Enhancing Cognitive Functioning in Healthly Older Adults: a Systematic Review of the Clinical Significance of Commercially Available Computerized Cognitive Training in Preventing Cognitive Decline

Successfully assisting older adults to maintain or improve cognitive function, particularly when they are dealing with neurodegenerative disorders such as Alzheimer’s disease (AD), remains a major challenge. Cognitive training may stimulate neuroplasticity thereby increasing cognitive and brain reserve. Commercial brain training programs are computerized, readily-available, easy-to-administer and adaptive but often lack supportive data and their clinical validation literature has not been previously reviewed. Therefore, in this review, we report the characteristics of commercially available brain training programs, critically assess the number and quality of studies evaluating the empirical evidence of these programs for promoting brain health in healthy older adults, and discuss underlying causal mechanisms. We searched PubMed, Google Scholar and each program’s website for relevant studies reporting the effects of computerized cognitive training on cognitively healthy older adults. The evidence for each program was assessed via the number and quality (PEDro score) of studies, including Randomized Control Trials (RCTs). Programs with clinical studies were subsequently classified as possessing Level I, II or III evidence. Out of 18 identified programs, 7 programs were investigated in 26 studies including follow-ups. Two programs were identified as possessing Level I evidence, three programs demonstrated Level II evidence and an additional two programs demonstrated Level III evidence. Overall, studies showed generally high methodological quality (average PEDro score?=?7.05). Although caution must be taken regarding any potential bias due to selective reporting, current evidence supports that at least some commercially available computerized brain training products can assist in promoting healthy brain aging.     

Crosswords to Computers: A Critical Review of Popular Approaches to Cognitive Enhancement

Cognitive enhancement strategies have gained recent popularity and have the potential to benefit clinical and non-clinical populations. As technology advances and the number of cognitively healthy adults seeking methods of improving or preserving cognitive functioning grows, the role of electronic (e.g., computer and video game based) cognitive training becomes more relevant and warrants greater scientific scrutiny. This paper serves as a critical review of empirical evaluations of publically available electronic cognitive training programs. Many studies have found that electronic training approaches result in significant improvements in trained cognitive tasks. Fewer studies have demonstrated improvements in untrained tasks within the trained cognitive domain, non-trained cognitive domains, or on measures of everyday function. Successful cognitive training programs will elicit effects that generalize to untrained, practical tasks for extended periods of time. Unfortunately, many studies of electronic cognitive training programs are hindered by methodological limitations such as lack of an adequate control group, long-term follow-up and ecologically valid outcome measures. Despite these limitations, evidence suggests that computerized cognitive training has the potential to positively impact one’s sense of social connectivity and self-efficacy.     

Control beliefs and susceptibility to the promises of memory improvement

Brain training is increasingly popular, and many believe in the efficacy of such programs without empirical evidence. We examined whether instructions promising memory improvement would influence subjective and objective cognition. Participants (n = 145; age: M = 50.64) were randomly assigned to a memory improvement or memory task condition. Participants completed demographic and perceived control over cognition measures, in addition to cognitive tasks and subjective cognition items for 7 days. Participants in the improvement condition reported significantly greater memory increases than those in the memory task condition. This effect was moderated by perceived control over cognition; participants in the improvement condition with high control beliefs were significantly more likely than those with low control beliefs or those in the task condition to report better memory. Individuals with higher control beliefs may be more susceptible to the claims of brain training programs, which is significant given that such programs are increasingly popular and commercially available.     

Behavioural and ERP Effects of Cognitive and Combined Cognitive and Physical Training on Working Memory and Executive Function in Healthy Older Adults

Cognitive and physical training have been shown to be effective in improving older adults’ cognition. However, it is not yet clear whether combined cognitive and physical training offers an advantage compared to cognitive training alone. Twenty-two older adults performed cognitive or combined cognitive and physical training in order to compare their effects on working memory event-related potentials (ERPs) and on working memory and executive function performance. Before and after eight weeks of training, performance in Plus Minus, Flanker, Updated Span, and Complex Span tasks was measured, and ERPs were registered during performance of an n-back task (0-back, 2-back, and 3-back). Post-training behavioural improvement was observed in Updated Span, Complex Span, and n-back tasks. During the n-back task, the N2/P3 complex was modulated by training, with a decrease in N2 amplitude and an increase in P3 amplitude in the posttraining session compared to the pretraining session. These changes in ERP components suggest that both types of training potentially reduce the need for attentional control to perform the tasks correctly and increase working memory capacity. Thus, based on our data, no conclusion can be reached on the direct advantage of combined training, either at behavioural or at neural level. However, the present study might suggest an indirect advantage of such a combined training, because the cognitive benefit was found to be highly similar in both types of training. Using combined cognitive and physical training may produce a potential improvement in general fitness and an increased appeal of training.     

Memory rehabilitation for older adults: preserving independent living / Rehabilitación de la memoria para adultos mayores: preservación de la autonomía de vida

Abstract

Episodic memory problems are the hallmark of cognitive ageing in normal elderly people. Learning of new material is worse in pathological cognitive ageing, such as dementia and its preliminary states (mild cognitive impairment). Because episodic learning is crucial to preserve independent living in the elderly, rehabilitation programmes for everyday memory problems are welcomed. The scope of scientific interest has switched from treatment to prevention. We claim that lifestyle interventions are the most direct way to preserve cognition. We summarize evidence for changes in nutrition and exercise. In addition, psychological interventions for elderly people with normal or pathological cognitive ageing are available. Recent meta-analyses found lacking evidence of transfer to everyday life and long-term effects. We critically assess these meta-analyses. We propose theoretically derived experimental interventions relying on spared learning mechanisms. As an example we report visual-imagery training showing positive effects in a randomized control trial, using individual memory diaries on memory improvement.     

Effects of motor-cognitive coordination training and cardiovascular training on motor coordination and cognitive functions

ObjectivesNumerous recent studies showed that physical training can enhance cognitive abilities, such as attention, spatial ability, memory performance, and executive functions. However, most of these studies focused on the efficiency of cardiovascular training, whereas evidence for combined motor-cognitive training emphasizing coordination abilities is scarce. Therefore, the aim of the present study was to investigate the effects of motor-cognitive coordination training and moderate cardiovascular training on cognitive functions and to test whether these effects were related to participant's fitness level.Design and methodWe tested 50 physically active (mean age = 23.5 years, SD = 3.2) and 56 sedentary participants (mean age = 23.4 years, SD = 3.2) in a pretest-training-posttest design with 12 sessions of moderate cardiovascular training (≈60% HRmax) or motor-cognitive coordination training. The training groups were compared to a passive control group. At pretest and posttest, participants performed an untrained motor-cognitive coordination task, measures of executive control (cognitive flexibility, inhibition, working memory), spatial ability, and fluid intelligence.Results and conclusionsWe found improved coordination abilities in the coordination training group, but no transfer of training to cognitive measures in physically active participants. However, sedentary participants showed larger improvements in terms of inhibition in the coordination training group compared to the remaining groups, while the cardiovascular training group improved in cognitive flexibility compared to the remaining groups. In sum, there are positive but differential effects of cardiovascular training and coordination training on cognitive performance in sedentary young participants, suggesting that coordination training may be a useful intervention especially for individuals that cannot perform cardiovascular training.     

Selling points: What cognitive abilities are tapped by casual video games?

The idea that video games or computer-based applications can improve cognitive function has led to a proliferation of programs claiming to “train the brain.” However, there is often little scientific basis in the development of commercial training programs, and many research-based programs yield inconsistent or weak results. In this study, we sought to better understand the nature of cognitive abilities tapped by casual video games and thus reflect on their potential as a training tool. A moderately large sample of participants (n = 209) played 20 web-based casual games and performed a battery of cognitive tasks. We used cognitive task analysis and multivariate statistical techniques to characterize the relationships between performance metrics. We validated the cognitive abilities measured in the task battery, examined a task analysis-based categorization of the casual games, and then characterized the relationship between game and task performance. We found that games categorized to tap working memory and reasoning were robustly related to performance on working memory and fluid intelligence tasks, with fluid intelligence best predicting scores on working memory and reasoning games. We discuss these results in the context of overlap in cognitive processes engaged by the cognitive tasks and casual games, and within the context of assessing near and far transfer. While this is not a training study, these findings provide a methodology to assess the validity of using certain games as training and assessment devices for specific cognitive abilities, and shed light on the mixed transfer results in the computer-based training literature. Moreover, the results can inform design of a more theoretically-driven and methodologically-sound cognitive training program.     

视频游戏对认知能力的影响及其神经基础

视频游戏是一类需要借助视听设备并基于一定剧情进行操作的游戏。先前研究大多关注暴力视频游戏对攻击等负面行为的影响,但本文着重探讨视频游戏对个体认知能力的积极影响及内在神经基础,以辩证看待视频游戏对个体心理和行为的作用。本文对前人研究归纳梳理发现,视频游戏训练能使个体认知能力得到持久改善,同时论述了视频游戏中脑神经基础和奖赏预期对认知能力的调控作用。未来研究应在规范视频游戏训练技术的基础上,用其干预靶脑区以提升个体特定脑功能。     

音乐训练对统计学习能力的促进作用

统计学习能力作为快速习得环境中信息规则的先决条件之一,有助于个体以较小的消耗代价适应环境。音乐训练作为一种由多个感官共同参与的强化活动,被广泛认为是有助于提升认知能力的有效手段。随着统计学习在音乐适应中核心地位的确认以及音乐训练效应的反复验证,近年来,陆续有研究在行为表现和脑机制上证实了音乐训练能够增强个体对输入信息中统计规则的敏感性、促进听觉统计学习能力的提升。然而,关于音乐训练能否促进视觉等其他模态的统计学习能力,目前还存在不一致的结果。未来研究还应对跨模态统计学习能力的音乐训练促进效应做进一步探索;也可选用新手被试进行音乐训练干预,以明确音乐训练与各模态统计学习能力增强之间的因果关系。     

Training attentional control and working memory – Is younger,better?

Authors have argued that various forms of interventions may be more effective in younger children. Is cognitive training also more effective, the earlier the training is applied? We review evidence suggesting that functional neural networks, including those subserving attentional control, may be more unspecialised and undifferentiated earlier in development. We also discuss evidence suggesting that certain skills such as attentional control may be important as ‘hub’ cognitive domains, gating the subsequent acquisition of skills in other areas. Both of these factors suggest that attentional training administered to younger individuals ought to be relatively more effective in improving cognitive functioning across domains. We evaluate studies that have administered forms of cognitive training targeting various subcomponents of attention and the closely related domain of working memory, and we contrast their reported transfer to distal cognitive domains as a function of the age of the participants. Although negative findings continue to be common in this literature we find that cognitive training applied to younger individuals tends to lead to significantly more widespread transfer of training effects. We conclude that future work in this area should concentrate on understanding early intensive training, and discuss a number of practical steps that might help to achieve this aim.     

Metacognitive scaffolding boosts cognitive and neural benefits following executive attention training in children

Interventions including social scaffolding and metacognitive strategies have been used in educational settings to promote cognition. In addition, increasing evidence shows that computerized process‐based training enhances cognitive skills. However, no prior studies have examined the effect of combining these two training strategies. The goal of this study was to test the combined effect of metacognitive scaffolding and computer‐based training of executive attention in a sample of typically developing preschoolers at the cognitive and brain levels. Compared to children in the regular training protocol and an untrained active control group, children in the metacognitive group showed larger gains on intelligence and significant increases on an electrophysiological index associated with conflict processing. Moreover, changes in the conflict‐related brain activity predicted gains in intelligence in the metacognitive scaffolding group. These results suggest that metacognitive scaffolding boosts the influence of process‐based training on cognitive efficiency and brain plasticity related to executive attention.     

Cognitive training programs for childhood cancer patients and survivors: A critical review and future directions

A robust literature has developed documenting neurocognitive late effects in survivors of leukemia and central nervous system (CNS) tumors, the most frequent cancer diagnoses of childhood. Patterns of late effects include deficits in attention and concentration, working memory, processing speed, and executive function, as well as other domains. As childhood cancer survivors are living longer, ameliorating deficits both in broad and specific neurocognitive domains has been increasingly recognized as an endeavor of paramount importance. Interventions to improve cognitive functioning were first applied to the field of pediatric oncology in the 1990s, based on strategies used effectively with adults who had sustained a traumatic brain injury (TBI). Compilation and modification of these techniques has led to the development of structured cognitive training programs, with the effectiveness and feasibility of such interventions currently an active area of research. Consequently, the purpose of this critical review is to: (1) review cognitive training programs intended to remediate or prevent neurocognitive deficits in pediatric cancer patients and survivors, (2) critically analyze training program strengths and weaknesses to inform practice, and (3) provide recommendations for future directions of clinical care and research.     

Cognitive effects of MBSR/MBCT: A systematic review of neuropsychological outcomes

Mindfulness is theorised to improve attention regulation and other cognitive processes. This systematic review examines whether 8-week standardised and manualised mindfulness training programs such as Mindfulness Based Cognitive Therapy (MBCT) and Mindfulness Based Stress Reduction (MBSR) enhances attention, memory and executive function abilities measured by objective neuropsychological tests. Seven databases were searched resulting in 18 studies meeting inclusion criteria for review. Overall studies did not support attention or executive function improvements. We found preliminary evidence for improvements in working memory and autobiographical memory as well as cognitive flexibility and meta-awareness. Short-term mindfulness meditation training did not enhance theorised attentional pathways. Results call into question the theoretical underpinnings of mindfulness, further highlighting the need for a comprehensive theoretical framework.     

Who benefits from memory training?

Cognitive training programs can have significant benefits. However, their efficacy is often reduced for individuals of advanced age or lower cognitive ability. Using older adult subjects, we examined the role of self-initiation of cognitive control in a training program that targets recollection memory. Relative time spent on an open-ended, intentional encoding task that requires the self-initiation of cognitive control was highly predictive of improvement in the training task, and fully accounted for individual differences related to age and crystallized intelligence. Analyzing training programs from the perspective of cognitive theory may help clarify how these programs have their effects and suggest ways to optimize such programs for the individuals who need them most.     

工作记忆训练及对数学能力的迁移作用

工作记忆缺陷会影响个体数学能力发展。通过记忆策略、广度、刷新、转换等功能的工作记忆训练,可以改善个体认知功能。然而,工作记忆训练对个体的阅读、数学、流体智力等方面的远迁移效果并不一致。研究表明,工作记忆训练可以改善数感、视觉空间能力、推理能力等数学一般技能;也会通过改善语音工作记忆以及空间能力促进数学计算能力,或者通过改善中央执行系统,提升数学问题表征、模式识别、解题迁移、策略选择等复杂的过程,从而促进数学问题解决能力。因此,区分不同数学任务的认知过程,可以获得工作记忆训练对数学能力迁移效果的进一步证据。今后,神经影像学的证据或许也是未来工作记忆训练对数学能力提高的又一佐证。     

工作记忆训练对药物成瘾者认知功能的改善及其机制

对处于戒断期的各类药物成瘾群体进行认知训练，训练后药物成瘾个体认知能力得到改善，成瘾症状也得到了一定缓解。认知训练能够加速药物成瘾者大脑受损区域的自发性恢复，尤其是使影响个体抑制控制能力的中脑边缘多巴胺系统和前额叶系统发生功能性和结构性的积极变化，实现药物成瘾个体高级认知能力的改善。今后可以从不同类别的药物成瘾是否全部具有可逆性，设置的认知训练任务能否起到改善认知能力的效果，药物成瘾个体训练的性别差异以及训练效果的保持时间等角度进行研究。     

Short-term music training enhances verbal intelligence and executive function

Researchers have designed training methods that can be used to improve mental health and to test the efficacy of education programs. However, few studies have demonstrated broad transfer from such training to performance on untrained cognitive activities. Here we report the effects of two interactive computerized training programs developed for preschool children: one for music and one for visual art. After only 20 days of training, only children in the music group exhibited enhanced performance on a measure of verbal intelligence, with 90% of the sample showing this improvement. These improvements in verbal intelligence were positively correlated with changes in functional brain plasticity during an executive-function task. Our findings demonstrate that transfer of a high-level cognitive skill is possible in early childhood.     

Are there pre-existing neural, cognitive, or motoric markers for musical ability?

Adult musician's brains show structural enlargements, but it is not known whether these are inborn or a consequence of long-term training. In addition, music training in childhood has been shown to have positive effects on visual-spatial and verbal outcomes. However, it is not known whether pre-existing advantages in these skills are found in children who choose to study a musical instrument nor is it known whether there are pre-existing associations between music and any of these outcome measures that could help explain the training effects. To answer these questions, we compared 5- to 7-year-olds beginning piano or string lessons (n=39) with 5- to 7-year-olds not beginning instrumental training (n=31). All children received a series of tests (visual-spatial, non-verbal reasoning, verbal, motor, and musical) and underwent magnetic resonance imaging. We found no pre-existing neural, cognitive, motor, or musical differences between groups and no correlations (after correction for multiple analyses) between music perceptual skills and any brain or visual-spatial measures. However, correlations were found between music perceptual skills and both non-verbal reasoning and phonemic awareness. Such pre-existing correlations suggest similarities in auditory and visual pattern recognition as well a sharing of the neural substrates for language and music processing, most likely due to innate abilities or implicit learning during early development. This baseline study lays the groundwork for an ongoing longitudinal study addressing the effects of intensive musical training on brain and cognitive development, and making it possible to look retroactively at the brain and cognitive development of those children who emerge showing exceptional musical talent.     

Does cognitive flexibility training enhance subjective mental functioning in healthy older adults?

Declining cognitive abilities in older adults can contribute to significant changes in socioemotional health and substantially reduce their perception of well-being. Whereas much attention has been dedicated to creating cognitive training programs to improve cognitive health in old age, there is little emphasis on the consequences of such interventions for subjective mental functioning. We created a randomized controlled trial in which we evaluated the effects of an adaptive computerized cognitive flexibility training. Healthy older adults (60–80 years old) were assigned to one of three conditions (frequent or infrequent switching or active control group) and performed 58 half-hour sessions within a period of 12 weeks. We measured effects on subjective cognitive failures and executive dysfunctioning, everyday functioning, depressive symptoms, anxiety, and quality of life, before, and after training. Additionally, participants’ proxies rated their cognitive failures and executive dysfunctioning. Subjective cognitive failures and executive dysfunctioning improved 4 weeks posttraining in all groups, although effect sizes were low (?_p² = .058 and .079, respectively) and there were no differences between groups (all p’s > .38). No significant changes in subjective reports were seen directly after training, which was the case in all groups. Proxies did not report any functional changes over time, yet their evaluations were significantly more favorable than those of the participants, both pretraining (p < .0005) and posttraining (p = .004). Although we found no evidence of improvement on subjective mental functioning, we adduce several factors that encourage further research into the effects of computerized cognitive training on subjective performance.     

Grounding: it’s (probably) all in the head

In this paper we provide a psychological explanation for ‘grounding observations’—observations that are thought to provide evidence that there exists a relation of ground. Our explanation does not appeal to the presence of any such relation. Instead, it appeals to certain evolved cognitive mechanisms, along with the traditional modal relations of supervenience, necessitation and entailment. We then consider what, if any, metaphysical conclusions we can draw from the obtaining of such an explanation, and, in particular, if it tells us anything about whether we ought to posit a relation of ground.