There have been increasing efforts to develop cognitive interventions to ameliorate cognitive problems experienced by older adults. In healthy elderly populations, cognitive training has centered on the enhancement of memory and speed of processing, with the goal of maximizing current function and reducing the risk of cognitive decline. Among elderly persons with nonprogressive neurological conditions such as traumatic brain injury (TBI) and stroke, there has been an emphasis on rehabilitation to help restore function. Most recently, there has been increased attention on the development of new cognitive techniques to treat persons with progressive neurodegenerative conditions such as Alzheimer disease. The literature is reviewed on current approaches to cognitive interventions in elderly healthy populations, and a particular emphasis is placed on the most recent strides in progressive neurocognitive conditions, particularly Alzheimer disease. Important issues such as study design, the use of ecologically and functionally valid outcome measures, the need to examine heterogeneous populations and cross-cultural variables, and the incorporation of technologically based systems are examined. It is concluded that cognitive interventions in the elderly show considerable promise and deserve further study. (J Geriatr Psychiatry Neurol 2007;20:239—249)
Wilson BACognitive rehabilitation: how it is and how it might be. J Int Neuropsychol Soc. 1997;3:487-496.
2.
Boake CAHistory of cognitive rehabilitation of head-injured patients, 1915 to 1980 . J Head Trauma Rehabil. 1989;4:1-8.
3.
Friedland R. , Fritsch T., Smyth K.Patients with Alzheimer's disease have reduced activities in midlife compared with healthy control-group members. Proc Natl Acad Sci U S A. 2001;98:3440-3445.
4.
Kondo K., Niino M., Shido K.A case-control study of AD in Japan: significance of life-styles. Dementia. 1994;5:314-326.
5.
Newson RS, Kemps EBGeneral lifestyle activities as a predictor of current cognition and cognitive change in older adults: a cross-sectional and longitudinal examination . J Gerontol.2005; 60B:113-251.
6.
Verghese J., Lipton RB, Katz MJ, et al. Leisure activities and the risk of dementia in the elderly. N Engl J Med.2003;348: 2508-2516.
7.
Wilson RS, Bennett DA, Bienias JL, et al. Cognitive activity and incident Alzheimer's disease in a population-based sample of older persons. Neurology. 2002;59:1910-1914.
8.
Wilson RS, Mendes de Leon Cf, Barnes Ll.Participation in cognitively stimulating activities and incident risk of Alzheimer's disease. JAMA.2002;287:742-748.
9.
Fratiglioni L., Paillard-Borg S., Winblad B.An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurol.2004;3:343-353.
10.
Epstein EFLeisure activities and the risk of dementia [letter]. N Engl J Med.2003;349:1290-1292.
11.
Coyle JTUse it or lose it: do effortful mental activities protect against dementia?N Engl J Med.2003;348:2489-2490.
12.
Salthouse TAThe processing-speed theory of adult age differences in cognition. Psychol Rev.1996;103:403-428.
13.
Saxton JA, Ratcliff G., Dodge H., et al. Speed and capacity of language processing test: normative data from an older American community-dwelling sample. Appl Neuropsychol . 2001;8: 193-203.
Luszcz MA, Bryan J.Toward understanding age-related memory loss in late adulthood. Gerontology. 1999;45:2-9.
16.
Baudouin A. , Vanneste S., Isingrini M.Age-related cognitive slowing: the role of spontaneous tempo and processing speed. Exp Aging Res. 2004;30:225-239.
17.
Salthouse TA , Babcock RLDecomposing adult age differences in working memory. Dev Psychol. 1991;27:763-776.
18.
Cerella J.Aging and information processing rates. In: Birren JE, Schaie KW, eds. Handbook of the Psychology of Aging. 3rd ed. San Diego, CA: Academic Press; 1990:201-221.
19.
Salthouse TASpeed mediation of adult age differences in cognition. Dev Psychol. 1993;29:722-738.
20.
Bryan J., Luszcz MA, Crawford JRVerbal knowledge and speed of information processing as mediators of age differences in verbal fluency performance among older adults. Psychol Aging.1997;12:473-478.
21.
Lindenberger U., Mayr U., Kliegl R.Speed and intelligence in old age. Psychol Aging.1993;8:207-220.
22.
Backman L., Jones S., Berger AK, et al. Multiple cognitive deficits during the transition to Alzheimer's disease. J Intern Med.2004;256:195-204.
23.
Edwards JD, Wadley VG, Vance DE, et al. The impact of speed of processing training on cognitive and everyday performance. Aging Ment Health. 2005 ;9:262-271.
24.
Ball K., Berch DB, Helmbers KF, et al. Effects of cognitive training intervention with older adults: a randomized controlled trial. JAMA.2002;288:2271-2281.
25.
Willis S., Tennstedt S., Marsiske M., et al. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA.2006;296:2805-2814.
26.
Shumaker SA , Legualt C., Coker LHBehavior-based interventions to enhance cognitive functioning and independence in older adults. JAMA.2006;296:2852-2854.
27.
Edwards JD, Wadley VG, Myers RS, et al. Transfer of a speed of processing intervention to near and far cognitive functions. Gerontology.2002;48:329-340.
28.
Mahncke H., Connor BB, Appelman J., et al. Memory enhancement in healthy older adults using a brain plasticity-based training program: a randomized, controlled study. Proc Natl Acad Sci U S A.2006;103:12523-12528.
29.
Stuss DT, Robertson IH, Craik Fim, et al. Cognitive rehabilitation in the elderly: a randomized trial to evaluate a new protocol. J Int Neuropsychol Soc.2007;13:120-131.
30.
Craik Fim, Winocur G., Palmer H., et al. Cognitive rehabilitation in the elderly: effects on memory. J Int Neuropsychol Soc.2007;13:132-142.
31.
Levine B., Stuss DT, Winocur G., et al. Cognitive rehabilitation in the elderly: effects on strategic behavior in relation to goal management. J Int Neuropsychol Soc.2007;13:143-152.
32.
Winocur G., Palmer H., Dawson D., et al. Cognitive rehabilitation in the elderly: an evaluation of psychosocial factors. J Int Neuropsychol Soc.2007;13:153-165.
33.
Neely AS, Backman L.Effects of multifactorial memory training in old age: generalizability across tasks and individuals. J Gerontol B Psychol Sci Soc Sci.1995;50:P134-P140.
34.
Oswald WD, Gunzelmann T., Rupprecht R., Hagen B.Differential effects of single versus combined cognitive and physical training with older adults: the SIMA study in a 5-year perspective. Eur JAgeing. 2006;3:179-192.
35.
Oswald WD, Rupprecht R., Gunzelann T., Tritt K.The SIMAproject: effects of 1 year cognitive and psychomotor training on cognitive abilities of the elderly. Behav Brain Res.1996;78: 67-72.
36.
Prigatano GPLearning from our successes and failures: reflections and comments on “cognitive rehabilitation: how it is and how it might be.” J Int Neuropsychol Soc. 1997;3:497-499.
37.
Salazar AM, Warden DL, Schwab K., et al. Cognitive rehabilitation for traumatic brain injury: a randomized trial. JAMA.2000;283:3075-3081.
38.
Wilson BAMemory rehabilitation in brain-injured people. In: Stuss DT, Winocur G, Robertson IH, eds. Cognitive Neuro-rehabilitation. Cambridge, England: Cambridge University Press; 1999:333-346.
39.
Carney N., Chesnut RM, Maynard H., et al. Effect of cognitive rehabilitation on outcomes for persons with traumatic brain injury: a systematic review. J Head Trauma Rehabil. 1999;14: 277-307.
40.
Rehabilitation of persons with traumatic brain injury. NIH Consens Statement Online1998 Oct 26-28; 16(1):1-41. Available at: http://consensus.nih.gov/1998/1998traumaticbraininjury109html.htm . Accessed September 23, 2007.
41.
Cicerone KD , Dahlberg C., Malec JF, et al. Evidence-based cognitive rehabilitation: updated review of the literature from 1998-2002 . Arch Phys Med Rehabil.2005;86:1681-1692.
42.
Frankel JE, Marwitz JH, Cifu D., et al. A follow-up study of older adults with traumatic brain injury: taking into account decreasing length of stay. Arch Phys Med Rehabil.2006;87:57-62.
43.
Livingston DH , Lavery RF, Mosenthal AC, et al. Recovery at one year following isolated traumatic brain injury: a Western Trauma Association prospective multicenter trial. J Trauma. 2005 ;59:1298-1304.
44.
Ragnarsson KTTraumatic brain injury research since the 1998 NIH Consensus Conference: accomplishments and unmet goals. J Head Trauma Rehabil. 2006;21:379-387.
45.
Landauer TK, Bjork RAOptimal rehearsal patterns and name learning. In: Gruneberg MM, Harris PE, Sykes RN, eds. Practical Aspects of Memory . New York, NY: Academic Press ; 1978:625-632.
46.
Schacter DL, Rich SA, Stampp MSRemediation of memory disorders: experimental evaluation of the spaced-retrieval technique. J Clin Exp Neuropsychol. 1985;7:79-96.
47.
Bird M., Kinsella G.Long-term cued recall of tasks in senile dementia. Psychol Aging.1996;11:45-56.
48.
Camp CJFacilitation of new learning in Alzheimer's disease. In: Gilmore G, Whitehouse P, Wykle M, eds. Memory and Aging: Theory, Research, and Practice. New York, NY: Springer ; 1989:212-225.
49.
Camp CJ, Bird MJ, Cherry KERetrieval strategies as a rehabilitation aid for cognitive loss in pathological aging. In: Hill RD, Backman A, Stigsdotter N, eds. Cognitive Rehabilitation in Old Age. New York, NY: Oxford University Press; 2000:224-248.
50.
Camp CJ, Stevens ABSpaced-retrieval: a memory intervention for dementia of the Alzheimer's type (DAT). Clin Gerontol.1990;10:58-60.
51.
Clare L., Wilson BA, Carter G., et al. Relearning face-name associations in early Alzheimer's disease . Neuropsychology. 2002;16:538-547.
52.
Davis RN, Massman PJ, Doody RSCognitive intervention in Alzheimer disease: a randomized placebo-controlled study. Alzheimer Dis Assoc Disord. 2001;15:1-9.
53.
Bjork RARetrieval practice and the maintenance of knowledge. In: Gruneberg MM, Morris P, Sykes R, eds. Practical Aspects of Memory. Vol 2. London, England: Academic Press; 1988:396-401.
54.
Balota DA, Duchek JMSemantic priming effects, lexical repetition effects and contextual disambiguation effects in healthy aged individuals and individuals with senile dementia of the Alzheimer type. Brain Lang.1991;40:181-201.
55.
Fleischman DA, Wilson RS, Gabrieli JD, et al. Implicit memory and Alzheimer's disease neuropathology. Brain. 2005;128: 2006-2015.
56.
Meiran N., Jelicic M.Implicit memory in Alzheimer's disease: a meta-analysis. Neuropsychology. 1995;9:291-303.
57.
Dick MB, Kean ML, Sands D.The preselection effect on the recall facilitation of motor movements in Alzheimer-type dementia. J Gerontol.1988 ;43:127-135.
58.
Hirono H., Mori E., Ikejiri Y., et al. Procedural memory in patients with mild Alzheimer's disease . Dement Geriatr Cogn Disord. 1997;8:210-216.
59.
Lekeu F., Wojtasik V., Van der Linden M., Salmon E.Training early Alzheimer's patients to use a mobile phone. Acta Neurol Belg. 2002;102:114-121.
60.
Eslinger PJ , Damasio ARPreserved motor learning in Alzheimer's disease: implications for anatomy and behavior. J Neurosci.1986;6:3006-3009.
61.
Gabrieli Jde , Corkin S., Mickel SF, Growdon JHIntact acquisition and long-term retention of mirror-tracing skill in Alzheimer's disease and global amnesia. Behav Neurosci.1993;107:899-910.
62.
Rosler A., Seifritz E., Krauchi K., et al. Skill learning in patients with moderate Alzheimer's disease: a prospective pilot-study of waltz-lessons. Int J Geriatr Psychiatry. 2002;17:1155-1156.
63.
Loewenstein DA, Acevedo A.Training of cognitive and functionally relevant skills in mild Alzheimer's disease: an integrated approach. In: Attix DK, Welsh-Bohmer KA, eds. Geriatric Neuropsychological Assessment and Intervention. New York, NY: Guilford Press; 2006 :261-274.
64.
Backman L.Memory training and memory improvement in Alzheimer's disease: rules and exception . Acta Neurol Scand.1992;139(suppl):84-89.
65.
Davis PE, Mumford SJCued recall and the nature of the memory disorder in dementia. Br J Psychiatry. 1984;144:383-386.
66.
Herlitz A., Viitanen M.Semantic organization and verbal episodic memory in patients with mild to moderate Alzheimer's disease. J Clin Exp Neuropsychol . 1991;13:559-574.
67.
Johnson DL, Smith SDEffects of familiarity and temporal organization on memory for events schemas in aged and Alzheimer subjects: implications for clinical management . Alzheimer Dis Assoc Disord. 1998;12:18-25.
68.
De Vreese LP , Neri M., Fioravanti M., et al. Memory rehabilitation in Alzheimer's disease: a review of progress. Int J Geriatr Psychiatry . 2001;16:794-809.
69.
Moayeri SE, Cahil L., Jin Y., Potkin SGRelative sparing of emotionally influenced memory in Alzheimer's disease . Neuroreport. 2000;11:653-655.
70.
Lipinska B. , Backman L.Encoding-retrieval interactions in mild Alzheimer's disease: the role of access to categorical information . Brain Cogn.1997;34:274-286.
71.
Quayhagen MP , Quayhagen M.Differential effects of family-based strategies on Alzheimer's disease. Gerontologist. 1989 ; 29:150-155.
72.
Quayhagen MP , Quayhagen M., Corbeil RR, et al. A dyadic remediation program for care recipients with dementia. Nurs Res.1995;44:153-159.
73.
Quayhagen MP , Quayhagen M.Testing of a cognitive stimulation intervention for dementia caregiving dyads . In: Clare L, Woods RT, eds. Cognitive Rehabilitation in Dementia. New York, NY: Psychology Press Ltd; 2001:319-332.
74.
Zanetti O., Rozzini ME, Bianchetti A., Trabucci M.Procedural memory stimulation in Alzheimer's disease: impact of a training programme. Acta Neurol Scand.1997 ;95:152-157.
75.
Zanetti O., Zanieri G., Di Giovanni G., et al. Effectiveness of procedural memory stimulation in mild Alzheimer's disease patients: a controlled study. Neuropsychol Rehabil . 2001;11: 263-272.
76.
Spector A., Thorgrimsen L., Woods B., et al. Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomized controlled trial. Br J Psychiatry. 2003;183:248-254.
77.
Woods B., Thorgrimsen L., Spector A., et al. Improved quality of life and cognitive stimulation therapy in dementia. Aging Ment Health. 2006;10:219-226.
78.
Farina E., Fioravanti R., Chiavari L., et al. Comparing two programs of cognitive training in Alzheimer's disease: a pilot study. Acta Neurol Scand.2002;105:365-371.
79.
Farina E., Mantovani F., Fioravanti R., et al. Efficacy of recreational and occupational activities associated to psychologic support in mild to moderate Alzheimer disease: a multicenter controlled study. Alzheimer Dis Assoc Disord. 2006;20:275-282.
80.
Clare L.Multitechnique program approaches. In: Attix DK, Welsh-Bohmer KA, eds. Geriatric Neuropsychological Assessment and Intervention. New York, NY: Guilford Press; 2006 : 293-314.
81.
Clare L., Woods RTCognitive training and cognitive rehabilitation for people with early-stage Alzheimer's disease: a review. Neuropsychol Rehabil. 2004;14:385-401.
82.
Loewenstein DA, Acevedo A., Czaja SJ, Duara R.Cognitive rehabilitation of mildly impaired Alzheimer's disease patients on cholinesterase inhibitors . Am J Geriatr Psychiatry. 2004; 12:395-402.
83.
Salthouse TA , Somberg BLIsolating the age deficit in speeded performance . J Gerontol.1982;37:59-63.
84.
Czaja SJ, Charness N., Fisk AD, et al. Factors predicting the use of technology: findings from the Center for Research and Education on Aging and Technology Enhancement (CREATE) . Psychol Aging.2006;21:333-352.
85.
Czaja SJ, Sharit J.Age differences in attitudes toward computers. J Gerontol B Psychol Sci Soc Sci.1998;53B(5):P329-P340.
86.
Ellis D., Allaire JCModeling computer interest in older adults: the role of age, education, computer knowledge, and computer anxiety. Hum Factors. 1999;41:345-355.
87.
Fisk AD, Rogers WA, Charness N., et al. Designing for Older Adults: Principles and Creative Human Factors Approaches. Boca Raton, FL: CRC Press; 2004.
88.
Pew Internet & American Life Project. Older Americans and the Internet . March 25, 2004. Avaialble at: http://www.pewinternet.org/pdfs/pip_seniors_online_2004.pdf. Accessed April 15, 2005 .
89.
Sharit J.Perspectives on computer aiding in cognitive work domains: toward predictions of effectiveness and use. Ergonomics. 2003 ;46:126-140.
90.
Lytle ME, Vander Bilt J., Pandav RS, et al. Exercise level and cognitive decline: the MoVIES project. Alzheimer Dis Assoc Disord. 2004;18:57-64.
91.
Weuve J., Kang JH, Manson JE, et al. Physical activity, including walking, and cognitive function in older women. JAMA.2004;292:1454-1461.
92.
Yaffe K., Barnes D., Nevitt M., et al. A prospective study of physical activity and cognitive decline in elderly women: women who walk. Arch Intern Med.2001;161:1703-1708.
93.
Abbot RD, White LR, Ross GW, et al. Walking and dementia in physically capable elderly men. JAMA.2004;292:1447-1453.
94.
Larson EB, Want L., Bowen JD, et. al. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med.2006;144:73-81.
95.
Podewils LJ , Guallar E., Kuller LH, et al. Physical activity, APOE genotype, and dementia risk: findings from the Cardiovascular Health Cognition Study . Am J Epidemiol.2005;161:639-651.
96.
Heyn P., Abreu BC, Ottenbacher KJThe effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Arch Phys Med Rehabil.2004;85:1694-1704.
97.
Colcombe S. , Kramer AFFitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci.2003; 14:125-130.
98.
Churchill JD , Galvez R., Colcombe S., et al. Exercise, experience and the aging brain. Neurobiol Aging. 2002 ;23:941-955.
99.
He W., Sengupta M., Velkoff VA, DeBarros KAUS Census Bureau, Current Population Reports, 65+ in the United States . Washington, DC: US Government Printing Office; 2005:23-209.
100.
Hayden KM, Zandi PP, Lyketsos CG, et al. Vascular risk factors for incident Alzheimer disease and vascular dementia: the Cache County study. Alzheimer Dis Assoc Disord . 2006;20: 93-100.
101.
Lindeman RD , Romero LJ, Hundley R., et al. Prevalence of type 2 diabetes, the insulin resistance syndrome, and coronary heart disease in an elderly, biethnic population. Diabetes Care. 1998;21:959-966.
102.
Sacco RL, Boden-Albala B., Gan R., et al. Stroke incidence among white, black, and Hispanic residents of an urban community: the Northern Manhattan Stroke Study. Am J Epidemiol.1998;147:259-268.
103.
Sudano JJ, Baker DWAntihypertensive medication use in Hispanic adults: a comparison with black adults and white adults. Med Care.2001 ;39:575-587.
104.
Anstey K., Christensen H.Education, activity, health, blood pressure and apolipoprotein E as predictors of cognitive change in old age: a review. Gerontology . 2000;46:163-177.
105.
Haan MN, Mungas DM, Gonzalez HM, et al. Prevalence of dementia in older Latinos: the influence of type 2 diabetes mellitus, stroke and genetic factors. J Am Geriatr Soc.2003;51:169-177.
106.
Luchsinger JA, Reitz C., Patel B., et al. Relation of diabetes to mild cognitive impairment. Arch Neurol.2007;64:570-575.
107.
Reed BR, Eberling JL, Mungas D., et al. Effects of white matter lesions and lacunes on cortical function . Arch Neurol.2004;61:1545-1550.
108.
Reitz C., Luchsinger JA, Tang MX, et al. Stroke and memory performance in elderly persons without dementia . Arch Neurol.2006;630:571-576.
109.
Evans DA, Hebert LE, Beckett LA, et al. Education and other measures of socioeconomic status and risk of incident Alzheimer disease in a defined population of older persons. Arch Neurol.1997;51:1399-1405.
110.
Lopez OL, Jagust WJ, Dulberg C., et al. Risk factors for mild cognitive impairment in the Cardiovascular Health Study Cognition Study: part 2. Arch Neurol.2003;601:1394-1399.
111.
Clare L., Woods RT, Moniz Cook ED, et al. Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia. Cochrane Database Syst Rev.2003;4:CD003260.
