The Effect of Solving Jigsaw Puzzles on Visuospatial Cognition in Older Adults: Jigsaw Puzzles As Cognitive Enrichment

Study Overview
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Brief Summary
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Meta-analyses indicate beneficial effects of cognitive training and cognitively challenging video games on cognition. However, cognitive effects of solving jigsaw puzzles - a popular, visuospatial cognitive leisure activity - have not been investigated, yet. Thus, the primary aim of this study is to evaluate the effect of solving jigsaw puzzles on visuospatial cognition. As secondary aims, effects on psychological outcomes (self-efficacy, perceived stress, well-being) and visuospatial everyday functioning (instrumental activities of daily living and self-reported cognitive failures in everyday life) are examined.

Detailed Description
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see References section below for the study protocol article

Official Title
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Jigsaw Puzzles As Cognitive Enrichment

Conditions
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Cognitive Impairment

Intervention / Treatment
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* Behavioral: Jigsaw puzzles
* Behavioral: Cognitive health counseling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: No cognitive impairment (Mini-Mental State Examination ≥ 24) Commitment to minimum jigsaw puzzle time (1 hour/day, 6 days/week, 5 weeks) Interest in jigsaw puzzles Low jigsaw puzzle experience (less than 5 completed puzzles within the last 5 years) Exclusion Criteria: Cognitive impairment (Mini-Mental State Examination < 24) Participation in another interventional study Self-reported psychiatric, neurologic or other disease, which could affect cognitive change over time Self-reported, severe visual impairment or motoric impairment of the upper extremity which significantly affects ability to solve jigsaw puzzles

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Jigsaw Puzzle Group<br>Jigsaw puzzles & Cognitive health counseling | Behavioral: Jigsaw puzzles<br>* Intervention period 1: Participants are asked to solve jigsaw puzzles at home 6 times per week for at least 1 hour over a period of 5 weeks. Intervention period 2 (voluntary): Participants receive the possibility to solve jigsaw puzzles free-of-charge at home for a period of at least 3 month before the 1.5-year follow-up.<br>Behavioral: Cognitive health counseling<br>* Cognitive health counseling regarding modifiable risk and protective factors of cognitive decline and dementia at baseline, and four telephone calls for expert monitoring (three calls during the 5-week period between pre- and posttest, and one call 12 month later)<br>|
| Active Comparator: Cognitive Health Counseling Group<br>Cognitive health counseling only | Behavioral: Cognitive health counseling<br>* Cognitive health counseling regarding modifiable risk and protective factors of cognitive decline and dementia at baseline, and four telephone calls for expert monitoring (three calls during the 5-week period between pre- and posttest, and one call 12 month later)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in global visuospatial cognition from baseline to post intervention and to the 1.5-year follow-up | Averaged score of eight z-standardized visuospatial cognitive ability scores (see secondary outcomes 2 - 9) | Baseline and post intervention (after 5 weeks and 1.5 years) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in visual perception from baseline to post intervention and to the 1.5-year follow-up | Judgment of Line Orientation Test | Baseline and post intervention (after 5 weeks and 1.5 years) | 
| Change in visuoconstruction from baseline to post intervention and to the 1.5-year follow-up | Copying in Complex Figure Tests; parallel versions for baseline and post-test | Baseline and post intervention (after 5 weeks and 1.5 years) | 
| Change in mental rotation from baseline to post intervention and to the 1.5-year follow-up | Mental Rotations Test-Letters (2D) and Form A (3D) | Baseline and post intervention (after 5 weeks and 1.5 years) | 
| Change in visuospatial processing speed from baseline to post intervention and to the 1.5-year follow-up | Trail Making Test A | Baseline and post intervention (after 5 weeks and 1.5 years) | 
| Change in visuospatial flexibility from baseline to post intervention and to the 1.5-year follow-up | Trail Making Test B | Baseline and post intervention (after 5 weeks and 1.5 years) | 
| Change in visuospatial working memory from baseline to post intervention and to the 1.5-year follow-up | Block span (Wechsler Memory Scale, German version) | Baseline and post intervention (after 5 weeks and 1.5 years) | 
| Change in visuospatial reasoning from baseline to post intervention and to the 1.5-year follow-up | Block design (Wechsler Adult Intelligence Scale-III, German version) | Baseline and post intervention (after 5 weeks and 1.5 years) | 
| Change in visuospatial episodic memory from baseline to post intervention and to the 1.5-year follow-up | Recall in Complex Figure Tests (sum score of immediate and delayed recall); parallel versions for baseline and post-test | Baseline and post intervention (after 5 weeks and 1.5 years) | 
| Change in psychological health from baseline to post intervention and to the 1.5-year follow-up | Averaged score of three z-standardized psychological health sub-scores (see secondary outcomes 11 - 13) | Baseline and post intervention (after 5 weeks and 1.5 years) | 
| Change in psychological well-being from baseline to post intervention and to the 1.5-year follow-up | WHO-Five Well-being Index (WHO-5), German version | Baseline and post intervention (after 5 weeks and 1.5 years) | 
| Change in self-efficacy from baseline to post intervention and to the 1.5-year follow-up | General Self-Efficacy Scale, German version | Baseline and post intervention (after 5 weeks and 1.5 years) | 
| Change in perceived stress from baseline to post intervention and to the 1.5-year follow-up | Perceived Stress Scale-14, German translation | Baseline and post intervention (after 5 weeks and 1.5 years) | 
| Change in objective everyday functioning from baseline to post intervention and to the 1.5-year follow-up | TIADL (1-3): Timed instrumental activities of daily living (Task 1-3; sum-score) | Baseline and post intervention (after 5 weeks and 1.5 years) | 
| Change in self-reported everyday functioning from baseline to post intervention and to the 1.5-year follow-up | CFQ (visuospatial items): Cognitive Failures Questionnaire, sum score of visuo-spatial items; German version | Baseline and post intervention (after 5 weeks and 1.5 years) | 
| Change in jigsaw puzzle performance from baseline to post intervention and to the 1.5-year follow-up | 40-pieces mini puzzle (completed pieces per minute) | Baseline and post intervention (after 5 weeks and 1.5 years) | 
| Hair cortisol concentration at the 1.5-year follow-up | Hair cortisol will be measured in 1cm segements | 1.5-year follow-up | 
| Hair dehydroepiandrosteron concentration at the 1.5-year follow-up | Hair dehydroepiandrosteron will be measured in 1cm segements | 1.5-year follow-up | 
| Hair brain-derived neurotrophic factor concentration at the 1.5-year follow-up | Hair brain-derived neurotrophic factor will be measured in 1cm segements | 1.5-year follow-up | 
| Neurocognitive disorder | Neurocognitive disorder is a categorical outcome and includes mild and major neurocognitive disorders. Mild neurocognitive disorder (mild cognitive impairment) is defined by subjective cognitive decline (self-report), and an objective cognitive impairments in at least one cognitive abilitiy score (below -1 SD of the norm group), without an essential impairment of daily functioning compared to the premorbid level (self-report). In major neurocognitive decline (dementia), in addition to cognitive decline and impairment, daily functioning is essentially impaired compared to the permorbid level (self-report). | 1.5-year follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cognition, Cognitive Aging, Dementia, Neurocognitive Disorders, Cognitive Therapy, Cognitive Reserve, Cognitive Enrichment, Jigsaw Puzzles