Evaluation of Online Cognitive Fitness Programs
Phase: NA
Conditions: Aging, Cognitive Decline
Sponsor: Baycrest

 
 
 
 
 
 
 
 
 
 
Evaluation of the Online Memory & Aging Program and Online Goal Management Training 
 
 
Study Protocol 
& 
Statistical Analysis Plan 
& 
Informed Consent Form 
 
 
Study 17-24 
 
 
July 6, 2018 
 
 
 
 

Study Protocol 
 
The study is designed to test the effectiveness of online versions of the Memory & Aging 
Program (MAP) and Goal Management Training (GMT), on the measures used for in-person 
MAP and GMT in healthy older adults experiencing subjective cognitive impairment.  
 
Background 
Normal aging is associated with decline in some aspects of memory, such as memory for recent 
information (e.g., where did I put my glasses?), associations (e.g., what was your name again?), 
and intentions (e.g., why did I come in this room?), as well as changes to executive functions, 
such as sustaining attention, problem-solving, and planning. These age-related cognitive changes 
can be a source of frustration and anxiety and may be a risk factor for reductions in everyday 
functioning, which threatens the independence of otherwise healthy older adults. Secondary 
prevention programs that target positive adaptation to age-related cognitive changes, including 
lifestyle behaviour change to maximize cognitive health and compensatory strategies for 
mitigating the functional impact of normal memory & executive functioning change, are a 
promising avenue to enhance the health and wellness of our aging population. 
 
The Baycrest Memory and Aging Program (MAP) is an education and intervention program for 
older adults experiencing normal age-related memory changes. The program is offered quarterly 
at Baycrest. Over 1,000 clients have participated since its inception in 1997. The goals of the 
program are to (a) increase participant knowledge about memory and aging, (b) expand 
participants’ repertoire of evidence-based strategies for learning and remembering, (c) increase 
participant confidence in memory ability, (d) foster adoption of healthier lifestyle practices, and 
(e) reduce intention to use unneeded health care resources. Two prior formal program evaluation 
studies have demonstrated efficacy of the MAP in achieving these stated goals (Troyer, 2001; 
Wiegand, Troyer, Gojmerac, & Murphy, 2013). Goal Management Training™ (GMT) is another 
evidence-based cognitive intervention program developed at Baycrest that targets executive 
functioning. The program includes an engaging narrative that increases awareness about these 
cognitive abilities, teaches strategies to help control automatic processing that hinders flexibility 
of cognitive performance, provides practice exercises and assignments that help internalize and 
harness these strategies, and teaches meditation techniques that promote mindfulness (Levine, et. 
al., 2000; Levine, et. al., 2007; Levine, et. al., 2011). 
 
As in any in-person intervention, participation may be restricted for some individuals because of 
obstacles that prevent them from attending sessions at Baycrest, such as physical disabilities, 
transportation impediments, scheduling difficulties, or living outside of the Toronto area. 
Recently, online versions of the MAP and GMT were designed to overcome some of these 
limitations and increase the outreach of the program to a broader audience. These versions 
consist of weekly modules that relay the material in a variety of forms including videos, 
animations, interactive games, discussion boards, live chats, and homework assignments. The 
current project seeks to evaluate participant outcomes following the online version of the MAP 
and GMT using a randomized controlled pretest-posttest design. 
 
 
 

Objectives 
The online program was designed to be similar to the in-person version in terms of content and 
activities to provide similar levels of engagement. We therefore expect similar outcomes, namely: 
For MAP: that compared to the control groups, participants in the intervention group will 
demonstrate greater knowledge about memory and memory strategies, increased confidence and 
satisfaction with their memory, healthier lifestyle behaviors, and decreased intentions to seek 
unnecessary medical attention;  
And for GMT: that compared to control groups, participants will demonstrate increased 
executive functioning and decreased cognitive failures.  
 
Method 
Study population 
200 healthy community-dwelling older adults will be recruited by newspaper and online 
advertisements (see Appendix). 
 
Inclusion criteria: 
(a) Age 60+ 
(b) Available to participate in all testing and intervention sessions and access to a computer 
(c) Computer familiarity  
(d) Cognitive complaint/concern/frustration 
 
Exclusion criteria: 
(a) Health conditions with major effects on cognition, including a current or previous history 
of stroke, brain surgery, or diagnosed neurological disorder; 
(b) Dependence in instrumental activities of daily living 
(c) Cognitive impairment, defined as performance below cutoff for cognitive impairment on 
a standardized cognitive screening measure, the modified Telephone Interview for 
Cognitive Status (Welsh et al., 1993) 
(d) Affective impairment, defined as performance below cutoff for depression on 
standardized depression screen, the Geriatric Depression Scale (Yesavage et al., 1983) 
 
Study Procedures 
Study procedures are illustrated in figure, below. The estimate of the number of participants 
reflects the expectation of attrition due to the length of the study. Potential participants will be 
screened online and over the telephone for inclusions and exclusions as outlined above. Informed 
consent, pretest, posttest, and follow-up testing sessions will be completed online. The online 
cognitive training protocols are largely completed online from the participants’ home or other 
location of their choosing. All protocols include interactive components; in some cases this 
involves telephone calls and/or online discussion with research personnel.  Total participation 
duration is 17 weeks. Data collection is planned to be completed within one year of REB 
approval. 
 
 
 
 
 

 
 
 
Interested participants who replied by email to the study advertisement (see Appendix) will be 
emailed the information sheet portion (excluding the signature section) of the informed consent, 
and will be asked to complete the online screening form and phone screening interview (see 
script in Appendix). Eligible participants will then be emailed a link to an online pre-test 
assessment. As the bulk of the study will be taking place online, participants will accept 
provisions of the study through an online consent form.  
 
 
 
Following completion of the pre-test assessment session, participants will be randomly assigned 
to one of four groups according to a blocked randomization scheme (stratified on age, gender, 
and education) created by a study team member unknown to participants or otherwise involved 
in data collection procedures. Participants will be informed of their group allocation by email 
and then begin the assigned program at their convenience, immediately following the completion 
of the pretest.  
 
The intervention groups are as follows: 
1. Online Memory and Aging Program: consists of weekly modules, and will take 
approximately 10 hours to complete over eight consecutive weeks. The content of the 
program includes: (a) the provision of factual information (i.e., about memory, age-
related memory changes, lifestyle factors affecting memory, and memory strategies); and 
(b) memory intervention (i.e., practice and application of several evidence-based memory 
strategies). The information is delivered in a variety of formats, including videos, 
animations, interactive games, discussion boards, and live chats. As in the in-person 
MAP, participants will complete homework assignments in a Participant Workbook that 
will be mailed to them at the onset of the intervention. The program includes pre/post 

assessment of knowledge, memory and lifestyle behaviours, and personal goals for 
reducing impact of memory change.  
2. Test-retest group:  This group will complete two assessments of knowledge, memory and 
lifestyle behaviours, and personal goals for reducing impact of memory change. These 
assessments will include a mix of online questionnaires and a telephone interview. Our 
prior research has shown equal attainment of personal goals for memory and lifestyle 
change in the face-to-face Memory and Aging program and a test-retest condition. 
Participants in this group will be offered the opportunity to complete the online Memory 
and Aging Program after study completion. 
3. Online Goal Management Training: consists of 9 weekly modules composed of videos, 
interactive applets, and assignments, which take about approximately 20 hours total to 
complete. The program presents factual information about automatic processing, teaches 
strategies to stop and control automatic processes while maintaining focus on the current 
task goals and sub-goals, provides assignments that raise awareness into participants’ 
own automatic processing and cognitive control, and provides games that allow 
participants to practice and build on the strategies acquired throughout the program. The 
program includes pre/post online assessment of cognition. 
4. BrainHQ: is a commercial brain training platform that has a variety of short tasks. We 
will be using a customized training regimen that focuses on games designed to hone 
attention, memory, and brain speed. The program involves about an hour of training on 
this platform per week, which consists of a series of short games (5 min each) for half an 
hour at a time. The program includes pre/post online assessment of cognition. 
 
 
Pre-/Post-test measures 
Measures were selected based on previous findings from the in-person MAP and GMT 
evaluations. Most are standardized questionnaires and/or tasks, and most have been used 
previously, as noted below, and during preliminary pilot testing of the program. All measures 
will be administered during each testing session, and all will be administered online. 
 
Primary Outcome Measures: 
 Memory knowledge quiz, modified from Troyer (2001), will be used to quantify 
memory, lifestyle, and strategy knowledge 
 Health Promoting Lifestyle Profile II (Walker, Sechrist, & Pender, 1987) will be used to 
quantify healthy lifestyle behaviours  
 Memory strategy toolbox (Troyer, 2001) will be used to quantify application of strategies 
in memory-demanding everyday situations  
 Multifactorial Metamemory Questionnaire (Troyer & Rich, 2002), will be used to 
quantify subjective memory abilities, satisfaction, and strategy use  
 Dysexecutive functioning questionnaire (DEX; Burgess, Alderman, Wilson, Evans, & 
Emslie, H. (1996)  
 Cognitive Failures questionnaire (CFQ; Broadbent, Cooper, FitzGerald, & Parkes, K. R. 
(1982)  
 
Secondary Outcome Measures (embedded within intervention conditions): 
 Conditions 1 and 2: 

o Psychological Normalization Inventory will be used to quantify feelings of 
normalization of memory concerns  
o Memory Impact Questionnaire and Patient-Specific Functional Scale (Horn et al., 
2012) will be used to quantify the impact of memory changes on daily activities 
and self-image 
o Intentions to seek medical attention modified from Wagner, Phillips, Radford, and 
Hornsby (1995) will be used to quantify change in intentions to seek medical 
attention pertaining to memory concerns 
 Conditions 3 and 4: 
o Cambridge Brain Sciences online cognitive assessment (Hampshire et al., 2012) 
o Face-name memory task (Troyer et al., 2012)  
 
 
 
 
 

Statistical Analysis Plan 
 
 
Data management 
An anonymized database will be created to link identifying participant information to the 
outcome measure data. Participants will be given unique ID numbers, and information that links 
identifying information to participant ID numbers will be stored on a password-protected secure 
server. 
 
Statistical analyses 
Mixed-model ANOVAs will be used to examine pre-test and post-test scores on the outcome 
measures in the control and intervention groups. We will compare pre-test to immediate post-test 
and pre-test to follow-up post-test. The multiple test periods will be within-group repeated 
measures, and group assignment will be a between-groups variable. We expect significant 
interactions between group and pretest-posttest scores, with greater improvements over repeated 
test periods in the intervention group than the control. 
 
This analysis will be done for each of the primary outcomes for both interventions. The same 
tests will be run on secondary outcomes to contrast the relevant intervention-control pair (e.g., 
GMT secondary outcomes measured/tested for GMT and BrainHQ, MAP secondary outcomes 
measures/tested in MAP and test-retest (waitlist) group.  
 
No adjustments will be used for these primary and secondary a priori analyses.  
 
We will also explore whether key variables including age, degree of engagement with the 
program, presence of subjective cognitive impairment, and computer familiarity covary with the 
effects of the intervention, and if so control for them by adding them as covariates in our 
statistical models.  
 
 
 
 
 

Informed Consent Form 
 
Below is the informed consent form, which was administered as part of an online survey: 
 
 
 
 
 
Title of project:          Evaluation of online cognitive fitness programs 
  
  
Investigators:            Dr. Susan Vandermorris, Dr. Angela Troyer, Ms. Iris Yusupov, Dr. Brian 
Levine, Dr. Jordan Lass 
  
Study description: 
At Baycrest, we have developed online programs that target common age-related cognitive 
changes. These online programs are based on well-validated, in-person offerings that have been 
delivered at Baycrest and other sites for many years. The aim of this study is to evaluate whether 
the online programs help people achieve the same outcomes as the in-person programming. 
  
Procedures: 
Participation in the study will involve completing online programming in your own home using 
your own computer or tablet. You will be randomly assigned to one of four programming groups. 
The programs consist of modules composed of videos, slides, activities, memory and thinking 
exercises, discussion boards, and small homework assignments. Some groups include some brief 
telephone interviews with a member of the study team. You may complete most of the 
programming at your convenience, on your own schedule. The programs are designed to take 
approximately 10-20 hours of your time over 5-9 weeks. These programs will be provided to you 
free of charge. 
  
You will also be asked to complete three online assessment sessions consisting of questionnaires 
and tasks pertaining to your memory and aspects of your daily life. These assessment sessions 
will take place three times over the course of the study, approximately 5-9 weeks apart.  The 

sessions are about 1-2 hours in duration and may be completed in multiple shorter sittings. You 
will be compensated $30 per testing session after completion of the study, and prorated based on 
participation if you withdraw from the study.  
  
Benefits and risks: 
Persons who complete our in-person programs have shown increased confidence in everyday 
memory and thinking ability. You may also experience these benefits. In addition, participants 
who have tried earlier versions of the online programs have expressed that the programs are 
enjoyable to them. There are no known risks associated with participation in this study. If new 
information related to the risks of the study is obtained, you will be informed. 
  
Confidentiality: 
If you agree to join this study, we will collect the data from questionnaires and tasks you 
complete. Your data will be identified with a study number only and will never be identified 
by name. 
  
  
  
The information that is collected will be kept in a password protected electronic file. Only the 
researchers listed at the top of this form will be allowed to look at the data. Data collected in this 
study may be used for future, related studies by the research team. Baycrest’s Research Ethics 
Committee may also examine collected data to ensure adherence to ethical standards. 
  
All information collected during this study will be kept confidential and will not be shared with 
anyone outside the study unless required by law. If you decide to withdraw from the study, the 
information about you that was collected to that point will not be used. 
  
Voluntary participation: 
Your participation in this study is completely voluntary. You may decide not to be in this study, 
or to be in the study now and then change your mind later. You may leave the study at any time 
without affecting the nature of your relationship with Baycrest Health Sciences either now or in 
the future. You may refuse to answer questions you do not want to answer. In no way does 
signing this consent form waive your legal rights nor does it relieve the investigators, sponsors or 
involved institutions from their legal and professional responsibilities. It is suggested that you 
print a copy of this consent form for your own records.   
  

Questions about the study: 
If you have any questions, concerns or would like to speak to the study team for any reason, 
please contact study coordinators at onlinetraining.info@research.baycrest.org or 416-785- 2500 
x3104. 
  
If you wish to contact someone not connected with the project about your rights as a research 
participant, please call Dr. Ron Heslegrave, Chair of the Research Ethics Board at (416) 785-
2500 ext. 2440. 
  
  
  
  
Agreement section: 
  
I have read the preceding information, and I understand the purpose of my participation, the 
procedures involved and the potential risks to myself, as stated in this document. All my 
questions have been answered to my satisfaction. I understand that I can ask further questions 
during any stage of the study. 
  
  
I understand that my participation in the study is voluntary. I may withdraw from the study at 
any point in time. I am aware that the study will not benefit me specifically, but knowledge will 
be gained that will benefit others. It has been explained to me that the results of the study are 
confidential. Neither my identity nor any personal information will be available to anyone other 
than the investigators. No personal information will be disclosed in any resulting publication or 
presentation. 
  
  
  
  
 
 I Agree 
 
 I Disagree