Computerized Cognitive Training for the Elderly

Study Overview
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Brief Summary
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The purpose of this study is to investigate the effect of a neuroplasticity-based computerized cognitive training for the elderly

Detailed Description
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Cognitive impairments are prominent features of aging and are mostly characterized by memory difficulties. Neuroplasticity based computerized cognitive trainings have been emerging for the last two decades and are an attempt to help the elderly population with their impairments. The aim of this study is to perform a computerized cognitive training to improve attention, concentration, learning, and quality of life in elderly participants. The investigators are interested in testing the differential efficacy between a bottom-up to top-down versus a top-down to bottom-up computerized cognitive training. The investigators will conduct a 40 hours computerized, adaptable, cognitive training program in participants 60 years of age and above. Participants will come for 1 hour, daily, and perform a bottom-up to top-down or top-down to bottom-up training, or control games for about 2 months. Bottom-up to top-down and top-down to bottom-up exercises are chosen to target cognitive domains such as divided and selective attention, short-term and working memory, orientation skills and social cognition. Cognitive and emotional data will be collected before the training, half way through, and after the training, to assess progress in several aspects of their functioning. The investigators hypothesize bottom-up to top-down and top-down to bottom-up trainings will be effective as compared to the control games. They also expect that bottom-up to top-down training to be more efficient compared to top-down to bottom-up training because the first targets more basic cognitive functions which then allows triggering higher cognitive functions, reaching optimal cognitive performance levels more rapidly, where as the second may start with a too high demand on cognitive functions, which may compromise participants ability to reach optimal levels of cognitive performance as fast as the first type of training, if they do not have the bottom-up lever first. The investigators also hypothesize that both trainings will improve quality of life.

Official Title
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Computerized Cognitive Training for the Elderly

Conditions
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Aging

Intervention / Treatment
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* Behavioral: Computerized cognitive training
* Behavioral: Computer games


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age above 60 years old; Portuguese as main language (learned before 12 years of age); Mini Mental State Examination above 26 points; Exclusion Criteria: Intellectual Quotient below 70; serious medical or neurological condition preventing from participation in the study; substance abuse (according to Diagnostic and Statistical Manual of mental disorders-IV criteria).

Ages Eligible for Study
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Minimum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Bottom-up to top-down cognitive training<br>Participants are given 20 hours of cognitive training with exercises that involve essentially bottom-up cognitive processes, followed by 20 hours of cognitive training with exercises that involve essentially top-down cognitive processes | Behavioral: Computerized cognitive training<br>* 40 hours of a computerized cognitive training, given 1 hour daily<br>* Other names: training;|
| Active Comparator: Top-down to bottom-up cognitive training<br>Participants are given 20 hours of cognitive training with exercises that involve essentially top-down cognitive processes, followed by 20 hours of cognitive training with exercises that involve essentially bottom-up cognitive processes | Behavioral: Computerized cognitive training<br>* 40 hours of a computerized cognitive training, given 1 hour daily<br>* Other names: training;|
| Placebo Comparator: Computer games<br>Participants are given 40 hours of computer games commonly found on the internet and which do not involve a high demand in cognitive functions (e.g. fishing game, pinball game, tetris, etc). | Behavioral: Computer games<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Global cognition score change | An average of all the cognitive measures will be done to calculate the global cognition score and change will be made between endpoint and midpoint and midpoint and baseline | through study completion, an average of 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Processing speed score change | Processing speed score will be measured using the identification task from Cogstate tests battery | through study completion, an average of 1 year | 
| Attention score change | Attention score will be measured using the detection task from Cogstate tests battery | through study completion, an average of 1 year | 
| Concentration score change | Concentration score will be measured using the Trail Making Test | through study completion, an average of 1 year | 
| Short-term memory score change | Short- term memory score will be measured using the Rey Auditory-Verbal learning test | through study completion, an average of 1 year | 
| long-term memory score change | long- term memory score will be measured using the Rey Auditory-Verbal learning test | through study completion, an average of 1 year | 
| learning score change | learning score will be measured using the Rey Auditory-Verbal learning test | through study completion, an average of 1 year | 
| working memory score change | working memory score will be measured using the 1-back and 2-back tasks from the Cogstate tests battery | through study completion, an average of 1 year | 
| Semantic memory score change | semantic memory score will be measured using the Verbal fluency test | through study completion, an average of 1 year | 
| Cognitive flexibility score change | Cognitive flexibility score will be measured using the Set shifting task from the Cogstate tests battery | through study completion, an average of 1 year | 
| social cognition score change | Social cognition score will be measured using the Social-Emotional Cognition task from the Cogstate tests battery | through study completion, an average of 1 year | 
| Depression score change | Depression score will be measured using the Geriatric Depression Scale | through study completion, an average of 1 year | 
| Instrumental activity of daily living score change | Instrumental activity of daily living score will be measured using the Lawton instrumental activity of daily living scale | through study completion, an average of 1 year | 
| Independence in activities of daily living score change | Independence in activities of daily living score will be measured using the Katz Independence in activities of daily living scale | through study completion, an average of 1 year | 
| Functional status score change | Functional status score will be measured using the Direct Assessment of Functional Status questionnaire | through study completion, an average of 1 year | 
| Timed instrumental activities of daily living score change | Timed instrumental activities of daily living score will be measured using the Timed instrumental activities of daily living scale | through study completion, an average of 1 year | 
| Physical activity score change | Physical activity score will be measured using the International Physical Activity Questionnaire | through study completion, an average of 1 year | 
| Praxis score change | Praxis score will be measured using the Cambridge Cognition Examination test | through study completion, an average of 1 year | 
| Episodic memory score change | Episodic memory score will be measured using the Cambridge Cognition Examination test | through study completion, an average of 1 year | 
| Quality of life score change | Quality of life will be assessed with the World Health Organization Quality of Life questionnaire | through study completion, an average of 1 year |