Beyond social engagement: cognitive training leads to greater cognitive improvement in older adults

Aging is often accompanied by a decline in cognitive functions, with memory being particularly affected. Recent studies suggest that cognitive training sessions that teach memory strategies relevant to daily life may benefit seniors who live in the community. However, it is possible that the cognitive improvement observed in these programs results from the social encounters embedded in them. In this study, we aimed to investigate the effect of a social cognitive training group, which met regularly for an extended period, on enhancing cognitive indices compared to a control group that only received social engagement meetings without training. Sixty-six participants with a mean age of 78 took part in 12 sessions of a social engagement group, with or without strategy training. Cognitive performance was assessed before and after training using four memory tasks, two similar to the trained tasks (near-transfer tasks) and two novel (far-transfer tasks). Both groups showed a slight improvement in most of the evaluation tasks, but the cognitive training combined with social engagement group showed a significant improvement in the Word Recall and Verbal Fluency tests compared to the social engagement group without training. Our findings suggest that cognitive training sessions may be a useful tool in promoting cognitive improvement among older adults living in the community, even beyond the improvement obtained from the social engagement that occurs during the training sessions.Trial registration number:NCT05016336. Date of registration: 20 August 2021. Retrospectively registered.

Feasibility, Acceptability, and Impact of a self-guided e-learning Memory and Brain Health Promotion Program for Healthy Older Adults

OBJECTIVES

To examine the feasibility (e.g., completion rate), acceptability (e.g., satisfaction), and participant-reported impact (e.g., memory concerns, behavior change, goal attainment) of a self-guided, e-learning adaptation of a validated, facilitator-guided, in-person memory intervention for older adults.

METHODS

Participants were 139 healthy older adults (mean age: 73 ± 7, 73% women). Participation tracking and pre/post questionnaires embedded within the e-learning program were used to assess feasibility, acceptability, and impact.

RESULTS

Sixty-eight percent of participants completed the program. Anonymous feedback data indicated a high level of satisfaction with the program, the pace and clarity of the learning modules, and the user interface. Suggested improvements included offering more interaction with others and addressing minor platform glitches. There was a 41% decrease in the prevalence of concern about memory changes from baseline to posttest. The majority of participants reported an increase in use of memory strategies and uptake of health-promoting lifestyle behaviors. All participants reported moderate-to-high satisfaction with personal goal attainment.

CONCLUSIONS

The program demonstrated good feasibility, acceptability, and lead to reduction in age-related memory concerns.

CLINICAL IMPLICATIONS

Self-guided, e-learning programming shows promise for fostering positive adaptation to age-related memory changes and improving the uptake of evidence-based strategies to promote brain health among older adults.

Delivery of Neuropsychological Interventions for Adult and Older Adult Clinical Populations: An Australian Expert Working Group Clinical Guidance Paper

Delivery of neuropsychological interventions addressing the cognitive, psychological, and behavioural consequences of brain conditions is increasingly recognised as an important, if not essential, skill set for clinical neuropsychologists. It has the potential to add substantial value and impact to our role across clinical settings. However, there are numerous approaches to neuropsychological intervention, requiring different sets of skills, and with varying levels of supporting evidence across different diagnostic groups. This clinical guidance paper provides an overview of considerations and recommendations to help guide selection, delivery, and implementation of neuropsychological interventions for adults and older adults. We aimed to provide a useful source of information and guidance for clinicians, health service managers, policy-makers, educators, and researchers regarding the value and impact of such interventions. Considerations and recommendations were developed by an expert working group of neuropsychologists in Australia, based on relevant evidence and consensus opinion in consultation with members of a national clinical neuropsychology body. While the considerations and recommendations sit within the Australian context, many have international relevance. We include (i) principles important for neuropsychological intervention delivery (e.g. being based on biopsychosocial case formulation and person-centred goals); (ii) a description of clinical competencies important for effective intervention delivery; (iii) a summary of relevant evidence in three key cohorts: acquired brain injury, psychiatric disorders, and older adults, focusing on interventions with sound evidence for improving activity and participation outcomes; (iv) an overview of considerations for sustainable implementation of neuropsychological interventions as 'core business'; and finally, (v) a call to action.

Effects of Strategy-Based Memory Training for Older Adults: Do Booster Sessions Prompt Long-Term Benefits?

This study examined the efficacy of a strategy-based memory training for older adults at short- and long-term with two (5- and 11 months) follow-ups. We also explored whether booster sessions (additional training before the first follow-up) facilitated the maintenance of benefits. Thirty-three older adults received a training based on the teaching of different effective memory strategies. One group completed three booster sessions before the 5 months follow-up. Training gains were examined using a word-list and a face-surname association recall tasks, and transfer effects with a grocery-word list (GL) recall task, a working memory (WM) measure, and a perceived memory functioning questionnaire. Training gains and transfer effects to the WM measure emerged and were maintained up to the second follow-up. No benefits for the GL and perceived memory functioning were found. The "boosted" group had only a slight advantage-in one of the transfer tasks-as shown by effect sizes. This pilot study confirms the efficacy of strategy-based memory training in supporting older adults' memory performance up to 11 months since training completion. However, booster sessions seem not to make a clear difference in prompting long-lasting benefits. Training features capable of fostering generalized, prolonged effects are worth investigating.

Fostering cognitive performance in older adults with a process- and a strategy-based cognitive training

       The present study investigates the impact of process-based and strategy-based cognitive training to boost performance in healthy older adults. Three groups trained with either a dichotic listening training (process-based training, n = 25), an implementation intention strategy training (strategy-based training, n = 23), or served as a non-contact control group (n = 30). Our results demonstrated that training participants improved their performance in the trained tasks (process-based training: d = 3.01, strategy-based training: d = 2.6). For untrained tasks, the process-based training group showed significant working memory (d = .58) as well as episodic memory task improvement (d = 1.19) compared to the strategy-based training and to the non-contact control group (all d < .03). In contrast, in the strategy-based training group there was a tendency towards some performance gain in a fluid intelligence test (d = .92). These results indicate that cognitive training can be tailored to improve specific cognitive abilities.

Usability of a memory aid handbook for older people with subjective cognitive impairment-An explorative pilot study

BACKGROUND

Memory problems are common in advanced age. Memory strategies can be used to manage such challenges. To assist older people facing memory problems, we conducted a pilot study to evaluate the usability of a memory aid handbook that we developed specifically for this purpose.

METHOD

A memory aid handbook with a 7-week program was developed based on a systematic review. A total of 19 older people with self-reported memory problems (mean age: 76.11 years, female: 73.68%) tested the memory aid handbook and completed the System Usability Scale (SUS), a checklist on the relevance of the strategies in the handbook, and questionnaires on daily life functioning and self-efficacy. Further, they participated in cognitive tests. In a pre-post design, within-subject differences were determined using paired t-tests.

RESULTS

The usability of the memory aid handbook scores as were high (mean SUS score: 99.21). The checklist indicated that the handbook was perceived as beneficial for confirming already established memory strategies and stimulating new ones, such as self-acceptance, visualizing and verbalizing daily routines, and asking for help. In addition, the checklist revealed that using a calendar was considered the most helpful strategies for daily living, followed closely by taking notes, having specific places for certain items and creating routines in daily life. After the 7 weeks, participants scored significantly better in the cognitive and self-efficacy tests. The exploratory nature of the study combined with the small sample size should be considered when interpreting the results.

CONCLUSION

The usability of the handbook was high, reflecting the relevance of the strategies it contains. Teaching memory strategies can be a useful, inexpensive method to foster independence among those at risk for cognitive impairment.

Effectiveness of Computerized Cognitive Training by VIRTRAEL on Memory and Executive Function in Older People: A Pilot Study

The prevalence of people over 60 years of age with cognitive impairment has increased in recent decades. As a consequence, numerous computerized cognitive trainings (CCT) have been developed. This pilot study aimed to determine the effectiveness of the CCT with VIRTRAEL in improving older adults' cognition. Fifty-five participants (x¯ = 72.7 years; SD = 6.5) underwent CCT, and twenty participants (x¯ = 76.1 years; SD = 7.6) received face-to-face cognitive stimulation with a paper-and-pencil methodology. Both trainings were conducted in nine sessions (45-60 min each). Participants completed a pre-post training neuropsychological assessment. ANCOVAs and the standardized clinical change were performed. VIRTRAEL's group showed a significant and greater improvement in verbal learning (p < 0.006) and delayed recall (p ≤ 0.001), working memory (p < 0.005), abstract (p < 0.002) and semantic reasoning (p < 0.015), and planning (p < 0.021). Additionally, more large clinical changes (d > 0.8) were found in the VIRTRAEL condition (in verbal learning and delayed free and cued recall) than in the standard group. Here we show that the CCT with VIRTRAEL is effective in improving cognitive function in older adults and is superior to the standard format. These preliminary findings indicate that CCT is a useful tool potentially applicable in the fight against cognitive symptomatology associated with aging and neurodegenerative diseases. VIRTRAEL represents a breakthrough in this field as it is inexpensive and easily accessible to any older person, regardless of whether they live far from health care resources.

Cognitive Computerized Training for Older Adults and Patients with Neurological Disorders: Do the Amount and Training Modality Count? An Umbrella Meta-Regression Analysis

Numerous applications have been created to train cognition and challenge the brain, a process known as computerized cognitive training (CCT). Despite potential positive results, important questions remain unresolved: the appropriate training duration, the efficacy of CCT depending on its type (commercial or developed in-house for the rehabilitation of specific patients) and delivery mode (at-home or on-site), and the patients most likely to benefit such intervention. This study aims to perform an umbrella meta-analysis and meta-regression to determine if the type of CCT, the delivery mode, the amount of training, and participants' age at inclusion influence the improvement of the cognitive function. To do so, we performed a umbrella meta-analysis. One hundred studies were included in this analysis representing 6407 participants. Statistical improvements were found for the different conditions after the training. We do not find statistical difference between the type of intervention or the delivery mode. No dose-response relationship between the total amount of training and the improvement of cognitive functions was found. CCT is effective in improving cognitive function in patients suffering from neurological conditions and in healthy aging. There is therefore an urgent need for health care systems to recognize its therapeutic potential and to evaluate at a larger scale their integration into the clinical pipeline as preventive and rehabilitation tool.

Take a load off: examining partial and complete cognitive offloading of medication information

Although cognitive offloading, or the use of physical action to reduce internal cognitive demands, is a commonly used strategy in everyday life, relatively little is known about the conditions that encourage offloading and the memorial consequences of different offloading strategies for performance. Much of the extant work in this domain has focused on laboratory-based tasks consisting of word lists, letter strings, or numerical stimuli and thus makes little contact with real-world scenarios under which engaging in cognitive offloading might be likely. Accordingly, the current work examines offloading choice behavior and potential benefits afforded by offloading health-related information. Experiment 1 tests for internal memory performance for different pieces of missing medication interaction information. Experiment 2 tests internal memory and offloading under full offloading and partial offloading instructions for interaction outcomes that are relatively low severity (e.g., sweating). Experiment 3 extends Experiment 2 by testing offloading behavior and benefit in low-severity, medium-severity (e.g., backache), and high-severity interaction outcomes (e.g., heart attack). Here, we aimed to elucidate the potential benefits afforded by partial offloading and to examine whether there appears to be a preference for choosing to offload (i) difficult-to-remember information across outcomes that vary in severity, as well as (ii) information from more severe interaction outcomes. Results suggest that partial offloading benefits performance compared to relying on internal memory alone, but full offloading is more beneficial to performance than partial offloading.

An Agile Development Cycle of an Online Memory Program for Healthy Older Adults

Online interventions for older adults should be tailored to their unique needs to increase the efficacy of and adherence to the intervention. The agile development cycle is a dynamic model to solicit and incorporate feedback from older adults during the design process. We combined this approach with the framework of Harvard University's clinical and translational phases that provide a clear structure for evaluating new health programs before they are offered in the community. We based our online memory program on the empirically validated in-person Memory and Aging Program. The aim of the present study was to combine the agile development cycle with the clinical and translational phases framework to develop and pilot an online memory program tailored to the unique needs of older adults. Study 1 involved piloting individual program modules on site and integrating participant feedback into the program's design to optimize usability. Study 2 involved two sequential pilots of the program accessed remotely to evaluate preliminary clinical outcomes and obtain feedback for iterative modifications. Plans for further validation and limitations are discussed. The successful application of the agile development cycle implemented in this series of studies can be adapted by others seeking to offer online content for targeted end users.

A Cost-Benefit Analysis of a Group Memory Intervention for Healthy Older Adults with Memory Concerns

This study examines whether memory intervention programs can mitigate health care costs. Research suggests these programs translate to a decreased intention of older adults who are worried about age-normal memory changes to seek traditional outlets for medical/psychiatric help. We employed a cost-benefit analysis approach to analyze the effectiveness of a memory intervention program within Ontario. We leveraged estimates of decreased intentionality to seek physician care following a community-based memory intervention with physician billing profiles to calculate the potential cost savings to the province's health care system. The intervention studied was found to reduce provincial health care spending by $6,094 per program group. This amount exceeds $121.25 in direct costs per attendee associated with administering five program sessions. This analysis justifies further research on how community-based memory and aging programs can offer low-cost solutions to help individuals cope with subjective memory complaints and assist the health care system in prioritizing care for aging patients.

Efficacy of memory training interventions targeting metacognition for older adults: a systematic review and meta-analysis

OBJECTIVES

This review examined the evidence about training interventions targeting metacognition in improving memory and cognitive performance, metacognitive functioning, and well-being in healthy older adults.

METHODS

Studies were identified in the PsycInfo, PubMed, and Scopus databases. The risk of bias was assessed using tools based on the Joanna Briggs criteria. The data were meta-analyzed using random effects models for those training targeting metacognition alone (metacognitive training) or combined with memory strategy training (strategic metacognitive training).

RESULTS

Out of the 3,487 articles first identified, 25 studies were eligible for our review (N = 1,768 older adults; mean age range: 64-85 years). Metacognitive training and strategic metacognitive training elicited improvements in memory (d = 0.52 [95% CI: 0.19; 0.84], and d = 0.44 [95% CI: 0.29; 0.58], respectively), metacognitive beliefs (d = 0.58 [95% CI: 0.23; 0.93], and d = 48 [95% CI: 0.28; 0.69], respectively), strategy use (d = 0.98 [95% CI: 0.46; 1.49] and 0.87 [95% CI: 0.14; 1.61], respectively), and memory self-efficacy (d = 0.08 [95% CI: -0.39; 0.56] and 0.55 [95% CI: 0.36; 0.75], respectively). Strategic metacognitive training also improved well-being (d = 0.21 [95% CI: 0.07; 0.35]).

CONCLUSION

Interventions targeting metacognition (alone or combined with memory strategy training) have the potential to support older adults' memory and metacognitive functioning. The methodological quality of most studies on the topic was often limited, however. Furthermore, well-designed studies needed to confirm the benefits of such interventions in older age.

Examination of the Feasibility, Acceptability, and Efficacy of the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) Program for Older Adults: Results from a Single-Arm Pre-Post Trial (Preprint)

BACKGROUND

Memory strategy training for older adults helps maintain and improve cognitive health but is traditionally offered face-to-face, which is resource intensive, limits accessibility, and is challenging during a pandemic. Web-based interventions, such as the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) program, may overcome such barriers.

OBJECTIVE

We report on OPTIMiSE's feasibility, acceptability, and efficacy.

METHODS

Australians aged ≥60 years reporting subjective cognitive decline participated in this single-arm pre-post web-based intervention. OPTIMiSE is a 6-module web-based program offered over 8-weeks with a 3-month booster. It has a problem-solving approach to memory issues, focusing on psychoeducation about memory and aging, knowledge and practice of compensatory memory strategies, and personalized content related to individual priorities. We examined the feasibility (recruitment, attrition, and data collection), acceptability (recommendation to others, suggestions for improvement, and withdrawal reasons), and efficacy (change in goal satisfaction, strategy knowledge and use, self-reported memory, memory satisfaction and knowledge, and mood; thematic content analysis of the most significant change; and the application of knowledge and strategies in daily life) of OPTIMiSE.

RESULTS

OPTIMiSE was feasible, demonstrated by strong interest (633 individuals screened), a satisfactory level of attrition (158/312, 50.6%), and minimal missing data from those completing the intervention. It was acceptable, with 97.4% (150/154) of participants agreeing they would recommend OPTIMiSE, the main suggestion for improvement being more time to complete modules, and withdrawal reasons similar to those in in-person interventions. OPTIMiSE was also efficacious, with linear mixed-effects analyses revealing improvements, of moderate to large effect sizes, across all primary outcomes (all P<.001): memory goal satisfaction (Cohen d after course=1.24; Cohen d at 3-month booster=1.64), strategy knowledge (Cohen d after course=0.67; Cohen d at 3-month booster=0.72) and use (Cohen d after course=0.79; Cohen d at 3-month booster=0.90), self-reported memory (Cohen d after course=0.80; Cohen d at 3-month booster=0.83), memory satisfaction (Cohen d after course=1.25; Cohen d at 3-month booster=1.29) and knowledge (Cohen d after course=0.96; Cohen d at 3-month booster=0.26), and mood (Cohen d after course=-0.35; nonsignificant Cohen d at booster). Furthermore, the most significant changes reported by participants (strategy use, improvements in daily life, reduced concern about memory, confidence and self-efficacy, and sharing and shame busting with others) reflected the course objectives and were consistent with themes arising from previous in-person interventions. At the 3-month booster, many participants reported continued implementation of knowledge and strategies in their daily lives.

CONCLUSIONS

This feasible, acceptable, and efficacious web-based program has the potential to enable access to evidence-based memory interventions for older adults worldwide. Notably, the changes in knowledge, beliefs, and strategy use continued beyond the initial program. This is particularly important for supporting the growing number of older adults living with cognitive concerns.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12620000979954; https://tinyurl.com/34cdantv.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.3233/ADR-200251.

A Randomized Controlled Trial Study of a Multimodal Intervention vs. Cognitive Training to Foster Cognitive and Affective Health in Older Adults

Research over the past few decades has shown the positive influence that cognitive, social, and physical activities have on older adults’ cognitive and affective health. Especially interventions in health-related behaviors, such as cognitive activation, physical activity, social activity, nutrition, mindfulness, and creativity, have shown to be particularly beneficial. Whereas most intervention studies apply unimodal interventions, such as cognitive training (CT), this study investigates the potential to foster cognitive and affective health factors of older adults by means of an autonomy-supportive multimodal intervention (MMI). The intervention integrates everyday life recommendations for six evidence-based areas combined with psychoeducational information. This randomized controlled trial study compares the effects of a MMI and CT on those of a waiting control group (WCG) on cognitive and affective factors, everyday life memory performance, and activity in everyday life. Three groups, including a total of 119 adults aged 65–86 years, attended a 5- or 10-week intervention. Specifically, one group completed a 10-week MMI, the second group completed 5-week of computer-based CT followed by a 5-week MMI, whereas the third group paused before completing the MMI for the last 5 weeks. All participants completed online surveys and cognitive tests at three test points. The findings showed an increase in the number and variability of activities in the everyday lives of all participants. Post hoc analysis on cognitive performance of MMI to CT indicate similar (classic memory and attention) or better (working memory) effects. Furthermore, results on far transfer variables showed interesting trends in favor of the MMI, such as increased well-being and attitude toward the aging brain. Also, the MMI group showed the biggest perceived improvements out of all groups for all self-reported personal variables (memory in everyday life and stress). The results implicate a positive trend toward MMI on cognitive and affective factors of older adults. These tendencies show the potential of a multimodal approach compared to training a specific cognitive function. Moreover, the findings suggest that information about MMI motivates participants to increase activity variability and frequency in everyday life. Finally, the results could also have implications for the primary prevention of neurocognitive deficits and degenerative diseases.

Keeping Your Glass Half Full: Cognitive Strategy Intervention for Older Adults

When older adults experience memory dysfunction it often compromises their confidence. Older adults’ confidence in their memory can be improved through interventions designed to teach strategies for improving everyday memory functioning. The present study examines the efficacy of a five-session cognitive strategy program designed to be optimistic and inclusive for older adults living in a residential community. The memory self-efficacy of participants in the intervention group improved significantly relative to a control group. Additionally, participants’ knowledge of memory strategies improved overall after completion of this program. Such findings highlight the benefits of practical cognitive-behavioral interventions for bolstering older adults’ confidence and knowledge of memory strategies.

Psychosocial modification of general self-efficacy in older adults: A restricted review

OBJECTIVES

In recent years, the concept of general self-efficacy has increased in popularity. General self-efficacy is positively associated with quality of life and has the potential to act as a psychological buffer against adverse events and circumstances. However, due to the long-term influences that are said to shape general self-efficacy beliefs, they may be resistant to intervention, particularly within the older population. This restricted review aimed to explore whether psychosocial interventions could improve the general self-efficacy of older adults. Aspects of intervention design associated with improvements were also investigated.

METHODS

A restricted review was undertaken. This included a keyword search of four major health databases (PubMed, CINAHL, PsycINFO and AgeLine). Search terms focused on general self-efficacy and the commonly used measures of this concept and were limited to the older adult population.

RESULTS

In total, 848 articles were screened, with 20 studies proceeding to data extraction. The modification of general self-efficacy in older adults appears possible, with 7 out of the 20 included studies reporting improvements postintervention. Despite issues relating to the quality of included studies and the generalisability of their results, several aspects of intervention design coincided with intervention success, including intervention duration, and employing sufficiently-qualified staff.

CONCLUSIONS

Future research must address the generalisability issues identified in this review. Studies comparing the effectiveness of individual- and group-based interventions, the efficacy of remote delivery platforms and the possibility for long-term transfer of any improvements are needed to contribute the high-quality data required for policy and practice decisions in this area.

Systematic Review of Correlates of Internal and External Memory Strategy Use in Older Adults

Memory strategies promote independence during aging. We systematically reviewed literature on correlates and predictors of internal and external memory strategy use for older adults. Of 212 articles identified, 29 met inclusion criteria. Overall, increasing age was associated with decreasing internal but increasing external memory strategy use. Females reported more external memory strategy use, though findings were mixed regarding internal memory strategies. Clinical status appeared to alter the relationship between cognition and internal and external memory strategy use. There were mixed results regarding the relationship between memory strategy use and education, psychological functioning, and health variables. In addition to identifying areas for future research, we provide recommendations to develop primary prevention strategies for intervention and promote successful aging.

Alleviated Anxiety Boosts Memory Training Gain in Older Adults with Subjective Memory Complaints: A Randomized Controlled Trial

OBJECTIVE

Older adults with subjective memory complaints (SMC) have a higher risk of dementia and commonly demonstrate symptoms of depression and anxiety. The study aimed to examine the effect of a memory training program for individuals with SMC, and whether additional group counseling aimed at alleviating depression and anxiety would boost memory training gains.

DESIGN

A three-armed, double-blind, randomized controlled trial.

SETTING AND PARTICIPANTS

Community-dwelling older adults with SMC, age ≥60.

METHODS

Participants (n = 124) were randomly assigned to memory training (MT), group counseling (GC), or GC + MT intervention. The GT + MT group received 3 sessions of group counseling followed by a 4-week memory training, while the MT group attended reading and memory training, and the GC group received group counseling and health lectures. Cognitive function and symptoms of depression and anxiety were assessed at baseline, mid-, and post-intervention.

RESULTS

After group counseling, the GC + MT and GC groups showed reduced symptoms of anxiety compared to the MT group. Memory training enhanced associative learning in both MT and GC + MT groups compare with the GC group, but the GC + MT group demonstrated a larger memory improvement (Cohen's d = 0.57) than the MT group (Cohen's d = 0.44).

CONCLUSION AND IMPLICATIONS

Group counseling decreased symptoms of anxiety, memory training increased associative learning, and the combination of two intervention induced larger memory gain than memory training alone. The results suggest that it may need to integrate treatment for anxiety into memory training for older adults with SMC to achieve better intervention effect.

TRIAL REGISTRATION

ChiCTR-IOR-15006165 in the Chinese Clinical Trial Registry.

Feasibility of a Home-Based Task-Switching Training in Middle-Aged Caregivers

The current study aimed at investigating feasibility of a self-administered task-switching training in a middle-aged working population. Eighty-one caregivers (41–62 years old) were instructed to train at home 8 times either within a 7- or 14-day interval. Only 56.7% performed more than 50% of the instructed number of training sessions. However, compliant caregivers (who completed more than 4 training sessions) showed significant training gains and transfer to an untrained task-switching task. Although transfer effects to other cognitive tasks were not found, trained participants tended to report fewer everyday memory failures than a control group. In conclusion, the implementation of a home-based task-switching training in everyday life of caregivers is possible. However, there is only limited evidence for generalization of results of previous laboratory studies. Adherence and transfer to other cognitive tasks are discussed as important challenges in conveying laboratory findings into real life.

A cross-sectional survey of a public, evidence-based multimodal program for cognitive health in older adults

BACKGROUND

In recent decades, the proportion of older adults in the population has continued to rise, and with it, the need for intervention programs to maintain cognitive functions into old age. Multiple lifestyle factors, including physical, cognitive, and social activities, are crucial to forestalling a decline in cognitive functions. However, Covid-19 curtailed most activities, and therefore, strategies are needed to support older adults in remaining cognitively healthy. This study describes a newly developed and publicly available multimodal program, called "brain coach", to support and stimulate cognitive activity in older adults. The autonomy supportive program integrates into daily life recommendations for evidence-based physical, cognitive, social, mindful, and creative activation exercises.

METHODS

The study design corresponds to a correlational, analytical, and cross-sectional study with 660 older adults, who participated in the program for at least 3 months and completed an online survey.

RESULTS

The survey results demonstrate that the average age of the participants was 71 years and 75 % were female. Participants experienced benefits in memory, well-being, attitudes towards the brain, and lifestyle habits. Importantly, time invested in the intervention and participant's positive attitude toward brain health and neuroplasticity, show positive relationships with the experienced benefits.

CONCLUSIONS

The results reveal the potential of a public program with a multimodal approach to increase cognitive health and promote an active lifestyle. Further research will explore the effects of such a multimodal intervention in a longitudinal randomized controlled trial study.

Ancient Mnemonic in New Format-Episodic Memory Training With the Method of Loci in a Smart Phone Application

Objectives

Episodic memory is age-sensitive but can be strengthened by targeted training interventions. The method of loci (MoL) is a classic mnemonic which if successfully implemented greatly improves memory performance. We developed and investigated the effects of a MoL training program implemented in a smart phone application (app) with the aim of studying usage of the application, training effect and its modifiability by age, predictors for MoL proficiency, transfer effects to a face-name memory task, and perceived benefit in everyday memory.

Method

A total of 359 adults participated. Instruction and training of the MoL, transfer test (face-name paired associates cued recall task), and surveys were performed in an in-house developed app.

Results

The app interested people across the adult life span. Older adults practiced the most, whereas younger and young-old participants showed the highest level of MoL proficiency. Level of proficiency was modulated by amount of practice, but in the oldest participants this effect was less pronounced. Greater self-rated health was associated with higher level of proficiency. No transfer effect was observed. Among those who answered the survey, about half expressed that MoL training had benefitted memory in their everyday life.

Discussion

App-based memory training in the MoL can be delivered successfully via an app across the adult life span. Level of performance reached in training is variable but generally high, and mainly influenced by amount of training and age of the participants. Our data suggest plasticity across the life span, but to a lesser degree for adults between 70 and 90 years.

Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) Program for Older Adults with Cognitive Concerns: Pilot Study Protocol

Memory interventions for older adults with cognitive concerns result in improved memory performance and maintenance of cognitive health. These programs are typically delivered face-to-face, which is resource intensive and creates access barriers, particularly for those with reduced mobility, limited transportation, and living in rural or remote areas. The COVID-19 pandemic has created an additional access barrier, given the increased risk this disease poses to older adults. Internet-based interventions seek to overcome these barriers. This paper describes the protocol of a pilot study that aims to evaluate the feasibility, acceptability, and efficacy of one such internet-based intervention: the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) program. OPTIMiSE focuses on improving knowledge regarding memory and providing training in effective memory strategies for everyday life. The pilot study described in this protocol will be a single-arm pre-post study of 8 weeks duration, with a single maintenance session 3 months post-intervention. Participants will be Australian adults aged ≥60 years reporting cognitive changes compared with 10 years ago. Primary outcome measures will address feasibility, acceptability, and efficacy. Secondary outcome measures assessing sense of community and self-efficacy will be administered at the 8-week and 3-month timepoints. Data collection will conclude mid-2021, and results will be presented in a subsequent publication. Translation of memory interventions to internet-based delivery has the potential to remove many access barriers for older adults; however, the acceptability and feasibility of this modality needs investigation. OPTIMiSE is the initial step in what could be an important program enabling access to an evidence-based memory intervention for older adults worldwide. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12620000979954.

Mental imagery training in older adults: Which are benefits and individual predictors?

OBJECTIVES

Strategic memory training involves explicit instructions in mnemonic methods to improve recall. Mental imagery is considered among the most effective encoding strategies. The aim of the present study was to assess the benefits of a strategic memory training based on mental imagery (originally proposed by Carretti et al., 2007) and to further investigate its potentials. The study represents a replication in a new and independent cultural setting and features valuable methodological amendments, while it also examines individual predictors of training efficacy.

DESIGN

A sample of 91 older volunteers (age 61-88), divided in training and control group, participated in the training. Specific training gain in the immediate word list recall (criterion task), as well as transfer effects on Letter-Number Sequencing (working memory [WM] task), long-term recall and recognition (LTM tasks) were tested at the pretest and at the posttest.

RESULTS

Analysis of variance showed posttraining effects in immediate word recall and long-term verbal recall, but no effects in WM task and long-term recognition. Regression analysis showed age to be the only significant predictor in one task, the immediate word recall.

CONCLUSIONS

Overall, proposed training can improve some aspects of memory performance by aiding in strategic use of mental imagery. Transfer to other tasks and contribution of individual predictors to training efficacy results limited, however. It seems that training benefits are evident when task similarity enables transfer-appropriate processing (as evidenced in gains of both recall tasks), while training efficacy relies on individual characteristics which contribute to the execution of some task components.

Initiation and maintenance of behaviour change to support memory and brain health in older adults: A randomized controlled trial

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02087137.

Initial Evidence for the Efficacy of an Everyday Memory and Metacognitive Intervention

BACKGROUND AND OBJECTIVES

The objective of this paper is to demonstrate the efficacy of an Everyday Memory and Metacognitive Intervention (EMMI) designed to improve everyday functioning of older adults. The EMMI emphasizes self-regulation as a behavioral approach to take priority over habitual behaviors that often impede everyday functioning.

RESEARCH DESIGN AND METHODS

This study used a quasi-experimental design (intervention vs waitlist control) to test whether the EMMI improved several aspects of everyday cognition. Thirty-three EMMI participants (M age = 70.24) were compared to 20 control participants (M age = 71.70 years). The 2 groups were compared on everyday memory failures and successes, measures of well-being, subjective memory, and a prospective memory task.

RESULTS

Participants who received the EMMI reported more memory successes and fewer memory failures over a 10-day measurement period postintervention. In addition, EMMI participants reported significantly higher life satisfaction and better subjective memory at posttest than the control group. Critically, the EMMI participants performed better on a laboratory contact prospective memory task.

DISCUSSION AND IMPLICATIONS

The results from this study suggest that the EMMI is a promising approach that has potential to improve everyday memory functioning and perhaps help extend functional independence. Future studies will include randomized controlled trials as well as electronic measurement of memory incidents.

International relevance of two measures of awareness of age-related change (AARC)

BACKGROUND

A questionnaire assessing awareness of positive and negative age-related changes (AARC gains and losses) was developed in the US and Germany. We validated the short form of the measure (AARC-10 SF) and the cognitive functioning subscale from the 50-item version of the AARC (AARC-50) questionnaire in the UK population aged 50 and over.

METHODS

Data from 9410 participants (Mean (SD) age = 65.9 (7.1)) in the PROTECT cohort were used to explore and confirm the psychometric properties of the AARC measures including: validity of the factor structure; reliability; measurement invariance across men and women, individuals with and without a university degree, and in middle age, early old age, and advanced old age; and convergent validity with measures of self-perception of aging and mental, physical, and cognitive health. We explored the relationship between demographic variables (age, sex, marital status, employment, and university education) and AARC.

RESULTS

We confirmed the two-factor structure (gains and losses) of the AARC-10 SF and the AARC-50 cognitive functioning subscale. Both scales showed good reliability and good convergent validity for AARC losses, but weak convergent validity for AARC gains. For both scales metric invariance was held for the two subgroups defined by education level and age. For the AARC-50 subscale, but not for the AARC-10 SF, strong invariance was also held for the two subgroups defined by sex. Age, sex, marital status, employment, and university education predicted AARC gains and losses.

CONCLUSIONS

The AARC-10 SF and AARC-50 cognitive functioning subscale identify UK individuals who perceive age-related changes in their mental, physical, and cognitive health.

The use of commercial computerised cognitive games in older adults: a meta-analysis

Brain training programs are currently one effective solution to prevent cognitive decline in healthy aging. We conducted a meta-analysis of randomized controlled trials assessing the use of commercially available computerised cognitive games to improve cognitive function in people aged above 60 years old without cognitive impairment. 1,543 participants from sixteen studies were included in the meta-analysis. Statistically significant improvements were observed for processing speed (SMD increased 0.40 [95% CI 0.20-0.60], p < 0.001), working memory (0.21 [95% CI 0.08-0.34], p = 0.001), executive function (0.21 [95% CI 0.06-0.35], p = 0.006), and for verbal memory (0.12 [95% CI 0.01-0.24, p = 0.031), but not for attention or visuospatial abilities. No relationship between the age of the participants and the amount of training was found. Commercially available computerised cognitive games are effective in improving cognitive function in participants without cognitive impairment aged over 60 years.

Augmenting Computerized Cognitive Training With Vortioxetine for Age-Related Cognitive Decline: A Randomized Controlled Trial

OBJECTIVE

Age-related cognitive decline, the deterioration in functions such as memory and executive function, is faced by most older adults and affects function and quality of life. No approved treatments exist for age-related cognitive decline. Computerized cognitive training has been shown to provide consistent albeit modest improvements in cognitive function as measured by neuropsychological testing. Vortioxetine, an antidepressant medication, has putative procognitive and proneuroplastic properties and therefore may be able to augment cognitive training. In this placebo-controlled study, the authors tested the cognitive benefits of vortioxetine added to cognitive training for adults age 65 or older with age-related cognitive decline.

METHODS

After a 2-week lead-in period of cognitive training, 100 participants were randomly assigned to receive either vortioxetine or placebo in addition to cognitive training for 26 weeks. The primary outcome measure was global cognitive performance, assessed by the NIH Toolbox Cognition Battery Fluid Cognition Composite. The secondary outcome measure was functional cognition, assessed by the UCSD Performance-Based Skills Assessment. All participants received motivational messaging and support from study staff to maximize adherence to the training.

RESULTS

Participants who received vortioxetine with cognitive training showed a greater increase in global cognitive performance compared with those who received placebo with cognitive training. This separation was significant at week 12 but not at other assessment time points. Both groups showed improvement in the secondary outcome measure of functional cognition, with no significant difference between groups.

CONCLUSIONS

Vortioxetine may be beneficial for age-related cognitive decline when combined with cognitive training. These findings provide new treatment directions for combating cognitive decline in older adults.

Cognition-Oriented Treatments for Older Adults: a Systematic Overview of Systematic Reviews

Cognition-oriented treatments - commonly categorized as cognitive training, cognitive rehabilitation and cognitive stimulation - are promising approaches for the prevention of cognitive and functional decline in older adults. We conducted a systematic overview of meta-analyses investigating the efficacy of cognition-oriented treatments on cognitive and non-cognitive outcomes in older adults with or without cognitive impairment. Review quality was assessed by A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR). We identified 51 eligible reviews, 46 of which were included in the quantitative synthesis. The confidence ratings were "moderate" for 9 (20%), "low" for 13 (28%) and "critically low" for 24 (52%) of the 46 reviews. While most reviews provided pooled effect estimates for objective cognition, non-cognitive outcomes of potential relevance were more sparsely reported. The mean effect estimate on cognition was small for cognitive training in healthy older adults (mean Hedges' g = 0.32, range 0.13-0.64, 19 reviews), mild cognitive impairment (mean Hedges' g = 0.40, range 0.32-0.60, five reviews), and dementia (mean Hedges' g = 0.38, range 0.09-1.16, seven reviews), and small for cognitive stimulation in dementia (mean Hedges' g = 0.36, range 0.26-0.44, five reviews). Meta-regression revealed that higher AMSTAR score was associated with larger effect estimates for cognitive outcomes. The available evidence supports the efficacy of cognition-oriented treatments improving cognitive performance in older adults. The extent to which such effects are of clinical value remains unclear, due to the scarcity of high-quality evidence and heterogeneity in reported findings. An important avenue for future trials is to include relevant non-cognitive outcomes in a more consistent way and, for meta-analyses in the field, there is a need for better adherence to methodological standards. PROSPERO registration number: CRD42018084490.

Artificial neural networks reveal individual differences in metacognitive monitoring of memory

Previous work supports an age-specific impairment for recognition memory of pairs of words and other stimuli. The present study tested the generalization of an associative deficit across word, name, and nonword stimulus types in younger and older adults. Participants completed associative and item memory tests in one of three stimulus conditions and made metacognitive ratings of perceptions of self-efficacy, task success ("postdictions"), strategy success, task effort, difficulty, fatigue, and stamina. Surprisingly, no support was found for an age-related associative deficit on any of the stimulus types. We analyzed our data further using a multilayer perceptron artificial neural network. The network was trained to classify individuals as younger or older and its hidden unit activities were examined to identify data patterns that distinguished younger from older participants. Analysis of hidden unit activities revealed that the network was able to correctly classify by identifying three different clusters of participants, with two qualitatively different groups of older individuals. One cluster of older individuals found the tasks to be relatively easy, they believed they had performed well, and their beliefs were accurate. The other cluster of older individuals found the tasks to be difficult, believed they were performing relatively poorly, yet their beliefs did not map accurately onto their performance. Crucially, data from the associative task were more useful for neural networks to discriminate between younger and older adults than data from the item task. This work underscores the importance of considering both individual and age differences as well as metacognitive responses in the context of associative memory paradigms.