The Future of Cognitive Remediation Training in Older Adults

Availability of Cognitive Remediation Therapy in United States Mental Health Facilities Serving Older Adults: A Statistical Study

INTRODUCTION

 Older age is a major risk factor for many neurocognitive disorders like Alzheimer's disease. While there are limited treatment options for improving memory in this population, research has shown that special psychotherapeutic modalities like Cognitive Remediation Therapy (CRT), especially when coupled with psychosocial and vocational rehabilitation (PSR and VCR respectively), benefit older adults. This study examines the availability of these services in US mental health (MH) facilities serving older adults and compares the characteristics of the facilities providing these services.

METHODS

Our study includes 1216 MH facilities using the 2022 National Substance Use and Mental Health Services Survey (N-SUMHSS) data from the Substance Abuse and Mental Health Services Administration (SAMHSA). Descriptive statistics were used to determine availabilities, while multivariable logistic regression was used to compare facilities that offer the services compared to those that do not.

RESULTS

Of the total facilities included, 78 (6%), 634 (52%), and 381 (31%) offered CRT, PSR, and VCR respectively. Facilities that provided only MH services compared to those providing substance use and MH services, those that offer special services for veterans, and special Alzheimer's programs compared to those that do not were more likely to have CRT services. MH facilities that provide supplemental employment services, housing services and recovery housing were more likely to offer PSR and VCR compared to those that do not. Compared to facilities in Midwest states, facilities in East South-Central were less likely to offer PSR and VCR.

CONCLUSION

This study highlights the relative unavailability of CRT, indicating a need for more interest in evidence-based nonpharmacological treatment options for cognitive decline in the aging population.

Effect of interactive multitouch game-based cognitive intervention on cognitive function in older adults: A randomized controlled trial

Purpose

This study investigated the effects of an interactive multitouch game-based cognitive intervention (ICI) on cognitive function in community-dwelling older adults.

Methods

Thirty-two older adults (19 women) between 65 and 84 years of age (mean age, 74.47 ± 4.30 years) without a history of neurological disease participated. They were randomized into two groups: intervention and control. The intervention group took part in ICI sessions using HAPPYTABLE® (Spring Soft Co. Ltd, Seoul, Korea) (ICI group), and the control group underwent a traditional paper-and-pencil-based cognitive intervention (TCI group). Both groups completed 10 intervention sessions over four consecutive weeks. Cognitive function was assessed before (pre-intervention) and after (post-intervention) intervention. Executive function was evaluated through the Color-Word Stroop Test (CWST) and Controlled Oral Word Association Test (COWAT). Memory was assessed through the Verbal Learning Test (VLT) and Rey Complex Figure Test (RCFT).

Results

The ICI and TCI groups showed significant improvements in some cognitive functions after the intervention. Both groups showed substantial improvements in VLT and RCFT (P < 0.05), reflecting memory function. Regarding the executive role, the ICI group showed significant post-intervention improvements in the conditions of the CWST incongruent (ICI 76.31 ± 23.82; P = 0.004) compared to the pre-intervention scores. ANCOVA with pre-intervention scores and gender as covariates revealed improved results in the ICI group compared with the VLT delayed (ICI 9.18 ± 1.68, TCI 7.56 ± 2.13; P = 0.015) and VLT recognition task (ICI 22.81 ± 1.22, TCI 21.38 ± 1.09; P = 0.035).

Conclusions

These findings revealed that both ICI and TCI helped increase cognitive performance in community-dwelling older persons; nevertheless, ICI showed better improvement in memory function than TCI. Thus, the ICI can be used to improve cognitive performance among older adults living in the community.

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.

A Conceptual View of Cognitive Intervention in Older Adults With and Without Cognitive Decline-A Systemic Review

Background: Dementia is the one of the most common and prominent disease in the elderly person that results in the Cognitive interventions. In this study, we aim to conceptualize the cognitive intervention for older adults with and without cognitive dysfunction and to clarify the heterogeneity existing in this literature field by determining the main variables implicated. Methods: We conducted a study analysis using previous literature highlighting the significant data reporting empirical results from cognitive intervention for healthy older adults and other seniors with different types of dementia. Each paper was reviewed in terms of compensatory cognitive training, cognitive remediation, enrichment, cognitive activation, brain training, cognitive stimulation, cognitive training, and cognitive rehabilitation. The research analysis was performed following rigorous inclusion and exclusion criteria with the purpose of collecting relevant answers to our research questions. Results: We included a total of 168 studies in our review. Our findings indicated heterogeneity regarding methods, concepts, and procedures. Additionally, the values were integrated using different information existing in this field. Conclusion: In conclusion, we highlighted that this is the first review that clarify the discrepancy of various existing definitions, methods, and procedures, as well as the overlapping information in the cognitive interventions.

Protocol for a pilot randomised controlled trial evaluating feasibility and acceptability of cognitive remediation group therapy compared with mutual aid group therapy for people ageing with HIV-associated neurocognitive disorder (HAND) in Toronto, Canada

INTRODUCTION

HIV-associated neurocognitive disorder (HAND) may affect 30%-50% of people ageing with HIV. HAND may increase stress and anxiety, and impede coping. Psychosocial group therapy may ameliorate HAND's symptoms, yet the ideal intervention is unclear. This protocol outlines a pilot randomised controlled trial (RCT)-designed using community-based participatory research-to pilot cognitive remediation group therapy (CRGT) against an active comparator.

METHODS AND ANALYSIS

This is a pilot, parallel design, two-arm RCT that will recruit participants diagnosed with the mild neurocognitive disorder form of HAND from a neurobehavioural research unit at a tertiary care hospital in Toronto, Canada. Eligibility criteria include age ≥40 years, known HIV status for 5+ years, English fluency, able to consent and able to attend 8 weeks of group therapy. Eligible participants will be randomised to one of two treatment arms, each consisting of eight-session group interventions delivered once weekly at 3 hours per session. Arm 1 (novel) is CRGT, combining mindfulness-based stress reduction with brain training activities. Arm 2 (active control) is mutual aid group therapy. The primary outcomes are feasibility, measured by proportions of recruitment and completion, and acceptability, determined by a satisfaction questionnaire. The secondary outcome is intervention fidelity, where content analysis will be used to assess facilitator session reports. A between-group analysis will be conducted on exploratory outcomes of stress, anxiety, coping and use of intervention activities that will be collected at three time points.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Research Ethics Boards of St. Michael's Hospital and the University of Toronto. Findings will be disseminated through peer-reviewed publications, conference presentations and community reporting. This study could provide insight into design (eg, recruitment, measures) and intervention considerations (eg, structure, content) for a larger trial to lessen the burden of cognitive decline among people ageing with HIV.

TRIAL REGISTRATION NUMBER

NCT03483740; Pre-results.

Fun cube based brain gym cognitive function assessment system

The aim of this study is to design and develop a fun cube (FC) based brain gym (BG) cognitive function assessment system using the wireless sensor network and multimedia technologies. The system comprised (1) interaction devices, FCs and a workstation used as interactive tools for collecting and transferring data to the server, (2) a BG information management system responsible for managing the cognitive games and storing test results, and (3) a feedback system used for conducting the analysis of cognitive functions to assist caregivers in screening high risk groups with mild cognitive impairment. Three kinds of experiments were performed to evaluate the developed FC-based BG cognitive function assessment system. The experimental results showed that the Pearson correlation coefficient between the system's evaluation outcomes and the traditional Montreal Cognitive Assessment scores was 0.83. The average Technology Acceptance Model 2 score was close to six for 31 elderly subjects. Most subjects considered that the brain games are interesting and the FC human-machine interface is easy to learn and operate. The control group and the cognitive impairment group had statistically significant difference with respect to the accuracy of and the time taken for the brain cognitive function assessment games, including Animal Naming, Color Search, Trail Making Test, Change Blindness, and Forward / Backward Digit Span.

A theoretical framework for cognitive and non-cognitive interventions for older adults: stimulation versus compensation

BACKGROUND

Recently, interest in cognitive training for older adults has grown significantly, reflecting a need for preserving the quality of life into late adulthood. In spite of increasing interest in cognitive rehabilitation, recent meta-analyses have questioned reported training gains and determined that cognitive gain from cognitive training might be no larger than the gain observed from active controls such as unspecific, non-cognitive activities.

AIMS

This paper presents a theoretical framework for clarifying specificity of cognitive training by exploring mechanisms of current cognitive and non-cognitive interventions for older adults. By differentiating compensatory aspects from the components of specific and non-specific stimulation in current training, two related strategies of interventions for age-related cognitive decline, i.e., stimulation versus compensation, are proposed.

OVERVIEW

Current interventions for age-related cognitive decline are reviewed in terms of stimulation- and compensation-focused interventions. Stimulation-focused, cognitive and non-cognitive training, with or without specific targets, tend to result in general improvement in attention and sensory or other cognitive functions. Meanwhile, compensation-focused training is likely to be the most effective when the intervention specifically supports the frontally mediating activity in accordance with the direction of indigenous adjustments in the aging brain.

CONCLUSIONS

It can be inferred that stimulation-focused training is to ameliorate the adverse effects of neurological aging, whereas compensation-focused cognitive training is primarily to facilitate compensatory adaptation in the brain.

Relationship of age to impulsivity and decision making: a baseline secondary analysis of a behavioral treatment study in stimulant use disorders

Because stimulant use disorders remain prevalent across the lifespan, cognition is an important area of clinical care and research focus among aging adults with stimulant use disorders. This secondary analysis of a National Institute on Drug Abuse Clinical Trials Network study suggests that decision making, verbal learning/memory, executive function, and set shifting are important cognitive domains to screen clinically and treat in aging adults with stimulant use disorders. Some suggestions are made on how clinical treatment providers can practically use these results. An important direction for future research is the development of cognitively remediating treatments for impaired cognitive domains in aging adults with stimulant use disorders.

tDCS selectively improves working memory in older adults with more education

Cognitive performance, including performance on working memory (WM) tasks declines with age. Changes in brain activations are one presumed contributor to WM decline in the healthy aging population. In particular, neuroimaging studies show that when older adults perform WM tasks there tends to be greater bilateral frontal activity than in younger adults. We hypothesized that stimulating the prefrontal cortex in healthy older adults would improve WM performance. To test this hypothesis we employed transcranial direct current stimulation (tDCS), a neurostimulation technique in which small amounts of electrical current are applied to the scalp with the intent of modulating the activity in underlying neurons. Across three testing sessions we applied sham stimulation or anodal tDCS to the left (F3) or right (F4) prefrontal cortex to healthy older adults as they performed trials of verbal and visual 2-back WM tasks. Surprisingly, tDCS was uniformly beneficial across site and WM task, but only in older adults with more education. In the less educated group, tDCS provided no benefit to verbal or visual WM performance. We interpret these findings as evidence for differential frontal recruitment as a function of strategy when older adults perform WM tasks.

Habitual Sleep, Reasoning, and Processing Speed in Older Adults with Sleep Complaints

The relationship between habitual sleep and cognition in older adults with sleep complaints is poorly understood, because research has focused on younger adults, used experimental or retrospective quasi-experimental designs, and generally produced equivocal results. Prospective studies using sleep diaries are rare, but may provide important insights into this relationship as they offer greater ecological validity and allow for examination of the impact of night-to-night variability in sleep (an often overlooked aspect of sleep) on cognitive performance. Seventy-two older adults (M(age) = 70.18 years, SD(age) = 7.09 years) completed fourteen consecutive days of sleep diaries and paper/pencil self-administered cognitive tasks, including measures of processing speed (Symbol Digit) and reasoning (Letter Series). Regression analyses revealed increased average total wake time (TWT) during the night was associated with higher Symbol Digit scores, β = 0.45, P < 0.05. Night-to-night variability in either total sleep time (TST) or TWT was not associated with either cognitive measure. Implications and potential explanations for these initially counterintuitive findings are discussed.