Strategic Training to Optimize Neurocognitive Functions in Older Adults
Condition: Cognitive Aging; Functional Magnetic Resonance Imaging
Study type: Interventional

Summary: 
      The goal of the present randomized control trial is to evaluate the efficacy of a novel
      cognitive training approach using simulated games, where older adults will learn to flexibly
      deploy attentional control during working memory, for prevention of Alzheimer's Disease (AD).
      Based on our extensive pilot work, we expect training-related enhancements in both neural and
      cognitive functions on a broad range of cognitive abilities due to the importance of
      attentional control and working memory in many types of cognition. These outcomes are widely
      applicable to the cognitive health and the quality of life of elderly Americans, and have
      further potential to offset degenerative processes common to normal aging.
    

Detailed description: 
      Almost all older adults experience cognitive frailty with age, with around one-third of
      adults aged 85 or older suffering from Alzheimer's disease (AD). Cognitive frailty,
      particularly AD, threatens to overwhelm medical resources in the United States and much of
      the developed world. Therefore, it is important that we learn how to optimize and maintain
      cognitive performance in cognitively-frail older adults, particularly those who are at high
      risk of suffering from AD, such as adults over 70 years of age where more than half express
      AD pathology. The present multi-arm randomized control trial takes a novel theory-driven
      approach to enhancing cognition in older adults by training them to flexibly deploy
      attentional focus in working memory. Flexibility in allocating and switching attentional
      resources will be trained by having participants respond to unpredictable cues in working
      memory. The ability to flexibly and efficiently allocate attentional control underlies
      successful performance on a broad array of cognitive tasks. Hence, training in this area may
      enhance performance not only on related tasks (near transfer) but also on tasks that are
      perceptibly not related to the training task (far transfer).

      The current proposal has three training arms and utilizes game-based simulations in all arms
      in healthy older adults. The first two arms use experimenter-designed simulation games, where
      participants will be trained on either predictable low attentional control (Arm 1) or
      unpredictable high attentional control (Arm 2) working memory games. The third arm uses a
      commercially available strategy game requiring the highest level of attentional control, by
      adding multi-tasking to the unpredictable attentional shifts in working memory. In all three
      training arms, neural and cognitive changes in near (secondary outcome) and far (primary
      outcome) transfer tasks will be examined immediately after the intervention; cognitive
      changes will also be assessed at 6-month post-training duration. Additionally, a
      single-session, baseline neuroimaging data (no training) will be collected in a functional
      control group of younger adults. We expect that the high attentional control training arms
      will greatly improve both near and far cognition in older adults, with cognitive frailty
      interacting with the extent to which attentional control is trained. High attentional control
      training arms are also expected to heighten compensatory brain activation after the
      intervention, for both near and far in-scanner transfer tasks, mimicking the baseline
      activity of younger brains. These training arms are also expected to positively impact brain
      structures that progressively decline with aging. This clinical trial will result in the
      development of behavioral intervention tools, which will have the potential to delay the
      onset of memory-related disorders, such as AD, by instantiating durable improvements in
      cognitive functions in older adults. Such interventions can not only improve an individual's
      quality of life but also decrease the financial burden of a rapidly aging society.
    

Intervention name(s): Low-C; High-C; High-C+
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): This is the active control group, where participants will be trained to play an experimenter developed game that requires least attentional control among all arms.; In this intervention, participants will be trained on this experimenter developed game which requires a lot of attentional control.; A commercial video game will be used that requires a lot of demand on attentional control.
Other intervention name(s): Predictable Bird Watch; Unpredictable Bird Watch; Video Game
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: We will conduct a randomized control trial on healthy older adults, where attentional control demands in cognitive training will be systematically increased using engaging game-based simulations. There are three parallel arms: predictable low attentional control (Arm 1: Low-C), unpredictable high attentional control (Arm 2: High-C), and a commercially-available strategy video game (Arm 3: High-C+). In all three training arms, neural and cognitive changes in both near and far tasks will be examined immediately after the 8-week long intervention. Long-term cognitive changes will also be assessed at 6 months after completion of training. The far and near cognitive outcomes that will be examined are episodic memory (the primary cognitive outcome) and executive control (the secondary cognitive outcome).
Additionally, a single-session functional neuroimaging dataset will be collected in a functional control group of younger adults; they will not undergo any intervention.
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: randomized control trial; cognitive training; simulation games; improving brain function; improving cognition; functional magnetic resonance imaging