Effects of Internet Based Training on Cognition in Older Adults
Running Head: EFFECTS OF TRAINING ON COGNITION
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EFFECTS OF TRAINING ON COGNITION
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Effects of Internet Based Training on Cognition in Older Adults
Student A. Smith
PSY625: Biological Bases of Behavior
Instructor B. Jones, PhD.
September 19, 2014
Effects of Internet Based Training on Cognition in Older Adults
Specific Aims
The idea that maintaining high levels of cognitive activity protects the brain from neurodegeneration is not new, and much evidence has accumulated that people with high levels of cognitive ability and activity tend to maintain cognitive function well as they age (Hertzog et al. 2009). Beyond the idea of maintaining cognitive function in healthy aging, studies such as Verghese et al. (2003) found that higher levels of cognitive activity were associated with lower rates of dementia in a 21- year longitudinal study. While much of the data indicating higher levels of cognitive activity leads to better long-term function is necessarily correlational, a number of studies have begun to systematically assess the effect of cognitive interventions on cognitive function. The largest of these, the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE; Jobe et al. 2001) has found long lasting effects (5 years; Willis et al. 2006) of relatively short cognitive training activities (10 hours).
The specific aim of this proposal is to assess the effectiveness of A Fictitious Brain Training Program on research participants followed longitudinally who may be experiencing the very earliest signs of cognitive decline. Recent research tracking the trajectory of age related cognitive decline (e.g., Mungas et al. 2010) has suggested that it may be possible to identify cognitively healthy individuals at risk for significant imminent cognitive decline by examining baseline cognitive assessments or recent change, even though test scores do not reach the abnormal range.
Background
Techniques for maintaining and enhancing cognitive function in an increasingly aging population are of great potential benefit to those who might suffer from Alzheimer’s disease and related disorders and also to society as a whole. Higher cognitive function leads to better maintenance of activities of daily life, less need for chronic care, and direct improvements in quality of life. Research examining effective methods for cognitive enhancement is becoming increasingly prevalent and has led to a number of recent review studies, e.g., Hertzog et al. (2009), Lustig et al. (2009), Green & Bavalier (2008). These studies review evidence from both longitudinal studies of increased levels of mental activity on maintenance of cognitive function and intervention studies aimed at directly improving cognition with targeted cognitive training. For these cognitive interventions to provide widespread benefit, it is critical to identify who will gain from cognitive intervention studies and to assess methods of administering effective cognitive training.
In a large scale cognitive intervention study (ACTIVE), Ball et al. (2002) found that training increased cognitive function with as little as 10 hours of task-specific training and these gains were still evident 5 years later (Willis et al. 2006). However, none of the three types of training used in that study were found to generalize to the other types of cognitive function. Participants were trained on either verbal episodic memory, reasoning (pattern identification), or speed-of-processing (visual search skills). Gains were observed in the domain of training, but not on the other two domains. As noted by Salthouse (2006), this result is inconsistent with the strongest form of the “use it or lose it” hypothesis. However, it does hold promise for cognitive training interventions that train broadly across a wide variety of domains. The hypotheses implied by the “use it or lose it” hypothesis is that cognitive training is protective broadly against the cognitive decline associated with aging. The more commonly observed specific areas of training improvement suggest an analogy to physical fitness training: the brain should not be thought of as a single “muscle” to be strengthened but as a collection of individual abilities that could each be improved through “exercise.” In addition, the analogy could be extended to the idea that cognitive training “exercise” should be thought of as an activity to be engaged in on a regular basis, not as a single intervention.
The cognitive training that will be used in the proposed project is based on an internet delivered set of activities designed by the company BrainExercise. The training is based on practice across a wide range of cognitive abilities, and by being highly available via the internet, is also available for regular follow-up re-training to maintain benefits. With this type of intervention, even if a cognitive intervention training does not provide a global benefit and delay decline across all types of cognition, training can be used across many areas to increase overall function. The ability to deliver cognitive training via the internet becomes important logistically since the benefit of training may depend on regular access to a broad array of cognitive activities. In the successful ACTIVE study, training was administered in face-to-face sessions requiring significant personnel and logistical support.
The issue of identifying tasks suitable for cognitive training with memory-impaired patients is an important one. In a follow-up reanalysis of the ACTIVE study data, Unverzagt et al. (2007) found that patients scoring >1.5 standard deviations low on memory tests did not benefit from the verbal episodic memory training in ACTIVE. In addition to seeing cognitive training as a method for delaying or reducing the onset of memory disorders such as MCI or AD (as in Verghese et al. 2003), suitable interventions to try to rehabilitate memory function or train compensatory strategies may provide an important benefit to MCI and AD patients.
Numerous studies have suggested that elderly who are currently cognitively within the normal range, but on the lower end of the range are at risk for subsequent cognitive decline, including the development of Alzheimer’s Disease (Rubin et al, 1998; Sliwinski, Lipton, Buschke, & Stewart, 1996).
Older participants who score within normal cognitive ranges but who exhibit personal cognitive decline within that normal range are also at higher risk for the later development of Alzheimer’s Disease (Villemagne et al, 2008; Collie et al, 2001). The most at-risk group of currently healthy elderly may be those who have shown some cognitive decline and are now at the bottom of the healthy range. Since this proposal is to investigate at the effectiveness of cognitive training in patients at risk for Alzheimer’s Disease, the ideal comparison groups are healthy older adults who are at increased risk relative to their age group (cognitively normal, but lower scoring) and those who are cognitively normal and exhibiting no current evidence of memory impairment.
Significance
The proposed research will use an online-based software company to administer a structured intervention of cognitive skill training to patients experiencing some memory decline. Prior intervention studies have typically provided cognitive training in individual or small-group environments with the patients physically present with a trainer. If interventions based on training via the internet are shown to have similar benefits, many more people can gain these benefits since the labor involved in administering this type of training is much lower. In addition, improvements in the type of training administered can be made centrally and more quickly positively impact many more patients. For the pilot intervention study proposed here, we will be working with the Brain Science division at A Fictitious Company. The Fictitious program is a home-based, computerized, cognitive training program in which a customized training plan is developed for each participant based on an initial baseline cognitive assessment and ongoing training progress. The training plan is based on 21 different tasks that each focus on one or two of 14 different specific cognitive abilities. To collaborate on examining the effectiveness of their training plan, they are making available licenses for all study participants to access the training program without cost. In addition, all performance data on all compliance, cognitive assessments and performance on training components will be available for collaborative analysis to assess efficacy of specific training elements in our study population.
The ability to deliver cognitive training via the internet holds tremendous promise for making training benefits available widely. Concerns about the task-specificity of benefits and the need for consistent training to maintain cognitive function can be met by making training easily available at home. The proposed research will work with the cognitive science research group of the A Fictitious company to assess the effectiveness of their targeted, individually customized cognitive training methods to improve cognitive functions in patients engaged in long-term outcome research at the Brain Center at an Important University.
Proposed Study
Research question: (header 2)
For each hypothesis, write a research question in one sentence.
Hypothesis:
See my study guide for changing the research question into a one sentence hypothesis. Identify the independent variable and dependent variable in each hypothesis. Label each hypothesis H1 or H2 etcetera. Remember the template for writing a hypothesis: IF …IV (independent variable) … THEN …DV (dependent variable). The IV is the study situation and the DV is the result of manipulation of the independent variable. The…
