Elise G. Valdés

Randomized trial of cognitive speed of processing training in Parkinson disease

Objective: To examine the efficacy of cognitive speed of processing training (SOPT) among individuals with Parkinson disease (PD). Moderators of SOPT were also examined. Methods: Eighty-seven adults, 40 years of age or older, with a diagnosis of idiopathic PD in Hoehn & Yahr stages 1–3 and on a stable medication regimen were randomized to either 20 hours of self-administered SOPT (using InSight software) or a no-contact control condition. Participants were assessed at baseline and after 3 months of training (or an equivalent delay). The primary outcome measure was useful field of view test (UFOV) performance, and secondary outcomes included cognitive self-perceptions and depressive symptoms. Results: Results indicated that participants randomized to SOPT experienced significantly greater improvements on UFOV performance relative to controls, Wilks λ = 0.938, F 1,72 = 4.79, p = 0.032, partial η2 = 0.062. Findings indicated no significant effect of training on secondary outcomes, Wilks λ = 0.987, F2,70 < 1, p = 0.637, partial η2 = 0.013. Conclusions: Patients with mild to moderate stage PD can self-administer SOPT and improve their cognitive speed of processing, as indexed by UFOV (a robust predictor of driving performance in aging and PD). Further research should establish if persons with PD experience longitudinal benefits of such training and if improvements translate to benefits in functional activities such as driving. Classification of evidence: This study provides Class III evidence that SOPT improves UFOV performance among persons in the mild to moderate stages of PD.

Mediators of the association between driving cessation and mortality among older adults.

Objective: The present study examined health and physical performance as mediators of the association between driving cessation and mortality among older residents of small and large cities. Method: Participants (N = 2,793) were from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. Participants’ driving status and health were measured at baseline, and mortality rates were observed across the subsequent 5 years. Results: Overall, mortality risk was 1.68 times higher for nondrivers versus drivers; this relationship was significantly mediated by physical performance and social, physical, and general health. For large-city residents, mediation effects for all mediators were significant and complete. For small-city residents, only physical and general health were significant mediators, and these effects were partial. Discussion: Health difficulties that accompany or follow driving cessation may explain the association between driving cessation and mortality, particularly for residents of large cities, where alternative transportation options may be more numerous.

Longitudinal Differences in Cognitive Functioning Among Older Adults With and Without Heart Failure

Objective: Secondary data analyses were conducted to examine cognitive function and longitudinal cognitive decline among older adults with and without heart failure (HF). Method: Data from the Advanced Cognitive Training for Independent and Vital Elderly study were used to compare baseline (N = 2,790) and longitudinal (n = 692) changes in memory, reasoning, and speed of processing performance among participants (M age = 73.61, SD = 5.89) who self-reported HF at baseline, developed HF over time, or never reported HF. Results: At baseline, there were differences in memory and speed of processing with participants who never reported HF performing better than those who reported developing HF over time, and those who reported HF at baseline performing the worst (ps < .05). Longitudinally, participants with self-reported HF at baseline showed declines in reasoning over time. Discussion: The results indicate that cognitive difficulties in memory and speed may occur prior to a HF diagnosis, while those with HF may experience steeper declines in reasoning as measured by word series test.

The Effects of Cognitive Speed of Processing Training Among Older Adults with Psychometrically- Defined Mild Cognitive Impairment

Despite the growing interest in cognitive training programs as a potential non-pharmacological approach to slowing cognitive decline in mild cognitive impairment (MCI), there has been little research on the differential effectiveness of training among subtypes of MCI (i.e., amnestic, single non-amnestic, and multi-domain). The current study examined the longitudinal effects of cognitive speed of processing training (SOPT) among older adults with psychometricallydefined MCI from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. Mixed model ANOVAs examined the effectiveness of SOPT in participants with MCI relative to controls and also compared training effectiveness in MCI subgroups to appropriate controls. A mixed effects model compared SOPT training effects longitudinally across five years relative to controls. A second mixed effects model compared the durability of training gains between the MCI subtypes across 5 years. All subtypes of MCI showed immediate improvement post-training relative to controls, with the single non-amnestic subtype showing the most benefit. Additionally, all subtypes showed similar trajectories across five years. There were no significant changes in performance across time, indicating initial training gains were maintained. These results provide support for the effectiveness and potential durability of SOPT among persons with MCI regardless of subtype. Future research should investigate if SOPT transfers to improvements in the everyday functioning of those with MCI.

Computerized auditory cognitive training to improve cognition and functional outcomes in patients with heart failure: Results of a pilot study

OBJECTIVES Feasibility and efficacy of computerized auditory cognitive training (ACT) was examined among patients with heart failure (HF). BACKGROUND Individuals with HF have four times increased risk of cognitive impairment, yet cognitive intervention studies are sparse. METHODS A pilot randomized controlled design was used. RESULTS The ACT group (n = 9) and control group (n = 8) had similar baseline characteristics. Seven participants (78%) completed ≥ 18 hours of ACT. Medium effect sizes were observed for improved cognition as indicated by auditory processing speed (d = 0.78), speech processing (d = 0.88), and working memory (d = 0.44-0.50). Small effect sizes were found for improved functional outcomes including HF selfcare (d = 0.34), Timed Instrumental Activities of Daily Living (d = 0.32), Six-Minute Walk Test (d = 0.38) and Short-Form-36 (d = 0.22) relative to controls. CONCLUSION Results indicated ACT is feasible among persons with HF. Despite a small sample size, ACT showed potential for improved speed of processing and working memory and improved functional outcomes, and warrants further exploration.

Systematic review and meta-analyses of useful field of view cognitive training

HighlightsUseful Field of View training improves neural outcomes, speed of processing, and attention.Useful Field of View training improves older adults’ everyday function.Improvements from Useful Field of View training endure across ten years. ABSTRACT Systematic review and meta‐analyses were conducted of Useful Field of View (UFOV) training, which was evaluated by Institute of Medicine criteria. Forty‐four studies of UFOV training from 17 randomized trials conducted among adults were identified in systematic review. Results addressing the Institute of Medicine criteria indicated that: (a) UFOV training enhanced neural outcomes, speed of processing, and attention. (b) UFOV training effects were equivalent when compared to active‐ or no‐contact control conditions. (c) UFOV training showed far transfer to everyday function. (d) Improvements on the trained skills endured across ten years. (e) Half of the clinical trials identified were conducted by researchers without financial interests in UFOV training. Results indicated that UFOV training effects were larger for adaptive‐ than non‐adaptive training techniques, and in community‐based as compared to clinical samples. UFOV training did not transfer to other neuropsychological outcomes, but positively enhanced well‐being, health, and quality of life longitudinally. Criticisms of cognitive training are addressed. UFOV training should be implemented among older adults to improve real‐world functional outcomes and well‐being.

Regular cognitive self-monitoring in community-dwelling older adults using an internet-based tool

ABSTRACT Introduction: Monitoring for various health conditions (e.g., breast cancer, hypertension) has become common practice. However, there is still no established tool for regular monitoring of cognition. In this pilot longitudinal study, we examined the utility and feasibility of internet-based cognitive self-monitoring using data from the first 12 months of this ongoing study. Method: Cognitively healthy community-dwelling older adults (Montreal Cognitive Assessment ≥ 26) were enrolled on a rolling basis and were trained in self-administration of the internet-based version of the CogState Brief Battery. The battery uses playing cards and includes Detection, Identification, One Back, and One Card Learning subtasks. Results: Of the 118 participants enrolled, 26 dropped out, mostly around first in-home session. Common reasons for participant attrition were internet browser problems, health problems, and computer problems. Common reasons for delayed session completion were being busy, being out of town, and health problems. Participants needed about one reminder phone call per four completed sessions or one reminder email per five completed sessions. Performance across the monthly sessions showed slight (but significant) improvement on three of the four tasks. Change in performance was unaffected by individual characteristics with the exception of previous computer use, with less frequent users showing greater improvement on One Card Learning. We also found low intraindividual variability in monthly test scores beyond the first self-administered testing session. Conclusions: Internet-based self-monitoring offers a potentially feasible and effective method of continuous cognitive monitoring among older adults.

Occupational Complexity and Risk of Parkinson's Disease

Background The etiology of Parkinsons disease (PD) remains unclear, and environmental risk-factors such as occupation have attracted interest. Objective The goal was to investigate occupational complexity in relation to PD. Methods We conducted a population-based cohort study based on the Swedish Twin Registry that included 28,778 twins born between 1886 and 1950. We identified 433 PD cases during the study period. Data on occupation were collected from either the 1970 or 1980 Swedish census, and occupational complexity was assessed via a job exposure matrix. Cox proportional hazard regression analyses with age as the underlying time scale were used to assess PD risk as a function of the three domains of occupational complexity: data, people, and things. Sex and smoking were included as covariates. Analyses stratified by twin pair were conducted to test for confounding by familial factors. Results High occupational complexity with data and people was associated with increased risk overall (Hazard Ratio [HR] = 1.07, 95% confidence interval [CI] 1.02–1.14, and HR = 1.10, 95% CI 1.01–1.21, respectively), and in men (HR = 1.08, 95% CI 1.01–1.16, and HR = 1.15, 95% CI 1.03–1.28, respectively). Complexity with things was not associated with risk of PD. When the analyses were stratified by twin pair, the HRs for occupational complexity with data and people were attenuated in men. Conclusions High complexity of work with data and people is related to increased risk of PD, particularly in men. The attenuation of risk observed in the twin pair-stratified analyses suggests that the association may partly be explained by familial factors, such as inherited traits contributing to occupational selection or other factors shared by twins.

Occupational stress and risk for Parkinson's disease: A nationwide cohort study: Stress and Risk of PD

Background: Stress has been suggested as a contributing factor in the etiology of Parkinsons Disease (PD), but epidemiological evidence is sparse.

Can Cognitive Speed of Processing Training Improve Everyday Functioning Among Older Adults With Psychometrically Defined Mild Cognitive Impairment

Objective: The aim of these secondary analyses was to examine cognitive speed of processing training (SPT) gains in cognitive and everyday functioning among older adults with psychometrically defined mild cognitive impairment (MCI). Method: A subgroup of participants from the Staying Keen in Later Life (SKILL) study with psychometrically defined MCI (N = 49) were randomized to either the SPT intervention or an active control group of cognitive stimulation. Outcome measures included the Useful Field of View (UFOV), Road Sign Test, and Timed Instrumental Activities of Daily Living (IADL) Test. A 2 × 2 repeated-measures MANOVA revealed an overall effect of training, indicated by a significant group (SPT vs. control) by time (baseline vs. posttest) interaction. Results: Effect sizes were large for improved UFOV, small for the Road Sign test, and medium for Timed IADL. Discussion: Results indicate that further investigation of cognitive intervention strategies to improve everyday functioning in patients with MCI is warranted.