (CDR = 0). Multiple-domain MCI participants had higher rates of progression to dementia than single-domain, but amnestic and non-amnestic MCIs had similar rates of conversion. Only three EC measures were predictive of subsequent cognitive and functional decline at the univariate level, but they failed to independently predict progression to dementia after adjusting for demographic, other cognitive characteristics, and measures of everyday functioning. Decline over 2 years was best predicted by informant ratings of subtle functional impairments and lower baseline scores on memory, category fluency, and constructional praxis.