Design and development of a gamified cognitive training program targeting executive functions for older adults

BackgroundUsing the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, we outline steps taken to implement an evidence-based cognitive training program, Club Connect, in older adults with major depressive disorder in an Older People’s Mental Health Service in Sydney, Australia. The primary aim was to explore feasibility (or ‘reach’), tolerability (or ‘implementation’), and acceptability (or ‘adoption’). The secondary aim was to explore the most sensitive clinical outcomes and measurement tools (i.e. ‘effectiveness’) to inform a formal randomised controlled trial, and to explore the healthcare resources used (i.e. costs) to assist decision-making by health care managers and policy-makers in relation to future resource allocation.MethodsUsing a single blinded feasibility design, 40 participants (mean age: 76.13 years, SD: 7.45, range: 65–95 years) were randomised to either (a) Club Connect, a 10-week group-based multifaceted program, comprising psychoeducation and computer-based cognitive training, or (b) a waitlist control group.ResultsImplementing group-based cognitive training within a clinical setting was feasible, well tolerated and accepted by participants. Further, cognitive training, in comparison to the waiting list control, was associated with moderate to very large effect size improvements in depression, stress and inhibition (ηp2 = 0.115–0.209). We also found moderate effect size improvements on measures of daily functioning, wellbeing and cognitive flexibility. Small effect size improvements for other cognitive and psychosocial outcomes were also observed. The average cost per person participating in in the intervention was AU$607.50.ConclusionsOur findings support the feasibility of implementing group-based cognitive training into a specialised clinical (public health) setting. This trial was registered on the Australian and New Zealand Clinical Trial Registry (ACTRN12619000195156, 12/02/2019).

<sec> <title>BACKGROUND</title> Cognitive decline in the aging population presents an unprecedented challenge worldwide. Recent research has shown the potential of cognitive training programs to mitigate cognitive decline. However, these interventions require sustained adherence to be effective, which can be challenging. </sec> <sec> <title>OBJECTIVE</title> In this study, we aim to enhance the accuracy of predicting adherence patterns in cognitive training programs for older adults, with the goal of developing personalized support systems that promote adherence and improve cognitive outcomes. </sec> <sec> <title>METHODS</title> A major challenge in developing deep neural networks for predicting adherence patterns is the limited availability of individual participants’ training data. Although domain adaptation techniques can address this issue by leveraging training data from other clinical studies, our research considers a more practical scenario where the use of such data from other studies is restricted due to privacy and confidentiality concerns. Therefore, we used source-free domain adaptation (SFDA), which uses models trained on other cognitive studies without requiring access to the corresponding datasets. To the best of our knowledge, this is the first effort to use SFDA to predict older adults’ daily adherence to cognitive training programs. </sec> <sec> <title>RESULTS</title> Using data from 3 previously conducted cognitive training intervention studies, our results demonstrated the efficacy of deep learning models combined with SFDA to accurately predict adherence lapses while addressing data privacy concerns. </sec> <sec> <title>CONCLUSIONS</title> Our findings indicate that deep learning and SFDA techniques can be useful in the development of adherence support systems for computerized cognitive training, aimed at improving the health and well-being of older adults. </sec>

Purpose: To demonstrate the effectiveness and value of a home-based information communication technology (ICT) training program for older adults. Methods: Thirteen older adults were provided in-home ICT training by graduate occupational therapy students using an iPad. The breadth and frequency of ICT use, perspectives on technology, and perceived independence were recorded at baseline, during the 3-month training and at follow-up, along with an end-of-study questionnaire. Non-parametric Friedman analysis was conducted to verify trends in the outcome measures. The qualitative data were examined by content analysis. Results: Participants’ breadth of ICT activities showed a significant trend across 6 months. Leisure accounted for the significant increase, while health management and social connections activities increased modestly. A positive trend in participants’ perspectives on technology was evident along with a marginal increase in perceived independence. Participants’ perspectives were thematically categorized as technology experiences, interactions with coach, training approach, and specific activities. As reflection of the training program’s value, 12 of the 13 participants took ownership of the iPad at the end of the study. Conclusion: Building capacity of older adults to utilize the multifaceted potential of ICT is critical in addressing declines in health, impending disabilities, and social isolation.Implications for RehabilitationA one-on-one home-based individualized information communication technology (ICT) training program for older adults could result in a progressive increase in the breadth of online activities carried out by them.Specifically, the increase in their usage of ICT could be expected in leisure-based online activities.Individualized training programs designed based on needs, priorities, and learning style of older adults could have a positive impact on their technological perspectives and intrinsic motivation to adopt ICT.

C-01 An Evaluative Study of a Cognitive Training Program on Cognitive Outcomes in Older Adults with Moderate to Severe Cognitive Impairment

Modulating fluid intelligence performance through combined cognitive training and brain stimulation

One modifiable risk factor of dementia is cognitive inactivity. Given cognitive ability is closely tied to continual performance of instrumental activities of daily living, cognitive training programs continue to be explored as a way to boost cognition and allow older adults to remain independent longer. While the efficacy of cognitive training is controversial, identifying activities older adults are willing to limit in exchange for cognitive training provides valuable information in relation to designing cognitive training programs that appeal to older adults. Using a qualitative approach, this study highlights activities older adults (ages 64+) noted as contributing to decreased gameplay of a cognitive training program on a tablet device. We found that respondents (61%) noted playing less as a result of entertainment activities (i.e., reading and playing games), social activities (31%) and travel (27%). Findings have implications for device form factor in administering cognitive training and other programs.

Cognitive training for older adults varies in efficacy, but it is unclear why some older adults benefit more than others. Positive affective experience (PAE), referring to high positive valence and/or stable arousal states across everyday scenarios, and associated functional networks can protect plasticity mechanisms against Alzheimer’s disease neurodegeneration, which may contribute to training outcome variability. The objective of this study is to investigate whether PAE explains variability in cognitive training outcomes by disrupting the adverse effect of neurodegeneration on plasticity. The study’s design is a secondary analysis of a randomized control trial of cognitive training with concurrent real or sham brain stimulation (39 older adults with mild cognitive impairment; mean age, 71). Moderation analyses, with change in episodic memory or executive function as the outcome, PAE or baseline resting-state connectivity as the moderator and baseline neurodegeneration as the predictor are the methods used in the study. The result of the study is that PAE stability and baseline default mode network (DMN) connectivity disrupted the effect of neurodegeneration on plasticity in executive function but not episodic memory. The study concludes that PAE stability and degree of DMN integrity both explained cognitive training outcome variability, by reducing the adverse effect of neurodegeneration on cognitive plasticity. We highlight the need to account for PAE, brain aging factors and their interactions with plasticity in cognitive training.

Effects of aerobic exercise on executive function of healthy middle-aged and older adults: A systematic review and meta-analysis

Objective24-h activity encompasses four categories: light-intensity physical activity (LPA), moderate-to-vigorous-intensity physical activity (MVPA), sedentary behavior (SB), and sleep (SP). This study aims to investigate the effects of different physical activity components on executive function in older adults with chronic diseases and to examine substitution effects among activity components. The findings provide scientific evidence to inform physical activity interventions for improving executive function in older adults with chronic diseases.MethodsA total of 105 older adults (72.64 ± 6.82 years) were recruited. Following questionnaire screening, 75 older adults with chronic diseases were ultimately included. Accelerometers objectively measured participants’ daily SP, SB, LPA, and MVPA. Executive function was objectively assessed using the Stroop task, N-back task, and More-odd-shifting task. Component linear regression equation assessed the relationship between different activities and executive function in older adults with chronic diseases. The dose–response effects of “one-for-one” substitutions between different activity behaviors were explored.ResultsComponent linear regression results showed that SB positively correlated with inhibitory control (β = 0.892, 95% CI = 0.044 to 1.741) and working memory (β = 1.610, 95% CI = 0.801 to 2.420). MVPA was negatively correlated with inhibitory control (β = −0.596, 95% CI = −1.156 to −0.036), while LPA was negatively correlated with working memory (β = −0.969, 95% CI = −1.812 to −0.127). No significant association with cognitive flexibility was found (p > 0.05). Isotemporal substitution results showed that for inhibitory control, replacing SB with SP for 30 min reduced z-scores by 0.068; replacing SB with MVPA for 30 min reduced z-scores by 0.285. For working memory, replacing SB with LPA every 30 min resulted in a z-score decrease of 0.152. Dose–response curves indicated that progressively increasing the proportion of time spent in SP and MVPA improved inhibitory control, while increasing LPA enhanced working memory.ConclusionSP and MVPA significantly improve inhibitory control in older adults with chronic diseases, while LPA significantly enhances their working memory. It is recommended that older adults with chronic diseases adjust their daily time structure by increasing diverse physical activities, ensuring adequate sleep duration, and reducing sedentary behavior to improve executive function.

BackgroundADHD is associated with deficits in executive functions. Cognitive training is a promising nonpharmacological intervention for ADHD, however, there is insufficient evidence to guide the selection of training for individuals with ADHD. This pilot study aims to investigate the efficacy of executive function training targeting key executive dysfunctions in ADHD, compared with general executive function training which targets other executive functions.MethodsA total of 127 subjects (6–12 years) diagnosed with ADHD were allocated to receive one of two different cognitive trainings. ADHD symptoms and cognitive functions were evaluated using parent-rated scales and CANTAB cognitive assessments. All participants were required to complete 48 training sessions within a two-month period.Results94 out of 127 children completed the required training and assessments. Both ADHD executive function training group and general executive function training group showed significant improvement in ADHD symptoms on the ADHD Rating Scale and in executive function on the assessment of CANTAB. There was no significant difference in improvements between the two groups. Subgroup analysis suggested that children who had ADHD-RS total scores less than or equal to 28 at baseline showed greater improvement following ADHD executive function training.ConclusionsThis study indicates that cognitive training can improve ADHD symptoms and executive function, with no difference in efficacy between targeted and generalized cognitive training. In addition, individuals with lower symptom severity may benefit more from training targeting key ADHD executive dysfunctions.

BackgroundPrevious research investigating exercise as a means of falls prevention in older adults has shown mixed results. Lack of specificity of the intervention may be an important factor contributing to negative results. Change-in-support (CIS) balance reactions, which involve very rapid stepping or grasping movements of the limbs, play a critical role in preventing falls; hence, a training program that improves ability to execute effective CIS reactions could potentially have a profound effect in reducing risk of falling. This paper describes: 1) the development of a perturbation-based balance training program that targets specific previously-reported age-related impairments in CIS reactions, and 2) a study protocol to evaluate the efficacy of this new training program.Methods/DesignThe training program involves use of unpredictable, multi-directional moving-platform perturbations to evoke stepping and grasping reactions. Perturbation magnitude is gradually increased over the course of the 6-week program, and concurrent cognitive and movement tasks are included during later sessions. The program was developed in accordance with well-established principles of motor learning, such as individualisation, specificity, overload, adaptation-progression and variability. Specific goals are to reduce the frequency of multiple-step responses, reduce the frequency of collisions between the stepping foot and stance leg, and increase the speed of grasping reactions. A randomised control trial will be performed to evaluate the efficacy of the training program. A total of 30 community-dwelling older adults (age 64–80) with a recent history of instability or falling will be assigned to either the perturbation-based training or a control group (flexibility/relaxation training), using a stratified randomisation that controls for gender, age and baseline stepping/grasping performance. CIS reactions will be tested immediately before and after the six weeks of training, using platform perturbations as well as a distinctly different method of perturbation (waist pulls) in order to evaluate the generalisability of the training effects.DiscussionThis study will determine whether perturbation-based balance training can help to reverse specific age-related impairments in balance-recovery reactions. These results will help to guide the development of more effective falls prevention programs, which may ultimately lead to reduced health-care costs and enhanced mobility, independence and quality of life.

Psychosocial stress and physical, cognitive, and social activity predict the risk of cognitive decline and dementia. The aim of this study was to elucidate brain-derived neurotrophic factor (BDNF), irisin, and the kynurenine pathway (KP) as potential underlying biological correlates. We evaluated associations of irisin and the KP with BDNF in serum and with cognition, stress, and activities. Furthermore, changes in serum concentrations of BDNF, irisin, and KP metabolites were investigated after physical or cognitive training. Forty-seven older adults at risk of dementia were assigned to 10 weeks of physical training, cognitive training, or await-list control condition. Previous physical, cognitive, and social activities and stressful life events were recorded; global cognition, episodic memory, and executive functions were assessed. Serum levels of L-kynurenine, kynurenic acid, 3-hydroxykynurenine (3-HK), and quinolinic acid (QUIN) were determined by validated assays based on liquid chromatography coupled to tandem mass spectrometry. BDNF and irisin serum levels were determined with enzyme-linked immunosorbent assays. BDNF and irisin correlated positively with global cognition and episodic memory, while the neurotoxic metabolite QUIN correlated negatively with executive functions. Stressful life events were associated with reduced BDNF and increased 3-HK. 3-HK decreased after cognitive training, while BDNF tended to increase after physical training. This suggests that psychosocial stress as well as cognitive and physical training may impact BDNF serum levels and the KP. Irisin and QUIN may constitute novel serum biomarkers of cognitive impairment, in addition to BDNF. Larger scale trials are needed to replicate and extend these novel findings.

Background and Objective: Aging is associated with a decline in attentional and executive abilities, which are linked to physiological, structural, and functional brain changes. A variety of novel non-invasive brain stimulation methods have been probed in terms of their neuroenhancement efficacy in the last decade; one that holds significant promise is transcranial random noise stimulation (tRNS) that delivers an alternate current at random amplitude and frequency. The aim of this study was to investigate whether repeated sessions of tRNS applied as an add-on to cognitive training (CT) may induce long-term near and far transfer cognitive improvements.Methods: In this sham-controlled, randomized, double-blinded study forty-two older adults (age range 60–86 years) were randomly assigned to one of three intervention groups that received 20 min of 0.705 mA tRNS (N = 14), 1 mA tRNS (N = 14), or sham tRNS (N = 19) combined with 30 min of CT of executive functions (cognitive flexibility, inhibitory control, working memory). tRNS was applied bilaterally over the dorsolateral prefrontal cortices for five sessions. The primary outcome (non-verbal logical reasoning) and other cognitive functions (attention, memory, executive functions) were assessed before and after the intervention and at a 1-month follow-up.Results: Non-verbal logical reasoning, inhibitory control and reaction time improved significantly over time, but stimulation did not differentially affect this improvement. These changes occurred during CT, while no further improvement was observed during follow-up. Performance change in logical reasoning was significantly correlated with age in the group receiving 1 mA tRNS, indicating that older participants profited more from tRNS than younger participants. Performance change in non-verbal working memory was significantly correlated with age in the group receiving sham tRNS, indicating that in contrast to active tRNS, older participants in the sham group declined more than younger participants.Interpretation: CT induced cognitive improvements in all treatment groups, but tRNS did not modulate most of these cognitive improvements. However, the effect of tRNS depended on age in some cognitive functions. We discuss possible explanations leading to this result that can help to improve the design of future neuroenhancement studies in older populations.

Interest in cognitive training for healthy older adults to reduce cognitive decline has grown considerably over the past few decades. Given the shift toward a more diverse society, the purpose of this review is to examine the extent of race/ethnic minority participation in cognitive training studies and characteristics of studies that included race/ethnic minority participants. This review considered peer-reviewed studies reporting cognitive training studies for cognitively healthy, community-dwelling older adults (age 55+) in the United States published in English before December 31, 2015. A total of 31 articles published between 1986 and 2015 meeting inclusion criteria were identified and included in the review. A total of 6,432 participants were recruited across all of the studies, and ranged in age from 55 to 99 years. Across all studies examined, 39% reported racial/ethnic background information. Only 3 of these studies included a substantial number of minorities (26.7% in the ACTIVE study; 28.4% in the SeniorWISE study; 22.7% in the TEAM study). Race/ethnic minority older adults were disproportionately underrepresented in cognitive training studies. Further research should aim to enroll participants representative of various race/ethnic minority populations. Strategies for recruitment and retention of ethnic minority participants in cognitive training research are discussed, which could lead to the development of more culturally appropriate and perhaps more effective cognitive interventions.

L’entraînement de la mémoire de travail est-il bénéfique pour les enfants présentant un trouble déficit de l’attention/hyperactivité ?