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Ageing Research Reviews 12 (2013) 263 275
Contents lists available at SciVerse ScienceDirect
Ageing Research Reviews
j ourna l ho mepage: www.elsev ier .c
Review
Cognitive interventions in healthy older adults animpair
Jennifer Boxa Department o icht Ub Department o , Maa
a r t i c l
Article history:Received 11 AReceived in reAccepted 17
JuAvailable onlin
Keywords:Systematic revCognitive interventionsHealthy older
adultsMild cognitive impairmentRandomized controlled trials
ive inore rervenal. (2er adtudien Aud RC
A total of thirty-ve studies were included; twenty-seven RTCs
and eight clinical studies. The contentof the intervention studies
differed widely, as did the methodological quality of the included
RCTs, butwas considerably low with an average of 44% of the Consort
items included. The results show evidencethat cognitive training
can be effective in improving various aspects of objective
cognitive functioning;memory performance, executive functioning,
processing speed, attention, uid intelligence, and subjec-
1. Introdu
The progrowing raof people enand speed odebate whein a
normalamong rese2009; Valeninvolving gstimulationtioning,
havcognitive ainvestigatedcognitive de
CorresponNeuroscience,MD Maastrich
E-mail add
1568-1637/$ http://dx.doi.otive cognitive performance. However,
the issue whether the effects of cognitive interventions
generalizeto improvement in everyday life activities is still
unresolved and needs to be addressed more explicitlyin future
research.
2012 Elsevier B.V. All rights reserved.
ction
portion of older individuals in our western society ispidly
(CBS, 2009). As a consequence a larger amountcounter difculties in
executive functioning, memory,f information processing (Glisky,
2007). It is an ongoingther such difculties can be postponed or
even reverted
aging population, but overall the general held opinionarchers in
this eld has been optimistic (Lustig et al.,zuela and Sachdev,
2009). Cognitive training programs,uided practice of specic
cognitive tasks, and cognitive
programs, aimed at enhancing general cognitive func-e been
offered to prevent or minimize the effects of
ging. The effects of such cognitive interventions were not only
in healthy older adults, but also in people withterioration beyond
the normal age-dependent changes,
ding author at: Maastricht University, School for Mental Health
and Department of Psychiatry and Neuropsychology, PO Box 616,
6200t, The Netherlands. Tel.: +31 43 3881029; fax: +31 43
3884092.ress: [email protected] (J.
Reijnders).
for example people with mild cognitive impairment (MCI)
(Lustiget al., 2009; Valenzuela and Sachdev, 2009).
In the last decade several reviews have been conducted into
theeffects of cognitive interventions in healthy older adults and
peoplewith MCI (Valenzuela and Sachdev, 2009; Jean et al., 2010a;
Martinet al., 2011; Papp et al., 2009; Tardif and Simard, 2011;
Teixeiraet al., 2012). Papp et al. (2009) performed a systematic
review withmeta-analytic techniques to analyze randomized
controlled trials(RCT) of cognitive interventions in healthy older
adults. Ten RCTspublished between 1996 and 2007 were included and
analyzedin their review. A mean effect size of 0.16 was found
across alloutcome measures. Effect sizes were larger when outcome
meas-ures were directly related to type of training. Their
conclusionwas that training improves immediate performance on
relatedtasks but there was no evidence for generalization effects
to over-all cognitive functioning. They also stated that their
review waslimited by small and heterogeneous studies with low
methodolog-ically quality and more RCTs are needed with sufcient
follow-uptime, matched active control groups and outcome measures
thatcan show changes in more than one specic domain (Papp et
al.,2009). The review of Martin et al. (2011) included, in
compari-son to Papp et al. (2009), more studies from both healthy
olderadults and MCI populations. A total of thirty-six RTCs were
included,
see front matter 2012 Elsevier B.V. All rights
reserved.rg/10.1016/j.arr.2012.07.003ment: A systematic review
Reijndersa,, Caroline van Heugtena,b, Martin van f Psychiatry
and Neuropsychology, School for Mental Health and Neuroscience,
Maastrf Neuropsychology and Psychopharmacology, Faculty of
Psychology and Neurosciences
e i n f o
pril 2012vised form 13 July 2012ly 2012e 25 July 2012
iew
a b s t r a c t
Given that the research area of cognitit is important to review
and gauge mfor the effectiveness of cognitive interecent systematic
reviews of Papp et cognitive interventions in healthy oldological
quality of the interventions sand clinical studies published
betweeperformed. The quality of the includeom/ locate /ar r
d people with mild cognitive
tela,b
niversity Medical Centre, Maastricht, The Netherlandsstricht
University, Maastricht, The Netherlands
tervention studies in the aging population is growing
rapidly,cent intervention studies, in order to determine the
evidencetions. The purpose of the present review was to update
the009) and Martin et al. (2011), to evaluate the effectiveness
ofults and people with MCI, by taking into account the method-s. A
systematic review of randomized controlled trials (RCT)gust 2007
and February 2012 in Pubmed and PsychINFO wasTs was assessed
according to the CONSORT criteria for RCTs.
-
264 J. Reijnders et al. / Ageing Research Reviews 12 (2013) 263
275
published bing could adults, immthrough tracompared tno longer
sistrated the a review of cognitive inteen studieconclusion outcome
mand contendifcult to rather difc
Given thgrowing rapinterventioMCI, in ordFig. 1. Selection
process of the systematic
etween 1985 and 2007. Only data on memory train-be pooled.
Results showed that, for healthy olderediate and delayed verbal
recall improved signicantlyining compared to a no-treatment control
group. Wheno an active control condition, the improvements
weregnicant. For individuals with MCI, the analysis demon-same
pattern (Martin et al., 2011). Only quite recently,Tardif and
Simard (2011) was published, who reviewedterventions in healthy
older adults and included four-s, published between 2001 and March
2011. Theirwas that improvements were observed on at least
oneeasure in each study. They also noted that the qualityt of the
studies included were very heterogeneous andcompare which made
generalization to everyday lifeult (Tardif and Simard, 2011).at the
research area of cognitive intervention studies isidly, it is
important to review and gauge more recent
n studies in both healthy older adults and people wither to
determine the evidence for the effectiveness of
cognitive inthat one shof the studioutcome mtive outcomThe
purposeffectivenepeople withological qua
2. Method
A systemwas done iincluded stFebruary 14lier perform2009). Our
following te review.
terventions. In doing so, it is important to recognizeould
consider the heterogeneity in quality and contentes and
interventions and to include not only objectiveeasures (e.g. test
performance) but also the subjec-e of such interventions (e.g.
cognitive complaints).
e of the present review was therefore to evaluate thess of
cognitive interventions in healthy older adults and
MCI, by taking into account the content and method-lity of the
interventions studies.
s
atic literature search for cognitive intervention studiesn two
databases: Pubmed and PsychINFO. Our searchudies that were
performed between August 1, 2007 and, 2012, as we wanted to build
on the results of two ear-ed systematic reviews (Martin et al.,
2011; Papp et al.,initial search strategy included the intersection
of therms: [cognitive intervention OR cognitive training OR
-
J. Reijnders
et al.
/ A
geing Research
Review
s 12 (2013) 263 275
265Table 1Intervention characteristics of studies in healthy
older adults (n = 21).
Study Aim of intervention Intervention Duration Total hours
ofintervention
Control group
Bailey et al. (2010) Improving ability to regulatelearning
Training metacognitive skills at home such asself-testing and
efcient time allocation
2 weeks manual with lessonsand 4 assignments
NC Waiting list
Basak et al. (2008) To improve executive functions A real-time
strategy game (rise of nation) thatcombines the speed of real-time
gaming and thecomplexity of strategy games
15 training sessions of 1.5 h45 weeks
22.5 h No training and nocontact
Berry et al. (2010) To improve perceptual abilities Visual
cognitive training using the Sweep Seekerprogram (Posit
science)
35 sessions per week. Total of10 h training
10 h No training
Borella et al. (2010) To improve performance onWM tasks and
generalizationto untrained task
Verbal WM training using the categorization workingmemory span
task
3 sessions of 60 min 3 h Active control
Bottiroli and Cavallini (2009) Improve the use of
memorystrategies and transfer effectsto non-practiced tasks
Teaching 2 memory strategies and practicing on 3computerized
memory tasks which were adapted fromthe neuropsychological training
software
3 sessions of 2 h 6 h Waiting list
Buiza et al. (2008) To improve cognitive functionsand quality of
life
Cognitive therapy based on Braak and Braaks model ofAlzheimers
staging addressing memory, attention,language, visuoconstructive
ability, executivefunctions, visuo-motor coordination, and praxis
(EG1and 2). In EG1 issues related to well-being werediscussed
2 years, total of 180 session 270 h No training
Buschkuehl et al. (2008) To improve memoryperformance in oldold
adults
Computerized WM training 3 months2 sessions per week of 45
min
18 h Active control(physicalintervention)
Carlson et al. (2008) To enhance physical, social,and cognitive
activity and, indoing so, exercise memory andexecutive
functions
Community-based program Experience Corps to helpelementary
school children with reading achievement,library support and
classroom behavior
1 year15 h per week
630 h Waiting list
Cavallini et al. (2010) Instruction-based memorytraining to
promote transfereffects to other memory tasks
Training in mnemonics (EG1) and in EG2: alsoinstructions how to
apply these to other tasks, imageryand sentence generation were
practiced
4 sessions of 2 h 8 h No training
Fairchild and Scogin (2010) To improve both objective
andsubjective memory
Memory enhancement program addressing objectiveand subjective
memory; information about agingprocess; nutrition; mood;
controllability of memoryand teaching mnemonics
6 weeks1 session per week of3060 min
6 h Minimal socialsupport
Hastings and West (2009) To improve self-efcacy andmemory
performance
Multi-factorial training program centred on
increasingself-efcacy, including strategy training,
classdiscussions, homework reading and practice exercisesSelf help
participants used a manual containing thesame strategy training
material and practice exercises
6 sessions of 2 h 12 h Waiting list
Klusmann et al. (2010) To increase cognitiveperformance
Computer course (EG1): creative, coordinative, andmemory
tasksPhysical exercise course (EG2): aerobic endurance,strength,
and exibility training
6 months75 session of 90 min
112.5 h No contact
McDougall et al. (2010) To increase memoryself-efcacy
Memory training based on cognitive behavioral modelof everyday
memory derived from Bandurasself-efcacy theory (SeniorWISE
study)
8 sessions and 4 boostersessions
18 h Health promotiontraining
Mozolic et al. (2011) To help people suppressirrelevant auditory
and visualstimuli
Individual training program focused on visual andauditory
selective attention
8 sessions of 1 h per week 8 h Educational lecture
Noice and Noice (2009) To improve cognitive functionand
affective measures
Offering a specic type of novel, stimulating,multi-modal
activity: acting course
8 sessions of 1 h2 sessions per week
8 h Waiting listAdditional controlgroup (CG2):singing course
Richmond et al. (2011) To improve performance onWM tasks and
generalizationto untrained task
Complex WM training using both a verbal and a spatialWM
tasks
45 weeks5 days per week2030 min per day
12.5 h Active control
-
266 J. Reijnders et al. / Ageing Research Reviews 12 (2013) 263
275
Tabl
e
1
(Con
tinu
ed)
Study
Aim
of
inte
rven
tion
Inte
rven
tion
Dura
tion
Tota
l hou
rs
ofin
terv
ention
Con
trol
grou
p
Sleg
ers
et
al. (
2008
)
To
impro
ve
the
qual
ity
of
life
ofol
der
adults
Firs
t
trai
nin
g
in
com
pute
r
use
;
during
inte
rven
tion
assign
men
ts
on
the
com
pute
r
and
inte
rnet
Trai
nin
g:
3
sess
ions
of
4
hIn
terv
ention
:
16
assign
men
tsduring
1
year
431
h
CG1:
trai
nin
g,
no
inte
rven
tion
CG2:
no
trai
nin
g,no
inte
rven
tion
CG3:
no
conta
ctSm
ith
et
al. (
2009
)
To
impro
ve
spee
d
and
accu
racy
of
auditor
y
info
rmat
ion
pro
cess
ing
Plas
ticity
-bas
ed
Adap
tive
Cog
nitiv
e
Trai
nin
g
(IM
PACT)
:6
exer
cise
s
with
adju
stin
g
difcu
lty
8
wee
ks5
day
s
per
wee
k1
h
per
day
40
h
Act
ive
control
conditio
n
(gen
eral
cogn
itiv
est
imula
tion
pro
gram
)Ta
lib
et
al. (
2008
)
To
impro
ve
cogn
itiv
eper
form
ance
and
PLA
2ac
tivi
tyM
emor
y
trai
nin
g:
educa
tion
, mnem
onic
stra
tegi
es,
atte
ntion
and, w
orki
ng
mem
ory
exer
cise
s4
sess
ions
of
90
min
6 h
Stan
dar
dou
tpat
ient
care
Tran
ter
and
Kou
tsta
al
(200
8)
To
enhan
ce
uid
inte
llig
ence
per
form
ance
Div
erse
and
nov
el
men
tally
stim
ula
ting
activi
ties
101
2
wee
ks2
h
per
wee
k24
h
Social
grou
pm
eetings
Wes
t
et
al. (
2008
)To
impro
ve
self-e
fca
cy
and
mem
ory
per
form
ance
Multi-fa
ctor
ial t
rain
ing
pro
gram
centred
on
incr
easing
self-e
fca
cy, includin
g
stra
tegy
trai
nin
g,
clas
sdiscu
ssio
ns,
hom
ewor
k
read
ing,
and
pra
ctice
exer
cise
s
6
sess
ions
of
2
h
12
h
Wai
ting
list
NC, n
ot
calcula
ble;
EG, e
xper
imen
tal g
roup;
CG, c
ontrol
grou
p;
WM
, wor
king
mem
ory.
cognitive stimulation OR cognitive rehabilitation OR brain
train-ing OR memory training OR mnemonic training] AND
[healthyelderly OR older adults OR aging OR mild cognitive
impairmentOR MCI]. This search was supplemented by manual search
fromthe referenof missing rPapp et al. (used by two
The folloas eligible:study popuMCI, (3) antive and/orif the
langusame studywas found original stuassessmentthe original
After thedata indepestudies usinfor random(Schulz et aconsensus
wity of the stConsort staheterogenecally pool thmeta-analy
3. Results
3.1. Studies
In Fig. 1 thirty-ve sRTCs and eiseparately. studies incl2010;
BasaBottiroli an2008; CarlsScogin, 201McDougall 2009; Rich2009;
Talib2008) and ple with Met al., 20092008). Tabltion prograTables 3
anincluding o
3.2. Study c
The numvaried fromThe mean aet al., 2010)carried outtion was
uset al., 2008et al., 2010ces of selected articles. In order to
minimize the chanceelevant studies we extended the search terms
used by2009) and also used a combination of the search terms
earlier reviews (Martin et al., 2011; Papp et al., 2009).wing
inclusion criteria were used to identify studies
(1) randomized controlled trial or clinical study, (2)lation
consisting of healthy older adults or people withy type of
cognitive intervention, and (4) use of objec-
subjective outcome measures. Studies were excludedage was not
English. Furthermore, papers based on the
population were excluded. When more than one paperabout a specic
data set, only the main paper on thedy data was included for
further analysis and quality. If the original study was published
before 2007 then
study was also not included. nal selection, two reviewers (JR
and MvB) extractedndently and assessed the methodological quality
of theg a standardized form of the Consort statement 2010ized
controlled trials (www.consort-statement.org)
l., 2010). In case of discrepancies between the two raters,as
achieved after discussion. The methodological qual-udies was
indicated by the percentage of items of thetement reported in the
articles. Given the considerableity of the interventions it was
decided not to statisti-e data of the studies in order to perform a
quantitativesis.
included
the results of the selection process are shown. A total oftudies
were selected for further analysis; twenty-sevenght clinical
studies. The clinical studies will be discussedOf the twenty-seven
RCTs, twenty-one interventionuded a population of healthy older
adults (Bailey et al.,k et al., 2008; Berry et al., 2010; Borella
et al., 2010;d Cavallini, 2009; Buiza et al., 2008; Buschkuehl et
al.,on et al., 2008; Cavallini et al., 2010; Fairchild and0;
Hastings and West, 2009; Klusmann et al., 2010;et al., 2010;
Mozolic et al., 2011; Noice and Noice,mond et al., 2011; Slegers et
al., 2008; Smith et al.,
et al., 2008; Tranter and Koutstaal, 2008; West et al.,six
intervention studies included a population of peo-CI (Barnes et
al., 2009; Jean et al., 2010b; Kinsella
; Troyer et al., 2008; Tsolaki et al., 2011; Wagner et al.,es 1
and 2 present the characteristics of the interven-ms (for healthy
older adults population and MCI) andd 4 present the characteristics
of the included RCTs,utcome measures and effects.
haracteristics
ber of healthy older adults in the experimental groups 13
(Buschkuehl et al., 2008) to 242 (Smith et al., 2009).ge of the
study populations ranged from 63.5 (Cavallini
to 80.2 years (Noice and Noice, 2009). All studies were in an
experimental setting. A group-based interven-ed in ten studies
(Bottiroli and Cavallini, 2009; Buiza; Buschkuehl et al., 2008;
Carlson et al., 2008; Cavallini; Klusmann et al., 2010; McDougall
et al., 2010; Noice
-
J. Reijnders et al. / Ageing Research Reviews 12 (2013) 263 275
267
Table 2Intervention characteristics of studies in MCI population
(n = 6).
Study Aim of intervention Intervention Duration Total hours
ofintervention
Control group
Barnes et al. 1005 da6 w
Jean et al. (2 6 se45 m
Kinsella et a 1.5 5 w
Troyer et al. 10 s120
Tsolaki et al. 60 s90 m3 se
Wagner et a 7 se90 m
and Noice, number of set al., 2010;Fairchild an2011; Slege2008)
and studies inclvention (BoWest, 2009
The numied from 11mean age o2008) to 78ies, the inteet al.,
2009et al., 2008)(Kinsella et et al., 2008)vention
(Baeffectivenesately after (Kinsella etassessment
The totaas can be seanalysis to icould be prtiveness of of
signicanmeasures. Winterventiothat in the ship betwethe
interven
scrip
le 1 sed
moryput (2009) To improve auditoryprocessing speed and
accuracy
Computer-based cognitivetraining developed by PositScience
Corporation
010b) To re-learn face-nameassociations
Training in face-nameassociations using botherrorless learning
and spacedretrieval paradigm andpsycho-educational sessionson
memory
l. (2009) Memory rehabilitation, topractice memory strategies
foreveryday problems
Practice in memory strategies(internal and external),strategies
for improvingorganisational and attentionalskills and general
copingstrategies
(2008) Multidisciplinary group-basedintervention to
changeeveryday memory behavior
Practice and application ofmemory strategies andeducation about
lifestyle:nutrition, recreation andrelaxation
(2011) Holistic cognitiverehabilitation program to coverthe
needs and deciencies ofpatients with MCI
Practice of attention andparameters of executivefunction;
enhancement ofmental imagery, episodic,semantic, autobiographical
andvisual memory;relaxation techniques
l. (2008) To analyze everyday situationswith memory problem
andtrain specic strategies
Practicing prospective memoryand structured processing ofnew
information related toreal-life situations
2009; Talib et al., 2008; West et al., 2008), the sametudies
used an individually based intervention (Bailey
Basak et al., 2008; Berry et al., 2010; Borella et al., 2010;d
Scogin, 2010; Mozolic et al., 2011; Richmond et al.,rs et al.,
2008; Smith et al., 2009; Tranter and Koutstaal,one study used both
(Hastings and West, 2009). Five
3.3. De
Tabperforming meby comuded follow-up data, up till one year
after the inter-rella et al., 2010; Buschkuehl et al., 2008;
Hastings and; Slegers et al., 2008; Smith et al., 2009).ber of
people with MCI in the intervention groups var-
(Jean et al., 2010b) to 104 (Tsolaki et al., 2011). Thef the
study populations ranged from 53.7 (Wagner et al.,
years (Kinsella et al., 2009). In four (out of six)
stud-rventions were carried out in a clinical setting (Barnes;
Kinsella et al., 2009; Tsolaki et al., 2011; Wagner. A group-based
intervention was used in four studiesal., 2009; Troyer et al.,
2008; Tsolaki et al., 2011; Wagner, whereas two studies used an
individually based inter-rnes et al., 2009; Jean et al., 2010b). In
two studies thes of the intervention was not only assessed
immedi-the intervention but also after three or four months
al., 2009; Troyer et al., 2008). In one study a follow-up was
planned (Wagner et al., 2008).l hours of intervention varied widely
between studies,en in Tables 1 and 2. We performed a linear
regressionnvestigate whether the effectiveness of the
interventionedicted by the total hours of intervention. The
effec-an intervention was calculated by dividing the numbert
outcome measures by the total number of outcomee found no signicant
effect between total hours of
n and intervention effect (R2: 0.016, p = 0.54),
indicatingincluded studies there was no dose response relation-en
total hours of intervention and the effectiveness oftion.
2008; Richmtask (Borellof memory2010; Taliblessons (Faies aimed
atraining proa memory theory (Mccognitive fu(Klusmann tive
cognititraining (Buet al., 2008this, single ing metacoby a
real-timby training intelligence2008). Ten seleven usedtion of an
insessions (Bo
Table 2 in people wory performKinsella et aet al., 2008
min/dayys/weekeeks
50 h More passive computeractivities
ssions ofin
4.5 h Training in face-nameassociations using errorlesslearning
paradigm andpsycho-educational sessionson memory
h/weekeeks
7.5 h Waiting list
essions of min
20 h Waiting list
essions ofin
ssion/week
90 h Waiting list
ssions ofin
10.5 h No training
tion of interventions
hows the characteristics of the interventions that werein
healthy older adults. Eleven studies aimed at improv-
performance; four studies addressed working memoryerized
training (Berry et al., 2010; Buschkuehl et al.,
ond et al., 2011) or training of the categorization span
a et al., 2010); four studies provided training of the use
strategies (Bottiroli and Cavallini, 2009; Cavallini et al.,
et al., 2008), accompanied with psycho-educationalirchild and
Scogin, 2010) and the other three stud-t improving memory
self-efcacy by a multifactorialgram (Hastings and West, 2009; West
et al., 2008) or
training program derived from Banduras self-efcacyDougall et
al., 2010). Six studies aimed at improvingnctioning in general by
providing a computer courseet al., 2010; Slegers et al., 2008), a
plasticity-based adap-ve training (Smith et al., 2009), a
multifactorial cognitiveiza et al., 2008), a community-based
program (Carlson) or an acting course (Noice and Noice, 2009).
Besidesstudies aimed at improving learning abilities by
train-gnitive skills (Bailey et al., 2010), executive
functioning
e strategy game (Basak et al., 2008), attentional skillsa
selective attention task (Mozolic et al., 2011) and uid
by novel stimulating activities (Tranter and Koutstaal,tudies
used an active control condition, where the other
a waiting list or no training control group. The dura-tervention
varied between 3 hourly sessions up till 180rella et al., 2010;
Buiza et al., 2008).
shows the characteristics of the interventions assessedith MCI.
Most interventions aimed at improving mem-ance by training memory
strategies (Jean et al., 2010b;l., 2009; Troyer et al., 2008;
Tsolaki et al., 2011; Wagner), accompanied with psycho-education on
memory
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268J.
Reijnders
et al.
/ A
geing Research
Review
s 12 (2013) 263 275
Table 3Study characteristics of intervention studies in healthy
older adults (n = 21).
Study Sample size(EG/CG)
Mean age(year)
Intervention Follow-up Outcome measures of interest Signicant
effect forexperimental groupd
Bailey et al. (2010) 29/27 Range 6089 Metacognitive trainingat
home
Post-intervention Self-paced memory taskExperimenter-paced
memory task
+0
Basak et al. (2008) 20/20 69.1/70.0 Strategy-basedreal-time
videogame
Post-intervention Operation spanTask switchingN-back taskVisual
short-term memoryRavens Advanced Progressive MatricesStopping
taskFunctional eld of viewAttentional blinkEnumerationMental
rotation
0++++0000+
Berry et al. (2010) 15/15 71.9 Perceptualdiscrimination
training
Post-intervention Trained perceptual taskUntrained perceptual
taskWM/delayed recognition paradigm NIWM/delayed recognition
paradigm IS
+++0
Borella et al. (2010) 20/20 69.0/69.2 Verbal WM training
Post-interventionand 8 monthsfollow up
Visuospatial WM (dot matrix task)Short-term memory (digit
span)Inhibition (stroop color task)Processing speed (pattern
comparisontask)Fluid intelligence (Catells Culture Fair)
++++ (also at FU)+ (also at FU)
Bottiroli and Cavallini(2009)
21/23 66.2/66.1 Computer-basedmemory training
Post-intervention Figure list recognitionWord list
recognitionFace-name learningPlace-word learningPaired associated
recall
+++++
Buiza et al. (2008) 85/68/85a 74.4 Cognitive therapyEG1:
Cognitiveintervention andwell-beingEG2: cognitive therapy
Post-intervention Immediate memoryRecent logic execution
memoryShort-term memoryWorking memoryLearning potentialVisomanual
coordinationMotor executionPhonetic uencyCapacity for
abstractionPraxis
+ (for EG1)00+ (for EG1)+ (for EG1)0000+ (for EG1)
Buschkuehl et al.(2008)
13/19 80.1 Computerized WMtraining
Post-interventionand 1 year FU
Visual free recallVerbal free recallDigit spanBlock span
+00+
Carlson et al. (2008) 70/58 70.1/68.4 Community-basedprogram
At 4 and 8 months Word list memoryTrail Making
TestRey-Osterrieth Complex gure testPsychomotor speed
+++0
Cavallini et al. (2010) 27/24/29a 65.8/63.566.0
Memory trainingEG1: training inmnemonicsEG2: training
inmnemonics andinstructions
Post-intervention Associate learning (practiced task)List
learning (practiced task)Text learningPlace learningName-face
learningGrocery list learning
+ (EG1 = EG2)+ (EG1 = EG2)+ (EG2 > EG1)000
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269
Fairchild and Scogin(2010)
28/25 72.4 Memory enhancementprogram
Post-intervention Names and Faces taskAppointment Keeping
taskMultifactorial Memory QuestionnaireObject Misplacement
taskTarget Complaints Methodology
+0+++
Hastings and West(2009)
99/45/41a 70.9 Memory trainingEG1: group-based EG2:self help
Post-intervention(only performancemeasures) and 1month FU
Memory Self-Efcacy QuestionnaireMetamemory in Adulthood (3
subscales)-locus of control-anxiety-achievementName recallStory
recallShopping list recall
+ (for EG1 at FU)
+ (EG1 and EG2, at FU)00+ (EG1 and EG2, also at FU)+ (EG1 and
EG2, also at FU)0
Klusmann et al. (2010)e 92/91/76a 73.6 Computer course (EG1)and
physical exercisecourse (EG2)
Post-intervention Rivermead Behavioral Memory TestFree and Cued
Selective Reminding TestVerbal uencyStroop testTrail Making
TestSubjective ratings of-memory-concentration-exibility-physical
health-physical well-being
+ (EG1 and EG2)+ (due to worsening in CG)00+ (due to worsening
in CG)
+ (EG1)+ (EG1)0+ (EG2)0
McDougall et al. (2010) 135/130 75 Memory training At 2, 6, 14
and 26months
Mini-Mental State ExamHopkins Verbal Learning Test revisedBrief
Visuospatial Memory TestRivermead Behavioral Memory TestDirect
Assessment of Functional StatusMemory Self-Efcacy
QuestionnaireSpielberger State-Trait Anxiety InventoryCenters for
Epidemiologic Studies ScaleMetamemory in Adulthood
+ (only at 2 months)0000000+
Mozolic et al. (2011) 33/33 69.4 Modality specicattention
training
Post-intervention Selective attention task
(cross-modal)Selective attention task (within-modality)Multisensory
integration taskSymbol Digit Modalities TestWalk and talk
paradigmLetter n-back testStroop testTrail Making TestHopkins
verbal learning testProle of Mood StatesHealth status
Questionnaire
+0+++000000
Noice and Noice (2009) 42/40/40b 80.2/82.7/81.6 Multi-modal
activitiesin college acting classesEG: acting courseCG1: no
interventionCG2: singing course
Post-intervention Word list recallDelayed word list
recallCategory FluencyDigit SpanStory Recall TaskProblem
SolvingSelf-reported Personal Growth
Memory Controllability InventoryLifestyle Activities
Questionnaire
++0+ (only EG compared toCG1)+0 (improved in EG andCG2)00
-
270J.
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Table 3 (Continued)
Study Sample size(EG/CG)
Mean age(year)
Intervention Follow-up Outcome measures of interest Signicant
effect forexperimental groupd
Richmond et al. (2011) 21/19 66 Verbal and spatial WM training
Post-intervention Reading spanDigit span forwardDigit span
backwardRavens Advanced Progressive MatricesTest of everyday
attentionCVLT: total correctCVLT: repetitionsCVLT:
intrusionsSelf-reports: memorySelf-reports: attention
+00000+0++
Slegers et al. (2008)f 60/49/55/40c Range 6475 Computer training
and InternetUsageEG: training and interventionCG1: training, no
interventionCG2: no training, no interventionCG3: no contact
Post-intervention and 12 monthsFU
Short-Form Health Survey (SF-36)Loneliness questionnaireSymptom
Check List 90Development and activity (self-report)Instrumental
Activities of Daily LivingBelief in External Control ScaleMastery
ScaleComputer useVisual verbal learning testMotor choice reaction
time testLetter digit substitution testConcept shifting testStroop
color word testCognitive Failure Questionnaire
00000000000000
Smith et al. (2009) 242/245 75.6/75.0 Computerized cognitive
training Post-intervention and 3 months FU RBANS (auditory memory
and attention)Rey Auditory Verbal Learning TestRivermead Behavioral
Memory TestDigit span backwards testLetter-number
sequencingProcessing speedCognitive Self-Report Questionnaire
++ (also at FU)0++ (also at FU)+ (also at FU)+
Talib et al. (2008) 11/12 67.8/67.3 Memory training
Post-intervention Prose recallList recallWAIS digit symbolNumber of
underlined words in short textCategorization measure
+0+0+
Tranter and Koutstaal(2008)
22/22 67.8 Mentally stimulating activities Post-intervention
Catells Culture Fair (uid intelligence)WAIS-R blocks (Spatial
perceptual test)
++
West et al. (2008) 42/42 69.9 Group-based memory training
Post-intervention at week 6 andweek 9
Memory Self-Efcacy QuestionnaireMetamemory in Adulthood (3
subscales)-locus of control-anxiety-achievementName recallStory
recallShopping list recallDigit symbol substitution testStrategy
checklisteffective strategy use
+
+00++00+
EG, experimental group; CG, control group; N, number of
patients; FU, follow-up; WM, working memory; NI, no interference
task; IS, interrupting stimulus task; RBANS, Repeatable Battery for
the Assessment of NeuropsychologicalStatus; CVLT, California Verbal
Learning Test.
a Two experimental groups.b Two control groups.c Three control
groups.d +, positive effect for experimental group; 0, no
difference between groups; , negative effect for experimental
group.e Subjective measures reported in Klusmann et al. (2011).f
Objective outcome measures reported in Slegers et al. (2009).
-
J. Reijnders et al. / Ageing Research Reviews 12 (2013) 263 275
271
Table 4Study characteristics of intervention studies in MCI
population (n = 6).
Study Sample size(EG/CG)
Mean age(year)
Intervention Follow-up Outcome measures of interest Signicant
effect forexperimental groupa
Barnes et al.
Jean et al. (2
Kinsella et a
Troyer et al.
Tsolaki et al.
Wagner et a
MCI, mild cognMMQ, Multifa
a +, positiveb Improved
(Jean et al., 2tional skillsaimed at imcognitive tran active
colist or no trvaried betw2011).
3.4. Outcom
In the tour analysiobjective menteen studafter the intfollowing
taing memoret al., 2010;et al., 2011;(Bottiroli anand Cavallinory
and lea(Carlson et (2009) 22/25 74 Computer-basedauditoryprocessing
speedtraining
Post-intervention
010b) 11/11 68.5 Training inface-nameassociations
Post-interventionat 1 and 4 weeks
l. (2009) 22/22 78 Strategy training(memory,attention,
andorganisationalskills)
Post-interventionat 2 weeks and 4months
(2008) 24/24 75.4 Memory strategiestraining andlifestyle
education
Post-interventionand 3 months
(2011) 104/72 67 Cognitiverehabilitation
Post-interventionprogram
l. (2008) 33/40 53.7 Behavioral analysisand memorystrategy
training
Post-interventionand follow upplanned
itive impairment; EG, experimental group; CG, control group; N,
number of patients; RBActorial Memory Questionnaire; MoCA, Montreal
Cognitive Assessment.
effect for experimental group; 0, no difference between groups;
, negative effect for exin both groups.
010b), lifestyle (Troyer et al., 2008), or practice of atten-
(Kinsella et al., 2009; Tsolaki et al., 2011). One studyproving
processing speed by using a computer-basedaining program (Barnes et
al., 2009). Two studies usedntrol condition, where the other four
used a waitingaining control group. The duration of an
interventioneen 5 and 20 weeks (Kinsella et al., 2009; Tsolaki et
al.,
e measures and effects
wenty-one RCTs in healthy older adults included ins, the most
commonly used outcome measure wasemory performance (twenty studies)
(Table 3). In sev-ies, memory performance was signicantly
improvedervention. Signicant differences were observed on thesks;
self-paced memory task (Bailey et al., 2010), work-y tasks (Basak
et al., 2008; Berry et al., 2010; Borella
Buiza et al., 2008; Buschkuehl et al., 2008; Richmond Smith et
al., 2009; Talib et al., 2008), recognition taskd Cavallini, 2009),
face-name learning tasks (Bottirolii, 2009; Fairchild and Scogin,
2010), immediate mem-rning potential (Buiza et al., 2008), word
list recallal., 2008; Cavallini et al., 2010; Noice and Noice,
2009),
name recallrecall (CavaNoice, 2009ioral Memothe AssessmRey
Auditostrategy usies, measurve studiesswitching (et al.,
2010)Complex Fities Test (Met al., 2011)In three stuwere
obserTranter andces (Basak on attentionsensory intfor AssessmIn two
studwas observstudy a meRBANSCalifornia verbal learning testBoston
naming testTrial making testVerbal uencyDesign uencySpatial
span
0000000
Face-name associationsCalifornia verbal learning testDementia
Rating ScaleMini Mental State ExaminationRivermead Behavioral
Memory TestSelf-esteem scaleMultifactorial Memory Questionnaire
0b
000000b
Prospective memoryMMQ-abilityMMQ-strategyMMQ-contentmentStrategy
knowledge repertoire
+000+
Memory ToolboxMultifactorial Memory QuestionnaireImpact rating
scaleLifestyle importanceName recallNumber recallWordlist
recall
+000000
Mini Mental State ExaminationMontreal Cognitive Assessment
++Functional Cognitive Assessment ScaleMoCA (verbal
memory)Rey-sterrieth Complex Figure TestMoCA (Clock
drawing)Functional Rating Scale of Symptomsof Dementia
+++++
Appointment testLogical memory ILogical memory IIMemory
assessment clinicsquestionnaire
+0++
NS, Repeatable Battery for Assessment of Neuropsychological
Status;
perimental group.
(Hastings and West, 2009; West et al., 2008), story/textllini et
al., 2010; Hastings and West, 2009; Noice and; Talib et al., 2008;
West et al., 2008), Rivermead Behav-ry Test (Klusmann et al.,
2010), Repeatable Battery forent of Neuropsychological Status
(Smith et al., 2009),
ry Verbal Learning Test (Smith et al., 2009), memorye (Talib et
al., 2008; West et al., 2008). In eight stud-es of executive
functioning were included, of which
showed signicant effects on the following tasks; taskBasak et
al., 2008), Stroop Color Word Task (Borella, Trail Making Test
(Carlson et al., 2008), Rey-sterriethgure Test (Carlson et al.,
2008), Symbol Digit Modali-ozolic et al., 2011), walk and talk
paradigm (Mozolic, uency and problem solving (Noice and Noice,
2009).dies, signicant improvement on (uid) intelligence testved;
Catells Culture Fair (Bottiroli and Cavallini, 2009;
Koutstaal, 2008), Ravens Advanced Progressive Matri-et al.,
2008). In two studies, signicant improvemental tasks were observed;
selective attention task, multi-
egration task (Mozolic et al., 2011), Repeatable Batteryent of
Neuropsychological Status (Smith et al., 2009).ies, signicant
improvement in speed of processinged (Borella et al., 2010; Smith
et al., 2009). In oneasure of general cognitive functioning (Mini
Mental
-
272 J. Reijnders et al. / Ageing Research Reviews 12 (2013) 263
275
State Examination) was included as an outcome measure and
sig-nicantly improved by the intervention (McDougall et al.,
2010).Subjective measures of cognitive performance were included
inve studies. Signicant effects were observed for the
Multifacto-rial MemorMisplacemeEfcacy QueMetamemoet al.,
2010tionnaire (Sfunctioninget al., 2010et al., 2008)
All six Rused objectfour studiesinterventioon the follomemory
st2008), verbet al., 2011memory (Wfunctioningscale was s(Tsolaki et
afunctioningformance, mthe Montrethe intervenmeasure of Memory Quon
this scasure of dailDementia)
3.5. Method
The meassessed. Tincluded st(Table 5). Thological quathe lowest
qseven catemethods-ramation. In methods-rthan 50% of
3.6. Non-ra
Eight noolder adults2010) and 2008; HampLondos et a
In healthmemory pmemory trtransfer tasTwo studieSchmiedek
ronment inand workinreports as obrain traini
Nintendo Wii and reading sessions which showed
practice-relatedimprovement but no signicant transfer effects.
In people with MCI, two studies focused on improving adap-tive
behavior and functional ability. Greenaway et al. (2008)
d imppored ced acreas
focg or
effeos eon ptioneme, and
cussi
s systerved thas aspce, eence
bethetere mce aimilaa montiove oategt al., ntio-eduoging
muehfocusest, 2unctre, aing
ddit, theetwesed ing (>e and thaformtentiann eposiermer, tal
excompprov
anclitatiy Questionnaire (Fairchild and Scogin, 2010), Objectnt
task (Fairchild and Scogin, 2010), Memory Self-stionnaire (Hastings
and West, 2009; West et al., 2008),ry in Adulthood (Hastings and
West, 2009; McDougall; West et al., 2008), and Cognitive
Self-Report Ques-mith et al., 2009). In two studies, measures of
daily
(Direct Assessment of Functional Status (McDougall) and
Instrumental Activities of Daily Living (Slegers) were included,
but no signicant effect were observed.CTs in the MCI population
included in our analysisive memory performance as an outcome
measure: in
memory performance signicantly improved after then (Table 4).
Signicant improvements were observedwing tasks; prospective memory
(Kinsella et al., 2009),rategy knowledge (Kinsella et al., 2009;
Troyer et al.,al memory (Montreal Cognitive Assessment) (Tsolaki),
appointment test (Wagner et al., 2008) and logicalagner et al.,
2008). In two studies measures of executive
were included; the functional cognitive assessmentignicantly
improved by the intervention in one studyl., 2011). In three
studies, a measure of general cognitive
was included. In only one study general cognitive per-easured
with the Mini Mental State Examination and
al Cognitive Assessment was signicantly improved bytion (Tsolaki
et al., 2011). In three studies, a subjectivecognitive performance
was included, the Multifactorialestionnaire, although no signicant
effects were foundle. In one study a signicant improvement on a
mea-y functioning (Functional Rating Scale of Symptoms ofwas
observed (Tsolaki et al., 2011).
ological quality of study
thodological quality of the twenty-seven RCTs washe percentage
of the Consort items reported in theudies ranged from 16% to 73%,
with an average of 44%e study of Smith et al. (2009) had the
highest method-lity (73%), while the study of Wagner et al. (2008)
haduality (16%). The Consort statement can be divided into
gories: title/abstract; introduction; methods-trial;ndomization;
results; discussion; and other infor-ve of these categories
(title/abstract, methods-trial,andomization, results, and other
information) less
the items was reported.
ndomized controlled trials
n-RCTs were included; three clinical studies in healthy
(Ackerman et al., 2010; Li et al., 2008; Schmiedek et al.,ve
clinical studies in people with MCI (Greenaway et al.,stead et al.,
2008; Joosten-Weyn Banningh et al., 2008;
l., 2008; Ozgis et al., 2009).y older adults, one study aimed at
improving working
erformance by computerized training. The workingaining showed
improvements on practiced and nearks but no effects on far transfer
tasks (Li et al., 2008).s aimed at improving cognitive functioning
in general.et al. (2010) provided an internet-based training
envi-cluding tasks of perceptual speed, episodic memory,g memory.
They used only self-report evaluationutcome measures. Ackerman et
al. (2010) provided ang environment including training sessions
with the
showeory suprovidincreasand instudiestraininrelatedof
Londbilitatioccupaimprovmance
4. Dis
Thitive inshowevariouformanintelligparisonof the
outcomformanused strated interveobjectiory strTalib eof
attepsychoand ScworkinBuschkgrams and Wutive fmeasuimprov2008).
In astudiesonly baddresity ratipositivshoweof perand atKlusmhad
a the RivHowevphysicMCI, a no imperformrehabiprovement in
functional ability by the use of a mem-t system and Joosten-Weyn
Banningh et al. (2008)ognitive behavioral group therapy which
resulted incceptance and marital satisfaction in people with MCIed
awareness in their caregivers. The results of twousing on memory
improvement (by memory strategy
spaced retrieval memory training) showed practice-cts (Hampstead
et al., 2008; Ozgis et al., 2009). The studyt al. (2008) examined
the effect of an established reha-rogram designed to improve
cognitive performance,al performance, and quality of life. The
results showednts in cognitive processing speed, occupational
perfor-
some domains of quality of life (Londos et al., 2008).
on
tematic review, evaluating the effectiveness of cogni-ntions in
healthy older adults and people with MCI,t cognitive interventions
can be effective in improvingects of objective cognitive
functioning; memory per-xecutive functioning, processing speed,
attention, uid, and subjective cognitive performance. A critical
com-ween different intervention studies is difcult becauseogeneity
of the intervention programs and the choseneasures. Most
intervention studies used memory per-s the primary outcome measure,
but only few studiesr tests to measure memory functioning which
frus-re quantitative meta-analysis on these studies. Differentn
programs proved to be effective in improving eitherr subjective
memory performance; training of mem-ies (Bottiroli and Cavallini,
2009; Cavallini et al., 2010;2008; Wagner et al., 2008),
accompanied with practicenal skills (Kinsella et al., 2009; Tsolaki
et al., 2011),cational lessons on memory and/or lifestyle
(Fairchild, 2010; Troyer et al., 2008); computerized training
ofemory task (Berry et al., 2010; Borella et al., 2010;l et al.,
2008; Richmond et al., 2011); and training pro-ing on memory
self-efcacy or metacognition (Hastings009; McDougall et al., 2010;
West et al., 2008). Exec-ioning was mostly included as a secondary
outcomend only two intervention programs aimed directly atexecutive
functioning (Basak et al., 2008; Carlson et al.,
ion to the heterogeneity of the included intervention
methodological quality of the studies differed vastly:en 16% and
73% of the quality criteria items weren the studies. When assessing
studies with a high qual-60% of the Consort quality criteria), we
observed bothd negative results. The study of Smith et al. (2009)t
computerized cognitive training led to improvementance generalizing
to untrained measures of memoryon and subjective everyday
functioning. The study oft al. (2010) showed that a 6-month
computer course
tive affect on memory performance (measured withead Behavioral
Memory Test) in healthy older adults.he same improvement was
achieved with a 6-monthercise course (Klusmann et al., 2010). In
people withuter-based auditory processing speed training showed
ements on memory, executive, or general cognitivee (Barnes et
al., 2009). However, a 5-week memoryon program focusing on
practicing memory strategies
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J. Reijnders et al. / Ageing Research Reviews 12 (2013) 263 275
273
Table 5Quality assessment of included studies using the Consort
statement 2010.
Title, abstract(max. 2)
Introduction(max. 2)
Methods-trial(max. 9)
Methods-randomization(max. 8)
Results(max. 10)
Discussion(max. 3)
Other information(max. 3)
Total (%) score(max. 37)
Barnes et al.Jean et al. (2Kinsella et aTroyer et al. Tsolaki et
al.Wagner et aBailey et al. Basak et al. (Berry et al. (Borella et
al.Bottiroli and
(2009)Buiza et al. (Buschkuehl
(2008)Carlson et alCavallini et aFairchild and
(2010)Hastings and
(2009)Klusmann etMcDougall eMozolic et aNoice and NRichmond
eSlegers et alSmith et al. (Talib et al. (2Tranter and
(2008)West et al. (2
Total for cat 11
did show imknowledge
Anotheraddressed igroup receiWith an actattention alooking at
tan active comeasures ofunctioning(Borella et a2010; McDo2009;
RichmTranter andincluded anthese two s2009; Jean
interventioconcluded ton various ationing in h
An impowhether obfunctioningtioning, or lA number oalization
tofunctioningCavallini, 20Richmond e(ADL) meas
ant From (2009) 2 2 5 5 010a) 1 2 5 4 l. (2009) 2 2 5 5 (2008) 1
2 4 4
(2011) 1 2 2 2 l. (2008) 0 2 3 0 (2010) 0 1 4 12008) 0 2 5 1
2010) 0 1 4 2
(2010) 0 2 4 2 Cavallini 1 1 4 2
2008) 1 1 3 0et al. 0 2 3 1
. (2008) 1 2 5 2 l. (2010) 0 1 3 2
Scogin 0 2 1 3
West 0 2 4 1
al. (2010) 2 2 6 6t al. (2010) 0 2 4 3 l. (2011) 1 2 4 4 oice
(2009) 0 2 4 2 t al. (2011) 0 2 4 2 . (2008) 1 2 5 4 2009) 1 2 5 7
008) 0 2 3 1 Koutstaal 0 2 3 1
008) 0 2 2 1
egory (%)15 (28%) 49 (91%) 104 (43%) 68 (31%)
provements on prospective memory task and strategyrepertoire
(Kinsella et al., 2009).
signic2009). aspect of methodological quality, not specicallyn
the Consort Statement items, is whether the controlved an active
control intervention or no intervention.ive control condition the
effects of, for example, socials part of group meetings can be
controlled for. Whenhe RCTs in the healthy older adults, ten RCTs
includedntrol condition. These studies did show an effect onf
cognitive functioning, more specically executive, speed, attention,
and subjective memory functioningl., 2010; Buschkuehl et al., 2008;
Fairchild and Scogin,ugall et al., 2010; Mozolic et al., 2011;
Noice and Noice,ond et al., 2011; Slegers et al., 2008; Smith et
al., 2009;
Koutstaal, 2008). In the MCI population, two studies active
control group. The interventions executed intudies did not show any
signicant effect (Barnes et al.,et al., 2010b). In conclusion,
evaluating the results ofn studies with an active control
condition, it may behat cognitive interventions can have a positive
effectspects of both objective and subjective cognitive func-ealthy
older adults, but not in people with MCI.rtant question that was
raised in earlier reviews isserved training effects on various
aspects of cognitive
generalize to untrained tasks or overall cognitive func-ead to
functional improvement in daily life situations.f studies
specically addressed the question of gener-
untrained task or to subjective experience of cognitive (Berry
et al., 2010; Borella et al., 2010; Bottiroli and09; Buschkuehl et
al., 2008; Fairchild and Scogin, 2010;t al., 2011; Smith et al.,
2009). Activities of Daily Livingures were included in three
intervention studies and a
evidence foand daily liinterventiostill needs t
Anotherthe rootingFollow-up They showeremained apositive
effafter 1 monory and spepositive effmonths (Boup did notSlegers et
aing effects c
In compet al. (2011ies were incmore elabogating the However,
oearlier reviSimard, 201reviews, is ting to the Cquality of into
accounand interim5 3 2 24 (65%)5 2 1 20 (54%)6 3 1 24 (65%)6 2 0 19
(51%)2 1 0 10 (27%)1 0 0 6 (16%)3 3 1 13 (35%)6 3 1 18 (49%)4 1 1
13 (35%)3 3 0 14 (38%)4 1 0 13 (35%)
0 2 1 8 (22%)4 3 1 14 (38%)
5 3 1 19 (51%)2 2 1 11 (30%)6 3 1 16 (43%)
3 3 1 14 (38%)
6 3 1 26 (70%)5 2 2 18 (49%)4 3 1 19 (51%)6 2 1 17 (46%)3 3 1 15
(41%)5 3 1 21 (57%)8 3 1 27 (73%)3 1 1 11 (30%)5 3 1 15 (41%)
3 3 1 12 (32%)
3 (42%) 64 (79%) 24 (30%) 44%
effect on ADL was observed in one study (Smith et al., these
data it can be concluded that there is very little
r generalization effects to overall cognitive functioningfe
situations. The issue whether the effects of cognitivens generalize
to improvement in everyday life activitieso be addressed more
explicitly in future research.
important question is whether there is evidence of of training
effect after the training period has ended.data were available in
seven out of twenty-six RCTs.d that positive effects on memory
strategy knowledge
fter 3/4 months (Kinsella et al., 2009; Troyer et al.,
2008),ects on memory self-efcacy and recall tasks preservedth
(Hastings and West, 2009), positive effects on mem-ed preserved
after 3 months (Smith et al., 2009), andects on speed and uid
intelligence preserved after 8rella et al., 2010). Two studies
including a 1-year follow
nd any signicant effects (Buschkuehl et al., 2008;l., 2008).
From these data it can be concluded that train-an be preserved at
least for a couple of months.arison to the earlier reviews of Papp
et al. (2009), Martin) and Tardif and Simard (2011), more
intervention stud-luded in this review. This could be the results
of usingrated search terms or an increase in studies investi-effect
of cognitive interventions in the last few years.ur conclusions are
in line with the conclusions of theseews (Martin et al., 2011; Papp
et al., 2009; Tardif and1). A strength of this study, in comparison
with earlierhe methodological quality rating we performed
accord-onsort Statement 2010 for RCTs. The methodological
the twenty-seven RCTs differed considerably. Takingt that some
items (such as blinding, serious harms,
analysis) are less applicable for non-pharmacological
-
274 J. Reijnders et al. / Ageing Research Reviews 12 (2013) 263
275
interventions, it seems clear that substantial improvement in
termsof study quality can still be made in future intervention
studies. Inthis review we included intervention studies from both
healthyolder adults and MCI populations. Although a clear
differentiationbetween thmal versus cannot be cwith MCI bolder
adultsis that due outcome mmeta-analyble publicathe results
4.1. Conclu
The reseffective intioning; mespeed, atteformance. Astudies is
dtion prograthe heterogodological qthe effects oeveryday lifmore
explica core set othe effectivobjective andomains (emeasures
tshould be pthe methodimproved btained in thdesign and follow up
a
Source of f
This stunition (NIBResearch (N
Conict of
We decl
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inuencedour review.
sions
ults show evidence that cognitive training can be improving
various aspects of objective cognitive func-mory performance,
executive functioning, processingntion, uid intelligence, and
subjective cognitive per-
critical comparison between different interventionifcult because
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measures. In addition toeneity of the included intervention
studies, the meth-uality of the studies differed widely. The issue
whetherf cognitive interventions generalize to improvement ine
activities is still unresolved and needs to be addresseditly in
future research. For future research, inclusion off outcome
measures would be necessary to compare
eness of different cognitive intervention programs. Bothd
subjective outcome measures for specic cognitive
.g. memory, executive functioning) and ecological validhat show
improvements in daily cognitive functioningart of this core set of
outcome measures. Besides this,ological quality of future
intervention studies should bey specically addressing the quality
control items con-e Consort criteria. In particular, the
description of trialrandomization should be reporting more
accurately andssessments should be included.
unding
dy was funded by the National Initiative Brain & Cog-C) and
the Netherlands Organization for ScienticWO).
interest
are that there are no conicts of interest.
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Cognitive interventions in healthy older adults and people with
mild cognitive impairment: A systematic review1 Introduction2
Methods3 Results3.1 Studies included3.2 Study characteristics3.3
Description of interventions3.4 Outcome measures and effects3.5
Methodological quality of study3.6 Non-randomized controlled
trials
4 Discussion4.1 Conclusions
Source of fundingConflict of interestReferences