Cognitive rehabilitation in the elderly: effects on strategic behavior in relation to goal management. Do self-monitoring interventions improve older adult learning? Supplemental group discussions in memory training for older adults. Stories as a mnemonic aid for older learners. The impact of speed of processing training on cognitive and everyday performance. Efficacy of cognitive rehabilitation in patients with mild cognitive impairment treated with cholinesterase inhibitors. In-home cognitive training with older married couples: individual versus collaborative learning. Effects of cognitive training interventions with older adults: a randomized controlled trial. The effects of a rehabilitation program with mnemotechniques on the institutionalized elderly subject. Forgetting numbers in old age: strategy and learning speed matter. Memory-skills training, memory complaints, and depression in older adults. Improvement of cognitive function by mental and/or individualized aerobic training in healthy elderly subjects. Memory enhancement training for older adults with mild cognitive impairment: a preliminary study. Pretraining enhances mnemonic training in elderly adults. The effect of mnemonic training on perceived recall confidence in the elderly. A randomized, two-year study of the efficacy of cognitive intervention on elderly people: the Donostia Longitudinal Study. Memory enhancement in healthy older adults using a brain plasticity-based training program: a randomized, controlled study. Multifactorial memory training with older adults: how to foster maintenance of improved performance. Memory enhancement program for community-based older adults: development and evaluation. Memory training and drug therapy act differently on memory and metamemory functioning: evidence from a pilot study. Learning mnemonics: roles of aging and subtle cognitive impairment.
Executive functions are highly sensitive to the effects of aging and other conditions affecting frontal lobe function. Yet there are few validated interventions specifically designed to address executive functions, and, to our knowledge, none validated in a healthy aging sample. As part of a large-scale cognitive rehabilitation randomized trial in 49 healthy older adults, a modified Goal Management Training program was included to address the real-life deficits caused by executive dysfunction. This program emphasized periodic suspension of ongoing activity to establish goal hierarchies and monitor behavioral output. Tabletop simulated real-life tasks (SRLTs) were developed to measure the processes targeted by this intervention. Participants were randomized to two groups, one of which received the intervention immediately and the other of which was wait-listed prior to rehabilitation. Results indicated improvements in SRLT performance and self-rated executive deficits coinciding with the training in both groups. These gains were maintained at long-term follow-up. Future research will assess the specificity of these effects in patient groups. We describe a self-monitoring approach for improving older adult learning that older adults can use in conjunction with more traditional mnemonic-based interventions. According to the self-monitoring approach, older adults can improve the effectiveness of learning by accurately monitoring their progress toward a learning goal and by using the output from such monitoring to allocate study time and to inform strategy selection. We review current evidence, which includes outcomes from two previously unpublished interventions, relevant to the efficacy of this approach. Both interventions demonstrated performance gains in memory performance after self-monitoring training, although these training gains did not exceed gains obtained through standard mnemonic training. Our discussion highlights both successes and failures of self-monitoring to enhance learning as well as challenges for future research. Memory training was compared in adults aged 60-80. Groups 1 and 2 studied a self-instructional memory training manual; Group 2 also attended supplementary group discussions of typical problems of later life, related coping methods, and the techniques in the self-instructional manuals. Group 3 was a wait-list control group. Memory performance on 2 word lists significantly improved in the supplemental discussion group but not in the group that only studied the self-instructional manual. Enhanced performances were maintained at a 1-month follow-up. Bibliotherapy alone may be inferior to treatment involving a group component, although the mechanisms of such enhancement remain unexplored with respect to memory training. Neither treated group improved their digit span or recall of names and a brief prose passage; teaching older adults the strategies of chunking and use of imagery may not be beneficial. The effectiveness of a story mnemonic for free-recall learning was assessed in 71 community-dwelling elderly adults. Participants received 1 of 3 memory-training programs: (a) narrative story, (b) method of loci, or (c) placebo training. The stimuli consisted of 26 nouns chosen for being highly imagible and concrete. Recall was examined immediately following study of the words, after 1 hr, and after 3 days. At each testing interval, both mnemonic condition groups outperformed the placebo group. The results suggest that a story mnemonic can enhance word retention on a free-recall task. The purpose of the present 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 improves 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). Transfer of speed of processing training to other cognitive domains was not evident. 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. Further study is needed to learn about the long-term effects of such training in relation to everyday abilities. Individuals who have Mild Cognitive Impairment (MCI) may be in a transitional stage between aging and Alzheimer's disease (AD). The high rate of conversion from MCI to AD makes early treatment an important clinical issue. Recent evidence suggests that cognitive training intervention may reduce the rate of progression to AD.
                To evaluate the efficacy of a NeuroPsychological Training (TNP) in patients with MCI who are treated with cholinesterase inhibitors (ChEIs), compared with patients MCI treated only with ChEIs and patients not treated, in a longitudinal, one year follow-up study.
                One year longitudinal and retrospective comparison study of neuropsychological performances in 59 subjects affected by Mild Cognitive Impairment (MCI) according to Petersen's criteria. Fifteen subjects were randomised to receive TNP plus cholinesterase inhibitors; 22 subjects cholinesterase inhibitors alone and 22 subjects no treatment. All the subjects referring memory complaints, corroborated by an informant, underwent a multidimensional assessment concerning neuropsychological, behavioural and functional characteristics, at baseline and after one year follow-up.
                Subjects without treatment maintained their cognitive, functional and behavioural status after one year; patients treated only with ChEIs improved in depressive symptoms whereas subjects treated with TNP and ChEIs showed significant improvements in different cognitive areas, such as memory, abstract reasoning and in behavioural disturbances, particularly depressive symptoms.
                A long-term TNP in ChEIs-treated MCI subjects induces additional cognitive and mood benefits. Research has demonstrated that older adults' cognitive performance can be enhanced via formal intervention, as well as more informal intervention including collaboration or working with a partner. The current study investigated the effects of an inductive reasoning training program adapted for in-home use among older adults assigned to individual training (n = 30), collaborative training (n = 34), or a no-treatment control group (n = 34). The training consisted of 10 sessions, and all participants completed a pretest followed by a post-test 6 weeks later. Findings suggest that older adults could effectively "train themselves" without the guidance of a formal instructor. The results, however, did not indicate immediate added benefit in reasoning performance for collaborative versus individual training using the current reasoning program. 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.
                To evaluate whether 3 cognitive training interventions improve mental abilities and daily functioning in older, independent-living adults.
                Randomized, controlled, single-blind trial with recruitment conducted from March 1998 to October 1999 and 2-year follow-up through December 2001.
                Volunteer sample of 2832 persons aged 65 to 94 years 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.
                Cognitive function and cognitively demanding everyday functioning.
                Thirty participants were incorrectly randomized and were excluded from the analysis. 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). No training effects on everyday functioning were detected at 2 years.
                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. After having screened the cognitive functions in 103 institutionalized elderly subjects in Terni, a sample affected by mnemic deficit was obtained so as to verify the use of mnemotechniques on the same. Generally the findings show an improvement in cognitive performance in those treated which leads to suppose that our patients were affected by apparent cognitive deficits rather than real ones, supporting in any case the use of neuropsychological rehabilitative treatment in institutionalized subjects. Memory intervention research with older adults has primarily focused on immediate effects of training. Little is known about whether memory training can prevent forgetting of a learned material over time.
                The main purpose of this study was to investigate the effects of memory training on forgetting of numerical information in old age. In addition, the effect of speed of learning on forgetting rate was examined.
                Two training programs were employed contrasting a number-consonant mnemonic strategy with a self-generated strategy. A non-practice control group was also included. There were 20 participants in each group (age range=60-83 years). Following completion of training, participants memorized six 4-digit numbers to perfection. Retention was tested after 30 min, 24 h, 7 weeks, and 8 months.
                The three groups showed equal rates of forgetting across the first two follow-up assessments. A different picture emerged for the last two occasions, with the self-generated strategy group remembering more items relative to the two other groups. Moreover, participants reaching the criterion in few trials exhibited less forgetting than slow learners.
                These data indicate that self-generated strategy training may have advantages over learning a classical mnemonic for preventing long-term forgetting of numeric materials in old age.
                Copyright (c) 2005 S. Karger AG, Basel. This study examined the effectiveness of a self-taught program of memory-skills training for older adults complaining of memory difficulties in an immediate-treatment/waiting-list design. Analyses of covariance of measures of memory performance, memory evaluation (complaints), and a self-rating depression scale revealed a significant impact of training on memory performance but not on memory complaints or symptoms of depression. Subsequent evaluation of the waiting-list group, which was provided training after participation in the initial portion of the study, provided a partial replication of the design. The pattern of results was remarkably consistent with that obtained in the controlled evaluation of the training program. Finally, those complaining of memory problems were compared with a group of noncomplaining older adults. The two groups were comparable in memory performance and depression scores. Thus, memory complaints do not appear to reflect, systematically, memory problems or depression. The aim of this study was to compare the effects of aerobic and mental training on cognitive function and to determine if the association of the two techniques shows better results. Thirty-two healthy elderly subjects (60 - 76 years) were assigned to one of four groups: aerobic training, mental training, combined aerobic and mental training and a control group. All subjects took two cognitive tests and an incremental exercise test before and after the training period. The intensity of exercise was individualized at the heart rate corresponding to the ventilatory threshold of each subject. After two months, the control group showed no alteration in physiological and cognitive variables. After the training period, the results showed a significant improvement in VO(2)max (F = 4.45, DF = 1, p < 0.05) of 12 % and 11 % in aerobic training and combined aerobic and mental training groups, respectively. Logical memory (F = 4.31, DF = 1, p < 0.05), as well as paired associates learning scores (F = 5.47, DF = 1, p < 0.05) and memory quotient (F = 6.52, DF = 1, p < 0.01) were significantly improved in the three trained groups. The mean difference in memory quotient between pre and post training was significantly higher in the combined aerobic and mental training group compared to aerobic training or mental training groups (F = 11.60, DF = 3, p < 0.001). We conclude that the specific aerobic training and mental training used in this study could induce the same degree of improvement in cognitive function and that combined training seemed to lead to greater effects than either technique alone. 'Mild cognitive impairment' (MCI) in older adults refers to a significant decline in memory function but not other cognitive functions. Pharmacological and non-pharmacological treatments for MCI are needed. The present randomized clinical trial tests the efficacy of a cognitive and behavioral treatment to improve memory performance and participants' attitudes about their memory. A multi-faceted intervention that included education about memory loss, relaxation training, memory skills training, and cognitive restructuring for memory-related beliefs was compared to a no-treatment control condition. Outcomes included memory performance and appraisals of memory function and control. Results indicate that the treated group had significantly better memory appraisals than controls at the end of treatment and at a six-month follow-up. There were no differences between groups on memory performance at post-test but at follow-up the trained individuals showed a trend toward better word list recall than controls. Findings suggest that individuals with MCI can benefit from multi-component memory enhancement training. Further development of such training programs and tests of their efficacy alone and in combination with medications are needed. One hundred twenty-eight elderly adults were recruited to assess the effects of affective judgment, imagery, and relaxation pretraining on mnemonic training. Participants were assigned to one of the following conditions: (1) visual imagery and affective judgment pretraining plus mnemonic training, (2) visual imagery pretraining only plus mnemonic training, (3) relaxation pretraining plus mnemonic training, (4) nonspecific pretraining plus mnemonic training, (5) nonspecific pretraining only, and (6) wait list. Subjects were tested at three times: prior to training (Time 1), following pretraining (Time 2), and at the conclusion of mnemonic training (Time 3). Although those receiving active pretraining plus mnemonics did not differ from one another at Time 3, they recalled more than those with no active pretraining. The results suggest that for mnemonics to be effective they should be coupled with active pretraining techniques. This study examined the effects of memory training on the relationship between perceived recall confidence and recall performance. The sample consisted of 76 elderly, community dwelling volunteers. Fifty-nine individuals received eight hours of memory training; the remaining 17 were wait-list controls. Participants were tested at pre- and post-intervention, and rated their confidence for recall of name-face pairs prior to each testing. The results showed a significant improvement in name-face recall at post test, favoring the group receiving mnemonic training. There was a significant association found between confidence ratings and recall performance at post-test. A closer examination of standardized regression residuals (confidence ratings and number of name-face pairs recalled) revealed that with mnemonic training, there was an improvement in the relationship between perceived confidence and recall performance following mnemonic training. The results suggest that the ability to assess changes in recall capacity and to judge future memory performance is enhanced by exposure to mnemonic training. Research on non-pharmacological therapies (cognitive rehabilitation) in old age has been very limited, and most has not considered the effect of interventions of this type over extended periods of time.
                To investigate a new cognitive therapy in a randomized study with elderly people who did not suffer cognitive impairment.
                The efficacy of this therapy was evaluated by means of post-hoc analysis of 238 people using biomedical, cognitive, behavioural, quality of life (QoL), subjective memory, and affective assessments.
                Scores for learning potential and different types of memory (working memory, immediate memory, logic memory) for the treatment group improved significantly relative to the untreated controls.
                The most significant finding in this study was that learning potential continued at enhanced levels in trained subjects over an intervention period lasting two years, thereby increasing rehabilitation potential and contributing to successful ageing. Normal aging is associated with progressive functional losses in perception, cognition, and memory. Although the root causes of age-related cognitive decline are incompletely understood, psychophysical and neuropsychological evidence suggests that a significant contribution stems from poorer signal-to-noise conditions and down-regulated neuromodulatory system function in older brains. 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. We report here results from such a training program targeting age-related cognitive decline. 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 (effect size of 0.25) 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. The purpose of this study was to examine the effects of a multifactorial memory training program designed for normal older adults. The multifactorial program involved the training of three components that are critical to memory functioning: recoding operations, attentional functions and relaxation. Two controls groups were used. One control group took part in a general cognitive activation program involving training in problem solving, logical thinking, and visuospatial skills, whereas the other received no training. Three types of tasks were administered to assess potential effects of training: (a) free recall of words within the Buschke selective reminding paradigm, (b) digit span, and (c) the Benton visual retention test. Results indicated that the multifactorial group improved performance following training on several measures of the selective reminding task, and that this improvement was maintained 6 months after completion of training. In addition, the two other groups did not show any improvement of memory performance, and no effects occurred in the digit span and visual retention tasks. This pattern of results suggests that multifactorial training may be an effective way of achieving long-term benefits of training for older people, and that effects of memory training may be relatively task-specific. The purpose of the study was to develop a multifactorial memory enhancement program for community-dwelling older adults aimed at encouraging positive beliefs and behaviors about memory function and abilities in later life. The study evaluated the effectiveness of cognitive restructuring techniques (56 subjects) as compared to traditional memory training techniques (61 subjects) for purposes of enhancing memory performance. Posttest assessments were conducted after 10 weeks of memory training. Follow-up assessments were conducted 9 weeks later to assess maintenance of memory performance and memory beliefs. Three 2 x 3 (Treatment x Time) repeated measures multivariate analyses of variance were conducted to evaluate the effects of two types of intervention on memory performance, memory perception, and affective symptomatology over time. Results suggest that cognitive restructuring techniques may help community-dwelling older adults gain control over their beliefs about memory and thereby enhance their memory performance. The aim of this study was to assess the influence of drug therapy (DT) with pramiracetam and memory training (MT), each alone, and in combination (DTMT), on both the objective memory and metamemory performance. Thirty-five non-depressed, non-demented healthy elderly (mean age: 64.8 years) with objective (story recall) and/or subjective (cognitive difficulties scale) memory loss were randomly included in four open-label conditions: an MT condition (n = 10), a DT condition (n = 8), a DTMT condition (n = 10), and a control (CTR) condition (n = 7). MT and DTMT subjects participated in 12 real-life tutor-guided MT sessions, once weekly, each lasting 1.5 hrs. The subjects were tested for objective (Randt memory test) and subjective (Sehulster metamemory scale; memory functioning questionnaire) memory proficiency prior to (t(0)) and shortly after treatment (t(1)). Results showed that objective memory gains of the two groups receiving pramiracetam were significantly larger than that of the MT and CTR groups. The ranking order in terms of decreasing score improvements was DTMT - DT - MT - CTR. Metamemory, on the other hand, displayed only a trend to between-group differences with opposite patterns for the DT and DTMT groups. In the DT group, the level of depression, negatively interfered with metamemory but not with actual memory performance. The present findings stress, once again, the complex relationships between memory, metamemory and affective status, which may be differently modified by DT and MT. Previously validated methods of memory training were used in conjunction with the Folstein Mini-Mental State Examination (MMSE) to explore the relationship between complexity of learned mnemonic, aging, and subtle cognitive impairment. Subjects were 218 community-dwelling elderly. Treatment included imagery mnemonics for remembering names and faces and lists. There was a significant interaction among age, type of learning task (face-name vs. list), and improvement when controlling for MMSE score. There was also a significant interaction among MMSE score, type of learning task, and improvement when controlling for age. Scores on the more complex list-learning mnemonic were more affected by age and MMSE scores than were scores on the face-name mnemonic. Implications of the findings for cognitive training of the old old and the impaired are discussed.
There is evidence that cognitive interventions do lead to performance gains but none of the effects observed could be attributable specifically to cognitive training, as the improvements observed did not exceed the improvement in active control conditions. This does not mean that longer, more intense or different interventions might not be effective, but that those which have been reported thus far have only limited effect. We therefore suggest more standardized study protocols in order to maximize comparability of studies and to maximize the possibility of data pooling - also in other cognitive domains than memory.