Cognitive Flexibility Training: A Large-Scale Multimodal Adaptive Active-Control Intervention Study in Healthy Older Adults

Abstract

As aging is associated with cognitive decline, particularly in the executive functions, it is essential to effectively improve cognition in older adults. Online cognitive training is currently a popular, though controversial method. Although some changes seem possible in older adults through training, far transfer, and longitudinal maintenance are rarely seen. Based on previous literature we created a unique, state-of-the-art intervention study by incorporating frequent sessions and flexible, novel, adaptive training tasks, along with an active control group. We created a program called TAPASS (Training Project Amsterdam Seniors and Stroke), a randomized controlled trial. Healthy older adults (60–80 y.o.) were assigned to a frequent- (FS) or infrequent switching (IS) experimental condition or to the active control group and performed 58 half-hour sessions over the course of 12 weeks. Effects on executive functioning, processing- and psychomotor speed, planning, verbal long term memory, verbal fluency, and reasoning were measured on four time points before, during and after the training. Additionally, we examined the explorative question which individual aspects added to training benefit. Besides improvements on the training, we found significant time effects on multiple transfer tasks in all three groups that likely reflected retest effects. No training-specific improvements were detected, and we did not find evidence of additional benefits of individual characteristics. Judging from these results, the therapeutic value of using commercially available training games to train the aging brain is modest, though any apparent effects should be ascribed more to expectancy and motivation than to the elements in our training protocol. Our results emphasize the importance of using parallel tests as outcome measures for transfer and including both active and passive control conditions. Further investigation into different training methods is advised, including stimulating social interaction and the use of more variable, novel, group-based yet individual-adjusted exercises.

Does cognitive flexibility training enhance subjective mental functioning in healthy older adults?

“…Our results suggest that including specific elements such as adaptiveness and cognitive flexibility in a computerized training is not sufficient to lead to noteworthy subjective effects immediately after training. This outcome replicates results from our stroke sample (Van De Ven et al, 2017), in which we investigated subjective effects of the TAPASS training in recovering stroke patients. In this study, time effects on the DEX and CFQ appeared in all groups, including the no-contact waiting list condition.…”

“…To test whether the relationship between subjective and objective memory and depression is similar to that found in previous research (Hertzog & Pearman, 2013;Hulur et al, 2015), we computed an exploratory Pearson's correlation coefficient between scores on our subjective memory scale, the HADS-D, and objective score on verbal long term memory (RAVLT delay; see Buitenweg et al, 2017). In accordance with the literature, we found a significant correlation between metamemory and depression (r = .358, n = 135, p < .001), whereas no significant correlations arose between metamemory and objective memory score (r = −.063).…”

“…Of the 158 participants who completed baseline measurements, 19 dropped out for various reasons (see Buitenweg et al, 2017). Sustainers were significantly younger than dropouts (sustainers M = 67.77, SD 5.0; dropouts M = 72.3, SD = 7.8, t [20,134] = −2,454, p = 0.023).…”

“…Results are distributed over multiple publications. For a full detailed description of our methods, see Buitenweg, Van De Ven, Prinssen, Murre, and Ridderinkhof (2017).…”

Cognitive Training Does Not Enhance General Cognition

“…Other cognitive-training regimens have been recently examined. Examples include cognitive-flexibility training [66], task-switching training [67,68], spatial training [69,70], learning relational reasoning [71], exergames [72][73][74], meditation/mindfulness [75,76], and multimodal cognitive training [77]. In accordance with the findings presented above, none of these types of training appears to exert appreciable effects on overall cognitive function.…”