training

Brain training helps cognitive decline in many cancer survivors

November, 2012

A pilot study found that both training in memory strategies and processing speed training had significant benefits for breast cancer survivors with concerns about their memory and cognition.

Cancer survivors who underwent chemotherapy often suffer long-term cognitive problems. Until now, most research has been occupied with establishing that this is in fact the case, and studies investigating how to help have been rare. I recently reported on studies suggesting that help with sleep problems and stress can be beneficial. It has also been suggested that exercise can help. None of these suggestions are special to cancer survivors (although cancer survivors may well be one of several groups that derive particular benefit). Similarly, a new study investigates another familiar approach to improving cognitive decline.

The pilot study involved 82 post-menopausal breast cancer survivors (average age 56) who had received chemotherapy and who were worried about their cognitive abilities. The women were randomly assigned to one of three groups: one group received memory training adapted from the ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly) trial; another received processing speed training using Posit Science’s Insight program (commercially available); the third was a wait-listed control group.

Training consisted of ten 1-hour small-group (3-5 people) sessions over 6-8 weeks. Memory training involved learning strategies and applying them to word lists, sequences, and texts. Strategies included mnemonic techniques, as well as instruction in principles of meaningfulness, organization, visualization, and association. Strategies were taught and practiced in the first five sessions, and further practiced in the remaining sessions.

In the Insight program, stimulus duration is progressively shortened during a series of progressively more difficult information-processing tasks, such as time-order judgment, discrimination, spatial-match, forward-span, instruction-following, and narrative-memory tasks. Exercises automatically adjust to maintain an 85% correct rate.

Both programs proved beneficial. The memory training group showed significant improvement in immediate and delayed memory, which was maintained at the two-month follow-up. There was of course individual variability: 39% showed significant improvement on immediate memory (compared to 18% of controls) and 42% on delayed memory (compared to 11% of controls). While the group as a whole didn’t show significant improvement in processing speed, some 73% of the group showed reliable improvement at the two-month follow-up.

The Insight group showed significant improvement on both memory and processing speed. Some 68% improved processing speed (compared to 43% of controls). But note that at the 2-month follow-up, the 67% of the Insight group is not that much greater than the 61% of the controls (demonstrating very clearly the benefits of even the small amount of practice received in testing) and is in fact less than the 73% of the memory group.

The Insight group also showed significant improvement in memory. At two-month follow-up, some 30% of the Insight group had improved immediate memory (compared to the 18% of controls), and 33% had improved delayed memory (vs 11%).

Both training programs had a positive effect on perceived cognitive functioning and symptom distress (mood, anxiety, fatigue), and there was no difference between the groups in terms of satisfaction with the training (both groups were very satisfied).

The researchers concluded that, while both training programs were promising, the dual effect of processing speed training (on memory as well as processing speed) argued for its broader benefits.

However, I note that, although the size of the effect of memory training on processing speed was too small to reach statistical significance, the fact that the number of participants showing reliable improvement was greater than that of the Insight group points to an equally broad effect of memory training. If the memory training was supplemented by a small amount of practice on tasks designed to boost processing speed, it would seem to me that this might produce greater cognitive benefits than the processing speed training. Indeed, the Insight program was, I believe, first developed in the context of the ACTIVE program, and I have, of course, talked before about the value of training that includes multiple domains.

Still, the main message of this study should not be overlooked: it demonstrates that many cancer survivors suffering from cognitive decline can improve their cognitive performance through training and practice.

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Improving memory for specific events can help depression

November, 2012

A small study suggests that training in recalling personal memories can significantly help those with depression.

We know that people with depression tend to focus on, and remember, negative memories rather than positive. Interestingly, it’s not simply an emotion effect. People with depression, and even those at risk of depression (including those who have had depression), tend to have trouble remembering specific autobiographical memories. That is, memories of events that happened to them at a specific place and time (as opposed to those generalized event memories we construct from similar events, such as the ‘going to the dentist’ memory).

This cognitive difficulty seems to exacerbate their depression, probably through its effect on social encounters and relationships.

A new study, however, has found that a particular training program (“Memory Specificity Training”) can help both their memory for specific events and their symptoms of depression.

The study involved 23 adolescent Afghani refugees in Iran, all of whom had lost their fathers in the war in Afghanistan and who showed symptoms of depression. Half were randomly assigned to the five-week memory training program and half received no training.

The training program involved a weekly 80-minute group session, in which participants learned about different types of memory and memory recall, and practiced recalling specific memories after being given positive, neutral, and negative keywords.

Participants’ memory for specific events was tested at the start of the study, at the end of the five-week training period, and two months after the end of the training. Compared to the control group, those given the training were able to provide more specific memories after the training, and showed fewer symptoms of depression at the two month follow-up (but not immediately after the end of training).

The study follows on from a pilot study in which ten depressed female patients were given four weekly one-hour sessions of memory training. Improvements in memory retrieval were associated with less rumination (dwelling on things), less cognitive avoidance, and improvements in problem-solving skills.

It’s somewhat unfortunate that the control group were given no group sessions, indeed no contact (apart from the tests) of any kind. Nevertheless, and bearing in mind that these are still very small studies, the findings do suggest that it would be helpful to include a component on memory training in any cognitive behavioral therapy for depression.

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Growing the brain with a new language

November, 2012

A new study adds to the growing evidence for the cognitive benefits of learning a new language, and hints at why some people might be better at this than others.

A small Swedish brain imaging study adds to the evidence for the cognitive benefits of learning a new language by investigating the brain changes in students undergoing a highly intensive language course.

The study involved an unusual group: conscripts in the Swedish Armed Forces Interpreter Academy. These young people, selected for their talent for languages, undergo an intensive course to allow them to learn a completely novel language (Egyptian Arabic, Russian or Dari) fluently within ten months. This requires them to acquire new vocabulary at a rate of 300-500 words every week.

Brain scans were taken of 14 right-handed volunteers from this group (6 women; 8 men), and 17 controls that were matched for age, years of education, intelligence, and emotional stability. The controls were medical and cognitive science students. The scans were taken before the start of the course/semester, and three months later.

The brain scans revealed that the language students showed significantly greater changes in several specific regions. These regions included three areas in the left hemisphere: the dorsal middle frontal gyrus, the inferior frontal gyrus, and the superior temporal gyrus. These regions all grew significantly. There was also some, more selective and smaller, growth in the middle frontal gyrus and inferior frontal gyrus in the right hemisphere. The hippocampus also grew significantly more for the interpreters compared to the controls, and this effect was greater in the right hippocampus.

Among the interpreters, language proficiency was related to increases in the right hippocampus and left superior temporal gyrus. Increases in the left middle frontal gyrus were related to teacher ratings of effort — those who put in the greatest effort (regardless of result) showed the greatest increase in this area.

In other words, both learning, and the effort put into learning, had different effects on brain development.

The main point, however, is that language learning in particular is having this effect. Bear in mind that the medical and cognitive science students are also presumably putting in similar levels of effort into their studies, and yet no such significant brain growth was observed.

Of course, there is no denying that the level of intensity with which the interpreters are acquiring a new language is extremely unusual, and it cannot be ruled out that it is this intensity, rather than the particular subject matter, that is crucial for this brain growth.

Neither can it be ruled out that the differences between the groups are rooted in the individuals selected for the interpreter group. The young people chosen for the intensive training at the interpreter academy were chosen on the basis of their talent for languages. Although brain scans showed no differences between the groups at baseline, we cannot rule out the possibility that such intensive training only benefited them because they possessed this potential for growth.

A final caveat is that the soldiers all underwent basic military training before beginning the course — three months of intense physical exercise. Physical exercise is, of course, usually very beneficial for the brain.

Nevertheless, we must give due weight to the fact that the brain scans of the two groups were comparable at baseline, and the changes discussed occurred specifically during this three-month learning period. Moreover, there is growing evidence that learning a new language is indeed ‘special’, if only because it involves such a complex network of processes and brain regions.

Given that people vary in their ‘talent’ for foreign language learning, and that learning a new language does tend to become harder as we get older, it is worth noting the link between growth of the hippocampus and superior temporal gyrus and language proficiency. The STG is involved in acoustic-phonetic processes, while the hippocampus is presumably vital for the encoding of new words into long-term memory.

Interestingly, previous research with children has suggested that the ability to learn new words is greatly affected by working memory span — specifically, by how much information they can hold in that part of working memory called phonological short-term memory. While this is less important for adults learning another language, it remains important for one particular category of new words: words that have no ready association to known words. Given the languages being studied by these Swedish interpreters, it seems likely that much if not all of their new vocabulary would fall into this category.

I wonder if the link with STG is more significant in this study, because the languages are so different from the students’ native language? I also wonder if, and to what extent, you might be able to improve your phonological short-term memory with this sort of intensive practice.

In this regard, it’s worth noting that a previous study found that language proficiency correlated with growth in the left inferior frontal gyrus in a group of English-speaking exchange students learning German in Switzerland. Is this difference because the training was less intensive? because the students had prior knowledge of German? because German and English are closely related in vocabulary? (I’m picking the last.)

The researchers point out that hippocampal plasticity might also be a critical factor in determining an individual’s facility for learning a new language. Such plasticity does, of course, tend to erode with age — but this can be largely counteracted if you keep your hippocampus limber (as it were).

All these are interesting speculations, but the main point is clear: the findings add to the growing evidence that bilingualism and foreign language learning have particular benefits for the brain, and for protecting against cognitive decline.

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New direction for cognitive training in the elderly

October, 2012

A pilot study suggests declines in temporal processing are an important part of age-related cognitive decline, and shows how temporal training can significantly improve some cognitive abilities.

Here’s an exciting little study, implying as it does that one particular aspect of information processing underlies much of the cognitive decline in older adults, and that this can be improved through training. No, it’s not our usual suspect, working memory, it’s something far less obvious: temporal processing.

In the study, 30 older adults (aged 65-75) were randomly assigned to three groups: one that received ‘temporal training’, one that practiced common computer games (such as Solitaire and Mahjong), and a no-activity control. Temporal training was provided by a trademarked program called Fast ForWord Language® (FFW), which was developed to help children who have trouble reading, writing, and learning.

The training, for both training groups, occupied an hour a day, four days a week, for eight weeks.

Cognitive assessment, carried out at the beginning and end of the study, and for the temporal training group again 18 months later, included tests of sequencing abilities (how quickly two sounds could be presented and still be accurately assessed for pitch or direction), attention (vigilance, divided attention, and alertness), and short-term memory (working memory span, pattern recognition, and pattern matching).

Only in the temporal training group did performance on any of the cognitive tests significantly improve after training — on the sequencing tests, divided attention, matching complex patterns, and working memory span. These positive effects still remained after 18 months (vigilance was also higher at the end of training, but this improvement wasn’t maintained).

This is, of course, only a small pilot study. I hope we will see a larger study, and one that compares this form of training against other computer training programs. It would also be good to see some broader cognitive tests — ones that are less connected to the temporal training. But I imagine that, as I’ve discussed before, an effective training program will include more than one type of training. This may well be an important component of such a program.

Reference: 

[3075] Szelag, E., & Skolimowska J.
(2012).  Cognitive function in elderly can be ameliorated by training in temporal information processing.
Restorative Neurology and Neuroscience. 30(5), 419 - 434.

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Spatial skills can be improved through training

October, 2012

A review has concluded that spatial training produces significant improvement, particularly for poorer performers, and that such training could significantly increase STEM achievement.

Spatial abilities have been shown to be important for achievement in STEM subjects (science, technology, engineering, math), but many people have felt that spatial skills are something you’re either born with or not.

In a comprehensive review of 217 research studies on educational interventions to improve spatial thinking, researchers concluded that you can indeed improve spatial skills, and that such training can transfer to new tasks. Moreover, not only can the right sort of training improve spatial skill in general, and across age and gender, but the effect of training appears to be stable and long-lasting.

One interesting finding (the researchers themselves considered it perhaps the most important finding) was the diversity in effective training — several different forms of training can be effective in improving spatial abilities. This may have something to do with the breadth covered by the label ‘spatial ability’, which include such skills as:

  • Perceiving objects, paths, or spatial configurations against a background of distracting information;
  • Piecing together objects into more complex configurations, visualizing and mentally transforming objects;
  • Understanding abstract principles, such as horizontal invariance;
  • Visualizing an environment in its entirety from a different position.

The review compared three types of training. Those that used:

  • Video games (24 studies)
  • Semester-long instructional courses on spatial reasoning (42 studies)
  • Practical training, often in a lab, that involved practicing spatial tasks, strategic instruction, or computerized lessons (138 studies).

The first two are examples of indirect training, while the last involves direct training.

On average, taken across the board, training improved performance by well over half a standard deviation when considered on its own, and still almost one half of a standard deviation when compared to a control group. This is a moderately large effect, and it extended to transfer tasks.

It also conceals a wide range, most of which is due to different treatment of control groups. Because the retesting effect is so strong in this domain (if you give any group a spatial test twice, regardless of whether they’ve been training in between the two tests, they’re going to do better on the second test), repeated testing can have a potent effect on the control group. Some ‘filler’ tasks can also inadvertently improve the control group’s performance. All of this will reduce the apparent effect of training. (Not having a control group is even worse, because you don’t know how much of the improvement is due to training and how much to the retesting effect.)

This caution is, of course, more support for the value of practice in developing spatial skills. This is further reinforced by studies that were omitted from the analysis because they would skew the data. Twelve studies found very high effect sizes — more than three times the average size of the remaining studies. All these studies took place in poorly developed countries (those with a Human Development Index above 30 at the time of the study) — Malaysia, Turkey, China, India, and Nigeria. HDI rating was even associated with the benefits of training in a dose-dependent manner — that is, the lower the standard of living, the greater the benefit.

This finding is consistent with other research indicating that lower socioeconomic status is associated with larger responses to training or intervention.

In similar vein, when the review compared 19 studies that specifically selected participants who scored poorly on spatial tests against the other studies, they found that the effects of training were significantly bigger among the selected studies.

In other words, those with poorer spatial skills will benefit most from training. It may be, indeed, that they are poor performers precisely because they have had little practice at these tasks — a question that has been much debated (particularly in the context of gender differences).

It’s worth noting that there was little difference in performance on tests carried out immediately after training ended, within a week, or within a month, indicating promising stability.

A comparison of different types of training did find that some skills were more resistant to training than others, but all types of spatial skill improved. The differences may be because some sorts of skill are harder to teach, and/or because some skills are already more practiced than others.

Given the demonstrated difficulty in increasing working memory capacity through training, it is intriguing to notice one example the researchers cite: experienced video game players have been shown to perform markedly better on some tasks that rely on spatial working memory, such as a task requiring you to estimate the number of dots shown in a brief presentation. Most of us can instantly recognize (‘subitize’) up to five dots without needing to count them, but video game players can typically subitize some 7 or 8. The extent to which this generalizes to a capacity to hold more elements in working memory is one that needs to be explored. Video game players also apparently have a smaller attentional blink, meaning that they can take in more information.

A more specific practical example of training they give is that of a study in which high school physics students were given training in using two- and three-dimensional representations over two class periods. This training significantly improved students’ ability to read a topographical map.

The researchers suggest that the size of training effect could produce a doubling of the number of people with spatial abilities equal to or greater than that of engineers, and that such training might lower the dropout rate among those majoring in STEM subjects.

Apart from that, I would argue many of us who are ‘spatially-challenged’ could benefit from a little training!

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How piano tuning changes the brain

September, 2012

In another example of how expertise in a specific area changes the brain, brain scans of piano tuners show which areas grow, and which shrink, with experience — and starting age.

I’ve reported before on how London taxi drivers increase the size of their posterior hippocampus by acquiring and practicing ‘the Knowledge’ (but perhaps at the expense of other functions). A new study in similar vein has looked at the effects of piano tuning expertise on the brain.

The study looked at the brains of 19 professional piano tuners (aged 25-78, average age 51.5 years; 3 female; 6 left-handed) and 19 age-matched controls. Piano tuning requires comparison of two notes that are close in pitch, meaning that the tuner has to accurately perceive the particular frequency difference. Exactly how that is achieved, in terms of brain function, has not been investigated until now.

The brain scans showed that piano tuners had increased grey matter in a number of brain regions. In some areas, the difference between tuners and controls was categorical — that is, tuners as a group showed increased gray matter in right hemisphere regions of the frontal operculum, the planum polare, superior frontal gyrus, and posterior cingulate gyrus, and reduced gray matter in the left hippocampus, parahippocampal gyrus, and superior temporal lobe. Differences in these areas didn’t vary systematically between individual tuners.

However, tuners also showed a marked increase in gray matter volume in several areas that was dose-dependent (that is, varied with years of tuning experience) — the anterior hippocampus, parahippocampal gyrus, right middle temporal and superior temporal gyrus, insula, precuneus, and inferior parietal lobe — as well as an increase in white matter in the posterior hippocampus.

These differences were not affected by actual chronological age, or, interestingly, level of musicality. However, they were affected by starting age, as well as years of tuning experience.

What these findings suggest is that achieving expertise in this area requires an initial development of active listening skills that is underpinned by categorical brain changes in the auditory cortex. These superior active listening skills then set the scene for the development of further skills that involve what the researchers call “expert navigation through a complex soundscape”. This process may, it seems, involve the encoding and consolidating of precise sound “templates” — hence the development of the hippocampal network, and hence the dependence on experience.

The hippocampus, apart from its general role in encoding and consolidating, has a special role in spatial navigation (as shown, for example, in the London cab driver studies, and the ‘parahippocampal place area’). The present findings extend that navigation in physical space to the more metaphoric one of relational organization in conceptual space.

The more general message from this study, of course, is confirmation for the role of expertise in developing specific brain regions, and a reminder that this comes at the expense of other regions. So choose your area of expertise wisely!

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Review of working memory training programs finds no broader benefit

July, 2012

A meta-analysis of 23 studies has found no evidence that working memory training has wider cognitive benefits for normally developing children and healthy adults.

I have said before that there is little evidence that working memory training has any wider benefits than to the skills being practiced. Occasionally a study arises that gets everyone all excited, but by and large training only benefits the skill being practiced — despite the fact that working memory underlies so many cognitive tasks, and limited working memory capacity is thought to negatively affect performance on so many tasks. However, one area that does seem to have had some success is working memory training for those with ADHD, and researchers have certainly not given hope of finding evidence for wider transfer among other groups (such as older adults).

A recent review of the research to date has, sadly, concluded that the benefits of working memory training programs are limited. But this is not to say there are no benefits.

For a start, the meta-analysis (analyzing data across studies) found that working memory training produced large immediate benefits for verbal working memory. These benefits were greatest for children below the age of 10.

These benefits, however, were not maintained long-term (at an average of 9 months after training, there were no significant benefits) — although benefits were found in one study in which the verbal working memory task was very similar to the training task (indicating that the specific skill practiced did maintain some improvement long-term).

Visuospatial working memory also showed immediate benefits, and these did not vary across age groups. One factor that did make a difference was type of training: the CogMed training program produced greater improvement than the researcher-developed programs (the studies included 7 that used CogMed, 2 that used Jungle Memory, 2 Cognifit, 4 n-back, 1 Memory Booster, and 7 researcher-developed programs).

Interestingly, visuospatial working memory did show some long-term benefits, although it should be noted that the average follow-up was distinctly shorter than that for verbal working memory tasks (an average of 5 months post-training).

The burning question, of course, is how well this training transferred to dissimilar tasks. Here the evidence seems sadly clear — those using untreated control groups tended to find such transfer; those using treated control groups never did. Similarly, nonrandomized studies tended to find far transfer, but randomized studies did not.

In other words, when studies were properly designed (randomized trials with a control group that is given alternative treatment rather than no treatment), there was no evidence of transfer effects from working memory training to nonverbal ability. Moreover, even when found, these effects were only present immediately and not on follow-up.

Neither was there any evidence of transfer effects, either immediate or delayed, on verbal ability, word reading, or arithmetic. There was a small to moderate effect on training on attention (as measured by the Stroop test), but this only occurred immediately, and not on follow-up.

It seems clear from this review that there are few good, methodologically sound studies on this subject. But three very important caveats should be noted in connection with the researchers’ dispiriting conclusion.

First of all, because this is an analysis across all data, important differences between groups or individuals may be concealed. This is a common criticism of meta-analysis, and the researchers do try and answer it. Nevertheless, I think it is still a very real issue, especially in light of evidence that the benefit of training may depend on whether the challenge of the training is at the right level for the individual.

On the other hand, another recent study, that compared young adults who received 20 sessions of training on a dual n-back task or a visual search program, or received no training at all, did look for an individual-differences effect, and failed to find it. Participants were tested repeatedly on their fluid intelligence, multitasking ability, working memory capacity, crystallized intelligence, and perceptual speed. Although those taking part in the training programs improved their performance on the tasks they practiced, there was no transfer to any of the cognitive measures. When participants were analyzed separately on the basis of their improvement during training, there was still no evidence of transfer to broader cognitive abilities.

The second important challenge comes from the lack of skill consolidation — having a short training program followed by months of not practicing the skill is not something any of us would expect to produce long-term benefits.

The third point concerns a recent finding that multi-domain cognitive training produces longer-lasting benefits than single-domain training (the same study also showed the benefit of booster training). It seems quite likely that working memory training is a valuable part of a training program that also includes practice in real-world tasks that incorporate working memory.

I should emphasize that these results only apply to ‘normal’ children and adults. The question of training benefits for those with attention difficulties or early Alzheimer’s is a completely different issue. But for these healthy individuals, it has to be said that the weight of the evidence is against working memory training producing more general cognitive improvement. Nevertheless, I think it’s probably an important part of a cognitive training program — as long as the emphasis is on part.

Reference: 

Melby-Lervåg, M., & Hulme, C. (2012). Is Working Memory Training Effective? A Meta-Analytic Review. Developmental psychology. doi:10.1037/a0028228
Full text available at http://www.apa.org/pubs/journals/releases/dev-ofp-melby-lervag.pdf

[3012] Redick, T. S., Shipstead Z., Harrison T. L., Hicks K. L., Fried D. E., Hambrick D. Z., et al.
(2012).  No Evidence of Intelligence Improvement After Working Memory Training: A Randomized, Placebo-Controlled Study..
Journal of Experimental Psychology: General.
Full text available at http://psychology.gatech.edu/renglelab/publications/2012/RedicketalJEPG.pdf
 

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Even babies benefit from music lessons

June, 2012

A six-month study comparing the effects of two types of infant music class shows that babies can be taught to become sensitive to musical pitch, and that musical activity can improve social and cognitive skills.

I’ve talked before about the benefits of music lessons for children — most recently, for example, how music-based training 'cartoons' improved preschoolers’ verbal IQ. Now a new study extends the findings to infants.

In the study, 6-month-old babies were randomly assigned to six months of one of two types of weekly music class. The classes lasted an hour and involved either an active or passive approach.

In the active classes, parents and infants worked together to learn to play percussion instruments and sing lullabies and action songs. The classes emphasized musical expression, listening in order to play or sing at the right time, repetition, and developing parents’ awareness of their babies’ responses. There was also a CD that they were encouraged to play at home.

In the passive classes, parents and infants listened to CDs from the Baby Einstein series while playing and interacting at art, book, ball, block, and stacking cup play stations. Parents were encouraged to take home different CDs from the collection each week.

At the end of the program, those babies attending the active classes showed an earlier sensitive to pitch. Unlike infants from the passive classes, they preferred to listen to a piano piece played in key rather than one that included notes played out of key (you can hear the two versions at http://www.psychology.mcmaster.ca/ljt/stimuli.htm). Their brains also showed larger and/or earlier responses to musical tones.

On the cognitive side, babies from the active classes also showed better early communication skills, like pointing at objects that are out of reach, or waving goodbye. Socially, these babies also smiled more, were easier to soothe, and showed less distress when things were unfamiliar or didn't go their way. It is presumed that these social skills are due to the development of better social interaction between parent and child.

The classes were run at two centers — one in a lower socioeconomic area, and one in a middle-class area. The teachers of the classes were unaware of the nature of the experiment. Before the classes began, all the babies had shown similar communication and social development and none had previously participated in other baby music classes. There was no interaction between socioeconomic status and intervention, and the results from both were then analyzed together. There were 38 families (out of an initial 49 at the beginning) who were still attending regularly at the end of the program, and 34 of these (of whom 16 were from the lower SES centre) completed the testing.

The exciting question is of course what long-term effects this ‘head-start’ will have on cognitive and social development. I hope the researchers will follow this up.

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Cognitive training shown to help healthy older adults

May, 2012

A comparison of multi-domain and single-domain cognitive training shows both improve cognitive performance in healthy older adults, but multi-domain training produces greater benefits.

Previous research has been equivocal about whether cognitive training helps cognitively healthy older adults. One recent review concluded that cognitive training could help slow age-related decline in a range of cognitive tasks; another found no evidence that such training helps slow or prevent the development of Alzheimer’s in healthy older adults. Most of the studies reviewed looked at single-domain training only: memory, reasoning, processing speed, reading, solving arithmetic problems, or strategy training (1). As we know from other studies, training in specific tasks is undeniably helpful for improving your performance at those specific tasks. However, there is little evidence for wider transfer. There have been few studies employing multi-domain training, although two such have found positive benefits.

In a new Chinese study, 270 healthy older adults (65-75) were randomly assigned to one of three groups. In the two experimental groups, participants were given one-hour training sessions twice a week for 12 weeks. Training took place in small groups of around 15. The first 15 minutes of each hour involved a lecture focusing on diseases common in older adults. The next 30 minutes were spent in instruction in one specific technique and how to use it in real life. The last 15 minutes were used to consolidate the skills by solving real-life problems.

One group were trained using a multi-domain approach, involving memory, reasoning, problem solving, map reading, handicrafts, health education and exercise. The other group trained on reasoning only (involving the towers of Hanoi, numerical reasoning, Raven Progressive Matrices, and verbal reasoning). Homework was assigned. Six months after training, three booster sessions (a month apart) were offered to 60% of the participants. The third group (the control) was put on a waiting list. All three groups attended a lecture on aspects of healthy living every two months.

All participants were given cognitive tests before training and after training, and again after 6 months, and after one year. Cognitive function was assessed using the Stroop Test, the Trail Making test, the Visual Reasoning test, and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS, Form A).

Both the multi-domain and single-domain cognitive training produced significant improvement in cognitive scores (the former in RBANS, visual reasoning, and immediate and delayed memory; the latter in RBANS, visual reasoning, word interference, and visuospatial/constructional score), although single-domain training produced less durable benefits (after a year, the multi-domain group still showed the benefit in RBANS, delayed memory and visual reasoning, while the single-domain group only showed benefits in word interference). Booster training also produced benefits, consolidating training in reasoning, visuospatial/constructional abilities and faster processing.

Reasoning ability seemed particularly responsive to training. Although it would be reasonable to assume that single-domain training, which focused on reasoning, would produce greater improvement than multi-domain training in this specific area, there was in fact no difference between the two groups right after training or at six months. And at 12 months, the multi-domain group was clearly superior.

In sum, the study provides evidence that cognitive training helps prevent cognitive decline in healthy older people, that specific training can generalize to other tasks, but that programs that involve several cognitive domains produce more lasting benefits.

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Smartphone training helps people with serious memory impairment regain independence

April, 2012

A smartphone training program, specifically designed for those with moderate-to-severe memory impairment, was found to significantly improve day-to-day functioning in a small study.

While smartphones and other digital assistants have been found to help people with mild memory impairment, their use by those with greater impairment has been less successful. However, a training program developed at the Baycrest Centre for Geriatric Care has been using the power of implicit memory to help impaired individuals master new skills.

The study involved 10 outpatients, aged 18 to 55 (average age 44), who had moderate-to-severe memory impairment, the result of non-neurodegenerative conditions including ruptured aneurysm, stroke, tumor, epilepsy, closed-head injury, or anoxia after a heart attack. They all reported difficulty in day-to-day functioning.

Participants were trained in the basic functions of either a smartphone or another personal digital assistant (PDA) device, using an errorless training method that tapped into their preserved implicit /procedural memory. In this method, cues are progressively faded in such a way as to ensure there is enough information to prompt the correct response. The fading of the cues was based on the trainer’s observation of the patient’s behavior.

Participants were given several one-hour training sessions to learn calendaring skills such as inputting appointments and reminders. Each application was broken down into its component steps, and each step was given its own score in terms of how much support was needed. Support could either comprise a full explanation and demonstration; full explanation plus pointing to the next step; simply pointing to the next step; simply confirming a correct query; no support. The hour-long sessions occurred twice a week (with one exception, who only received one session a week). Training continued until the individual reached criterion-level performance (98% correct over a single session). On average, this took about 8 sessions, but as a general rule, those with relatively focal impairment tended to be substantially quicker than those with more extensive cognitive impairment.

After this first training phase, participants took their devices home, where they extended their use of the device through new applications mastered using the same protocol. These new tasks were carefully scaffolded to enable progressively more difficult tasks to be learned.

To assess performance, participants were given a schedule of 10 phone calls to complete over a two-week period at different times of the day. Additionally, family members kept a log of whether real-life tasks were successfully completed or not, and both participants and family members completed several questionnaires: one rating a list of common memory mistakes on a frequency-of-occurrence scale, another measuring confidence in dealing with various memory-demanding scenarios, and a third examining the participant's ability to use the device.

All 10 individuals showed improvement in day-to-day memory functioning after taking the training, and this improvement continued when the patients were followed up three to eight months later. Specifically, prospective memory (memory for future events) improved, and patient confidence in dealing with memory-demanding situations increased. Some patients also reported broadening their use of their device to include non-prospective memory tasks (e.g. entering names and/or photos of new acquaintances, or entering details of conversations).

It should be noted that these patients were some time past their injury, which was on average some 3 ½ years earlier (ranging from 10 months to over 25 years). Accordingly, they had all been through standard rehabilitation training, and already used many memory strategies. Questioning about strategy use prior to the training revealed that six participants used more memory strategies than they had before their injury, three hadn’t changed their strategy use, and one used fewer. Strategies included: calendars, lists, reminders from others, notebooks, day planner, placing items in prominent places, writing a note, relying on routines, alarms, organizing information, saying something out loud in order to remember it, mental elaboration, concentrating hard, mental retracing, computer software, spaced repetition, creating acronyms, alphabetic retrieval search.

The purpose of this small study, which built on an earlier study involving only two patients, was to demonstrate the generalizability of the training method to a larger number of individuals with moderate-to-severe memory impairment. Hopefully, it will also reassure such individuals, who tend not to use electronic memory aids, that these are a useful tool that they can, with the right training, learn to use successfully.

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