Cognitive Training Interventions Research Articles

Computerized cognitive interventions for adults with ADHD: A systematic review and meta-analysis.

Treatments for adults with attention-deficit hyperactivity disorder (ADHD) are understudied, compared to children and adolescents with the same condition. In this systematic review and random-effects meta-analysis, we aim to evaluate the outcomes of computerized cognitive training (CCT) interventions in randomized controlled trials (RCTs) including adults with ADHD. Cognitive outcomes and ADHD symptom severity were analyzed separately. In addition, the Cattell-Horn-Carroll (CHC) theory of cognitive abilities was used to categorize outcome variables into subdomains, which were analyzed separately in a subsequent analysis. The results revealed a small positive change in overall cognitive functioning, a measure of all cognitive outcomes in each study, for individuals who took part in CCT compared to controls (k = 9, Hedge's g = 0.235, 95% CI [0.002, 0.467], p = 0.048, τ² = 0.000, I² = 0.000). However, neither symptom severity nor specific cognitive outcomes (executive functioning, cognitive speed, or working memory) showed a significant improvement. We analyzed the risk of bias in the chosen studies and discuss the findings in terms of effect size. It is concluded that CCT has a small positive effect in adults with ADHD. Due to the lack of heterogeneity in intervention designs across the included studies, increased heterogeneity in future studies could help inform clinicians about the aspects of CCT, such as training type and length, that are most beneficial for this group. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cognitive Mastery in Sports: Exploring Cognitive Psychology's Influence

This article delves into the pivotal role of cognitive psychology in sports, illuminating its profound impact on athletes' performance. Over a comprehensive survey of literature spanning the past decade, this review synthesizes key developments and applications of cognitive psychology in the athletic domain. Utilizing databases such as PubMed, PsycINFO, Google Scholar, and SportDiscus, the study employs a meticulous selection process, focusing on peer-reviewed articles that significantly contribute to the understanding of cognitive training, assessment, and rehabilitation in sports. The review explores diverse facets of cognitive psychology in sports, including the theoretical underpinnings of cognitive functions, innovative cognitive training interventions, and the crucial role of mental processes in injury recovery. It presents an analysis of the effectiveness of various cognitive strategies in enhancing athletic performance and resilience. Additionally, it addresses the challenges and potential future directions of cognitive psychology applications in sports. This article aims to bridge the gap between cognitive psychological theory and practical sports applications, offering insights for athletes, coaches, and sports psychologists. By highlighting the symbiotic relationship between the mind and athletic prowess, "The Mind Game" underscores the transformative potential of cognitive psychology in elevating sports performance to new heights.

Reduction in sugar drink valuation and consumption with gamified executive control training

The overvaluation of high-energy, palatable food cues contributes to unhealthy eating and being overweight. Reducing the valuation of unhealthy food may thus constitute a powerful lever to improve eating habits and conditions characterized by unhealthy eating. We conducted a double-blind, placebo-controlled, randomized intervention trial assessing the efficacy of a five to twenty days online cognitive training intervention to reduce sugary drink perceived palatability and consumption. Our intervention involved a recently identified action-to-valuation mechanism of action, in which the repeated inhibition of prepotent motor responses to hedonic food cues in a Go/NoGo (GNG) and an attentional bias modification (ABM) task eventually reduces their valuation and intake. Confirming our hypotheses, the experimental intervention with consistent (100%) mapping between motor inhibition and the targeted unhealthy sugary drinks cues induced a larger decrease in their valuation than the control intervention with inconsistent (50%) mapping (− 27.6% vs. − 19%), and a larger increase of the (water) items associated with response execution (+ 11% vs + 4.2%). Exploratory analyses suggest that the effect of training on unhealthy items valuation may persist for at least one month. Against our hypothesis, we observed equivalent reductions in self-reported consumption of sugary drinks following the two interventions (exp: − 27% vs. ctrl: − 19%, BF01 = 4.7), suggesting a dose-independent effect of motor inhibition on self-reported consumption. Our collective results corroborate the robustness and large size of the devaluation effects induced by response inhibition on palatable items, but challenge the assumption of a linear relationship between such effects and the actual consumption of the target items.Protocol registrationThe stage 1 protocol for this Registered Report was accepted in principle on 30/03/2021. The protocol, as accepted by the journal, can be found at: https://doi.org/10.17605/OSF.IO/5ESMP.

The role of acute changes in mBDNF, cortisol and pro-BDNF in predicting cognitive performance in old age

The interplay between biomarkers of relevance to neuroplasticity and its association with learning and cognitive ability in old age remains poorly understood. The present study investigated acute changes in plasma concentrations of mature brain-derived neurotrophic factor (mBDNF), its precursor protein (pro-BDNF), and cortisol, in response to acute physical exercise and cognitive training interventions, their covariation and role in predicting cognitive performance. Confirmatory results provided no support for mBDNF, pro-BDNF and cortisol co-varying over time, as the acute interventions unfolded, but did confirm a positive association between mBDNF and pro-BDNF at rest. The confirmatory results did not support the hypothesis that mBDNF change following physical exercise were counteracted by temporally coupled changes in cortisol or pro-BDNF, or by cortisol at rest, in its previously demonstrated faciliatory effect on cognitive training outcome. Exploratory results instead provided indications of a general and trait-like cognitive benefit of exhibiting greater mBDNF responsiveness to acute interventions when coupled with lesser cortisol responsiveness, greater pro-BDNF responsiveness, and lower cortisol at rest. As such, the results call for future work to test whether certain biomarker profiles are associated with preserved cognition in old age.

Adherence and satisfaction with remote cognitive training in blood or marrow transplant (BMT) survivors: The cognitive training and attitudes towards genetics (cTAG) study.

7009 Background: Cognitive impairment is prevalent in hematologic cancer survivors treated with BMT. There is a need for remote, accessible, and engaging interventions in order to mitigate adverse cognitive outcomes following treatment. We report on feasibility, satisfaction and preliminary efficacy of a remote cognitive training intervention in BMT survivors. Methods: Participants enrolled in the cTAG study were randomized to either using the online brain games Lumosity program daily for 12 weeks, or the waitlist arm. Cognitive function was assessed using a comprehensive battery covering executive function, processing speed, attention, memory and learning domains, and PROMIS Short Form4a for cognitive complaints. Participants’ satisfaction was measured using an exit survey. Standardized T-scores (mean: 50; standard deviation: 10), were used for domain-specific outcomes. An intention-to-treat analysis was used to model the change in cognition at 12 weeks compared to baseline, between study arms, controlling for baseline cognitive reserve, age, sex and race/ethnicity to enhance estimate precision. Results: Feasibility: 150 eligible patients were approached, 88 (58.7%) consented and 71 (80.7%) were randomized. Fifty-five patients completed the study (28 on active and 27 on waitlist arm). Post-randomization attrition rate was 19.7%. Median age at time of test was 58y (range: 27-74); 60% males, 83.6% Non-Hispanic White and 16.4% non-Hispanic Black, and 49% with low cognitive reserve. There were no significant differences between study arms. Adherence on active arm: Median of 87.5% for 4.9 days/week and 10/12 weeks. Preliminary Efficacy: Compared to the waitlist arm, scores improved for the active arm in attention (2.14 points, SE=1.01, p-value=0.039) and memory domains (5.63, SE=2.40, p-value=0.02). There was no significant change on cognitive complaints between the two arms. Satisfaction: Overall 78.2% of patients had no prior experience with cognitive training, 58.7% felt it helped their recovery, 82.6% found time commitment reasonable, 87% found it easy to follow, fun, engaging and appropriately challenging. The intervention had a 91.3% satisfaction rate; 73.9% indicating they would continue training and 87% would recommend it to others. Participants’ perceived benefit from training was highest for attention (89.1%), memory (73.9%), and visual tasks (69.6%). Only 11% of participants perceived benefits for real word tasks. Conclusions: The intervention was feasible, favorably rated, and associated with both perceived and objective improvements in attention and memory domains. Remote cognitive training carries several advantages for BMT patients including early and convenient at home administration supporting its clinical utility and potential long-term adoption following treatment. Clinical trial information: NCT03094026 .

Influence of game features on attention in adults.

The incorporation of game features into cognitive tasks can inform us about the influence of reward and motivation on attention. Continuous performance tasks (CPTs), designed to assess attention abilities, are examples of cognitive tasks that have been targeted for the addition of game features. However, previous results have been mixed regarding how game elements affect attention abilities and task performance. Here, we studied if there were factors that predict which individuals exhibit changes in attention from game features added to a CPT. Participants (N = 94, aged 21-71) played a traditional CPT and a game CPT with identical mechanics, but featured engaging game elements (aesthetics, storyline, competition, feedback, and reward). We first found corroborating evidence that game features have mixed effects on attention performance: most attention metrics of interest exhibited no overall difference between the traditional and game CPT, while game elements reduced performance for a few metrics. Importantly, we also found that specific behavioral and demographic profiles predicted individual differences in performance on the game CPT compared to the traditional CPT. Those with more attention difficulties (ADHD symptoms), more reward responsiveness, and younger adults performed better on the game CPT while, conversely, those with fewer ADHD symptoms, less reward responsiveness, and older adults performed better on the traditional CPT. These findings provide insights into how game features can influence attention in different individuals and have important implications for the use of game elements in cognitive tasks and training interventions.

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.

A Real-World Data Study on the Impact of the ReadRx Cognitive Training and Reading Intervention on Cognition, Basic Reading Ability, and Psychosocial Skills for 3527 Children

The state of reading proficiency among children in the United States continues to be a subject of concern among psychologists, teachers, parents, policy makers, and the education community at large. Despite the widespread use of curricular methods that teach basic reading skills, there remains a large percentage of children that struggle to read. Therefore, novel approaches to reading remediation should be explored. The aims of this study were to examine 1) the effect of a multicomponent cognitive and reading intervention on cognitive and reading skills; 2) the role of ADHD, age, sex, IQ score, and individual cognitive skills on the effectiveness of the ReadRx intervention; and 3) parent-reported behavioral outcomes following the ReadRx intervention. The current study analyzed a large real-world dataset to examine cognitive, reading, and behavioral outcomes for struggling readers (n = 3527) who had completed 24 weeks (120 hours) of intense cognitive training integrated with a structured literacy intervention using ReadRx in a one-on-one clinic setting. Analyses of pretest and post-test scores showed statistically significant changes on all cognitive and reading measures including attention, visual processing, processing speed, long-term memory, working memory, reasoning, phonological awareness, Work Attack, phonetic coding, spelling, comprehension, and overall IQ score with medium to very large effect sizes. The results included an average 4.1-year gain in reading skills including a 6-year gain in phonological awareness. No differences were found based on age, sex, or ADHD status, and minimal differences were found based on pre-intervention IQ score and cognitive test scores. The study also included a qualitative thematic analysis of parent-reported behavioral outcomes revealing themes of improved cognition, academic performance, and psychosocial skills including confidence and perseverance. Our findings were consistent with previous controlled studies on this intervention and offer an encouraging alternative instructional approach to reading remediation that aligns with the Science of Reading and includes intensive remediation of underlying cognitive skills.

The effect of a virtual reality based intervention on processing speed and working memory in individuals with ADHD—A pilot-study

Introduction: This study aimed to evaluate the effectiveness of a virtual reality based intervention in processing speed and working memory in students with ADHD symptomatology.Methods: A randomized experimental study was conducted, with a sample consisting of 25 adult participants recruited from the Escola Superior de Saúde do Politécnico do Porto. The participants were allocated into two groups: a passive control group and an intervention group that completed 10 sessions using virtual reality-based games from the Enhance VR app. The intervention included 6 games: Whack-a-mole, Shuffled, Assembly, React, Memory Wall, and Maestro. The participants underwent pre- and post-intervention evaluations using the Southwestern Assessment of Processing Speed (SWAPS) and the Sequence of Letters and Numbers and Spatial Location of the Wechsler Adult Intelligence Scale - 3rd Edition - WAIS-III. Descriptive statistics were used to characterize the sample and a mixed ANOVA was used to test the effectiveness of the intervention.Results: There was an improvement in the results of processing speed in the group exposed to the intervention (p < 0.001) and the value of the interaction between intervention and time was also significant (p = 0.004). There were no statistically significant differences between the participants’ working memory in the different variables under study, except for the values of the Spatial location test in the experimental group that improved relative to the initial assessment (p = 0.034).Discussion: A virtual reality cognitive training intervention resulted in improvements in the processing speed measures, which were not found in the control group. Although we cannot make the same conclusions regarding working memory, these results suggest that the VR intervention resulted in progress in the experimental group, possibly influenced by the intervention, which should be verified in future studies with longer interventions.

Evaluating depressive symptoms, BDNF Val66Met, and APOE-ε4 as moderators of response to computerized cognitive training in heart failure

BackgroundDepressive symptoms, brain-derived neurotrophic factor (BDNF) Val66Met, and apolipoprotein (APOE)-ε4 may moderate response to computerized cognitive training (CCT) interventions among patients with heart failure (HF). ObjectivesThe purpose of this study was to examine moderators of intervention response to CCT over 8 months among patients with HF enrolled in a 3-arm randomized controlled trial. Outcomes were memory, serum BDNF, working memory, instrumental activities of daily living (IADLs), and health-related quality of life (HRQL). Methods256 patients with HF were randomized to CCT, computerized crossword puzzles active control, and usual care control groups for 8 weeks. Data were collected at enrollment, baseline, 10 weeks, and 4 and 8 months. Mixed effects models were computed to evaluate moderators. ResultsAs previously reported, there were no statistically significant group by time effects in outcomes among the 3 groups over 8 months. Tests of moderation indicated that depressive symptoms and presence of BDNF Val66Met and APOE-ε4 were not statistically significant moderators of intervention response in outcomes of delayed recall memory, serum BDNF, working memory, IADLs, and HRQL. In post hoc analysis evaluating baseline global cognitive function, gender, age, and HF severity as moderators, no significant effects were found. HF severity was imbalanced among groups (P = .049) which may have influenced results. ConclusionsStudies are needed to elucidate biological mechanisms of cognitive dysfunction in HF and test novel interventions to improve memory, serum BDNF, working memory, IADLs and HRQL. Patients may need to be stratified or randomized by HF severity within intervention trials.

Personalized Computerized Training for Cognitive Dysfunction after COVID-19: A Before-and-After Feasibility Pilot Study.

The current pilot study was set to evaluate the feasibility and potential benefit of a personalized computerized cognitive training (CCT) intervention to improve cognitive function among people living with post-acute sequelae of COVID-19 (PASC). Seventy three adults who self-reported cognitive dysfunction more than 3 months after a diagnosis of COVID-19 took part in an 8-week training study. Participants' general cognitive function was assessed before they completed as many cognitive daily training sessions as they wished during an 8-week period, using a personalized CCT application at home. At the end of this period, participants repeated the general cognitive function assessment. The differences between the scores at 8 weeks and baseline in five cognitive domains (attention, memory, coordination, perception, reasoning), complemented with analyses of the changes based on the participants' age, training time, self-reported health level at baseline and time since the initial COVID-19 infection. Participants had significant cognitive dysfunction and self-reported negative health levels at baseline. Most of the participants obtained higher scores after CCT in each of the domains as compared with baseline. The magnitude of this score increase was high across domains. It is concluded that a self-administered CCT based on gamified cognitive tasks could be an effective way to ameliorate cognitive dysfunction in persons with PASC. The ClinicalTrials.gov identifier is NCT05571852.

Cognitive rehabilitation for improving cognitive functions and reducing the severity of depressive symptoms in adult patients with Major Depressive Disorder: a systematic review and meta-analysis of randomized controlled clinical trials

IntroductionNearly 40% of patients with Major Depressive Disorder (MDD) have been found to experience cognitive impairment in at least one domain. Cognitive impairment associated with MDD is disproportionately represented in patients that have not fully returned to psychosocial functioning. As awareness regarding cognitive dysfunction in MDD patients grows, so does the interest in developing newer treatments that specifically address these deficits.MethodIn the present study, we conduct a systematic review of controlled randomized clinical trials that used cognitive training and remediation interventions for improving cognitive functions and reducing symptom severity in adult patients with MDD. We selected studies published before March 2022 using search databases including PubMed, ScienceDirect, Scopus, and Google scholar. For conducting the meta-analysis, standard differences in means with the random effect model and with a 95% confidence interval of change in outcome measures from baseline to post-intervention between the cognitive rehabilitation and the control groups were calculated.ResultsThe database search resulted in identifying 756 studies of interest, which ultimately 15 studies with 410 participants in the cognitive rehabilitation group and 339 participants in the control group were included. The meta-analysis of the data extracted from these studies, shows a moderate and significant effect on the executive function (d = 0.59 (95% CI, 0.25 to 0.93) p-value = 0.001, I2 = 15.2%), verbal learning (d = 0.45 (95% CI, 0.12 to 0.78) p-value = 0.007, I2 = 0.00%), and working memory (d = 0.41 (95% CI, 0.18 to 0.64) p-value < 0.001, I2 = 33%) of MDD patients. Although, there were no significant difference between intervention and control group in attention (d = 0.32 (95% CI, -0.01 to 0.66) p-value = 0.058, I2 = 0.00%) or depressive symptoms.ConclusionThis systematic review and meta-analysis indicate that cognitive rehabilitation is an effective intervention for the executive function, verbal learning, and working memory of MDD patients. Due to the importance of these neuropsychological deficits in day-to-day life and the core symptoms of MDD, cognitive rehabilitation should be considered an important part of treating MDD. Further research in this area and concentrated on these particular deficits is warranted.

Inclusion of hearing and vision impairments in cognitive training interventions.

Cognitive training can potentially reduce risk of cognitive decline and dementia in older adults. To support implementation of cognitive training in the broader population of older adults, it is critical to evaluate intervention implementation and efficacy among representative samples, particularly those at highest risk of cognitive decline. Hearing and vision impairments are highly prevalent among older adults and confer increased risk of cognitive decline/dementia. Whether cognitive training interventions enroll and are designed to include this important subgroup is unknown. A scoping review of PubMed and PsycINFO was conducted to examine the inclusion of older adults with hearing and vision impairment in cognitive training interventions. Two independent reviewers completed a full-text review of eligible articles. Eligible articles included cognitive training and multimodal randomized controlled trials and a study population that was cognitively unimpaired, aged≥55-years, and community dwelling. Articles were primary outcome papers published in English. Among the 130 articles included in the review, 103 were cognitive training interventions (79%) and 27 were multimodal interventions (21%). More than half the trials systematically excluded participants with hearing and/or vision impairment (n = 60, 58%). Few studies reported hearing and vision measurement (cognitive: n = 16, 16%; multimodal: n = 3, 11%) or incorporated universal design and accessibility into intervention design (cognitive: n = 7, 7%; multimodal: n = 0, 0%). Older adults with hearing and vision impairment are underrepresented in cognitive training interventions. Reporting of hearing and vision measurement, proper justification of exclusions, and inclusion of accessibility and universal intervention design are also lacking. These findings raise concerns about whether current trial findings apply to those with hearing and vision impairment and generalize to the broader population of older adults. It is critical to include more diverse study populations and integrate accessibility into intervention design to include and better represent older adults with hearing and vision impairment. Cognitive training interventions underrepresent hearing and vision impairment.Sensory measurement and proper justification of exclusions are rarely reported.Interventions lack inclusion of accessibility and universal intervention design.More diverse study populations are needed in cognitive training interventions.Integration of accessibility into cognitive training intervention design is needed.

Approach-Bias Retraining and Other Training Interventions as Add-On in the Treatment of AUD Patients.

In the past two decades, a variety of cognitive training interventions have been developed to help people overcome their addictive behaviors. Conceptually, it is important to distinguish between programs in which reactions to addiction-relevant cues are trained (varieties of cognitive bias modification, CBM) and programs in which general abilities are trained such as working memory or mindfulness. CBM was first developed to study the hypothesized causal role in mental disorders: by directly manipulating the bias, it was investigated to what extent this influenced disorder-relevant behavior. In these proof-of-principle studies, the bias was temporarily modified in volunteers, either temporarily increased or decreased, with corresponding effects on behavior (e.g., beer consumption), in case the bias was successfully manipulated. In subsequent clinical randomized controlled trials (RCTs), training (away from the substance vs. sham training) was added to clinical treatment. These studies have demonstrated that CBM, as added to treatment, reduces relapse with a small effect of about 10% (similar effect size as for medication, with the strongest evidence for approach-bias modification). This has not been found for general ability training (e.g., working memory training), although effects on other psychological functions have been found (e.g., impulsivity). Mindfulness also has been found to help people overcome addictions, and different from CBM, also as stand-alone intervention. Research on (neuro-)cognitive mechanisms underlying approach-bias modification has pointed to a new perspective in which automatic inferences rather than associations are influenced by training, which has led to the development of a new variety of training: ABC training.

Prenatal affective cognitive training: A proof-of-concept study

Negatively biased cognitive response to infant stimuli during pregnancy is associated with increased postpartum depression (PPD) risk. This proof-of-concept study aimed to investigate the feasibility and effects of a two-week affective cognitive training intervention on cognitive responses to emotional infant stimuli for pregnant participants at risk of PPD. Forty-three participants were included: 23 ​at high risk and 22 ​at low risk of PPD. Cognitive response to emotional infant stimuli was assessed at baseline, immediately after the intervention and at a two-week follow-up for the intervention group (n ​= ​16) and twice over two weeks for the comparison group. The intervention was feasible, as 80% completed all sessions and gave positive feedback. The intervention group showed increased sensitivity to happy infant faces (p-values < 0.02, d ​> ​0.1), more infant-directed facial expressions (p ​< ​0.001, d ​= ​0.6), greater attention toward infant stimuli (p ​= ​0.04, d ​= ​0.2), and reduced negative reactivity to infant distress (p ​= ​0.01, d ​= ​2.6). The increased sensitivity to happy infant faces correlated with fewer depressive symptoms six months after birth (r = −0.59, p = 0.03). Interpretation of the results is limited by the lack of a high-risk control group and small sample size. Randomised controlled trials are now warranted to investigate whether the effects of prenatal affective cognitive training on affective cognitive response to infant stimuli confer reduced risk of PPD.

Treatment engagement in first-episode schizophrenia: Associations between intrinsic motivation and attendance during cognitive training and an aerobic exercise program

Systematic cognitive training and aerobic exercise programs have emerged as promising interventions to improve cognitive deficits in first-episode schizophrenia, with successful outcomes closely linked with greater treatment engagement (e.g., higher attendance and homework completion rates). Unfortunately, treatment disengagement from these services remains a persistent issue. Intrinsic motivation, or the willingness to exert effort because a task is inherently interesting or meaningful, has emerged as a promising malleable personal factor to enhance treatment engagement. This study investigated whether early task-specific intrinsic motivation and its domains (e.g., interest, perceived competence, and value) predicted treatment engagement within the context of intensive cognitive training and aerobic exercise interventions over a 6-month period. Thirty-nine participants with first-episode schizophrenia were administered baseline measures of task-specific intrinsic motivation inventories, one for cognitive training and one for exercise, and completed a 6-month randomized clinical trial comparing a neuroplasticity-based cognitive training plus aerobic exercise program against the same cognitive training alone. Results indicated that higher baseline scores of intrinsic motivation for cognitive training, specifically early perceptions of task interest and value, were predictive of greater cognitive training and exercise group attendance. Scores for exercise-specific intrinsic motivation were generally unrelated to indices of exercise participation, with the exception that the gain over time in perceived choice for exercise was linked with greater exercise homework completion and a similar directional tendency for greater in-clinic exercise attendance. This study provides support for monitoring and enhancing motivation early during service delivery to maximize engagement and the likelihood of successful treatment outcomes.

PSYCHOSOCIAL RESILIENCE, FAMILY SUPPORT, AND COGNITIVE STATUS: FROM EVIDENCE TO ACTION

Abstract Increasing evidence suggests the important role of social connections and family support in maintaining optimal cognitive status among older adults. This symposium includes four studies from China and the U.S with a focus on generating actionable evidence to inform the development of strategies that target psychosocial resilience and family support to promote cognitive health. Using data from the 2006, 2010, and 2014 waves of the Health and Retirement Study, the first study assessed the impact of social isolation on cognitive function, and how sleep disturbance mediated the association on cognitive decline. The study findings suggest addressing sleep disturbance might be a viable way to mitigate the negative effect of social isolation on cognitive function. Companion piece includes another HRS-based study that assessed the impact of loneliness on psychological resilience and cognitive health in later life. Findings from this study show loneliness is indirectly associated with baseline cognitive status and accelerated cognitive decline through deteriorating phycological resources. The third study used a prospective longitudinal design and applied group-based trajectory modeling to identify distinct family functions among 170 Chinese stroke survivors. Four family function trajectories were identified; healthy and stable family function was associated with better cognition and quality of life. Lastly, the fourth study aimed to use an experienced-based co-design approach to develop a cognitive training intervention to promote cognitive health in older Chinese immigrants in the U.S. This approach allows researchers to engage end-users early and to optimize the development of a culturally and linguistically relevant cognitive training intervention.

COGNITIVE TRAINING FOR OLDER CHINESE IMMIGRANTS IN THE US: AN EXPERIENCE-BASED CO-DESIGN APPROACH

Abstract Older Chinese Americans face many socioeconomic barriers including limited English proficiency, low educational levels, and limited access to care. These socioeconomic disadvantages not only contribute to an increased risk of developing dementia but also worsen inequitable access to effective strategies to promote cognitive health. Cognitive training is shown to be beneficial to maintain or enhance cognitive function. However, most prior interventions were tested exclusively in non-Hispanic Whites. To address this gap, we aim to adapt empirically supported cognitive training activities into a culturally and linguistically relevant mHealth cognitive training intervention. The adaptation process of the cognitive training includes focus groups (n=6/group) with older Chinese Americans (3 groups) and adult children (2 groups) to adapt cognitive training components to our target population. We will then organize an experience-based co-design workshop to further refine the intervention. Engaging end-users early will optimize the development of a culturally and linguistically relevant cognitive training intervention.

IMPROVING COGNITION IN OLDER CANCER SURVIVORS USING NONPHARMACOLOGIC INTERVENTIONS: A SYSTEMATIC REVIEW

Abstract Cancer-related cognitive dysfunction (CRCD) is a side-effect of chemotherapy, particularly among young and adult populations. Results indicate CRCD is also prevalent in older adult populations. While various non-pharmacological interventions for cognitive impairments have been studied in young cancer and older adult populations, limited information is available regarding non-pharmacologic interventions for older adults with cancer. The purpose of this systematic review is to describe the current non-pharmacologic interventions for CRCD in the older adult cancer population. Databases searched included PubMed, MEDLINE, CINAHL, and EMBASE. Articles meeting inclusion criteria were appraised by 2 reviewers independently. The Cochrane Risk of Bias Assessment was used to assess study quality. The search located 3441 articles; 4 met inclusion criteria. Cognitive domains assessed by included studies comprised executive function (n=2), attention (n=1), learning/memory (n=2), perceptual-motor (n=1), and a general measure of global cognitive function (n=3). Two studies used exercise interventions and 2 employed cognitive training interventions. One exercise intervention improved executive function, while attention and learning/memory improved following cognitive training. However, a limited number of studies utilizing non-pharmacological approaches for treating cognitive impairment in this population showed high methodological heterogeneity. Non-pharmacologic interventions demonstrated positive outcomes for CRCD, however, methodological concerns in the included studies prevented definitive recommendations from being made. Findings may guide additional studies needed in this field in order to make more robust conclusions.

Multi-method study of the implementation of Cognitive Symptom Management and Rehabilitation Training (CogSMART) in real-world settings

Cognitive Symptom Management and Rehabilitation Training (CogSMART) and Compensatory Cognitive Training (CCT) are evidence-based compensatory cognitive training interventions that improve cognition in persons with a history of traumatic brain injury or other neuropsychiatric disorders. Despite demonstrated efficacy, use and effectiveness of CogSMART/CCT in real-world settings is not known.We used a multi-method design to collect and analyze quantitative and qualitative survey data from several domains of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to gather information about use of CogSMART/CCT in real-world settings from provider and patient perspectives. Surveys were sent to email addresses from persons who registered on the CogSMART website seeking access to training manuals and other resources. Descriptive statistics were generated, and we used Natural Language Processing methods to study the self-report free responses. Using n-gram analysis, we identified the most frequently reported responses.We found CogSMART/CCT was broadly used in real-world settings and delivered by a variety of providers for several patient groups with high attendance and overall high satisfaction. CogSMART/CCT seemed to be offered in VA- or university-related clinics more than in private practice or rehabilitation centers. The diversity of providers and variety of formats by which to deliver CogSMART/CCT (i.e., individual, group, telehealth) seemed to play a role in its widespread implementation, as did its adaptability. Most providers made adaptations to the intervention that reduced the length or number of sessions. These changes were most likely to be based on client characteristics. The low rates of formal training, however, may have contributed to lower levels of perceived helpfulness among patients.Reach and Adoption of a cognitive rehabilitation intervention improved by increasing access to the manuals. Attention to characteristics of dissemination and implementation in the design of an intervention may enhance its use in real-world settings. The relevant outcomes, easy access to training manuals, and adaptability of CogSMART/CCT seem to have been important factors in its use in a variety of settings and for several disorders with cognitive impairment. The adoption of CogSMART/CCT by a variety of providers other than neuropsychologists suggests its use may be broadened to other healthcare providers, if adequately trained, to increase access to an intervention with demonstrated efficacy for cognitive rehabilitation for several neuropsychiatric disorders.