1. A Cognitive Training Intervention Increases Resting Cerebral Blood Flow In Healthy Older Adults.
Mozolic JL, Hayasaka S, Laurienti PJ.
Neuroscience Program, Wake Forest University School of Medicine Winston-Salem, NC, USA.
Frontiers in Human Neuroscience. 2010 Mar 12;4:16.
Healthy aging is typically accompanied by some decline in cognitive performance, as well as by alterations in brain structure and function. Here we report the results of a randomized, controlled trial designed to determine the effects of a novel cognitive training program on resting cerebral blood flow (CBF) and gray matter (GM) volume in healthy older adults. Sixty-six healthy older adults participated in 8 weeks of either a training program targeting attention and distractibility or an educational control program. This training program produced significantly larger increases in resting CBF to the prefrontal cortex than the control program. Increases in blood flow were associated with reduced susceptibility to distraction after training, but not with alterations in GM volume. These data demonstrate that cognitive training can improve resting CBF in healthy older adults and that cerebral perfusion rates may be a more sensitive indicator of the benefits of cognitive training than volumetric analyses.
2. The Longitudinal Impact Of Cognitive Speed Of Processing Training On Driving Mobility.
Edwards JD, Myers C, Ross LA, Roenker DL, Cissell GM, McLaughlin AM, Ball KK.
School of Aging Studies, University of South Florida, 4202 East Fowler Avenue, MHC 1326, Tampa, FL 33600, USA. jerriedwardsconsulting@gmail.com
Gerontologist. 2009 Aug;49(4):485-94.
PURPOSE: To examine how cognitive speed of processing training affects driving mobility across a 3-year period among older drivers. DESIGN AND METHODS: Older drivers with poor Useful Field of View (UFOV) test performance (indicating greater risk for subsequent at-fault crashes and mobility declines) were randomly assigned to either a speed of processing training or a social and computer contact control group. Driving mobility of these 2 groups was compared with a group of older adults who did not score poorly on the UFOV test (reference group) across a 3-year period. RESULTS: Older drivers with poor UFOV test scores who did not receive training experienced greater mobility declines as evidenced by decreased driving exposure and space and increased driving difficulty at 3 years. Those at risk for mobility decline who received training did not differ across the 3-year period from older adults in the reference group with regard to driving exposure, space, and most aspects of driving difficulty. IMPLICATIONS: Cognitive speed of processing training can not only improve cognitive performance but also protect against mobility declines among older drivers. Scientifically proven cognitive training regimens have the potential to enhance the everyday lives of older adults.
3. A Cognitive Training Program Based On Principles Of Brain Plasticity: Results From The Improvement in Memory With Plasticity-Based Adaptive Cognitive Training (IMPACT) Study.
Smith GE, Housen P, Yaffe K, Ruff R, Kennison RF, Mahncke HW, Zelinski EM.
Journal of the American Geriatric Society. 2009 Apr;57(4):594-603.
OBJECTIVES: To investigate the efficacy of a novel brain plasticity-based computerized cognitive training program in older adults and to evaluate the effect on untrained measures of memory and attention and participant-reported outcomes. DESIGN: Multisite randomized controlled double-blind trial with two treatment groups. SETTING: Communities in northern and southern California and Minnesota. PARTICIPANTS: Community-dwelling adults aged 65 and older (N=487) without a diagnosis of clinically significant cognitive impairment. INTERVENTION: Participants were randomized to receive a broadly-available brain plasticity-based computerized cognitive training program (intervention) or a novelty- and intensity-matched general cognitive stimulation program modeling treatment as usual (active control). Duration of training was 1 hour per day, 5 days per week, for 8 weeks, for a total of 40 hours. MEASUREMENTS: The primary outcome was a composite score calculated from six subtests of the Repeatable Battery for the Assessment of Neuropsychological Status that use the auditory modality (RBANS Auditory Memory/Attention). Secondary measures were derived from performance on the experimental program, standardized neuropsychological assessments of memory and attention, and participant-reported outcomes. RESULTS: RBANS Auditory Memory/Attention improvement was significantly greater (P=.02) in the experimental group (3.9 points, 95% confidence interval (CI)=2.7-5.1) than in the control group (1.8 points, 95% CI=0.6-3.0). Multiple secondary measures of memory and attention showed significantly greater improvements in the experimental group (word list total score, word list delayed recall, digits backwards, letter-number sequencing; P<.05), as did the participant-reported outcome measure (P=.001). No advantage for the experimental group was seen in narrative memory. CONCLUSION: The experimental program improved generalized measures of memory and attention more than an active control program.
4. A Cognitive Training Intervention Improves Modality-Specific Attention In a Randomized Controlled Trial of Healthy Older Adults.
Mozolic JL, Long AB, Morgan AR, Rawley-Payne M, Laurienti PJ.
Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
Neurobiology of Aging. 2009 May 8.
Age-related deficits in cognitive and sensory function can result in increased distraction from background sensory stimuli. This randomized controlled trial investigated the effects of a cognitive training intervention aimed at helping healthy older adults suppress irrelevant auditory and visual stimuli. Sixty-six participants received 8 weeks of either the modality-specific attention training program or an educational lecture control program. Participants who completed the intervention program had larger improvements in modality-specific selective attention following training than controls. These improvements also correlated with reductions in bimodal integration during selective attention. Further, the intervention group showed larger improvements than the control group in non-trained domains such as processing speed and dual-task completion, demonstrating the utility of modality-specific attention training for improving cognitive function in healthy older adults.
5. The Impact Of Speed Of Processing Training On Cognitive And Everyday Functions.
Ball K, Edwards JD, Ross LA.
Department of Psychology, Edward R. Roybal Center for Translational Reseach on Aging and Mobility, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Gerontology. Series B, Psychological Sciences and Social Sciences 2007 Jun;62 Spec No 1:19-31.
We combined data from six studies, all using the same speed of processing training program, to examine the mechanisms of training gain and the impact of training on cognitive and everyday abilities of older adults. Results indicated that training produces immediate improvements across all subtests of the Useful Field of View test, particularly for older adults with initial speed of processing deficits. Age and education had little to no impact on training gain. Participants maintained benefits of training for at least 2 years, which translated to improvements in everyday abilities, including efficient performance of instrumental activities of daily living and safer driving performance.
6. Brain Plasticity And Functional Losses In The Aged: Scientific Bases For a Novel Intervention.
Mahncke HW, Bronstone A, Merzenich MM.
Posit Science Corporation, San Francisco, CA 94104, USA.
Progress in Brain Research. 2006;157:81-109.
Aging is associated with progressive losses in function across multiple systems, including sensation, cognition, memory, motor control, and affect. The traditional view has been that functional decline in aging is unavoidable because it is a direct consequence of brain machinery wearing down over time. In recent years, an alternative perspective has emerged, which elaborates on this traditional view of age-related functional decline. This new viewpoint--based upon decades of research in neuroscience, experimental psychology, and other related fields--argues that as people age, brain plasticity processes with negative consequences begin to dominate brain functioning. Four core factors--reduced schedules of brain activity, noisy processing, weakened neuromodulatory control, and negative learning--interact to create a self-reinforcing downward spiral of degraded brain function in older adults. This downward spiral might begin from reduced brain activity due to behavioral change, from a loss in brain function driven by aging brain machinery, or more likely from both. In aggregate, these interrelated factors promote plastic changes in the brain that result in age-related functional decline. This new viewpoint on the root causes of functional decline immediately suggests a remedial approach. Studies of adult brain plasticity have shown that substantial improvement in function and/or recovery from losses in sensation, cognition, memory, motor control, and affect should be possible, using appropriately designed behavioral training paradigms. Driving brain plasticity with positive outcomes requires engaging older adults in demanding sensory, cognitive, and motor activities on an intensive basis, in a behavioral context designed to re-engage and strengthen the neuromodulatory systems that control learning in adults, with the goal of increasing the fidelity, reliability, and power of cortical representations. Such a training program would serve a substantial unmet need in aging adults. Current treatments directed at age-related functional losses are limited in important ways. Pharmacological therapies can target only a limited number of the many changes believed to underlie functional decline. Behavioral approaches focus on teaching specific strategies to aid higher order cognitive functions, and do not usually aspire to fundamentally change brain function. A brain-plasticity-based training program would potentially be applicable to all aging adults with the promise of improving their operational capabilities. We have constructed such a brain-plasticity-based training program and conducted an initial randomized controlled pilot study to evaluate the feasibility of its use by older adults. A main objective of this initial study was to estimate the effect size on standardized neuropsychological measures of memory. We found that older adults could learn the training program quickly, and could use it entirely unsupervised for the majority of the time required. Pre- and posttesting documented a significant improvement in memory within the training group (effect size 0.41, p<0.0005), with no significant within-group changes in a time-matched computer using active control group, or in a no-contact control group. Thus, a brain-plasticity-based intervention targeting normal age-related cognitive decline may potentially offer benefit to a broad population of older adults.
7. Memory Enhancement In Healthy Older Adults Using a Brain Plasticity-Based Training Program: A Randomized, Controlled Study.
Mahncke HW, Connor BB, Appelman J, Ahsanuddin ON, Hardy JL, Wood RA, Joyce NM, Boniske T, Atkins SM, Merzenich MM.
Proc Natl Acad Sci U S A. 2006 Aug 15;103(33):12523-8.
Normal aging is associated with progressive functional losses in perception, cognition, and memory. Because the brain retains a lifelong capacity for plasticity and adaptive reorganization, dimensions of negative reorganization should be at least partially reversible through the use of an appropriately designed training program. Results from a training program targeting age-related cognitive decline are reported. Data from a randomized, controlled trial using standardized measures of neuropsychological function as outcomes are presented. Significant improvements in assessments directly related to the training tasks and significant generalization of improvements to nonrelated standardized neuropsychological measures of memory were documented in the group using the training program. Memory enhancement appeared to be sustained after a 3-month no-contact follow-up period. Matched active control and no-contact control groups showed no significant change in memory function after training or at the 3-month follow-up. This study demonstrates that intensive, plasticity-engaging training can result in an enhancement of cognitive function in normal mature adults.
8. Brain Plasticity And Functional Losses In The Aged: Scientific Bases For A Novel Intervention.
Mahncke HW, Bronstone A, Merzenich MM.
Progressive Brain Research. 2006;157:81-109.
Aging is associated with progressive losses in function across multiple systems, including sensation, cognition, memory, motor control, and affect. The traditional view has been that functional decline in aging is unavoidable because it is a direct consequence of brain machinery wearing down over time. Studies of adult brain plasticity have shown that substantial improvement in function and/or recovery from losses in sensation, cognition, memory, motor control, and affect should be possible, using appropriately designed cognitive training paradigms. Driving brain plasticity with positive outcomes requires engaging older adults in demanding sensory, cognitive, and motor activities on an intensive basis. Current treatments directed at age-related functional losses are limited in important ways. Pharmacological therapies can target only a limited number of the many changes believed to underlie functional decline. Behavioral approaches focus on teaching specific strategies to aid higher order cognitive functions, and do not usually aspire to fundamentally change brain function. A brain-plasticity-based cognitive skills training program would potentially be applicable to all aging adults with the promise of improving their operational capabilities. The authors constructed a brain-plasticity-based training program and conducted an initial randomized controlled pilot study to evaluate the feasibility of its use by older adults. Pre- and posttesting documented a significant improvement in memory within the training group with no significant changes in a time-matched computer using active control group, or in a no-contact control group.
9. Long-Term Effects of Cognitive Training On Everyday Functional Outcomes In Older Adults.
Willis SL, Tennstedt SL, Marsiske M, Ball K, Elias J, Koepke KM, Morris JN, Rebok GW, Unverzagt FW, Stoddard AM, Wright E; ACTIVE Study Group.
JAMA. 2006 Dec 20;296(23):2805-14.
Cognitive training has been shown to improve cognitive abilities in older adults but the effects of cognitive training on everyday function have not been demonstrated. The objective of the study was to determine the effects of cognitive training on daily function and durability of training on cognitive abilities. A five-year follow-up of a randomized controlled single-blind trial with 4 treatment groups was conducted. A volunteer sample of 2832 persons (mean age, 73.6 years; 26% black), living independently in 6 US cities, was recruited from senior housing, community centers, and hospitals and clinics. The study was conducted between April 1998 and December 2004. Five-year follow-up was completed in 67% of the sample. Ten-session training for memory (verbal episodic memory), reasoning (inductive reasoning), or speed of processing (visual search and identification); 4-session booster training at 11 and 35 months after training in a random sample of those who completed training. Reasoning training resulted in less functional decline in self-reported IADL. Compared with the control group, cognitive training resulted in improved cognitive abilities specific to the abilities trained that continued 5 years after the initiation of the intervention.
10. The Impact Of Speed Of Processing Training On Cognitive And Everyday Performance.
Edwards JD, Wadley VG, Vance DE, Wood K, Roenker DL, Ball KK.
Aging Ment Health. 2005 May;9(3):262-71.
The purpose of the investigation was to examine the impact of speed of processing training on the cognitive and everyday abilities of older adults with initial processing speed or processing difficulty. Participants were randomized to either a speed of processing intervention or a social- and computer-contact control group. Results indicate that speed of processing training not only improved processing speed, as indicated by performance on the Useful Field of View test (UFOV), but also transfers to certain everyday functions, as indicated by improved performance on Timed Instrumental Activities of Daily Living (Timed IADL). This study provides additional evidence that speed of processing training has the potential to enhance everyday functions that maintain independence and quality of life, particularly when the training is targeted toward individuals who most need it.
11. Effects Of Cognitive Training Interventions With Older Adults: A Randomized Controlled Trial.
Ball K, Berch DB, Helmers KF, Jobe JB, Leveck MD, Marsiske M, Morris JN, Rebok GW, Smith DM, Tennstedt SL, Unverzagt FW, Willis SL; Advanced Cognitive Training for Independent and Vital Elderly Study Group.
JAMA. 2002 Nov 13;288(18):2271-81.
Cognitive function in older adults is related to independent living and need for care. However, few studies have addressed whether improving cognitive functions might have short- or long-term effects on activities related to living independently. The purpose of the study was to evaluate whether 3 cognitive training interventions improve mental abilities and daily functioning in older, independent-living adults. A randomized, controlled, single-blind trial with recruitment was conducted from March 1998 to October 1999 and 2-year follow-up through December 2001. A volunteer sample of 2832 persons aged 65 to 94 years was recruited from senior housing, community centers, and hospital/clinics in 6 metropolitan areas in the United States. Participants were randomly assigned to 1 of 4 groups: 10-session group training for memory (verbal episodic memory; n = 711), or reasoning (ability to solve problems that follow a serial pattern; n = 705), or speed of processing (visual search and identification; n = 712); or a no-contact control group (n = 704). For the 3 treatment groups, 4-session booster training was offered to a 60% random sample 11 months later. Each intervention improved the targeted cognitive ability compared with baseline, durable to 2 years (P<.001 for all). Eighty-seven percent of speed-, 74% of reasoning-, and 26% of memory-trained participants demonstrated reliable cognitive improvement immediately after the intervention period. Booster training enhanced training gains in speed (P<.001) and reasoning (P<.001) interventions (speed booster, 92%; no booster, 68%; reasoning booster, 72%; no booster, 49%), which were maintained at 2-year follow-up (P<.001 for both). CONCLUSIONS: Results support the effectiveness and durability of the cognitive training interventions in improving targeted cognitive abilities. Training effects were of a magnitude equivalent to the amount of decline expected in elderly persons without dementia over 7- to 14-year intervals. Because of minimal functional decline across all groups, longer follow-up is likely required to observe training effects on everyday function.
