Mindfulness and Cognitive Training Interventions in Mild Cognitive Impairment: Impact on Cognition and Mood

With the lack of disease-modifying pharmacologic treatments for mild cognitive impairment and dementia, there has been an increasing clinical and research focus on nonpharmacological interventions for these disorders. Many treatment approaches, such as mindfulness and cognitive training, aim to mitigate or delay cognitive decline, particularly in early disease stages, while also offering potential benefits for mood and quality of life. In this review, we highlight the potential of mindfulness and cognitive training to improve cognition and mood in mild cognitive impairment. Emerging research suggests that these approaches are feasible and safe in this population, with preliminary evidence of positive effects on aspects of cognition (attention, psychomotor function, memory, executive function), depression, and anxiety, though some findings have been unclear or limited by methodological weaknesses. Even so, mindfulness and cognitive training warrant inclusion as current treatments for adults with mild cognitive impairment, even if there is need for additional research to clarify treatment outcomes and questions related to dose, mechanisms, and transfer and longevity of treatment effects.     

MEMO+: Efficacy,Durability and Effect of Cognitive Training and Psychosocial Intervention in Individuals with Mild Cognitive Impairment

Background/Objectives

There is no consensus on the efficacy of cognitive training in persons with mild cognitive impairment (MCI) because of the paucity of well‐designed randomized controlled trials. The objective was to assess the effect of memory training on the cognitive functioning of persons with MCI and its durability and to evaluate whether this effect generalizes to daily life and whether positive effects could be obtained from psychosocial intervention.

Design

Single‐blind randomized controlled trial.

Setting

Research centers of the Institut Universitaire de Gériatrie de Montréal and Institut Universitaire en Santé Mentale de Québec.

Participants

Older adults meeting criteria for amnestic MCI (N = 145).

Intervention

Participants were randomized to cognitive training, a psychosocial intervention, or a no‐contact control condition. Interventions were provided in small groups in eight 2‐hour sessions.

Measurement

Outcome measures were immediate and delayed composite performance memory scores, psychological health (depression, anxiety, well‐being), and generalization effects of the intervention (strategy use in everyday life, difficulties in complex activities of daily living, memory complaints). Testing was administered before training and immediately, 3 months, and 6 months after training.

Results

Participants in the cognitive training condition improved on the delayed composite memory score and on strategy use in everyday life. Improvement was maintained at the 3‐ and 6‐month follow‐up assessments. Participants in the psychosocial and no‐contact conditions did not show any significant improvement.

Conclusion

Cognitive training improves the memory of persons with amnestic MCI. The effect persists over a 6‐month period, and learned strategies are used in everyday life. Cognitive training is a valid way to promote cognition in MCI.     

A Cognitive Training Program Based on Principles of Brain Plasticity: Results from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) Study

OBJECTIVES: To investigate the efficacy of a novel brain plasticity–based computerized cognitive training program in older adults and to evaluate the effect on untrained measures of memory and attention and participant‐reported outcomes. DESIGN: Multisite randomized controlled double‐blind trial with two treatment groups. SETTING: Communities in northern and southern California and Minnesota. PARTICIPANTS: Community‐dwelling adults aged 65 and older (N=487) without a diagnosis of clinically significant cognitive impairment. INTERVENTION: Participants were randomized to receive a broadly‐available brain plasticity–based computerized cognitive training program (intervention) or a novelty‐ and intensity‐matched general cognitive stimulation program modeling treatment as usual (active control). Duration of training was 1 hour per day, 5 days per week, for 8 weeks, for a total of 40 hours. MEASUREMENTS: The primary outcome was a composite score calculated from six subtests of the Repeatable Battery for the Assessment of Neuropsychological Status that use the auditory modality (RBANS Auditory Memory/Attention). Secondary measures were derived from performance on the experimental program, standardized neuropsychological assessments of memory and attention, and participant‐reported outcomes. RESULTS: RBANS Auditory Memory/Attention improvement was significantly greater (P=.02) in the experimental group (3.9 points, 95% confidence interval (CI)=2.7–5.1) than in the control group (1.8 points, 95% CI=0.6–3.0). Multiple secondary measures of memory and attention showed significantly greater improvements in the experimental group (word list total score, word list delayed recall, digits backwards, letter–number sequencing; P<.05), as did the participant‐reported outcome measure (P=.001). No advantage for the experimental group was seen in narrative memory. CONCLUSION: The experimental program improved generalized measures of memory and attention more than an active control program.     

计算机辅助技术对血管性痴呆患者的认知康复的疗效观察

目的观察计算机辅助技术对血管性痴呆(vascular dementia,VD)患者的认知康复的疗效。方法将38例符合纳入标准的VD患者随机分为对照组和训练组,每组19例患者。对照组和训练组均给予规范抗痴呆药物治疗、常规康复训练。训练组在此基础上接受计算机辅助认知康复训练,1次/天,30分/次,治疗8周。分别于训练前、训练8周后采用简易精神状态量表(Mini-metal State Examination,MMSE)、蒙特利尔认知评估量表中文版(Montreal cognitive assessment,MoCA)对两组患者进行认知功能评定。比较训练组和对照组治疗前后的组内及组间成绩。结果计算机训练组及对照组MMSE、MoCA总分均比训练前提高(P<0.05);计算机训练组成绩高于对照组(P<0.01);轻、中度VD患者成绩提高明显(P<0.05),重度VD患者成绩提高无统计学差异(P>0.05)。结论规范的抗痴呆药物治疗可以改善VD的认知功能;药物联合计算机辅助技术训练,改善VD认知功能更显著;认知康复训练对改善轻、中度VD患者的认知功能效果显著,对重度VD患者疗效欠佳。     

针刺百会、神庭穴联合康复训练治疗卒中后认知功能障碍

目的分析采用针刺百会、神庭穴与康复训练对老年卒中后认知障碍患者的临床疗效。方法回顾性分析本院2016年4月到2018年6月收治的94例卒中后认知功能障碍患者,按照不同的治疗方案分为常规组和研究组,各47例。常规组使用基础治疗及常规康复训练治疗,研究组在常规组治疗的基础上实施针刺百会、神庭穴治疗,对比分析两组患者的治疗效果。结果治疗前,两组患者MMSE评分比较无显著性差异(P>0.05);治疗后,两组患者MMSE评分均显著增加,与治疗前比较有显著性差异(P<0.05),且研究组MMSE评分显著高于常规组(P<0.05)。两组患者治疗前认知量表各项评分比较无显著性差异(P>0.05),治疗后各项评分均明显增加,与治疗前比较有显著性差异(P<0.05),除了注意力外其他项均有显著差异(P<0.05)。临床治疗有效率为95.74%,显著高于常规组(72.34%),两组差异存在统计学意义(P<0.05)。结论针刺百会、神庭穴与康复训练治疗卒中后认知障碍患者疗效较佳,值得推广。     

A Multimodal Cognitive Enhancement Program for Older Adults: A Case Report of the Implementation of Brain Training

This case report describes the implementation of a holistic, multimodal clinical program aimed to enhance the cognitive and emotional well-being of community-dwelling older adult Veterans. Participants (N = 15) over age 65 attended a 12-week class adopted from a cognitive enhancement program developed by Huckans, Twamley et al. (2013) and Twamley et al. (2013). Assessment of cognition, mood, and lifestyle variables, were completed at two time points. At post-evaluation, participants made significant improvements on verbal learning, memory self-efficacy, and self-reported health. Results of a group evaluation revealed satisfaction among participants in the quality of the intervention. Clinical practice recommendations are noted.     

Cognitive Training Program to Improve Working Memory in Older Adults with MCI

ABSTRACT

Objectives: Deficits in working memory (WM) are associated with age-related decline. We report findings from a clinical trial that examined the effectiveness of Cogmed, a computerized program that trains WM. We compare this program to a Sham condition in older adults with Mild Cognitive Impairment (MCI). Methods: Older adults (N = 68) living in the community were assessed. Participants reported memory impairment and met criteria for MCI, either by poor delayed memory or poor performance in other cognitive areas. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS, Delayed Memory Index) and the Clinical Dementia Rating scale (CDR) were utilized. All presented with normal Mini Mental State Exams (MMSE) and activities of daily living (ADLs). Participants were randomized to Cogmed or a Sham computer program. Twenty-five sessions were completed over five to seven weeks. Pre, post, and follow-up measures included a battery of cognitive measures (three WM tests), a subjective memory scale, and a functional measure.Results: Both intervention groups improved over time. Cogmed significantly outperformed Sham on Span Board and exceeded in subjective memory reports at follow-up as assessed by the Cognitive Failures Questionnaire (CFQ). The Cogmed group demonstrated better performance on the Functional Activities Questionnaire (FAQ), a measure of adjustment and far transfer, at follow-up. Both groups, especially Cogmed, enjoyed the intervention.Conclusions: Results suggest that WM was enhanced in both groups of older adults with MCI. Cogmed was better on one core WM measure and had higher ratings of satisfaction. The Sham condition declined on adjustment.     

Cognitive function in normal-weight, overweight, and obese older adults: an analysis of the Advanced Cognitive Training for Independent and Vital Elderly cohort

OBJECTIVES: To assess how elevated body mass index (BMI) affects cognitive function in elderly people. DESIGN: Cross-sectional study. SETTING: Data for this cross-sectional study were taken from a multicenter randomized controlled trial, the Advanced Cognitive Training for Independent and Vital Elderly trial. PARTICIPANTS: The analytic sample included 2,684 normal-weight, overweight, or obese subjects aged 65 to 94. MEASUREMENTS: Evaluation of cognitive abilities was performed in several domains: global cognition, memory, reasoning, and speed of processing. Cross-sectional association between body weight status and cognitive functions was analyzed using multiple linear regression. RESULTS: Overweight subjects had better performance on a reasoning task (beta=0.23, standard error (SE)=0.11, P=.04) and the Useful Field of View (UFOV) measure (beta=-39.46, SE=12.95, P=.002), a test of visuospatial speed of processing, after controlling for age, sex, race, years of education, intervention group, study site, and cardiovascular risk factors. Subjects with class I (BMI 30.0-34.9 kg/m2) and class II (BMI>35.0 kg/m2) obesity had better UFOV measure scores (beta=-38.98, SE=14.77, P=.008; beta=-35.75, SE=17.65, and P=.04, respectively) in the multivariate model than normal-weight subjects. The relationships between BMI and individual cognitive domains were nonlinear. CONCLUSION: Overweight participants had better cognitive performance in terms of reasoning and visuospatial speed of processing than normal-weight participants. Obesity was associated with better performance in visuospatial speed of processing than normal weight. The relationship between BMI and cognitive function should be studied prospectively.     

Cognitive training on eating behaviour and weight loss: A meta‐analysis and systematic review

Cognitive deficits play a role in the development and maintenance of overeating and obesity, and cognitive training in obesity refers to a family of interventions aimed at reducing overeating and obesity by improving these cognitive deficits. In this review, we synthesize the current literature on these issues by conducting a meta‐analysis of studies investigating the effects of cognitive trainings on eating behaviour and presenting a systematic review of studies investigating the effects of cognitive trainings on weight loss. We examined 66 independent experiments that examined the effects of cognitive training aimed at reducing cognitive bias or improving executive control on eating behaviour and weight loss. Overall, inhibition training, attention bias modification training, and episodic future thinking training significantly influenced eating behaviour; however, approach/avoidance training did not significantly influence eating behaviour. Moderator analyses indicated that the effect of inhibition training on eating behaviour was moderated by training task and food novelty, the effect of approach/avoidance training was moderated by food type, and the effect of episodic future thinking training was moderated by type of episodic future thinking. Literature reviewed on cognitive training and weight loss provided preliminary support for the effects of food‐specific inhibition training on weight loss from pre‐intervention to post intervention. However, because most of the included studies focused on short‐term outcomes in normal‐weight samples, longer duration studies in clinical populations (eg, individuals with obesity) are needed to examine the generalizability of these results.     

三七总皂苷配合康复训练对轻中度老年痴呆认知功能的影响

目的 观察三七总皂苷时老年痴呆认知功能改善的作用.方法 将49例发病0.5年～2.0年的老年痴呆患者,随机分成两组,对照组24例,予脑复康片及康复训练,治疗组25例在对照组基础上加用血塞通软胶囊,两组均治疗12周.观察两组患者治疗前后简明智能状态检查量表(MMSE)的评分.结果 经治疗12周后治疗组与对照组MMSE评分均有所提高,治疗组总有效率为72%高于对照组的58%;治疗后治疗组MMSE为(14.00±8.92)分优于对照组的(12.85±4.07)分(P<0.01).结论 三七总皂苷配合康复训练在轻中度老年痴呆患者认知功能改善中具有较好的疗效.     

血浆同型半胱氨酸与认知功能

随着发病率的不断增高,痴呆已成为神经科学界关注的焦点。近年来的研究发现,血浆同型半胱氨酸与认知功能密切相关。文章对同型半胱氨酸的代谢、在认知功能减退和痴呆中的可能作用机制及其与认知功能的关系进行了综述。     

血压与认知功能障碍

许多临床研究表明 ,长期高血压可引起认知功能障碍 ,主要原因是脑灌注下降 ,有效控制血压尤其是收缩压可减少痴呆的发生。但也有研究得出了不同的结论。文章总结了近年来的相关研究成果 ,并对其发生机制进行了探讨 ,以寻求干预的可能性。     

Cognitive training decreases motor vehicle collision involvement of older drivers

OBJECTIVES: To test the effects of cognitive training on subsequent motor vehicle collision (MVC) involvement of older drivers. DESIGN: Randomized, controlled, multisite, single‐blind clinical trial. SETTING: Community‐dwelling seniors at four U.S. sites: Birmingham, Alabama; Baltimore, Maryland; Indianapolis, Indiana; and State College, Pennsylvania. PARTICIPANTS: Nine hundred eight older drivers (mean age 73.1; 18.6% African American) who were randomized to one of three cognitive interventions or a control condition. INTERVENTIONS: Up to 10 sessions of cognitive training for memory, reasoning, or speed of processing. MEASUREMENTS: State‐recorded MVC involvement up to 6 years after study enrollment. RESULTS: Speed‐of‐processing and reasoning training resulted in lower rates of at‐fault collision involvement over the subsequent approximately 6‐year period than controls. After adjusting for age, sex, race, education, mental status, health, vision, depressive symptoms, and testing site, participants randomized to the speed‐of‐processing and reasoning interventions had an approximately 50% lower rate (per person‐mile) of at‐fault MVCs than the control group (rate ratio (RR)=0.57, 95% confidence interval (CI)=0.34–0.96 for speed of processing), and (RR=0.50, 95% CI=0.27–0.92 for reasoning). There was no significant difference observed for the memory group. CONCLUSION: Cognitive speed‐of‐processing and reasoning training resulted in a lower at‐fault MVC rate in older drivers than in controls. Considering the importance of driving mobility, the costs of crashes, and the benefits of cognitive training, these interventions have great potential to sustain independence and quality of life of older adults. More research is needed to understand the effects of different types and quantities of training.