Cognitive Training and Social Interaction Effects on Cognitive Performance of Older Adults

Study Overview
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Brief Summary
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Aging is associated with a decline in almost all aspects of cognitive functions, particularly memory. Recent research suggests that combining cognitive training with ongoing social interaction may aid in improving cognitive functioning for older adults. Furthermore, accumulative evidence suggests that strategy-based cognitive training may also improve the trainee's memory. In this study, the investigators examined the effects of a combined strategy-based cognitive training and a socially interactive learning method on cognitive performance and transfer effects in older adults.

Detailed Description
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A major concern with the aging of the world's population is a higher prevalence of age-related impairment of cognitive functions. This concern highlights the need to identify quick and effective interventions that can preserve cognitive functions. A growing body of literature supports the notion that cognitive training may assist in promoting healthy brain aging and improve a wide range of cognitive abilities. Cognitive training refers to a protocol consisting of a set of exercises designed to improve performance in one or several cognitive abilities. One approach to cognitive training mentioned in the literature is strategy training. Strategy training usually focuses on teaching specific strategies designed to help encode or retrieve information and involves techniques such as rehearsal, chunking, mental imagery, and story-formation. A possible means for improving cognitive training outcomes is employing a socially interactive group-based cognitive training program versus an individual one. An abundance of studies has shown that social interaction may contribute to the slowing down of cognitive decline in old age. Recent studies suggest that social interaction alone may not be beneficial for enhancing cognitive abilities, but when combined with a mental stimulus that requires cognitive effort, such improvement might be achieved. Only a few studies to date have investigated the advantage of strategy training performed in-group vs individually and even fewer studies focused specifically on socially interactive learning methods. A recent pilot study combined cognitive training with social interaction for people with mild to moderate dementia and reported a significant cognitive improvement in favor of the social interaction group compared to the control group who was engaged in cognitive training only. Social cognition is supported by an extensive system of limbic, cortical and subcortical brain regions. Many of these regions are also involved in episodic memory, semantic memory and other cognitive functions. Thus, it is possible that aspects of cognitive processing, which are activated through social interaction will also strengthen these cognitive abilities. Engaging in social interaction usually consists of complex cognitive and memory challenges, which in turn may aid in enhancing cognitive abilities and cognitive reserve Training in a group setting can provide participants with an opportunity to problem-solve with a relevant peer group and allow individuals to gain comfort from sharing their concerns about memory. The purpose of the current study was therefore to determine the effectiveness of a strategy-based cognitive training approach combined with a socially interactive learning method on cognitive performance and transferability of training gains for older adults. Procedure: Meetings of both groups were held in public community centers. A pre-session meeting was devoted to explaining the research objectives and signing consent forms. Prior to the first training meeting and after the program ended, cognitive evaluation measurements were taken individually from each subject. Before the final cognitive evaluation, participants were reminded to use the learned strategies. Sample size assessment: A priori power analysis using pilot data and the SimR package in R (version 1.0.5) suggested that 30 participants would provide sufficient power (power > 80%) to detect the critical strategy training plus social interaction effect on cognitive performance. Statistical analysis plan: Data will be analyzed with IBM SPSS Statistics for Windows, version 23 (IBM Corp., Armonk, N.Y., USA). The main analysis 'שד a mixed-design analysis that compares the experimental conditions (between-subject factors) regarding their effect on cognitive performance in 4 cognitive tests and 2-time points (within-subjects variables).

Official Title
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Strategy Based Cognitive Training Effects on Cognitive Performance of Older Adults in a Socially Interactive Learning Group

Conditions
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Cognitive Decline

Intervention / Treatment
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* Other: Social interaction combined with cognitive training based on mnemonic strategies.
* Other: Social interaction group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Healthy participants who are active in a designated group in the community. Exclusion Criteria: • Any diagnosis of cognitive decline.

Ages Eligible for Study
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Minimum Age: 64 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: Other
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The study included 32 subjects, 20 in the experimental group and 12 in the control group. The experimental group received 12 sessions of strategy-based cognitive training combined with a socially interactive learning method. The control group received the same number of meetings but without the strategy training. Participants were recruited from designated active groups in the community.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: strategy-based cognitive training + social interaction<br>The experimental group received twelve 60 minutes sessions of strategy-based cognitive training. (i.e., training in mnemonic memory strategies). We chose to train multiple strategies instead of a single one in effort to reach larger training gains. each session began with engaging conversations between the researcher and participants. After each practice trial, participants were encouraged to share their ideas/stories/associations or visual images (mnemonic uses) in turn. All other participants were allowed to give feedback relating to what can be learned from each mnemonic use or give their own ideas on how they think it can be improved. | Other: Social interaction combined with cognitive training based on mnemonic strategies.<br>* In the first six sessions, participants in the experimental group learned and practiced six different mnemonic strategies: Story-Formation strategy, Face-Name strategy, Peg-Word strategy, Chunking strategy, Key-Word strategy and the Method of Loci. In the following six sessions, in order to assimilate the strategies they learned, participants practiced the same tasks.<br>|
| Active Comparator: social interaction<br>The social interaction control group received the same number of group meetings but without the strategy training. Meetings content consisted of providing tools for making social connections, providing tools for interpersonal communication and raising the participant's sense of personal well-being through group contact. | Other: Social interaction group<br>* In the control group, each session also began with a conversation between the participants. The sessions then dealt with the content of interpersonal communication and the acquisition of tools for creating interpersonal relationships. Participants were asked to share the way they used the tools they acquired between sessions and received feedback from the other participants<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Verbal Fluency Test (Chiu et al., 1997) | Participants were asked to say aloud as many words as possible belonging to a given category (animal's category and fruit and vegetables category) within a period of sixty seconds. | Change from baseline (before treatment) to immediately after treatment (12 weeks) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Wechsler Digit Span Test (Wechsler 2008) | Series of digits were presented verbally at a rate of one digit per second. Subjects were required to repeat the digits verbally in the order presented. | Change from baseline (before treatment) to immediately after treatment (12 weeks) | 
| Words Recall Test (Fairchild et al., 2013) | Subjects were asked to remember a list of 16 words and to recall the list after a 5-min delay. | Change from baseline (before treatment) to immediately after treatment (12 weeks) | 
| Corsi Block-Tapping Test (Corsi 1972) | The task involves mimicking the researcher as he taps a sequence of up to nine identical spatially separated blocks. | Change from baseline (before treatment) to immediately after treatment (12 weeks) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cognitive training, Strategy training, Older adults, Mnemonic, Social interaction