“Relative Effectiveness of General Versus Specific Cognitive Training for Aging Adults”, 2021-12-30 ():
A registered clinical trial assessing cognitive training for aging adults: What is it about? We compared the effectiveness of cognitive training techniques including general ability training using technology-based videogame interaction and specific instruction aimed at improving knowledge of driving and finances and fraud. Our primary outcomes included fraud detection, driving hazard perception, speed of processing, self-reported ability to carry out instrumental activities of daily living (IADLs), and other outcomes such as reasoning, numeracy, IADL task performance.
Why is it important? We found little or no benefit for 20 hours of cognitive training relative to an active control puzzle solving condition either short term or after a year in terms of improvement in cognitive abilities such as speed of processing, memory performance. Knowledge training had a weak benefit immediately following training that dissipated a year later. It appears that ~20 hr of cognitive training has little impact on the ability of aging adults to maintain cognition or improve functioning on daily living activities such as driving or managing finances and avoiding fraud.
In the present study, we examined 3 experimental cognitive interventions, two targeted at training general cognitive abilities and one targeted at training specific instrumental activities of daily living (IADL) abilities, along with one active control group to compare benefits of these interventions beyond expectation effects, in a group of older adults (n = 230). Those engaged in general training did so with either the web-based brain game suite BrainHQ or the strategy video game Rise of Nations, while those trained on IADL skills completed instructional programs on driving and fraud awareness. Active control participants completed sets of puzzles.
Comparing baseline and post-intervention data across conditions, none of the preregistered primary outcome measures demonstrated a statistically-significant interaction between session and intervention condition, indicating no differential benefits. Analysis of expectation effects showed differences between intervention groups consistent with the type of training. Those in the IADL training condition did demonstrate superior knowledge for specific trained information (driving and finances).
12 months after training, statistically-significant interactions between session and intervention were present in the primary measure of fraud detection, as well as the secondary measures of the letter sets task and Rey’s Auditory Verbal Learning Test. However, the specific source of these interactions was difficult to discern. At 1-year follow-up those in the IADL condition did not maintain superior knowledge of driving and finances gained through training, as was present immediately post-intervention.
Hence, the interventions, when compared to an active control condition, failed to show general or specific transfer in a meaningful or consistent way.
[Keywords: cognitive intervention, brain training, instrumental activities of daily living (IADL), older adults, active control]
…We failed to replicate the finding by et al 2008 that Rise of Nations leads to differential improvements in executive function in older adults. This could be due to some of the major differences between studies: (1) we used a strong ( et al 2013) control group: Puzzles that has been shown to equate for expectation effects about improvement in cognition ( et al 2016) compared to a no-training, no-contact control group in et al 2008 (although expectation effects were not equated in all domains in the present experiment); (2) training procedures varied in time distribution (20 hr over 1 month for our participants vs. 23.5 hr over 7–8 weeks for theirs), and in location (after initial training in the lab, in homes for our participants and always in the lab for et al 2008’s participants); (3) we had almost 3× as many participants per condition (an average of 57 vs. 20 hence more likely to have a precise estimate of effect size); (4) we had only one measure of executive functioning in common: Raven’s. There is some evidence that home-based, technology-delivered practice can be effective, with little difference between lab and home-based training ( et al 2020), and any large-scale (community-level) cognitive intervention will need to be carried out in the home environment rather than in labs. Further, commercial packages like BrainHQ are usually only available online.
…In spite of the caveats, among the strengths of our study were: Preregistering the study and analysis plan, the use of multiple training conditions and a strong control group, short-term & long-term (1-year) assessment of performance, use of alternate forms to minimize retest effects, and highly standardized procedures for training and testing. Our work lends support to the claim that general cognitive training does not appear to lead to transfer to everyday tasks ( et al 2016), here measured by simulator driving, self-rated IADL performance, detecting fraud, or the Miami computer-simulated IADL tasks. Specific training also failed to augment performance using those same outcome measures, though specific declarative knowledge about finances and driving was improved and well retained, at least immediately following training.