Cognitive Training In Older Adults Research Articles

The effects of computerized cognitive training in older adults' cognitive performance and biomarkers of structural brain aging.

Cognitive Training (CT) has been investigated as a means of delaying age-related cognitive decline in older adults. However, its impact on biomarkers of age-related structural brain atrophy has rarely been investigated, leading to a gap in our understanding of the linkage between improvements in cognition and brain plasticity. This study aimed to explore the impact of CT on cognitive performance and brain structure in older adults. 124 cognitively normal older adults recruited from two study sites were randomly assigned to either an adaptive CT (n=60) or a casual game training (Active Control, AC, n= 64). After 10 weeks of training, CT participants showed greater improvements in the overall cognitive composite score (Cohen's d=.66, p<.01) with non-significant benefits after 6 months from the completion of training (Cohen's d=.36, p=.094). The CT group showed significant maintenance of the caudate volume as well as significant maintained fractional anisotropy (FA) in the left Internal Capsule (IC) and in left Superior Longitudinal Fasciculus (SLF) compared to the AC group. The AC group displayed an age-related decrease in these metrics of brain structure. Results from this multi-site clinical trial demonstrate that the CT intervention improves cognitive performance and helps maintain caudate volume and integrity of white matter regions that are associated with cognitive control, adding to our understanding of the changes in brain structure contributing to changes in cognitive performance from adaptive CT.

Vision and hearing difficulty and effects of cognitive training in older adults.

Cognitive training is delivered visually and aurally. It is unknown whether self-reported sensory difficulty modifies the effects of cognitive training on cognition. Participants (N=2788) in the Advanced Cognitive Training for Independent and Vital Elderly Study were randomized to training in memory, reasoning, speed of processing, or control. Differences in the 10-year effect of cognitive training on cognition by self-reported vision and hearing difficulty were assessed using linear mixed effect models. Benefit (intervention vs. control) of reasoning training was smaller among participants with versus without vision difficulty (difficulty: -0.25, 95% confidence interval: [-0.88, 0.39], no difficulty: 0.58 [0.28, 0.89]). Benefit of memory training was greater for participants with versus without hearing difficulty (difficulty: 0.17 [-0.37, 0.72], no difficulty: -0.20 [-0.65, 0.24]). Older adults with sensory loss have increased risk for cognitive decline; benefits of cognitive training may be greater for these individuals. Sensory loss should be considered in training design. Memory training was more beneficial for participants with hearing loss.Participants with vision difficulties did not benefit as much from reasoning training.Low accessibility in design and learned compensation strategies may contribute.Consideration of sensory impairment in study design is needed.Inclusion of older adults with sensory impairment in cognitive training is needed.

TDCS reduces depression and state anxiety symptoms in older adults from the augmenting cognitive training in older adults study (ACT)

BackgroundPharmacological interventions for depression and anxiety in older adults often have significant side effects, presenting the need for more tolerable alternatives. Transcranial direct current stimulation (tDCS) is a promising non-pharmacological intervention for depression in clinical populations. However, its effects on depression and anxiety symptoms, particularly in older adults from the general public, are understudied. ObjectiveWe conducted a secondary analysis of the Augmenting Cognitive Training in Older Adults (ACT) trial to assess tDCS efficacy in reducing psychological symptoms in older adults. We hypothesized that active stimulation would yield greater reductions in depression and state anxiety compared to sham post-intervention and at the one-year follow-up. We also explored tDCS effects in subgroups characterized by baseline symptom severity. MethodsA sample of 378 older adults recruited from the community completed a 12-week tDCS intervention with cognitive or education training. Electrodes were placed at F3/F4, and participants received active or sham tDCS during training sessions. We assessed the association between tDCS group and changes in depression, state anxiety, and trait anxiety from baseline to post-intervention and one-year controlling for covariates. ResultsThe active tDCS group demonstrated greater reductions in depression and state anxiety compared to sham post-intervention, particularly in individuals with mild depression and moderate/severe state anxiety at baseline. Furthermore, the active tDCS group with moderate/severe state anxiety maintained greater symptom reductions at one-year. ConclusionstDCS effectively reduced depression and state anxiety symptoms in a large sample of older adults. These findings highlight the importance of considering symptom severity when identifying those who may benefit most from this intervention.

The impact of a tDCS and cognitive training intervention on task-based functional connectivity.

Declines in several cognitive domains, most notably processing speed, occur in non-pathological aging. Given the exponential growth of the older adult population, declines in cognition serve as a significant public health issue that must be addressed. Promising studies have shown that cognitive training in older adults, particularly using the useful field of view (UFOV) paradigm, can improve cognition with moderate to large effect sizes. Additionally, meta-analyses have found that transcranial direct current stimulation (tDCS), a non-invasive form of brain stimulation, can improve cognition in attention/processing speed and working memory. However, only a handful of studies have looked at concomitant tDCS and cognitive training, usually with short interventions and small sample sizes. The current study assessed the effect of a tDCS (active versus sham) and a 3-month cognitive training intervention on task-based functional connectivity during completion of the UFOV task in a large older adult sample (N = 153). We found significant increased functional connectivity between the left and right pars triangularis (the ROIs closest to the electrodes) following active, but not sham tDCS. Additionally, we see trending behavioral improvements associated with these functional connectivity changes in the active tDCS group, but not sham. Collectively, these findings suggest that tDCS and cognitive training can be an effective modulator of task-based functional connectivity above and beyond a cognitive training intervention alone.

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

Cognitive training holds potential as a non-pharmacological intervention to decrease cognitive symptoms associated with Alzheimer's disease (AD), but more research is needed to understand individual differences that may predict maximal training benefits. We conducted a pilot study using a six-month training regimen in healthy aging adults with no cognitive decline. We investigated the effects of baseline performance and age on training and transfer improvements. Out of 43 participants aged 65-84 years, 31 successfully completed cognitive training (BrainHQ) in one of three cognitive domains: processing speed (N = 13), inhibitory control (N = 9), or episodic memory (N = 9). We used standardized assessments to measure baseline performance and transfer effects. All 31 participants improved on the cognitive training regimen and age was positively associated with training improvement (p = 0.039). The processing speed group improved significantly across many near- and far-transfer tasks. In the inhibitory control group, individuals with lower baseline performance improved more on inhibitory control and cognitive flexibility tasks. In the episodic memory group, older individuals improved most on a memory task while younger individuals improved most on an executive function far-transfer task. Individual differences are predictive of cognitive training gains, and the impact of individual differences on training improvements is specific to the domain of training. We provide initial insight regarding how non-pharmacological interventions can be optimized to combat the onset of cognitive decline in older adults. With future research this work can inform the design of effective cognitive interventions for delaying cognitive decline in preclinical AD.

Effects of engagement, persistence and adherence on cognitive training outcomes in older adults with and without cognitive impairment: a systematic review and meta-analysis of randomised controlled trials.

Limited understanding exists regarding the influences of engagement, persistence and adherence on the efficacy of cognitive training for age-related cognitive decline and neurodegenerative cognitive impairment. This study conducted a meta-analysis of randomised controlled trials (RCTs). We systematically searched MEDLINE, PubMed, Web of Science, Embase and CINAHL databases from 1 January 2012 to 13 June 2023, and included RCTs assessing the effects of cognitive training in older adults, both with and without cognitive impairment. Hedges' g with a 95% confidence interval (CI) was used to synthesise cognitive training effect sizes on various neuropsychological tests. Subgroup analyses were conducted based on variables including engagement, persistence, adherence and cognitive conditions of normal cognition, mild cognitive impairment (MCI) or neurodegenerative dementia. This meta-analysis included 55 RCTs with 4,455 participants with cognitive conditions spanning normal cognition, MCI and neurodegenerative dementia. The mean age of participants was 73.9 (range: 65.7-84.5) years. Overall, cognitive training showed a significant cross-domain effect (Hedges' g = 0.286, 95% CI: 0.224-0.348). Training effects are significant when engagement or persistence rates exceed 60% or when adherence rates exceed 80%. Higher levels of persistence are required to achieve significant training effects in memory, visuospatial ability and reasoning than in executive function and attention and language. Higher persistence is also required for older adults with normal cognition to achieve significant training gains compared to those with cognitive impairment. This systematic review highlights the critical roles of engagement, persistence and adherence in augmenting the efficacy of cognitive training.

Hearing loss moderates cognitive‐motor dual‐tasking before and after combined exercise and cognitive training in older adults with mild cognitive impairment: Findings from the SYNERGIC and COMPASS‐ND studies

AbstractBackgroundAge‐related hearing loss is associated with poor cognitive‐motor dual‐task performance and is a risk factor for dementia and mild cognitive impairment (MCI). Although different interventions have shown to improve dual‐task performance in older adults, it is currently unclear whether hearing ability affects training efficacy in individuals with MCI.MethodsSecondary data analyses of 75 participants with MCI (Mage = 73.66 ± 6.67) who completed the Canadian Consortium on Neurodegeneration and Aging SYNERGIC and COMPASS‐ND studies. We investigated how hearing ability (normal hearing (n = 56), hearing loss (n = 19)) moderated the efficacy of a 20‐week intervention (combined exercise and cognitive training (n = 32), exercise training alone (n = 31), control (n = 12)) on single‐ and dual‐task working memory performance (serial one or seven subtractions, semantic fluency) and spatio‐temporal gait characteristics.ResultsAt baseline, participants with hearing loss had slower gait speed and higher step time variability while concurrently completing the semantic fluency task, compared to participants with normal hearing. Participants with hearing loss also had higher accuracy on the semantic fluency and serial seven subtractions tasks while dual‐tasking, compared to participants with normal hearing. Single‐ and dual‐task gait speed increased significantly following combined exercise and cognitive training, with greater improvements observed in participants with hearing loss compared to those with normal hearing. However, older adults with hearing loss showed a significant decrease in dual‐task serial seven subtractions and semantic fluency following combined exercise and cognitive training.ConclusionThese findings help clarify the relationship between hearing loss, cognition, and mobility in old age and inform training recommendations for persons with MCI based on hearing ability. Combined exercise and cognitive training appears to have increased attentional and physical resources, allowing participants with hearing loss to shift postural prioritization strategies while dual‐tasking from a posture‐second strategy to a posture‐first strategy. Thus, combined exercise and cognitive training may be particularly beneficial for older adults with both MCI and hearing loss, in order to improve safe walking behaviours while multi‐tasking and mitigate further decline.

Efficacy of smartphone application-based multi-domain cognitive training in older adults without dementia

Efficacy of smartphone application-based multi-domain cognitive training in older adults without dementia

53 2-Back Performance Does Not Differ Between Cognitive Training Groups in Older Adults Without Dementia

Objective:Cognitive training is a non-pharmacological intervention aimed at improving cognitive function across a single or multiple domains. Although the underlying mechanisms of cognitive training and transfer effects are not well-characterized, cognitive training has been thought to facilitate neural plasticity to enhance cognitive performance. Indeed, the Scaffolding Theory of Aging and Cognition (STAC) proposes that cognitive training may enhance the ability to engage in compensatory scaffolding to meet task demands and maintain cognitive performance. We therefore evaluated the effects of cognitive training on working memory performance in older adults without dementia. This study will help begin to elucidate non-pharmacological intervention effects on compensatory scaffolding in older adults.Participants and Methods:48 participants were recruited for a Phase III randomized clinical trial (Augmenting Cognitive Training in Older Adults [ACT]; NIH R01AG054077) conducted at the University of Florida and University of Arizona. Participants across sites were randomly assigned to complete cognitive training (n=25) or an education training control condition (n=23). Cognitive training and the education training control condition were each completed during 60 sessions over 12 weeks for 40 hours total. The education training control condition involved viewing educational videos produced by the National Geographic Channel. Cognitive training was completed using the Posit Science Brain HQ training program, which included 8 cognitive training paradigms targeting attention/processing speed and working memory. All participants also completed demographic questionnaires, cognitive testing, and an fMRI 2-back task at baseline and at 12-weeks following cognitive training.Results:Repeated measures analysis of covariance (ANCOVA), adjusted for training adherence, transcranial direct current stimulation (tDCS) condition, age, sex, years of education, and Wechsler Test of Adult Reading (WTAR) raw score, revealed a significant 2-back by training group interaction (F[1,40]=6.201, p=.017, η2=.134). Examination of simple main effects revealed baseline differences in 2-back performance (F[1,40]=.568, p=.455, η2=.014). After controlling for baseline performance, training group differences in 2-back performance was no longer statistically significant (F[1,40]=1.382, p=.247, η2=.034).Conclusions:After adjusting for baseline performance differences, there were no significant training group differences in 2-back performance, suggesting that the randomization was not sufficient to ensure adequate distribution of participants across groups. Results may indicate that cognitive training alone is not sufficient for significant improvement in working memory performance on a near transfer task. Additional improvement may occur with the next phase of this clinical trial, such that tDCS augments the effects of cognitive training and results in enhanced compensatory scaffolding even within this high performing cohort. Limitations of the study include a highly educated sample with higher literacy levels and the small sample size was not powered for transfer effects analysis. Future analyses will include evaluation of the combined intervention effects of a cognitive training and tDCS on nback performance in a larger sample of older adults without dementia.

Effects of a remotely supervised physical training program combined with cognitive training for older individuals at increased risk of clinical-functional vulnerability: study protocol for a randomized clinical trial.

Despite the robust body of evidence for the benefits of home-based physical exercise, there is still a paucity of data on the benefits of home-based cognitive training for older adults, especially in those at increased risk of clinical-functional vulnerability. As such, the present study aims to compare the chronic effects of a telehealth-delivered physical training intervention alone or combined with a cognitive training program in older adults at increased clinical-functional vulnerability risk. A randomized clinical trial will be conducted including 62 sedentary older individuals classified as at increased risk of clinical-functional vulnerability based on their Clinical-Functional Vulnerability Index score. Participants will be randomly allocated in a 1:1 ratio to one of two groups, an intervention group including physical training combined with cognitive training, or an active control group including physical training alone. Both groups will receive home-based supervised training remotely for 12weeks and will be assessed for the primary and secondary outcomes of the study before and after the training period. Primary outcomes include cognitive function and dynamic balance with a dual task. Secondary outcomes encompass physical, cognitive, and occupational performance, functional capacity, quality of life, and anxiety and depression symptoms, as well as hemodynamic measures. Data analysis will be performed by intention-to-treat and per protocol using mixed linearmodels and Bonferroni's post hoc (α = 0.05). Our conceptual hypothesis is that both groups will show improvements in the primary and secondary outcomes. Nevertheless, we expect physical combined with cognitive training to improve cognitive function, dual task, and occupational performance to a greater degree as compared to physical training alone. NCT05309278. Registered on April 4, 2022.

Microstructural and functional plasticity following repeated brain stimulation during cognitive training in older adults

The combination of repeated behavioral training with transcranial direct current stimulation (tDCS) holds promise to exert beneficial effects on brain function beyond the trained task. However, little is known about the underlying mechanisms. We performed a monocenter, single-blind randomized, placebo-controlled trial comparing cognitive training to concurrent anodal tDCS (target intervention) with cognitive training to concurrent sham tDCS (control intervention), registered at ClinicalTrial.gov (Identifier NCT03838211). The primary outcome (performance in trained task) and secondary behavioral outcomes (performance on transfer tasks) were reported elsewhere. Here, underlying mechanisms were addressed by pre-specified analyses of multimodal magnetic resonance imaging before and after a three-week executive function training with prefrontal anodal tDCS in 48 older adults. Results demonstrate that training combined with active tDCS modulated prefrontal white matter microstructure which predicted individual transfer task performance gain. Training-plus-tDCS also resulted in microstructural grey matter alterations at the stimulation site, and increased prefrontal functional connectivity. We provide insight into the mechanisms underlying neuromodulatory interventions, suggesting tDCS-induced changes in fiber organization and myelin formation, glia-related and synaptic processes in the target region, and synchronization within targeted functional networks. These findings advance the mechanistic understanding of neural tDCS effects, thereby contributing to more targeted neural network modulation in future experimental and translation tDCS applications.

Primary outcome from the augmenting cognitive training in older adults study (ACT): A tDCS and cognitive training randomized clinical trial

BackgroundThere is a need for effective interventions to stave off cognitive decline in older adults. Cognitive training has variably produced gains in untrained tasks and daily functioning. Combining cognitive training with transcranial direct current stimulation (tDCS) may augment cognitive training effects; however, this approach has yet to be tested on a large-scale. ObjectiveThis paper will present the primary findings of the Augmenting Cognitive Training in Older Adults (ACT) clinical trial. We hypothesize that receiving active stimulation with cognitive training will result in greater improvements on an untrained fluid cognition composite compared to sham following intervention. Methods379 older adults were randomized, and 334 were included in intent-to-treat analyses for a 12-week multidomain cognitive training and tDCS intervention. Active or sham tDCS was administered at F3/F4 during cognitive training daily for two weeks then weekly for 10 weeks. To assess the tDCS effect, we fitted regression models for changes in NIH Toolbox Fluid Cognition Composite scores immediately following intervention and one year from baseline controlling for covariates and baseline scores. ResultsAcross the entire sample, there were improvements in NIH Toolbox Fluid Cognition Composite scores immediately post-intervention and one year following baseline; however, there were no significant tDCS group effects at either timepoint. ConclusionsThe ACT study models rigorous, safe administration of a combined tDCS and cognitive training intervention in a large sample of older adults. Despite potential evidence of near-transfer effects, we failed to demonstrate an additive benefit of active stimulation. Future analyses will continue to assess the intervention's efficacy by examining additional measures of cognition, functioning, mood, and neural markers.

The effects of high versus low frequency of combined physical and cognitive training on cognitive function in older adults with cognitive decline: a quasi-experimental study

BackgroundThe effects of combined training can be affected by training characteristics such as frequency, session length, and duration. No empirical studies to date have directly compared how combined physical and cognitive training offered at different training frequencies affects cognitive function for older adults with cognitive decline. This study investigated the impact of training frequency on cognitive outcomes after combined physical and cognitive training for older adults with cognitive decline.MethodsA quasi-experimental study was conducted in community facilities and day care centers. The study assigned 89 older adults with cognitive decline into high-frequency (HF) or low-frequency (LF) training groups. The participants received 90- to 105-min training sessions, one (LF) or three (HF) times a week, for 12 weeks. Outcome measures were the Montreal Cognitive Assessment, Word List subtest of the Wechsler Memory Scale, Digit Symbol Substitution Test (DSST), and Stroop Color Word Test.ResultsThe HF group demonstrated greater improvement in immediate memory measured by the WL-IM (F = 8.7, P = 0.004) and in executive function measured by the SCWT (F = 5.89, P = 0.017) than the LF group. Compared with the HF group, the LF group showed a great improvement in delayed memory measured by the WL-DM (F = 9.62, P = 0.003). The HF and LF groups both increased in processing speed and global cognitive function.ConclusionsOur study indicated that the different training frequency of combined physical and cognitive training may result in benefits on different cognitive functions in older adults with cognitive decline. These findings may assist clinical practitioners in choosing appropriate training frequencies based on various intervention purposes for the elderly with cognitive decline.Trial registrationClinicalTrials.gov Identifier NCT03619577 (08/08/2018).

Feasibility and potential cognitive impact of a cognitive-motor dual-task training program using a custom exergame in older adults: A pilot study.

Dual-task training may be relevant and efficient in the context of active aging. An issue in training programs lies in enhancing the adherence of participants. This can potentially be improved using games as support. We designed and developed a custom interactive exergame in this way. The objective of this pilot study was to explore the potential use of this exergame and the feasibility of our intervention, including the level of safety and adherence. The result's trends on cognitive and motor capacities, as well as on the level of motivation for physical activity, fear of falling, and quality of life of participants, were also explored. Older adults aged 65 years or older were recruited and realized 30 min of supervised training in groups of 4, 2-3 times a week for 12 weeks. Exercises consisted of incorporated cognitive and motor dual tasks, with an increased difficulty over the weeks. Our program's safety, engagement, attendance, and completion levels were evaluated. Participants' postural control in single-task and dual-task conditions, as well as their performances in mental inhibition, flexibility, working memory, mobility, and postural control, and their levels of motivation for physical activity, fear of falling, and quality of life were also assessed. We realized a per protocol statistical analysis with a p-value set at 0.05. Thirty-nine participants (aged 84.6 ± 8.5 years) were recruited. No adverse events, and 89% adherence, 88% attendance, and 87% completion rates were observed. A potentially significant effect of our exergame on working memory in single-task conditions and on the cognitive aspect of dual-task conditions was also observed. We observed no differences in other parameters. Our exergame seemed feasible and safe and was enjoyed by participants, mainly due to the gamification of our training program. Moreover, our exergame may be efficient for cognitive training in older adults, as well as for the maintenance of motor functions, motivation for physical activity, fear of falling, and quality of life levels. This constitutes the first step for our solution with interesting results that need to be further studied.

Combination of transcranial direct current stimulation with cognitive training in older adults: behavioral and neuronal effects

Combination of transcranial direct current stimulation with cognitive training in older adults: behavioral and neuronal effects

Augmenting cognitive training in older adults with transcranial direct current stimulation: Initial results from the Phase III ACT trial and new directions

AbstractBackgroundEffective non‐pharmacological interventions to remediate age‐related cognitive decline and alter trajectories toward dementia are limited. The Augmenting Cognitive Training in Older Adults trial (ACT) was the first phase III randomized clinical trial initiated for transcranial direct current stimulation.MethodThis NIA funded trial sought to evaluate whether 3 months of cognitive training paired with bilateral 2mA tDCS to the frontal lobes could produce clinically meaningful improvement in a composite measure of cognitive function in healthy older adults: the NIH Toolbox Fluid Cognition Composite score. The ACT trial will be unblinded April 30, 2022. Further still, over the past 5 years, it has become increasingly evident that fixed dosing approaches to tDCS, like those used in the ACT and every other trial to date, are insufficient for addressing individual differences and maximizing clinical outcomes.ResultsWe will present, for the first time, the primary outcome results from the ACT trial. In addition, we will present initial findings from related secondary neuroimaging and cognitive indices. In this talk, we will also present preliminary findings from our ongoing work to refine dosing technology for tDCS in older adults using computational modeling, artificial intelligence and multimodal imaging, paired with tDCS outcomes from the ACT trial.ConclusionWe will present new analyses, available only upon unblinding of ACT. These data use person‐specific computational models of tDCS current flow paired with machine learning and clinical outcomes to identify critical characteristics of tDCS current in the brain (e.g., intensity, direction of current flow) most strongly associated with response vs. non‐response. These data will provide initial insight into which regions of the brain and what characteristics of current were strongly associated with treatment response in the ACT trial. In addition, these data also provide critical insight into how stimulation dosing (electrode positioning, stimulation intensity) can be modified at a person‐specific level to potentially enhance clinical outcomes. Thus, the proposed talk will provide state of the art trial findings from the first completed tDCS Phase III clinical trial paired with next generation approaches to remediated age‐related cognitive decline using tDCS technology.

Positive Effect of Cognitive Training in Older Adults with Different APOE Genotypes and COVID-19 History: A 1-Year Follow-Up Cohort Study.

(1) Background: Older people suffer from cognitive decline; several risk factors contribute to greater cognitive decline. We used acquired (COVID-19 infection) and non-modifiable (presence of APOE rs429358 and rs7412 polymorphisms) factors to study the progression of subjective cognitive impairment while observing patients for one year. Cognitive training was used as a protective factor. (2) Methods: Two groups of subjects over the age of 65 participated in the study: group with subjective cognitive decline receiving cognitive training and individuals who did not complain of cognitive decline without receiving cognitive training (comparison group). On the first visit, the concentration of antibodies to COVID-19 and APOE genotype was measured. At the first and last point (1 year later) the Mini-Mental State Examination scale and the Hospital Anxiety and Depression Scale were performed. (3) Results: COVID-19 infection did not affect cognitive function. A significant role of cognitive training in improving cognitive functions was revealed. Older adults with APOE-ε4 genotype showed no positive effect of cognitive training. (4) Conclusions: Future research should focus on cognitive dysfunction after COVID-19 in long-term follow-up. Attention to the factors discussed in our article, but not limited to them, are useful for a personalized approach to maintaining the cognitive health of older adults.

A-114 Feasibility of Telehealth Compensatory Cognitive Training for Older Adults with Mild Cognitive Difficulties

Objective: Older adults (OA) experiencing mild cognitive difficulties (MCD) may benefit from compensatory cognitive training (CCT) to address cognitive changes. CCT is typically delivered in person, which was not possible during the COVID-19 pandemic. This study sought to investigate the feasibility of a telehealth CCT program among OA with MCD.Method: Adults age 55+ with documented MCD (n = 28) and an optional care partner (CP; n = 18) were recruited for video-chat delivery of a 6-week, motivationally-enhanced CCT program. Participants and CPs rated technological interference following sessions on a 0 to 100 scale (higher scores = less interference), as did clinicians. Participants and CPs also provided feedback on the benefits and drawbacks of telehealth. Feasibility was assessed by tracking enrollment and completion rates, session ratings, and qualitative feedback.Results: Of 78 potential participants, only 6% declined participation due to telehealth delivery. Eighty-six percent of participants (N = 24/28) completed the program, and no dropouts were due to telehealth. Participants (M = 81.32, SD = 25.61) and clinicians (M = 76.24, SD = 33.37) rated technological interference as occurring infrequently, though 4% of sessions were rescheduled due to technological problems. Qualitative feedback highlighted the convenience of telehealth and the drawback of mild frustration while navigating technical interference.Conclusion: Telehealth CCT was found to be feasible among OA with MCD and their CPs. Telehealth delivery was not a barrier to recruitment, enrollment, or completion of the program, and technological problems were mostly minor. The feasibility of telehealth CCT could increase access to underserved OA and, in turn, support early detection and intervention among an at-risk population.

It’s never too late to improvise: The impact of theatre improvisation on elderly population

ABSTRACT Despite the availability of improvisational theater training in different settings, studies that assess its effectiveness as a means for enhancing cognitive training for older adults are scarce. This study examines the influence of short theater improvisation exercises on the cognitive flexibility of cognitively-healthy older adults, and their influence on the four core components of improvisation (i.e., spontaneity, flow, creativity, playfulness). The study also examines the correlation between an improvement in these four key agents and an improvement in cognitive flexibility among older adults. This quantitative empirical study was conducted in retirement homes and daycare centers in Israel. A total of 45 participants took part in this study, all in good physical health and with age-appropriate cognitive abilities. The participants were divided into five research groups; each group met twice a week for a one-hour improvisation session over a six-week period. The data was collected through five questionnaires that were completed at four points of time (before, during, and after the workshop). The findings did not indicate a significant effect of the improvisation exercises on the participants' cognitive flexibility, yet they did show improvement in three components of improvisation: spontaneity, flow, playfulness. As such, the findings of this study indicate that despite a normal decline in basic cognitive functioning among older adults, the beneficial effect of improvisation on cognitive flexibility might still occur through spontaneity, playfulness, and flow. In conclusion, short theater improvisation exercises could contribute to various indicators of healthy aging in various settings.

“CityQuest,” A Custom-Designed Serious Game, Enhances Spatial Memory Performance in Older Adults

Spatial cognition is known to decline with aging. However, little is known about whether training can reduce or eliminate age-related deficits in spatial memory. We investigated whether a custom-designed video game involving spatial navigation, obstacle avoidance, and balance control would improve spatial memory in older adults. Specifically, 56 healthy adults aged 65 to 84 years received 10 sessions of multicomponent video game training, based on a virtual cityscape, over 5 weeks. Participants were allocated to one of three training conditions: the main intervention, the “CityQuest” group (n = 19), and two control groups, spatial navigation without obstacle avoidance (“Spatial Navigation-only” group, n = 21) and obstacle avoidance without spatial navigation (“Obstacles-only” group, n = 15). Performance on object recognition, egocentric and allocentric spatial memory (incorporating direction judgment tasks and landmark location tasks, respectively), navigation strategy preference, and executive functioning was assessed in pre- and post-intervention sessions. The results showed an overall benefit on performance in a number of spatial memory measures and executive function for participants who received spatial navigation training, particularly the CityQuest group, who also showed significant improvement on the landmark location task. However, there was no evidence of a shift from egocentric to allocentric strategy preference. We conclude that spatial memory in healthy older participants is amenable to improvement with training over a short term. Moreover, technology based on age-appropriate, multicomponent video games may play a key role in cognitive training in older adults.