Cognitive Interventions For Older Adults Research Articles

Implementation of Cognitive (Neuropsychological) Interventions for Older Adults in Clinical or Community Settings: A Scoping Review.

Despite compelling evidence that cognitive interventions for older adults improve cognition, mood, and everyday function, few are implemented in clinical or community practice. This scoping review aims to understand the implementation frameworks and methods used and their contribution to implementation success of cognitive interventions for older adults. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR), and searched CINAHL, EMBASE, MEDLINE, and PSYCINFO databases, using terms related to cognitive interventions, implementation, and older adults. This resulted in 5002 studies, of which 29 were included following an iterative process. Most studies reported on implementation of cognitive stimulation for people with dementia. Only four studies used formal implementation frameworks, with three using RE-AIM, and one a process evaluation using complexity theory. The most frequently addressed implementation concepts were Acceptability, Feasibility, and Effectiveness, while Cost, Cost-Effectiveness, and Maintenance were rarely reported. Solutions to common barriers included the importance of good stakeholder relationships and engagement, a manualised intervention flexible enough to adapt to the context, and ensuring facilitators were well-trained, confident, and enthusiastic.

Literature Review on the Effectiveness and Required Dosages of Cognitive Interventions for Older Adults

Objective: The purpose of this article is to review interventions that have been shown to improve cognitive abilities in older adults, including aerobic training, resistance training, yoga, tai chi, dual tasking, and meditation. The purpose of this article is to identify findings that can lead to recommendations regarding optimal dosages of the above interventions. Methods: This literature review relied heavily on meta-analyses that combined data from randomized controlled studies in order to identify interventions that reliably produce meaningful improvements in cognition. In addition, the meta-analyses were used to find dosage recommendations that appeared when similar studies were analyzed. Conclusions: There is ample evidence that various physical exercise and cognitive stimulation interventions can lead to meaningful improvements in cognition. The results often vary as a function of the participants’ cognitive abilities and presence of cognitive impairment or dementia. In many cases, it is possible to begin making recommendations in terms of the length of sessions and the length of interventions for various populations.

Effects of a nurse-led staged integral art-based cognitive intervention for older adults on the Alzheimer's disease spectrum: A randomized controlled trial

BackgroundCombined art activities can improve the neural network function within various brain regions involved in emotions, cognition, and behavior, thereby preventing or reversing cognitive decline. However, few studies have systematically examined its effects. Furthermore, the impact of nurse-led art-based cognitive intervention on cognitive and psychological health is unclear. ObjectiveTo evaluate the effects of a nurse-led staged integral art-based cognitive intervention in older adults on the Alzheimer's disease spectrum. DesignThis was a randomized wait-list controlled trial with allocation concealment and blinding of outcome assessors and data analysts. All data were collected between April 2021 and January 2023 and analyzed from January to March 2023. SettingOne memory clinic and four medical partnership communities. ParticipantsA total of 144 participants with subjective or objective memory decline (aged ≥60 years). MethodsParticipants were randomized into an intervention group (n = 72) and a wait-list control group (n = 72), in a 1:1 ratio. The intervention group underwent a 16-week, 24-session nurse-led staged integral art-based cognitive intervention program, which was based on neurocognitive function training patterns. The control group underwent the program after the follow-up assessment. General and specific domains of cognitive function and other health-related outcomes were measured at baseline (T0), immediately after the intervention (T1), and at the 6-month follow-up (T2). ResultsOf the 144 participants (mean [SD] age, 71.6 [5.8] years; 50 [34.7 %] males and 94 [65.3 %] females), 130 and 115 completed the questionnaires at T1 and T2, respectively. The average attendance rate in the intervention group was 86.0 %. At T1, the intervention group showed greater improvement than the control group did in general cognitive functions (MoCA, between-group mean difference, 1.4 [95 % CIs, 0.4 to 2.5], p = 0.009). Additionally, the intervention group demonstrated statistically significant improvement compared to the control group in language, memory, quality of life, sleep quality and physical activity level at T1. Statistically significant group differences remained in sleep quality (PSQI, between-group mean difference, −1.3 [95 % CIs, −2.5 to −0.1], p = 0.035) at the 6-month follow-up. ConclusionsIn this randomized controlled trial of a nurse-led staged integral art-based cognitive intervention program, older adults on the Alzheimer's disease spectrum who participated in the program experienced improved cognition and psychological health. RegistrationThis study was registered with ChiCTR.org (ChiCTR2100044959) on April 3, 2021. Tweetable abstractA nurse-led staged integral art-based intervention for older adults on the Alzheimer's disease spectrum experienced improved cognition and psychological health.

Exploring the Therapeutic Role of Art in Enhancing Mental Health and Quality of Life in Older Adults

With a growing population of older adults facing age-related health issues, cognitive decline, and prevalent mental health disorders, the study focuses on the potential of art therapy as a holistic solution. Art therapy, beyond cognitive benefits, offers profound purpose, joy, and playfulness. It serves as a coping mechanism for traumatic events, fostering autonomy and positive self-perception. The study investigates the science and psychology of art therapy and highlights the neural basis for the rewarding aspects of creating art and the role of meta-cognitive processes. Other benefits include its impact on the environment, cognitive function, medical conditions, dementia, and cancer. Comparatively, art therapy emerges as a cost-effective and successful treatment option, particularly for individuals who may struggle with exclusively verbal approaches. Case studies, such as the Open Studio Approach, emphasize the flexibility of art therapy and its potential to aid depression and cognitive interventions for older adults. In conclusion, the incorporation of art therapy to comprehensively address the many health challenges faced by older adults showcases a potential to improve cognitive function, mental health, and overall quality of life.

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

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

Foreign Language Learning in Older Adults: Anatomical and Cognitive Markers of Vocabulary Learning Success.

In recent years, foreign language learning (FLL) has been proposed as a possible cognitive intervention for older adults. However, the brain network and cognitive functions underlying FLL has remained largely unconfirmed in older adults. In particular, older and younger adults have markedly different cognitive profile—while older adults tend to exhibit decline in most cognitive domains, their semantic memory usually remains intact. As such, older adults may engage the semantic functions to a larger extent than the other cognitive functions traditionally considered the most important (e.g., working memory capacity and phonological awareness). Using anatomical measurements and a cognitive test battery, the present study examined this hypothesis in twenty cognitively normal older adults (58–69 years old), who participated in a two-month Italian learning programme. Results showed that the immediate learning success and long-term retention of Italian vocabularies were most consistently predicted by the anatomical measures of the left pars orbitalis and left caudal middle frontal cortex, which are implicated in semantic and episodic memory functions. Convergent evidence was also found based on the pattern of cognitive associations. Our results are consistent with a prominent role of semantic and episodic memory functions in vocabulary learning in older learners.

Immersive Virtual Reality-Based Cognitive Intervention for the Improvement of Cognitive Function, Depression, and Perceived Stress in Older Adults With Mild Cognitive Impairment and Mild Dementia: Pilot Pre-Post Study.

BackgroundThe incidence of dementia is increasing annually, resulting in varying degrees of adverse effects for individuals, families, and society. With the continuous development of computer information technology, cognitive interventions are constantly evolving. The use of immersive virtual reality (IVR) as a cognitive intervention for older adults with mild cognitive impairment (MCI) and mild dementia (MD) is promising, although only few studies have focused on its use.ObjectiveThe Chinese virtual supermarket (CVSM) IVR system was developed to provide a comprehensive and individual cognitive intervention program for older patients with MCI and MD. The aim of this study was to explore the feasibility and clinical effectiveness of this 5-week IVR-based cognitive intervention.MethodsA pretest-posttest study design was conducted with 31 older adults with MCI and MD from August 2020 to January 2021. All participants participated in a 5-week immersive virtual cognitive training program using the CVSM system. Feasibility was assessed as the incidence and severity of cybersickness symptoms and participant satisfaction based on questionnaires conducted after the intervention. Clinical effectiveness was evaluated using neuropsychological assessments, including several commonly used measures of cognitive function, depression, perceived stress, and activities of daily living. Measurements were obtained at baseline and after the intervention period.ResultsA total of 18 patients with MCI (mean age 82.94 [SD 5.44] years; 12 females) and 13 patients with MD (mean age 85.7 [SD 4.67] years, 10 females) participated in this pilot study. Both groups showed significant improvements in all cognitive function measurements (P<.001). The MD group had a significantly greater improvement in general cognitive function compared to the MCI group in Montreal Cognitive Assessment Scale, Symbol Digit Modalities Test, Shape Trail Test, and Auditory Verbal Learning Test. Furthermore, an intervention effect was observed in the improvement of perceived stress (P=.048 for MD group, P=.03 for MCI group ).ConclusionsThe use of the CVSM system may be effective in enhancing the cognitive function of patients with MCI and MD, including general cognitive function, memory, executive function, and attention. IVR technology enriches cognitive intervention approaches and provides acceptable, professional, personalized, and interesting cognitive training for older adults with cognitive impairment.Trial RegistrationClinicalTrials ChiCTR2100043753; https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR2100043753

Multi-component cognitive intervention for older adults with mixed cognitive levels: implementation and preliminary effectiveness in real-world settings

BackgroundIn most controlled studies of multi-component cognitive intervention, participants’ cognitive levels are homogenous, which is contrary to real-world settings. There is a lack of research studying the implementation of evidence-based cognitive intervention in communities. This study describes the implementation and preliminary effectiveness of a Multi-component Cognitive Intervention using Simulated Everyday Tasks (MCI-SET) for older adults with different cognitive levels in real-world settings.MethodsSingle group, pre-intervention assessment, post-intervention assessment, and 3-month follow-up research design. MCI-SET consists of 12 two-hour weekly sessions that include motor-cognitive tasks, cognitive training, and cognitive rehabilitation. One hundred and thirty participants, > = 65 and frail, dependence on > = one instrumental daily activity, or with confirmed dementia, from eight community centers were included. The primary outcome is general cognition (Montreal Cognitive Assessment-Taiwan, MoCA-T). Secondary outcomes are memory (Miami Prospective Memory Test, Digits Forward, Digits Backward), attention (Color Trail Test-Part 1), executive function (Color Trail Test-Part 2), and general function (Kihon Checklist-Taiwan).ResultsPre-intervention workshop for group leaders, standardized activity protocols, on-site observation, and ten weekly conferences were conducted to ensure implementation fidelity. MCI-SET had an 85% retention rate and 96% attendance rate. The participants had a mean age of 78.26 ± 7.00 and a mean MoCA-T score of 12.55 ± 7.43. 73% were female.General cognition (Hedges’ g = 0.31), attention (Hedges’ g = 0.23), and general function (Hedges’ g = 0.31), showed significant post-intervention improvement with small effect size. Follow-ups showed maintained improvement in general cognition (Hedges’ g = 0.33), and delayed effect on attention (Hedges’ g = 0.20), short-term memory (Hedges’ g = 0.38), and executive function (Hedges’ g = 0.40). Regression analysis indicated that the intervention settings (day care centers vs neighborhood centers), the pre-intervention cognitive levels, and the pre-intervention general function of the participants were not associated with the outcomes.ConclusionsMCI-SET is feasible and can improve the cognitive skills and general functions of older adults with heterogeneous cognitive skills or disabilities. It is essential to tailor programs to fit the interests of the participants and the culture of local communities. Group leaders must also have the skills to adjust the cognitive demands of the tasks to meet the heterogeneous cognitive levels of participants.Trial registrationThis study was retrospectively registered at clinicaltrials.gov (Identifier: NCT04615169).

A theatrical evidence-based cognitive intervention for older adults

This article describes a 35-year program devoted to determining the cognitive learning strategies of professional actors and then using those strategies to lower the risk factors for dementia in older adults. Details of a series of successful evidence-based theatrical interventions are provided along with the identification of areas in which our work directly overlaps drama therapy research. The methods involved in this endeavour include protocol analysis, behavioural testing and pre- and post-intervention data comparison. Most recently, these results have been verified by neuroscientists using functional magnetic resonance imaging (fMRI). It is hoped that drama therapists will find elements of this program that will be applicable to their work with older adults.

Group music training as a multimodal cognitive intervention for older adults.

Group music training as a multimodal cognitive intervention for older adults.

Supplemental Material for Group Music Training as a Multimodal Cognitive Intervention for Older Adults

Supplemental Material for Group Music Training as a Multimodal Cognitive Intervention for Older Adults

Cognitive Interventions for Cognitively Healthy, Mildly Impaired, and Mixed Samples of Older Adults: A Systematic Review and Meta-Analysis of Randomized-Controlled Trials.

Cognitive interventions may improve cognition, delay age-related cognitive declines, and improve quality of life for older adults. The current meta-analysis was conducted to update and expand previous work on the efficacy of cognitive interventions for older adults and to examine the impact of key demographic and methodological variables. EBSCOhost and Embase online databases and reference lists were searched to identify relevant randomized-controlled trials (RCTs) of cognitive interventions for cognitively healthy or mildly impaired (MCI) older adults (60+ years). Interventions trained a single cognitive domain (e.g., memory) or were multi-domain training, and outcomes were assessed immediately post-intervention using standard neuropsychological tests. In total, 279 effects from 97 studies were pooled based on a random-effects model and expressed as Hedges' g (unbiased). Overall, results indicated that cognitive interventions produce a small, but significant, improvement in the cognitive functioning of older adults, relative to active and passive control groups (g=0.298, p<.001, 95% CI=0.248-0.347). These results were confirmed using multi-level analyses adjusting for nesting of effect sizes within studies (g=0.362, p<.001, 95% CI=0.275, 0.449). Age, education, and cognitive status (healthy vs. MCI) were not significant moderators. Working memory interventions proved most effective (g=0.479), though memory, processing speed, and multi-domain interventions also significantly improved cognition. Effects were larger for directly trained outcomes but were also significant for non-trained outcomes (i.e., "transfer effects"). Implications for future research and clinical practice are discussed. This project was pre-registered with PROSPERO (#42016038386).

COGNITIVE TRAINING AND MCI

Vision-based speed of processing (VSOP) training is a promising cognitive intervention for older adults. However, whether VSOP training can affect cognitive processing in individuals at high risk for dementia is unknown. Here, we examined cognitive and neural effects of VSOP training in older adults with amnestic mild cognitive impairment (MCI) and contrasted those effects with an active control (mental leisure activities (MLA)). We specifically aimed to identify potential neurophysiological mechanisms (both central and peripheral) supporting VSOP-induced plasticity.

Physical Exercise with Multicomponent Cognitive Intervention for Older Adults with Alzheimer's Disease: A 6-Month Randomized Controlled Trial

Aims: This study aimed to investigate the effect of 6-month physical exercise with a multicomponent cognitive program (MCP) on the cognitive function of older adults with moderate to severe Alzheimer's disease (AD). Methods: We included 33 participants with AD in a 6-month randomized controlled trial. The intervention group participated in physical exercise and received a MCP. The control group received only the MCP. Before and after the intervention, cognitive outcomes were assessed using the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), Mini-Mental State Examination, and the Clock Drawing Test. Physical performance was evaluated by exercise time, the number of pedal rotation, total load, grip strength, and the Berg Balance Scale (BBS). Results: In all cognitive measures, there were no significant improvements between the two groups after 6 months in the baseline value-adjusted primary analysis. However, the ADAS-cog score was significantly lower between the two groups in secondary analysis adjusted for baseline value, age, sex, and education years. All physical outcomes were significantly higher in the intervention group except for total load compared with baseline measurements. Conclusion: This study indicates that it is possible to improve cognitive function in older adults with moderate to severe AD through 6-month physical exercise with a multicomponent cognitive intervention.

Cognitive remediation therapy for older adults

There is a large body of research on cognitive interventions for older adults the review which suggests the following: (1) Cognition remediation therapy is indicated for healthy elderly, and in mild cognitive impairment (MCI), early dementia, brain disease and injury, and severe mental illness (SMI). (2) Studies on healthy elderly demonstrate that with cognitive training (CT), cognitive stimulation (CS), and/or cognitive rehabilitation (CR) age-related cognitive decline can be reversed, at least partially if not fully, even in advanced age, with improved social functioning and quality of life. Better results are obtained if cognitive remediation therapy (CRT) is combined with vocational/psychosocial rehabilitation. Generalization of training to activities of daily living (ADL) and to secondary outcome measures such as quality of life and self-esteem are issues that need to be addressed in older adults. (3) Research in MCI has indicated that CRT, especially memory training, has some role. Future studies should place focus on the assessment of dose-response relationship, training generalization, and ecologically relevant approaches. (4) Findings of earlier work in early-stage dementia were frustrating, more recent work, especially randomized controlled trials of high quality, has provided a ray of rope with respect to effectiveness of CT and CR. Further well-designed studies are required to provide more definitive evidence. (5) Significant therapeutic effects of CR have been observed on cognitive function and ADL in the elderly patients with stroke. Routine screening for stroke patients and those with brain injury for cognitive impairment is recommended. (6) Available research provides evidence that cognitive remediation benefits people with SMI, and when combined with psychiatric rehabilitation this benefit generalizes to functioning. Elderly with SMI need special focus. Further needs to be carried out on older people with SMI.

The art of self-testing by attempting cryptic crosswords in later life: the effect of cryptic crosswords on memory self-efficacy, metacognition and memory functioning

Background: Previous research has suggested that older adults who are more cognitively active in later life show an attenuation in cognitive decline in healthy aging. Furthermore, cognitive intervention studies have indicated that ecologically valid cognitive interventions can promote cognitive functioning but only in taskspecific abilities. Since it has been shown that the art of self-testing can promote metacognitive awareness in older adults, attempting cryptic crosswords may be used as a cognitive intervention for older adults. Methods: In Experiments 1 and 2, a questionnaire technique was used and demonstrated that older adults became more aware of their episodic memory deficits after attempting cryptic crossword clues. Based on this, Experiment 3 used an intervention technique over a six-week period to investigate whether such awareness enabled older adults to improve cognitive functioning in a number of domains. This experiment used a revolutionary within-subjects technique to control for potential mediating factors. Results: The results supported previous research in that older adults showed an increase in the monitoring pathway of metacognition but were unable to use this enhanced awareness to change their behaviour when undertaking objective tests of cognitive ability. Post-hoc analysis highlighted subgroups of older adults who showed improvements in certain cognitive abilities, such as episodic memory functioning and judgement of learning abilities. Conclusions: The standard clinical trial technique might be inappropriate when testing either cognitive interventions or pharmacological tests. The within-subjects approach could be adapted to investigate follow-up effects of different types of interventions including ecologically valid cognitive interventions.

Prospective memory on a novel clinical task in older adults with mild cognitive impairment and subjective cognitive decline

Despite the relevance of prospective memory to everyday functioning and the ability to live independently, prospective memory tasks are rarely incorporated into clinical evaluations of older adults. We investigated the validity and clinical utility of a recently developed measure, the Royal Prince Alfred Prospective Memory Test (RPA-ProMem), in a demographically diverse, non-demented, community-dwelling sample of 257 older adults (mean age = 80.78 years, 67.7% female) with amnestic mild cognitive impairment (aMCI, n = 18), nonamestic mild cognitive impairment (naMCI, n = 38), subjective cognitive decline (SCD, n = 83) despite intact performance on traditional episodic memory tests, and healthy controls (HC, n = 118). Those with aMCI and naMCI performed significantly worse than controls on the RPA-ProMem and its subtasks (time-based, event-based, short-term, long-term). Also, those with SCD scored significantly lower than controls on long-term, more naturalistic subtasks. Additional results supported the validity and inter-rater reliability of the RPA-ProMem and demonstrated a relation between test scores and informant reports of real-world functioning. The RPA-ProMem may help detect subtle cognitive changes manifested by individuals in the earliest stages of dementia, which may be difficult to capture with traditional episodic memory tests. Also, assessment of prospective memory can help guide the development of cognitive interventions for older adults at risk for dementia.

Cognitive interventions for older adults: Does approach matter?

A group training format was compared to one-to-one training in a cognitive intervention, Reasoning Exercises in Assisted Living (REAL), designed for elderly Assisted Living residents. Change scores on problem solving and functional outcomes were compared between participants in each group. In participants trained individually (n = 29), scores increased post-intervention on the Every Day Problems Test for Cognitively Challenged Elders (EPCCE; d = 3.10, p < 0.01) and the Direct Assessment of Functional Status (DAFS; d = 3.52, p < 0.001), at a cost of $132 per person. Participants (N = 4) in the group format REAL had mean score increases of 2.75 points on the EPCCE and 3.5 on the DAFS, at a cost of $25.60 per person. Additional testing is warranted to verify the group effects due to the limited size of the sample. Relative costs and effects of various training formats are important to consider when developing, testing, and disseminating interventions targeting older adults.

Training Requirements of a Video Game-Based Cognitive Intervention for Older Adults: Lessons Learned

To examine the potential benefits of a complex online video game as a cognitive intervention for older adults, participants first had to be able to engage in gameplay. This necessitated the development of a training and support program for a complex computer task, with the unusual aim of maximizing mental effort. The goal of the training program was to equip participants to handle the challenges of the game while keeping them near the limits of their ability while playing. The training program was multi-modal and encompassed both in-person and remote methods. Successes and failures are discussed.

Early intervention for mild cognitive impairment: a randomised controlled trial

Background:Positive effects are reported for memory training for healthy older adults, and yet there is limited information about the benefit of cognitive intervention for older adults with increasing memory difficulties—mild...