Working Memory Training for Healthy Older Adults: The Role of Individual Characteristics in Explaining Short- and Long-Term Gains

Youth-like brain activation linked with greater cognitive training gains in older adults: Insights from the ACTOP study

This study investigates the relationship between inter-individual neurofunctional differences in older adults and cognitive training efficacy, with a specific focus on the association between youth-like task-related brain activation and improvements in working memory (WM) training. The data is part of the Attentional Control Training for Older People (ACTOP) study, 30 older adults completed 12 half-hour WM training sessions. The WM performance slope, assessed at the conclusion of sessions 1 through 6 and sessions 7 to 12, determined early- and late-stage training gains, respectively. Transfer measures were taken before (PRE), midway (MID), and after (POST) training, and the differences in MID-PRE and POST-MID on transfer tasks were used to determine early- and late-stage transfer effects, respectively. The Goodness of Fit (GOF) metric was used to quantify the similarity between each older adult's activation pattern, as measured with functional magnetic resonance imaging (fMRI), to that of a group of younger adults. GOF scores were calculated for activation during low-load (1-0back) and high-load (2-0back) N-back tasks. The results indicated that larger GOF scores in the low-load condition were associated with greater training gains in both the early and late learning stages, and that larger GOF scores in the high-load condition were associated with greater training gains during the late-stage. These findings suggest that a youth-like brain activation pattern in older adults is associated with greater cognitive training benefits, underscoring the role of inter-individual neurofunctional differences to account for variations in training outcomes among older adults. TRIAL REGISTRATION: ClinicalTrials.gov NCT03532113; https://clinicaltrials.gov/ct2/show/NCT03532113.

Pragmatic Skills in Late Adulthood

Research investigating pragmatic abilities in healthy aging suggests that both production and comprehension might be compromised; however, it is not clear how pragmatic abilities evolve in late adulthood, as well as when difficulties are more likely to arise. The aim of this study is to investigate the decline of pragmatic skills in aging, and to explore what cognitive and demographic factors support pragmatic competence. We assessed pragmatic production skills, including discourse abilities such as speech, informativeness, information flow, paralinguistic aspects, as well as the ability to produce informative descriptions of pictures, and pragmatic comprehension skills, which encompassed the ability to understand discourse and the main aspects of a narrative text, to infer non-literal meanings and to comprehend verbal humor in a group of elderly individuals and in a sample of younger participants. Moreover, specific cognitive functions (short-term memory, verbal and visuospatial working memory, inhibition Theory of Mind, and Cognitive Reserve) were assessed in both groups. Pragmatic difficulties seem to occur in late adulthood, likely around 70 years, and emerge more prominently when participants are asked to understand verbal humor. Age was the only predictor of general pragmatic performance in a sample of cognitively unimpaired older adults; conversely, when elderly individuals with less intact inhibitory control are considered, a general role of inhibition emerged, in addition to working memory and ToM in specific tasks.

Toward Personalized Cognitive Training in Older Adults: A Pilot Investigation of the Effects of Baseline Performance and Age on Cognitive Training Outcomes

BACKGROUND

Cognitive training holds potential as a non-pharmacological intervention to decrease cognitive symptoms associated with Alzheimer's disease (AD), but more research is needed to understand individual differences that may predict maximal training benefits.

OBJECTIVE

We conducted a pilot study using a six-month training regimen in healthy aging adults with no cognitive decline. We investigated the effects of baseline performance and age on training and transfer improvements.

METHODS

Out of 43 participants aged 65-84 years, 31 successfully completed cognitive training (BrainHQ) in one of three cognitive domains: processing speed (N = 13), inhibitory control (N = 9), or episodic memory (N = 9). We used standardized assessments to measure baseline performance and transfer effects.

RESULTS

All 31 participants improved on the cognitive training regimen and age was positively associated with training improvement (p = 0.039). The processing speed group improved significantly across many near- and far-transfer tasks. In the inhibitory control group, individuals with lower baseline performance improved more on inhibitory control and cognitive flexibility tasks. In the episodic memory group, older individuals improved most on a memory task while younger individuals improved most on an executive function far-transfer task.

CONCLUSIONS

Individual differences are predictive of cognitive training gains, and the impact of individual differences on training improvements is specific to the domain of training. We provide initial insight regarding how non-pharmacological interventions can be optimized to combat the onset of cognitive decline in older adults. With future research this work can inform the design of effective cognitive interventions for delaying cognitive decline in preclinical AD.

Memory rehabilitation during the COVID-19 pandemic

BACKGROUND

Loss of cognitive and executive functions is a problem that affects people of all ages. That is why it is important to perform exercises for memory training and prevent early cognitive deterioration. The aim of this work was to compare the cognitive performance of the participants after an intervention by using two mnemonic techniques to exercise memory functions (paired-associate learning and method of loci).

METHODS

A longitudinal study was conducted with 21 healthy participants aged 18 to 55 years over a 2-month period. To assess the impact of this proposal, the NEUROPSI brief battery cognitive assessment test was applied before and after the intervention. In each session, a previous cognitive training was carried out using the paired-associate learning technique, to later perform a task based on the loci method, all from a smart device-based application. The accuracy response and reaction times were automatically collected in the app.

RESULTS

After the intervention, a statistically significant improvement was obtained in the neuropsychological assessment (NEUROPSI neuropsychological battery) reflected by the Wilcoxon paired signed-rank test (P < .05).

CONCLUSION

The task based on the method of loci also reflected the well-known age-related effects common to memory assessment tasks. Episodic memory training using the method of loci can be successfully implemented using a smart device app. A stage-based methodological design allows to acquire mnemic skills gradually, obtaining a significant cognitive improvement in a short period of time.

EngAge - A metacognitive intervention to supplement working memory training: A feasibility study in older adults

Working Memory (WM) training has shown promise in supporting cognitive functioning in older adult populations, but effects that generalize beyond the trained task have been inconsistent. Targeting cognitive processes in isolation might be a limiting factor given that metacognitive and motivational factors have been shown to impact older adults' engagement with challenging cognitive activities, such as WM training. The current feasibility study implemented a novel metacognitive intervention in conjunction with WM training in older adults and examined its potential amplifying short- and long-term effects on cognitive and self-report outcomes as compared to WM or active control training alone. One-hundred and nineteen older adults completed a cognitive training over the course of 20 sessions at home. The cognitive training targeted either WM or general knowledge. In addition, one of the WM training groups completed a metacognitive program via group seminars. We tested for group differences in WM, inhibitory control, and episodic memory, and we assessed participants' perceived self-efficacy and everyday memory failures. At post-test, we replicated earlier work by demonstrating that participants who completed the WM intervention outperformed the active control group in non-trained WM measures, and to some extent, in inhibitory control. However, we found no evidence that the supplemental metacognitive program led to benefits over and above the WM intervention. Nonetheless, we conclude that our metacognitive program is a step in the right direction given the tentative long-term effects and participants' positive feedback, but more longitudinal data with larger sample sizes are needed to confirm these early findings.

A Multicomponent Cognitive Intervention May Improve Self-Reported Daily Function of Adults With Subjective Cognitive Decline

IMPORTANCE

Limited evidence exists to support cognitive intervention improving the daily function of adults with subjective cognitive decline (SCD).

OBJECTIVE

To examine the preliminary efficacy of a group-based multicomponent cognitive intervention that integrates Lifestyle Redesign® (LR) techniques.

DESIGN

Single-arm two-period crossover trial; 16-wk waiting period, 16-wk intervention, and 16-wk follow-up.

SETTING

Memory clinic in a medical center, Taiwan.

PARTICIPANTS

Purposive sample of adults ages >55 yr with SCD.

INTERVENTION

Sixteen 1.5-hr weekly multicomponent sessions of cognitive training, cognitive rehabilitation, psychological intervention, and lifestyle intervention.

OUTCOMES AND MEASURES

Primary outcomes were (1) self-reported daily function, measured with the Activities of Daily Living Questionnaire (ADLQ) and Cognitive Failure Questionnaire; (2) performance-based daily function, measured with the Brief University of California San Diego Performance-Based Skills Assessment-Traditional Chinese Version; and (3) functional cognition, measured with the Contextual Memory Test (CMT) and Miami Prospective Memory Test. Secondary outcomes included cognitive functions, anxiety, and depression.

RESULTS

Seventeen participants completed the intervention; 4 missed the follow-up. The generalized estimating equations model showed significant changes from baseline to pretest (control) and pretest to posttest (intervention) on the ADLQ (p = .014) and CMT-delayed (p = .003). Effects remained at the 16-wk follow-up. After adjusting for the effects of covariates, the self-reported daily function of participants ages ≤ 63 yr improved more than that of other participants (p = .003).

CONCLUSIONS AND RELEVANCE

Multicomponent cognitive interventions integrating LR techniques may improve self-reported daily function and context-dependent memory function of adults with SCD, with efficacy sustained at follow-up. What This Article Adds: A group-based multicomponent cognitive intervention consisting of cognitive training, cognitive rehabilitation, psychoeducation, and lifestyle intervention may provide benefits for the daily function and cognitive function of adults with SCD.

Outcomes of a computer-based cognitive training (CoRe) in early phases of cognitive decline: a data-driven cluster analysis

The present study aimed to identify clusters of cognitive profiles as well as to explore the effects of these clusters on demographic/individual characteristics and on improvements after a computer-based cognitive training (CCT) in early cognitive impairment. Fifty-seven subjects underwent to an adaptive CCT for 3 weeks (4 individual face-to-face sessions/week of 45 min) and were evaluated at baseline (T0), post-intervention (T1), and after 6 (T2) and 12 (T3) months. Clusters of cognitive profiles were explored with k-means analysis. The analysis revealed two clusters, which were composed by 27 and 30 patients characterized by lower (Cluster 1) and higher (Cluster 2) cognitive functioning. At T1, cognitive performance improved in both groups, but Cluster 1 gained more benefits in global cognitive functioning than Cluster 2. However, at T3, Cluster 2 remained stable in its clinical condition, whereas Cluster 1 showed a pronounced worsening. In conclusion, Cluster 1 profile was associated with a more marked but also short-lasting responsiveness to CCT, whereas patients fitting with Cluster 2 characteristics seemed to obtain more CCT benefits in terms of stability or even delay of cognitive/functional decline. These findings may have relevant implications in informing the timing and modality of delivery of CCT.

Effects of working memory training on cognition in healthy older adults: A systematic review

ABSTRACT. The working memory (WM) training in older adults can benefit their cognition. However, there is a dearth of literature reviews on the subject. Objective: This study aimed to investigate and evaluate the effects of WM training on the cognition of healthy older adults, in individual and group interventions reported in the literature. Methods: This is a systematic review involving a qualitative analysis of publications on the SciELO, LILACS, and MEDLINE databases carried out between March and June 2021. Results: A total of 47 studies were identified and analyzed, comprising 40 in older adults only and 7 comparing older and younger adults, investigating individual or group WM training or other types of intervention focused on WM effects. Conclusions: Both individual and group intervention contributed to the maintenance and/or improvement of cognition in older adults exploiting brain plasticity to promote mental health and prevent cognitive problems that can negatively impact quality of life of this group.

Training attentive individuation leads to visuo-spatial working memory improvement in low-performing older adults: An online study

Cognitive decrements are typical of physiological aging. Among these age-related cognitive changes, visuo-spatial working memory (vWM) decline has a prominent role due to its effects on other cognitive functions and daily routines. To reinforce vWM in the aging population, several cognitive training interventions have been developed in the past years. Given that vWM functioning depends (at least partially) on the efficiency of attention selection of the relevant objects, in the present study we implemented a short (five sessions), online intervention that primarily trained attentive individuation of target items and tested training effects on a vWM task. Attention training effects were compared with practice (i.e., a group that repeatedly performed the same vWM task) and test-retest effects (i.e., a passive group). After the training, the results showed attention training effects of the same magnitude as practice effects, confirming that the enhancement of attentive individuation has a positive cascade influence on maintaining items in vWM. Moreover, training and practice effects were only evident in low-performing older adults. Thus, interindividual differences at baseline crucially contribute to training outcomes and are a fundamental factor to be accounted for in the implementation of cognitive training protocols.

Cognitive remediation for depression vulnerability: Current challenges and new directions

It is increasingly acknowledged that cognitive impairment can play an important role in depression vulnerability. Therefore, cognitive remediation strategies, and cognitive control training (CCT) procedures have gained attention in recent years as possible interventions for depression. Recent studies suggest a small to medium effect on indicators of depression vulnerability. Despite initial evidence for the efficacy and effectiveness of CCT, several central questions remain. In this paper we consider the key challenges for the clinical implementation of CCT, including exploration of (1) potential working mechanisms and related to this, moderators of training effects, (2) necessary conditions under which CCT could be optimally administered, such as dose requirements and training schedules, and (3) how CCT could interact with or augment existing treatments of depression. Revisiting the CCT literature, we also reflect upon the possibilities to evolve toward a stratified medicine approach, in which individual differences could be taken into account and used to optimize prevention of depression.

Cognitive-motor multitasking in older adults: a randomized controlled study on the effects of individual differences on training success

Background

Multitasking is an essential part of our everyday life, but performance declines typically in older age. Many studies have investigated the beneficial effects of cognitive, motor and combined cognitive-motor training on multitasking performance in older adults. Previous work, however, has not regarded interindividual differences in cognitive functioning and motor fitness that may affect training benefits. The current study aims to identify whether different training programs may have differential effects on multitasking performance depending on the initial level of cognitive functioning and motor fitness.

Methods

We conduct a 12-week single-blinded randomized controlled trial. A total of N = 150 healthy older adults are assigned to either a single cognitive, a single motor, or a simultaneous cognitive-motor training. Participants are trained twice per week for 45 min. A comprehensive test battery assesses cognitive functions, motor and cardiovascular fitness, and realistic multitasking during walking and driving in two virtual environments. We evaluate how multitasking performance is related not only to the training program, but also to participants’ initial levels of cognitive functioning and motor fitness.

Discussion

We expect that multitasking performance in participants with lower initial competence in either one or both domains (cognitive functioning, motor fitness) benefits more from single-task training (cognitive training and/or motor training). In contrast, multitasking performance in participants with higher competence in both domains should benefit more from multitask training (simultaneous cognitive-motor training). The results may help to identify whether tailored training is favorable over standardized one-size-fits all training approaches to improve multitasking in older adults. In addition, our findings will advance the understanding of factors that influence training effects on multitasking.

Trial registration

DRKS (German Clinical Trials Register), DRKS00022407. Registered 26/08/2020 - Retrospectively registered at https://www.drks.de/drks_web/setLocale_EN.do

Working Memory Training Coupled With Transcranial Direct Current Stimulation in Older Adults: A Randomized Controlled Experiment

Background

Transcranial direct current stimulation (tDCS) has been employed to boost working memory training (WMT) effects. Nevertheless, there is limited evidence on the efficacy of this combination in older adults. The present study is aimed to assess the delayed transfer effects of tDCS coupled with WMT in older adults in a 15-day follow-up. We explored if general cognitive ability, age, and educational level predicted the effects.

Methods

In this single-center, double-blind randomized sham-controlled experiment, 54 older adults were randomized into three groups: anodal-tDCS (atDCS)+WMT, sham-tDCS (stDCS)+WMT, and double-sham. Five sessions of tDCS (2 mA) were applied over the left dorsolateral prefrontal cortex (DLPFC). Far transfer was measured by Raven’s Advanced Progressive Matrices (RAPM), while the near transfer effects were assessed through Digit Span. A frequentist linear mixed model (LMM) was complemented by a Bayesian approach in data analysis.

Results

Working memory training improved dual n-back performance in both groups submitted to this intervention but only the group that received atDCS+WMT displayed a significant improvement from pretest to follow-up in transfer measures of reasoning (RAPM) and short-term memory (forward Digit Span). Near transfer improvements predicted gains in far transfer, demonstrating that the far transfer is due to an improvement in the trained construct of working memory. Age, formal education, and vocabulary score seem to predict the gains in reasoning. However, Bayesian results do not provide substantial evidence to support this claim.

Conclusion

This study will help to consolidate the incipient but auspicious field of cognitive training coupled with tDCS in healthy older adults. Our findings demonstrated that atDCS may potentialize WMT by promoting transfer effects in short-term memory and reasoning in older adults, which are observed especially at follow-up.

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.

The Role of Individual Characteristics in Predicting Short- and Long-Term Cognitive and Psychological Benefits of Cognitive Stimulation Therapy for Mild-to-Moderate Dementia

Introduction: This study examined the role of individual characteristics in predicting short- and long-term benefits of the Italian version of Cognitive Stimulation Therapy (CST-IT), an evidence-based intervention for people with mild-to-moderate dementia.

Materials and Methods: Data were drawn from a sample (N = 123) of people with dementia (PwD) who took part in a multicenter controlled clinical trial of CST-IT. Assessments at pre-test, immediately after completing the treatment, and 3 months later investigated the following outcomes: general cognitive functioning and language, mood and behavior, everyday functioning, and quality of life. Age, education and baseline (pre-test) cognitive functioning, mood (depression) and behavioral and neuropsychiatric symptoms were considered as predictors of any short- and long-term benefits.

Results: Linear mixed-effects models showed that different individual characteristics -particularly education and age- influenced the benefits of CST-IT, depending on the outcome measures considered. Higher education predicted larger gains in general cognitive functioning and, along with less severe depressive symptoms, in language (magnification effects). Older age was associated with positive changes in mood (compensation effects). Albeit very modestly, older age was also associated with larger gains in everyday functioning (compensation effects). Gains in quality of life were predicted by older age and lower education (compensation effects). Baseline cognitive functioning, mood and/or behavioral symptoms broadly influenced performance too, but their role again depended on the outcomes considered.

Discussion: These findings underscore the importance of considering and further exploring how psychosocial interventions like CST are affected by individual characteristics in order to maximize their efficacy for PwD.

Working Memory Training and Cortical Arousal in Healthy Older Adults: A Resting-State EEG Pilot Study

The current pilot study aimed to test the gains of working memory (WM) training, both at the short- and long-term, at a behavioral level, and by examining the electrophysiological changes induced by training in resting-state EEG activity among older adults. The study group included 24 older adults (from 64 to 75 years old) who were randomly assigned to a training group (TG) or an active control group (ACG) in a double-blind, repeated-measures experimental design in which open eyes, resting-state EEG recording, followed by a WM task, i.e., the Categorization Working Memory Span (CWMS) task, were collected before and after training, as well as at a 6-month follow-up session. At the behavioral level, medium to large Cohen's d effect sizes was found for the TG in immediate and long-term gains in the WM criterion task, as compared with small gains for the ACG. Regarding intrusion errors committed in the CWMS, an index of inhibitory control representing a transfer effect, results showed that medium to large effect sizes for immediate and long-term gains emerged for the TG, as compared to small effect sizes for the ACG. Spontaneous high-beta/alpha ratio analyses in four regions of interest (ROIs) revealed no pre-training group differences. Significantly greater TG anterior rates, particularly in the left ROI, were found after training, with frontal oscillatory responses being correlated with better post-training CWMS performance in only the TG. The follow-up analysis showed similar results, with greater anterior left high-beta/alpha rates among TG participants. Follow-up frontal high-beta/alpha rates in the right ROI were correlated with lower CWMS follow-up intrusion errors in only the TG. The present findings are further evidence of the efficacy of WM training in enhancing the cognitive functioning of older adults and their frontal oscillatory activity. Overall, these results suggested that WM training also can be a promising approach toward fostering the so-called functional cortical plasticity in aging.

Initial performance predicts improvements in computerized cognitive training: Evidence from a selective attention task

Computerized cognitive training (CCT) has been found to improve a range of skills such as attention, working memory, inhibition control, and decision making. However, the relationship between the initial performance, amount of improvement, time constant, and asymptotic performance level in CCT is still unclear. In the current study, we performed selective attention training on college students and addressed this issue by mathematically modeling the learning curve with an exponential function. Twenty-nine students completed approximately 10 days of CCT. Presentation time served as the dependent variable and was measured by three-down/one-up adaptive algorithms. We fitted an exponential function to the estimated block thresholds during CCT and obtained three learning parameters (amount of improvement, time constant, and asymptotic performance level) for all subjects. The initial performance was defined by the sum of the amount of improvement and the asymptotic performance level. Pearson correlation analyses were conducted between the initial performance and the three leaning parameters. The initial performance was positively correlated with the amount of improvement and asymptotic performance level, but was negatively correlated with the time constant. The time constant was negatively correlated with the amount of improvement and asymptotic performance level. Poorer initial performance was linked to a larger amount of improvement, shorter time constant, and higher asymptotic threshold, which supported the compensation account. Our results may help improve the present understanding of the nature of the CCT process and demonstrate the advantages of using a customized training protocol to enhance the efficiency of cognitive training in practical applications.

Cognitive reserve and the effects of virtual reality-based cognitive training on elderly individuals with mild cognitive impairment and normal cognition

BACKGROUND

Cognitive reserve (CR) is a concept proposed to account for discrepancies between the extent of brain pathology and clinical manifestations of that pathology. This study aimed to explore the associations between CR and the effects of cognitive training using fully immersive virtual reality (VR).

METHODS

A total of 44 older adults (22 cognitively normal, 22 with mild cognitive impairment) underwent eight cognitive training sessions using VR for a period of 4 weeks. CR was assessed using the Cognitive Reserve Index questionnaire (CRIq). To evaluate baseline cognitive function and the effects of VR training, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery was administered to all participants before and after the training.

RESULTS

Greater improvement in the total CERAD score was seen for cognitively normal participants with higher versus lower scores on the Education subdomain of the CRIq. Among patients with mild cognitive impairment, none of the CRIq subdomain scores (Education, Working Activity, Leisure Time) were related to a change in CERAD total scores. The CRIq total score did not predict the improvement of global cognition in either group.

CONCLUSIONS

This study revealed different impacts of CR on cognitive training according to the participants' cognitive status. It also suggests that employing three proxies of CR rather than using a composite score would provide a more accurate understanding of one's CR.

Cognitive training with modern board and card games in healthy older adults: two randomized controlled trials

OBJECTIVES

The aim of this study was to assess the effectiveness of a cognitive intervention based on modern board and card games.

METHODS

We conducted two two-arm parallel-group, randomized controlled trials. The first one (pilot study) was nonblind. The second one (main study) was a double-blind design. Participants (14 in a pilot study and 35 in the main study) were healthy older adults over 65 years old who were assisting to adult care institutions. In the pilot study, participants in the experimental group (n = 6) played modern board and card games which activated cognitive processes; whereas the control group (n = 6) was in the wait-list condition. In the main study, participants in the experimental group (n = 12) also played modern board and card games; whereas the control group (n = 15) performed standardized paper-and-pencil cognitive tasks. Psychologists specialized in older-people conducted all the interventions. In both studies, intervention sessions were bi-weekly for 5 weeks. The outcomes of both studies were cognitive status and executive functioning, depressive symptomatology, and quality of life measures. All assessment and intervention sessions took place in their habitual centers.

RESULTS

In the pilot study, participants in the games intervention showed a significant improvement in semantic verbal fluency. In the main study, both interventions showed significant improvements in phonemic verbal fluency. Whilst board and card games maintained motor impulsivity control, paper-and-pencil tasks improved speed in an inhibition task.

CONCLUSIONS

Modern board and card games could be an effective cognitive intervention to maintain some cognitive functions.

Why Does Cognitive Training Yield Inconsistent Benefits? A Meta-Analysis of Individual Differences in Baseline Cognitive Abilities and Training Outcomes

Despite growing interest in improving cognitive abilities across the lifespan through training, the benefits of cognitive training are inconsistent. One powerful contributor may be that individuals arrive at interventions with different baseline levels of the cognitive skill being trained. Some evidence suggests poor performers benefit the most from cognitive training, showing compensation for their weak abilities, while other evidence suggests that high performers benefit most, experiencing a magnification of their abilities. Whether training leads to compensation or magnification effects may depend upon the specific cognitive domain being trained (such as executive function or episodic memory) and the training approach implemented (strategy or process). To clarify the association between individual differences in baseline cognitive ability and training gains as well as potential moderators, we conducted a systematic meta-analysis of the correlation between these two variables. We found evidence of a significant meta-correlation demonstrating a compensatory effect, a negative association between initial ability on a trained cognitive process and training gains. Too few papers met our search criteria across the levels of proposed moderators of cognitive domain and training approach to conduct a reliable investigation of their influence over the meta-analytic effect size. We discuss the implications of a compensatory meta-correlation, potential reasons for the paucity of qualifying papers, and important future directions for better understanding how cognitive trainings work and for whom.

The Long-Term Efficacy of Working Memory Training in Healthy Older Adults: A Systematic Review and Meta-Analysis of 22 Randomized Controlled Trials

OBJECTIVES

The long-lasting efficacy of working memory (WM) training has been a controversial and still ardently debated issue. In this meta-analysis, the authors explored the long-term effects of WM training in healthy older adults on WM subdomains and abilities outside the WM domain assessed in randomized controlled studies.

METHOD

A systematic literature search of PubMed, Web of Science, PsycINFO, Cochrane Library, ProQuest, clinicaltrials.gov, and Google Scholar was conducted. Random-effects models were used to quantitatively synthesize the existing data.

RESULTS

Twenty-two eligible studies were included in the meta-analysis. The mean participant age ranged from 63.77 to 80.1 years. The meta-synthesized long-term effects on updating were 0.45 (95% confidence interval = 0.253-0.648, <6 months: 0.395, 0.171-0.619, ≥6 months: 0.641, 0.223-1.058), on shifting, 0.447 (0.246-0.648, <6 months: 0.448, 0.146-0.75, ≥6 months: 0.446, 0.176-0.716); on inhibition, 0.387 (0.228-0.547, <6 months: 0.248, 0.013-0.484, ≥6 months: 0.504, 0.288-0.712); on maintenance, 0.486 (0.352-0.62, <6 months: 0.52, 0.279-0.761, ≥6 months: 0.471, 0.31-0.63).

DISCUSSION

The results showed that WM training exerted robust long-term effects on enhancing the WM system and improving processing speed and reasoning in late adulthood. Future studies are needed to use different tasks of the same WM construct to evaluate the WM training benefits, to adopt more ecological tasks or tasks related to daily life, to improve the external validity of WM training, and to identify the optimal implementation strategy for WM training.

Dual n-back working memory training evinces superior transfer effects compared to the method of loci

Working memory (WM) training is a prevalent intervention for multiple cognitive deficits, however, the transfer effects to other cognitive tasks from gains in WM induced by different training techniques still remains controversial. Therefore, the current study recruited three groups of young adults to investigate the memory training transference, with N-back group (NBG) (n = 50) training on dual n-back task, Memory Palace group (MPG) (n = 50) on method of loci, and a blank control group (BCG) (n = 48) receiving no training. Our results showed that both training groups separately improved WM capacity on respective trained task. For untrained tasks, both training groups enhanced performance on digit-span task, while on change detection task, significant improvement was only observed in NBG. In conclusion, while both techniques can be used as effective training methods to improve WM, the dual n-back task training method, perhaps has a more prominent transfer effect than that of method of loci.

Predicting Working Memory Training Responsiveness in Parkinson's Disease: Both "System Hardware" and Room for Improvement Are Needed

Background. Patients with Parkinson's disease (PD) are highly vulnerable to develop cognitive dysfunctions, and the mitigating potential of early cognitive training (CT) is increasingly recognized. Predictors of CT responsiveness, which could help to tailor interventions individually, have rarely been studied in PD. This study aimed to examine individual characteristics of patients with PD associated with responsiveness to targeted working memory training (WMT). Methods. Data of 75 patients with PD (age: 63.99 ± 9.74 years, 93% Hoehn & Yahr stage 2) without cognitive dysfunctions from a randomized controlled trial were analyzed using structural equation modeling. Latent change score models with and without covariates were estimated and compared between the WMT group (n = 37), who participated in a 5-week adaptive WMT, and a waiting list control group (n = 38). Results. Latent change score models yielded adequate model fit (χ²-test p > .05, SRMR ≤ .08, CFI ≥ .95). For the near-transfer working memory composite, lower baseline performance, younger age, higher education, and higher fluid intelligence were found to significantly predict higher latent change scores in the WMT group, but not in the control group. For the far-transfer executive function composite, higher self-efficacy expectancy tended to significantly predict larger latent change scores. Conclusions. The identified associations between individual characteristics and WMT responsiveness indicate that there has to be room for improvement (e.g., lower baseline performance) and also sufficient "hardware" (e.g., younger age, higher intelligence) to benefit in training-related cognitive plasticity. Our findings are discussed within the compensation versus magnification account. They need to be replicated by methodological high-quality research applying advanced statistical methods with larger samples.

Is Training with the N-Back Task More Effective Than with Other Tasks? N-Back vs. Dichotic Listening vs. Simple Listening

Cognitive training most commonly uses computerized tasks that stimulate simultaneous cognitive processing in two modalities, such as a dual n-back task with visual and auditive stimuli, or on two receptive channels, such as a listening task with dichotically presented stimuli. The present study was designed to compare a dual n-back task and a dichotic listening (DL) task with an active control condition (a simple listening task) and a no-training control condition for their impact on cognitive performance, daily life memory, and mindfulness. One hundred thirty healthy adults aged 18–55 years were randomly assigned to one of the four conditions. The training consisted of twenty 15-min sessions spread across 4 weeks. The results indicated some improvement on episodic memory tasks and a trend for enhanced performance in an untrained working memory (WM) span task following cognitive training relative to the no-training control group. However, the only differential training effects were found for the DL training in increasing choice reaction performance and a trend for self-reported mindfulness. Transfer to measures of fluid intelligence and memory in daily life did not emerge. Additionally, we found links between self-efficacy and n-back training performance and between emotion regulation and training motivation. Our results contribute to the field of WM training by demonstrating that our listening tasks are comparable in effect to a dual n-back task in slightly improving memory. The possibility of improving attentional control and mindfulness through dichotic listening training is promising and deserves further consideration.

The Effect of Baseline Performance and Age on Cognitive Training Improvements in Older Adults: A Qualitative Review

Findings that the brain is capable of plasticity up until old age have led to interest in the use of cognitive training as a potential intervention to delay the onset of dementia. However, individuals participating in training regimens differ greatly with respect to their outcomes, demonstrating the importance of considering individual differences, in particular age and baseline performance in a cognitive domain, when evaluating the effectiveness of cognitive training. In this review, we summarize existing literature on cognitive training in adults across the domains of episodic memory, working memory and the task-switching component of executive functioning to clarify the picture on the impact of age and baseline performance on cognitive training-related improvements. Studies targeting episodic memory induced greater improvements in younger adults with more intact cognitive abilities, explained in part by factors specific to episodic memory training. By contrast, older, lower baseline performance adults improved most in several studies targeting working memory in older individuals as well as in the majority of studies targeting executive functioning, suggesting the preservation of neural plasticity in these domains until very old age. Our findings can have important implications for informing the design of future interventions for enhancing cognitive functions in individuals at the prodromal stage of Alzheimer's Disease and potentially delaying the clinical onset of Alzheimer's Disease. Future research should more clearly stratify individuals according to their baseline cognitive abilities and assign specialized, skill-specific cognitive training regimens in order to directly answer the question of how individual differences impact training effectiveness.

Working memory training effects across the lifespan: Evidence from human and experimental animal studies

Working memory refers to a cognitive function that provides temporary storage and manipulation of the information necessary for complex cognitive tasks. Due to its central role in general cognition, several studies have investigated the possibility that training on working memory tasks could improve not only working memory function but also increase other cognitive abilities or modulate other behaviors. This possibility is still highly controversial, with prior studies providing contradictory findings. The lack of systematic approaches and methodological shortcomings complicates this debate even more. This review highlights the impact of working memory training at different ages on humans. Finally, it demonstrates several findings about the neural substrate of training in both humans and experimental animals, including non-human primates and rodents.

How to improve social communication in aging: Pragmatic and cognitive interventions

Among all aspects of the linguistic and communicative competence, pragmatics seems especially vulnerable in aging, due also to cognitive decline. However, pragmatics has never been considered as an intervention target in healthy aging. Here we tested the effects of a novel training program to improve pragmatics (PragmaCom) in older adults, compared with an active cognitive control group in a randomized-controlled-trial design. Both the PragmaCom group and the control group improved in pragmatic skills such as understanding metaphors and avoiding off-topic speech, indicating that it is possible to improve pragmatics in aging both with a specific training and with a cognitive training. Individual cognitive factors predicted pragmatic improvement in the control group, while in the PragmaCom group benefits were less dependent on individual characteristics. We discuss the results in terms of pragmatic plasticity, highlighting the importance of these findings for promoting older adults' social communication and well-being.

Working memory training format in older adults: individual versus group sessions

Working memory (WM) training has been shown to increase the performance of participants in WM tasks and in other cognitive abilities, but there has been no study comparing directly the impact of training format (individual vs. group) using the same protocol. Therefore, the aim of this study was to compare the efficacy of the Borella et al. three session verbal WM training offered in two different formats on target and transfer tasks. This study was conducted in two waves. In the first wave, participants were randomized into individual training (n = 11) and individual control conditions (n = 15). In the second wave, participants were randomized into group training (n = 16) and group control conditions (n = 17). Training consisted of three sessions of WM exercises and participants in the active control condition responded to questionnaires during the same time. There was significant improvement for both training conditions at post-test and maintenance at follow-up for the target task, other WM tasks, processing speed, and executive functions tasks. The ANOVA results showed that the training gains did not depend on the WM training format. However, the effect size analyses suggested that this intervention can be more effective, at short term and follow-up, when provided individually. To conclude, this study showed that providing this training collectively or individually does not change the training benefits, which increases the possibilities of its use in different contexts.

A Systematic Review on Predictors of Working Memory Training Responsiveness in Healthy Older Adults: Methodological Challenges and Future Directions

Background: Research on predictors of working memory training responsiveness, which could help tailor cognitive interventions individually, is a timely topic in healthy aging. However, the findings are highly heterogeneous, reporting partly conflicting results following a broad spectrum of methodological approaches to answer the question “who benefits most” from working memory training.

Objective: The present systematic review aimed to systematically investigate prognostic factors and models for working memory training responsiveness in healthy older adults.

Method: Four online databases were searched up to October 2019 (MEDLINE Ovid, Web of Science, CENTRAL, and PsycINFO). The inclusion criteria for full texts were publication in a peer-reviewed journal in English/German, inclusion of healthy older individuals aged ≥55 years without any neurological and/or psychiatric diseases including cognitive impairment, and the investigation of prognostic factors and/or models for training responsiveness after targeted working memory training in terms of direct training effects, near-transfer effects to verbal and visuospatial working memory as well as far-transfer effects to other cognitive domains and behavioral variables. The study design was not limited to randomized controlled trials.

Results: A total of 16 studies including n = 675 healthy older individuals with a mean age of 63.0–86.8 years were included in this review. Within these studies, five prognostic model approaches and 18 factor finding approaches were reported. Risk of bias was assessed using the Quality in Prognosis Studies checklist, indicating that important information, especially regarding the domains study attrition, study confounding, and statistical analysis and reporting, was lacking throughout many of the investigated studies. Age, education, intelligence, and baseline performance in working memory or other cognitive domains were frequently investigated predictors across studies.

Conclusions: Given the methodological shortcomings of the included studies, no clear conclusions can be drawn, and emerging patterns of prognostic effects will have to survive sound methodological replication in future attempts to promote precision medicine approaches in the context of working memory training. Methodological considerations are discussed, and our findings are embedded to the cognitive aging literature, considering, for example, the cognitive reserve framework and the compensation vs. magnification account. The need for personalized cognitive prevention and intervention methods to counteract cognitive decline in the aging population is high and the potential enormous.

Registration: PROSPERO, ID CRD42019142750.

From Evaluation to Prediction: Behavioral Effects and Biological Markers of Cognitive Control Intervention

Although the intervention effectiveness of cognitive control is disputed, some methods, such as single-task training, integrated training, meditation, aerobic exercise, and transcranial stimulation, have been reported to improve cognitive control. This review of recent advances from evaluation to prediction of cognitive control interventions suggests that brain modularity may be an important candidate marker for informing clinical decisions regarding suitable interventions. The intervention effect of cognitive control has been evaluated by behavioral performance, transfer effect, brain structure and function, and brain networks. Brain modularity can predict the benefits of cognitive control interventions based on individual differences and is independent of intervention method, group, age, initial cognitive ability, and education level. The prediction of cognitive control intervention based on brain modularity should extend to task states, combine function and structure networks, and assign different weights to subnetwork modularity.

Verbal working memory training in older adults: an investigation of dose response

The WM training protocol proposed by Borella et al. found specific and transfer effects among seniors, however, the studies were carried out in the same socio-cultural context and variations in the procedure were never tested. The present study aimed at analyzing the efficacy of Borella et al.'s training, in terms of short and long-term benefits, in a different socio-cultural context (Study 1), and the effect of change in the training's length (duplicating the number of sessions (Study 2). Participants were randomly assigned to a trained group (N = 18 for Study 1, and N = 23 for Study 2) and active control group (N = 28 for Study 1, and N = 27 for Study 2), and evaluated at pre, post-test and six-month follow-up for verbal WM task (criterion task), and for visuospatial and verbal WM, inhibition, processing speed, executive function, and fluid intelligence measures (transfer tasks). The trained groups had higher performance in all tasks when compared with active control groups after training and at 6 month follow-up. The longer training (Study 2) generated similar gains as the original protocol, with some advantage in far transfer tasks at post-test and follow-up. Study limitations include the small sample sizes. In conclusion, this training was effective in a different socio-cultural context and adding three sessions to the protocol did not significantly change training impact.

Working Memory Training for Older Adults After Major Surgery: Benefits to Cognitive and Emotional Functioning

OBJECTIVES

Cognitive and mood changes can affect postoperative recovery in hospitalized older adults undergoing major surgical procedures, but few studies have considered postoperative cognitive interventions to sustain such patients' cognitive functioning and mood. The aim of this pilot study was to assess the efficacy of working memory training in improving cognitive functioning and mood, or emotional functioning, in older adults undergoing major surgery.

METHODS

Thirty-four older adults (from 64 to 75 years of age) hospitalized for partial or total arthroplasty of the knee were randomly assigned to either a trained group (N = 18) or an active control group (N = 16). The former received working memory training during the postoperative period, while the latter engaged in alternative activities. In addition to specific training gains in a working memory task similar to the one used in the training (criterion task), transfer effects to cognitive abilities (short- and long-term memory, and cognitive inhibition), and mood or emotional functioning (signs of depression or anxiety) were investigated.

RESULTS

Immediately after the training, results showed a main effect of group (in favor of the trained group) in the criterion task, in one of the short-term memory measures, and in cognitive inhibition. In addition, only the trained group showed a decrease in depression and anxiety scores.

CONCLUSION

The results of this pilot study suggest that cognitive training targeting working memory administered in the postoperative period after major surgery can sustain older adults' cognitive and emotional functioning, and especially their mood.

The Construction and Evaluation of Executive Attention Training to Improve Selective Attention, Focused Attention, and Divided Attention for Older Adults With Mild Cognitive Impairment: A Randomized Controlled Trial

OBJECTIVES

To examine the immediate and long-term effects of executive attention training on selective attention, focused attention, and divided attention in older adults with mild cognitive impairment.

METHODS

A double-blind, multisite randomized controlled trial at five sites. Seventy participants (mean age: 78.19 ± 7.22 years) were assigned to an experimental group (executive attention training, n = 35) or an active control group (n = 35). The training duration was the same for both groups (45 minutes per session, 3 times per week, 18 sessions in total). Primary outcome measure was selective attention (Digit Span Task). Secondary outcome measures included focused attention (Stroop Color Word Test) and divided attention (Trail-Making Test Part B). Data were collected at pretest, post-test, 3-month follow-up, and 6-month follow-up.

RESULTS

In GEE analysis, findings indicated a significant improvement in selective attention at post-test, whereas divided attention showed significant reducing omission error at 3-month follow-up. There was no significant effect of group in focused attention associated with the executive attention training compared with active control group.

CONCLUSION

The executive attention training significantly improved selective attention and divided attention performance. Future studies should identify transfer effects of attention training, and that can employ early screening to provide integrated attention training, and decrease its relevant risks on competency in performing daily activities, such as falling and driving.

Improving Everyday Functioning in the Old-Old with Working Memory Training

OBJECTIVE

The aim of this study was to assess gains related to working memory (WM) training, in the short and long term (9 months after the training), in abilities required in everyday life, and in cognitive measures in old-old adults (aged ≥ 75 years).

METHODS

Thirty-two community-dwelling older adults (aged 75-85 years) were randomly assigned to a training or an active control group. In addition to testing for any specific gains in a WM task similar to the one used in the training (criterion task), we sought transfer effects to: 1) abilities involved in everyday life using objective performance-based tasks (the Everyday Problem Test [EPT] and the Timed Instrumental Activities of Daily Living [TIADL] scale; 2) tasks demanding the comprehension and recall of spatial information and pairing names with faces; and 3) a measure of inhibitory control, that is, recall errors (intrusion errors).

RESULTS

Only the trained group showed specific gains in the criterion task, and in the TIADL in the short term. At follow-up, the trained group maintained gains in the criterion task, and showed transfer effects to everyday problem-solving (in the EPT), and in constructing spatial representations of an environment. The trained group also improved in a cognitive inhibition measure (intrusion errors) at follow-up. No such improvements were seen in the active control group.

CONCLUSION

WM training may be a valid way to help old-old adults preserve at least some abilities related to everyday functioning.

Examining Positivity Effect and Working Memory in Young-Old and Very Old Adults Using EEG-Derived Cognitive State Metrics

The positivity effect among older adults is a tendency to process more positive and/or less negative emotional stimuli compared to younger adults, with unknown upper age boundaries. Cognitive and emotional working memory were assessed in young-old adults (60-75) and very old adults (VOAs; 80+) to determine whether emotional working memory declines similar to the age-related decline of cognitive working memory. The moderating role of valence on the link between age and emotional working memory was examined to identify change in positivity effect with advanced age. Electroencephalography (EEG) markers of cognitive workload and engagement were obtained to test the theory of cognitive resource allocation in older adults' emotional stimuli processing. EEG recordings were collected during cognitive memory task and emotional working memory tasks that required rating emotional intensity of images pairs. Results indicate a positivity effect among VOAs that does not require additional cognitive effort and is not likely to diminish with age.

Most evidence for the compensation account of cognitive training is unreliable

Cognitive training and brain stimulation studies have suggested that human cognition, primarily working memory and attention control processes, can be enhanced. Some authors claim that gains (i.e., post-test minus pretest scores) from such interventions are unevenly distributed among people. The magnification account (expressed by the evangelical “who has will more be given”) predicts that the largest gains will be shown by the most cognitively efficient people, who will also be most effective in exploiting interventions. In contrast, the compensation account (“who has will less be given”) predicts that such people already perform at ceiling, so interventions will yield the largest gains in the least cognitively efficient people. Evidence for this latter account comes from reported negative correlations between the pretest and the training/stimulation gain. In this paper, with the use of mathematical derivations and simulation methods, we show that such correlations are pure statistical artifacts caused by the widely known methodological error called “regression to the mean”. Unfortunately, more advanced methods, such as alternative measures, linear models, and control groups do not guarantee correct assessment of the compensation effect either. The only correct method is to use direct modeling of correlations between latent true measures and gain. As to date no training/stimulation study has correctly used this method to provide evidence in favor of the compensation account, we must conclude that most (if not all) of the evidence should be considered inconclusive.

Working Memory Capacity as a Predictor of Cognitive Training Efficacy in the Elderly Population

Aging is associated with a decline in a wide range of cognitive functions and working memory (WM) deterioration is considered a main factor contributing to this. Therefore, any attempt to counteract WM decline seems to have a potential benefit for older adults. However, determination of whether such methods like WM trainings are effective is a subject of a serious debate in the literature. Despite a substantial number of training studies and several meta-analyses, there is no agreement on the matter of their effectiveness. The other important and still not fully explored issue is the impact of the preexisting level of intellectual functioning on the training's outcome. In our study we investigated the impact of WM training on variety of cognitive tasks performance among older adults and the impact of the initial WM capacity (WMC) on the training efficiency. 85 healthy older adults (55-81 years of age; 55 female, 30 males) received 5 weeks of training on adaptive dual N-back task (experimental group) or memory quiz (active controls). Cognitive performance was assessed before and after intervention with measures of WM, memory updating, inhibition, attention shifting, short-term memory (STM) and reasoning. We found post-intervention group independent improvements across all cognitive tests except for inhibition and STM. With multi-level analysis individual learning curves were modeled, which enabled examining of the intra-individual change in training and inter-individual differences in intra-individual changes. We observed a systematic and positive, but relatively small, learning trend with time. Moderator analyses with demographic characteristics as moderators showed no additional effects on learning curves. Only initial WMC level was a significant moderator of training effectiveness. Older adults with initially lower WMC improved less and reached lower levels of performance, compared to the group with higher WMC. Overall, our findings are in accordance with the research suggesting that post-training gains are within reach of older adults. Our data provide evidence supporting the presence of transfer after N-back training in older adults. More importantly, our findings suggest that it is more important to take into account an initial WMC level, rather than demographic characteristics when evaluating WM training in older adults.

Aging of the frontal lobe

Healthy aging is associated with numerous deficits in cognitive function, which have been attributed to changes within the prefrontal cortex (PFC). This chapter summarizes some of the most prominent cognitive changes associated with age-related alterations in the anatomy and physiology of the PFC. Specifically, aging of the PFC results in deficient aspects of cognitive control, including sustained attention, selective attention, inhibitory control, working memory, and multitasking abilities. Yet, not all cognitive functions associated with the PFC exhibit age-related declines, such as arithmetic, comprehension, emotion perception, and emotional control. Moreover, not all older adults exhibit declines in cognition. Multiple life-course and lifestyle factors, as well as genetics, play a role in the trajectory of cognitive performance across the life span. Thus many adults retain cognitive function well into advanced age. Moreover, the brain remains plastic throughout life and there is increasing evidence that most age-related declines in cognition can be remediated by various methods such as physical exercise, cognitive training, or noninvasive brain stimulation. Overall, because cognitive aging is associated with numerous life-course and lifestyle factors, successful aging likely begins in early life, while maintaining cognition or remediating declines is a life-long process.

Cognitive Improvement in Healthy Older Adults Can Parallel That of Younger Adults Following Lifestyle Modification: Support for Cognitive Reserve During Aging

Executive function was assayed following a nutritional supplementation in healthy adults using the Trail Making Test. Comparison with published normative scores demonstrated that cohorts from 35-74 years of age displayed similar relative improvement compared to their own baseline performance. These findings support early, pro-active lifestyle modifications to maintain cognitive performance during aging and further demonstrate the persistence of cognitive reserve in healthy older adults.

WOME: Theory-Based Working Memory Training - A Placebo-Controlled, Double-Blind Evaluation in Older Adults

Background: Scientifically evaluated cognitive intervention programs are essential to meet the demands of our increasingly aging society. Currently, one of the “hottest” topics in the field is the improvement of working memory function and its potential impact on overall cognition. The present study evaluated the efficacy of WOME (WOrking MEmory), a theory-based working memory training program, in a double-blind, placebo-controlled, and randomized controlled trial (www.drks.de, DRKS00013162).

Methods:N = 60 healthy older adults were allocated to (1) the WOME intervention, (2) an active low-level intervention, or (3) a passive control group. Overall, the intervention groups practiced twelve sessions of 45 min within 4 weeks of their respective training. Transfer effects were measured via an extensive battery of neuropsychological tests and questionnaires both pre-/post-training and at a 3-month follow-up.

Results:WOME led to a significant improvement in working memory function, demonstrated on a non-trained near transfer task and on two different composite scores with moderate to large effect sizes. In addition, we found some indication of relevant impact on everyday life. The effects were short-term rather than stable, being substantially diminished at follow-up with only little evidence suggesting long-term maintenance. No transfer effects on other cognitive functions were observed.

Conclusion:WOME is an appropriate and efficient intervention specifically targeting the working memory system in healthy older adults.

Trial Registration: German Clinical Trials Register (DRKS), Identifier: DRKS00013162.

The effect of strategic memory training in older adults: who benefits most?

ABSTRACTBackground:Previous research has suggested that there is a degree of variability among older adults' response to memory training, such that some individuals benefit more than others. The aim of the present study was to identify the profile of older adults who were likely to benefit most from a strategic memory training program that has previously proved to be effective in improving memory in healthy older adults.

METHOD

In total, 44 older adults (60-83 years) participated in a strategic memory training. We examined memory training benefits by measuring changes in memory practiced (word list learning) and non-practiced tasks (grocery list and associative learning). In addition, a battery of cognitive measures was administered in order to assess crystallized and fluid abilities, short-term memory, working memory, and processing speed.

RESULTS

Results confirmed the efficacy of the training in improving performance in both practiced and non-practiced memory tasks. For the practiced memory tasks, results showed that memory baseline performance and crystallized ability predicted training gains. For the non-practiced memory tasks, analyses showed that memory baseline performance was a significant predictor of gain in the grocery list learning task. For the associative learning task, the significant predictors were memory baseline performance, processing speed, and marginally the age.

CONCLUSIONS

Our results indicate that older adults with a higher baseline memory capacity and with more efficient cognitive resources were those who tended to benefit most from the training. The present study provides new avenues in designing personalized intervention according to the older adults' cognitive profile.

Training working memory updating in Parkinson's disease: A randomised controlled trial

Frontostriatal dysfunction in Parkinson's disease (PD) increases the risk for working memory (WM) impairment and depression, calling for counteractive measures. Computerised cognitive rehabilitation is a promising option, but targeted training protocols are lacking and lab-based training can be demanding due to the repeated visits. This study tested the feasibility and efficacy of home-based computerised training targeting mainly WM updating in PD. Fifty-two cognitively well-preserved PD patients were randomised to a WM training group and an active control group for five weeks of training (three 30-min sessions per week). WM training included three computerised adaptive WM tasks (two updating, one maintenance). The outcomes were examined pre- and post-training with trained and untrained WM tasks, tasks tapping other cognitive domains, and self-ratings of executive functioning and depression. Home-based training was feasible for the patients. The training group improved particularly on the updating training tasks, and showed posttest improvement on untrained WM tasks structurally similar to the trained ones. Moreover, their depression scores decreased compared to the controls. Our study indicates that patients with mild-to-moderate PD can self-administer home-based computerised WM training, and that they yield a similar transfer pattern to untrained WM tasks as has been observed in healthy older adults.

Beyond Verbal Behavior: An Empirical Analysis of Speech Rates in Psychotherapy Sessions

Objective: The present work aims to detect the role of the rate of speech as a mechanism able to give information on patient's intrapsychic activity and the intersubjective quality of the patient–therapist relationship.

Method: Thirty clinical sessions among five patients were sampled and divided into idea units (N = 1276) according to the referential activity method. Each idea unit was rated according to referential activity method and in terms of speech rate (syllables per second) for both patient and therapist. A mixed-effects model was applied in order to detect the relationship between the speech rate of both the patient and the therapist and the features of the patient's verbal production in terms of referential activity scales. A Pearson correlation was applied to evaluate the synchrony between the speech rate of the patient and the therapist.

Results: Results highlight that speech rate varies according patient's ability to get in touch with specific aspects detected through referential activity method: patient and the therapist speech rate get synchronized during the course of the sessions; and the therapist's speech rate partially attunes to the patient's ability to get in touch with inner aspects detected through RA method.

Conclusion: The work identified speech rate as a feature that may help in the development of the clinical process in light of its ability to convey information about a patient's internal states and a therapist's attunement ability. These results support the intersubjective perspective on the clinical process.

Efficacy of Cognitive Training in Older Adults with and without Subjective Cognitive Decline Is Associated with Inhibition Efficiency and Working Memory Span, Not with Cognitive Reserve

The present study explores the role of cognitive reserve, executive functions, and working memory (WM) span, as factors that might explain training outcomes in cognitive status. Eighty-one older adults voluntarily participated in the study, classified either as older adults with subjective cognitive decline or cognitively intact. Each participant underwent a neuropsychological assessment that was conducted both at baseline (entailing cognitive reserve, executive functions, WM span and depressive symptomatology measures, as well as the Mini-Mental State Exam regarding initial cognitive status), and then 6 months later, once each participant had completed the training program (Mini-Mental State Exam at the endpoint). With respect to cognitive status the training program was most beneficial for subjective cognitive decline participants with low efficiency in inhibition at baseline (explaining a 33% of Mini-Mental State Exam total variance), whereas for cognitively intact participants training gains were observed for those who presented lower WM span.

Auditory and cognitive performance in elderly musicians and nonmusicians

Musicians represent a model for examining brain and behavioral plasticity in terms of cognitive and auditory profile, but few studies have investigated whether elderly musicians have better auditory and cognitive abilities than nonmusicians. The aim of the present study was to examine whether being a professional musician attenuates the normal age-related changes in hearing and cognition. Elderly musicians still active in their profession were compared with nonmusicians on auditory performance (absolute threshold, frequency intensity, duration and spectral shape discrimination, gap and sinusoidal amplitude-modulation detection), and on simple (short-term memory) and more complex and higher-order (working memory [WM] and visuospatial abilities) cognitive tasks. The sample consisted of adults at least 65 years of age. The results showed that older musicians had similar absolute thresholds but better supra-threshold discrimination abilities than nonmusicians in four of the six auditory tasks administered. They also had a better WM performance, and stronger visuospatial abilities than nonmusicians. No differences were found between the two groups' short-term memory. Frequency discrimination and gap detection for the auditory measures, and WM complex span tasks and one of the visuospatial tasks for the cognitive ones proved to be very good classifiers of the musicians. These findings suggest that life-long music training may be associated with enhanced auditory and cognitive performance, including complex cognitive skills, in advanced age. However, whether this music training represents a protective factor or not needs further investigation.