Randomized controlled trials of non-pharmacological interventions for healthy seniors: Effects on cognitive decline, brain plasticity and activities of daily living-A 23-year scoping review.

Little is known about the simultaneous effects of non-pharmacological interventions (NPI) on healthy older adults' behavior and brain plasticity, as measured by psychometric instruments and magnetic resonance imaging (MRI). The purpose of this scoping review was to compile an extensive list of randomized controlled trials published from January 1, 2000, to August 31, 2023, of NPI for mitigating and countervailing age-related physical and cognitive decline and associated cerebral degeneration in healthy elderly populations with a mean age of 55 and over. After inventorying the NPI that met our criteria, we divided them into six classes: single-domain cognitive, multi-domain cognitive, physical aerobic, physical non-aerobic, combined cognitive and physical aerobic, and combined cognitive and physical non-aerobic. The ultimate purpose of these NPI was to enhance individual autonomy and well-being by bolstering functional capacity that might transfer to activities of daily living. The insights from this study can be a starting point for new research and inform social, public health, and economic policies. The PRISMA extension for scoping reviews (PRISMA-ScR) checklist served as the framework for this scoping review, which includes 70 studies. Results indicate that medium- and long-term interventions combining non-aerobic physical exercise and multi-domain cognitive interventions best stimulate neuroplasticity and protect against age-related decline and that outcomes may transfer to activities of daily living.

Multimodal cognitive and behavioral interventions for patients with MCI: a systematic review and meta-analysis on cognition and mood.

Background: Research has increasingly suggested a benefit to combining multiple cognitive or behavioral strategies in a single treatment program for cognitively impaired older adults. Therefore, this systematic review and meta-analysis aimed to summarize results on the effects of multimodal cognitive and behavioral interventions versus control conditions on changes in cognition and mood in patients with mild cognitive impairment (pwMCI). Methods: The review followed a general PRISMA guideline for systematic literature review with a format consisting of participants, interventions, comparators, and outcomes (PICO). Multilevel meta-analyses of aggregated efficacy were performed to assess the pooled effect sizes for cognitive and mood outcomes. Risk-of-bias, heterogeneity across studies, and publication bias were assessed for each outcome. Results: After primary and reference searches, 18 studies with low or some concerns of risk of bias were included. Low heterogeneity was found for mood and cognition. Funnel plots did not indicate publication bias. All the studies assessed changes in cognition (n = 1,555) while seven studies with mood outcomes (n = 343) were included. Multilevel meta-analyses demonstrated moderate effect (Hedge's g = 0.44, 95% CI = [0.21-0.67]) in cognitive outcomes and large effect in mood (g = 0.65, 95% CI = [0.37-0.93]). Subdomain analyses found low-moderate effects in global cognition, verbal and non-verbal memory, executive function, visuospatial abilities, and semantic fluency (0.20 < g < 0.50). Conclusion: These findings showed comparable to larger effects of multimodal cognitive and behavioral interventions on cognition than pharmacological treatment. Future studies should focus on the longitudinal effects of multimodal interventions in delaying dementia.Systematic review registration: PROSEPRO, CRD42022349297.

The effects of a combination of cognitive interventions and loving-kindness meditations (C-METTA) on guilt, shame and PTSD symptoms: results from a pilot randomized controlled trial.

Background: Trauma-related guilt and shame are crucial for the development and maintenance of PTSD (posttraumatic stress disorder). We developed an intervention combining cognitive techniques with loving-kindness meditations (C-METTA) that specifically target these emotions. C-METTA is an intervention of six weekly individual treatment sessions followed by a four-week practice phase.Objective: This study examined C-METTA in a proof-of-concept study within a randomized wait-list controlled trial.Method: We randomly assigned 32 trauma-exposed patients with a DSM-5 diagnosis to C-METTA or a wait-list condition (WL). Primary outcomes were clinician-rated PTSD symptoms (CAPS-5) and trauma-related guilt and shame. Secondary outcomes included psychopathology, self-criticism, well-being, and self-compassion. Outcomes were assessed before the intervention phase and after the practice phase.Results: Mixed-design analyses showed greater reductions in C-METTA versus WL in clinician-rated PTSD symptoms (d = -1.09), guilt (d = -2.85), shame (d = -2.14), psychopathology and self-criticism.Conclusion: Our findings support positive outcomes of C-METTA and might contribute to improved care for patients with stress-related disorders. The study was registered in the German Clinical Trials Register (DRKS00023470).

C-METTA is an intervention that addresses trauma-related guilt and shame and combines cognitive interventions with loving-kindness meditations.A proof-of-concept study was conducted examining C-METTA in a wait-list randomized controlled trialC-METTA led to reductions in trauma-related guilt and shame and PTSD symptoms.

The Effectiveness of Cognitive-Focused Interventions for Adults With Diabetes: A Systematic Review.

BACKGROUND: Adults with diabetes and impaired memory and executive functions are more likely to experience difficulties in diabetes self-management and achieving glycemic targets. The purpose of this systematic review was to evaluate the evidence of the effects of cognitive-focused interventions on cognitive ability, diabetes self-management, and management of glycemic levels for middle-aged adults and older adults with diabetes. METHODS: A systematic review of randomized controlled/clinical trials published in English between 2012 and 2022 was conducted. A search was performed using 5 databases (PubMed, CINAHL, Embase, Web of Science, and Scopus) in addition to hand-searching. The search terms included diabetes, adults, cognitive-focused intervention, cognition, self-management, and hemoglobin A1C (HbA1C). RESULTS: Eleven studies met the inclusion criteria. Cognitive ability and diabetes self-management were assessed using different measurements, and glycemic levels were measured with HbA1C. Nine studies applied cognitive training, one provided working memory training, and one used occupational therapy. Eight studies combined cognitive training with a co-intervention, including self-efficacy, lifestyle management, physical training, chronic disease self-management program, square-stepping exercise, psychoeducational intervention, and empowerment. Eight studies showed statistically significant improvements in at least one cognitive domain. CONCLUSIONS: Cognitive-focused interventions have a positive effect on improving memory and executive function. However, the evidence of cognitive-focused interventions on diabetes self-management and glycemic levels has not been established. Future studies to improve cognition using effective strategies to improve cognitive function enhancing diabetes self-management behaviors and managing glycemic levels are warranted.

Improving Eating Habits at the Office: An Umbrella Review of Nutritional Interventions.

(1) Workplace nutrition interventions have garnered attention as a pivotal component of employee well-being and organisational productivity. However, the effectiveness of various intervention types remains inconclusive. This review aims to systematically evaluate the efficacy of cognitive, behavioural, and mixed nutrition interventions in the workplace, considering the nuances of intervention design, setting, and target demographics. (2) A comprehensive umbrella review was conducted, categorising the existing literature into person-oriented and environmental strategies. This review was prepared in line with the Joanna Briggs Institute methodology for umbrella reviews and the preferred reporting items for systematic reviews and meta-analyses reporting standard. (3) The analysis revealed a lack of definitive evidence supporting the universal effectiveness of any single intervention type. Nonetheless, behavioural and mixed interventions demonstrated more favourable outcomes as compared to purely cognitive strategies. Factors such as intervention design, workplace setting, and target group characteristics were identified as significant determinants of the intervention success. (4) The review emphasises the imperative for additional investigations that utilise evidence-based approaches to formulate sound guidelines for efficacious nutrition interventions in occupational settings. This review functions as a foundational framework for guiding both scholarly research and the pragmatic execution of nutrition programs in the workplace.

Multidisciplinary Approaches and Community-Based Interventions: Adaptable Strategies for Managing Sensory Impairments in Older Adults.

Sensory impairments including hearing and vision loss are becoming increasingly prevalent among older adults worldwide, and are adversely affecting their quality of life, independence and cognitive health. This article focuses on the global rise of sensory impairments in the ageing population and evaluates the efficacy of multidisciplinary interventions for management and prevention, including assistive-technology-based medicine, exercise programs and cognitive strategies. Drawing from a wide range of studies, we emphasize the importance of developing globally adaptable, community-based solutions that not only address the direct challenges posed by sensory impairments but also their broader implications for cognitive decline. Additionally, we highlight the need for continuous international research to fine-tune these interventions, to ensure they are holistic and responsive to the diverse needs of older adults across different regions worldwide.

Use of focused computerized cognitive training (Neuroflex) to improve symptoms in women with persistent chemotherapy-related cognitive impairment.

Purpose: Chemotherapy-related cognitive impairment (CRCI) is a distressing and increasingly recognized long-term sequela reported by breast cancer patients following cancer treatment. There is an urgent but unmet clinical need for treatments that improve CRCI. In this context, we proposed the use of a novel cognitive enhancement strategy called Neuroflex to target CRCI experienced by breast cancer survivors. Methods: The primary aim of this pilot study was to evaluate the feasibility and acceptability of Neuroflex, a novel digital cognitive enhancement strategy, in breast and gynecologic cancer survivors with CRCI. Secondary analyses focused on whether improvements in performance on Neuroflex were associated with improvement in subjective cognitive complaints and objective cognitive performance measures. Results: Participants (N = 21) completed an average of 7.42 hours of Neuroflex training per week, an average of 44.5 (±1.01) hours total, and had a 100% completion rate. Participants exhibited significant improvement in self-reported cognitive function as well as significant improvement on tasks of verbal learning and memory and auditory working memory. Participants also exhibited improvement in mood, as well as improvement on a disability assessment. Conclusions: Results demonstrate feasibility and that breast cancer survivors are capable of completing a lengthy and challenging cognitive training program. Secondly, Neuroflex may confer specific cognitive benefits to both self-reported and objective performance. Results strongly support further investigation of Neuroflex in a larger controlled trial to establish efficacy for CRCI symptoms. Further studies may also result in optimization of this digital intervention for women with CRCI.

A systematic review and meta-analysis of the effect of cognitive interventions to prevent intrusive memories using the trauma film paradigm.

There is an unmet need for effective early interventions that can relieve initial trauma symptoms and reduce symptoms of posttraumatic stress disorder (PTSD). We evaluated the efficacy of cognitive interventions compared to control in reducing intrusion frequency and PTSD symptoms in healthy individuals using the trauma film paradigm, in which participants view a film with aversive content as an experimental analogue of trauma exposure. A systematic literature search identified 41 experiments of different cognitive interventions targeting intrusions. In the meta-analysis, the pooled effect size of 52 comparisons comparing cognitive interventions to no-intervention controls on intrusions was moderate (g = -0.46, 95% CI [-0.61 to -0.32], p < .001). The pooled effect size of 16 comparisons on PTSD symptoms was also moderate (g = -0.31, 95% CI [-0.46 to -0.17], p < .001). Both visuospatial interference and imagery rescripting tasks were associated with significantly fewer intrusions than controls, whereas verbal interference and meta-cognitive processing tasks showed nonsignificant effect sizes. Interventions administered after viewing the trauma film showed significantly fewer intrusions than controls, whereas interventions administered during film viewing did not. No experiments had low risk of bias (ROB), 37 experiments had some concerns of ROB, while the remaining four experiments had high ROB. To the best of our knowledge, this is the first meta-analysis investigating the efficacy of cognitive interventions targeting intrusions in non-clinical samples. Results seem to be in favour of visuospatial interference tasks rather than verbal tasks. More research is needed to develop an evidence base on the efficacy of various cognitive interventions and test their clinical translation to reduce intrusive memories of real trauma.

Effects of cognitive interventions on quality of life among adults with mild cognitive impairment: A systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: There is considerable research exploring the impact of cognitive interventions on cognition in people with mild cognitive impairment (MCI). However, the impact on quality of life (QOL) is not routinely reported. As QOL is a key predictor of health outcomes, it is important to determine the evidence supporting cognitive interventions for improving QOL in people with MCI. OBJECTIVE: To evaluate the evidence on the effectiveness of cognitive interventions for improving QOL among people with MCI. DESIGN: Systematic review and meta-analysis. METHODS: A systematic database search was conducted from inception to December 11, 2021, using four databases. Quality assessment was conducted, and data on the characteristics of the studies and the effects on QOL were extracted. Subgroup analyses and meta-regression were conducted to elucidate the effects of potential moderator variables on QOL measures. RESULTS: Of the 1550 records initially identified, 17 studies met the criteria for the final meta-analysis. The findings revealed that cognitive interventions produced moderate gains in overall QOL compared to the control group at the posttest (standardized mean difference (SMD): 0.53, 95% confidence interval (CI): [0.23, 0.84]), but no statistically significant differences were found at the end of follow-up (SMD: 0.40, 95% CI: [-0.15,0.94]). Furthermore, the effects of cognitive interventions were moderated by intervention duration, session duration, and study location. However, intervention types, session frequency, intervention components, control condition, total number of sessions, types of QOL measures, and responders to QOL-AD had no statistically significant effects on QOL outcome. CONCLUSIONS: Cognitive interventions have positive effects on QOL among adults with MCI. However, the high heterogeneity of the included studies calls for more well-designed cognitive intervention trials to examine the association between QOL and relevant moderators.

The application of technology to improve cognition in older adults: A review and suggestions for future directions.

The rapidly increasing worldwide population of older adults, along with the increasing prevalence of cognitive impairment and dementia in this population, is a growing health-care problem. As such, advances in technology-based cognitive interventions and games are playing an increasingly key role in preserving and improving older adults' cognitive function, especially during the COVID-19 pandemic when opportunities for face-to-face activities or training are few. In this paper, we summarize from previous studies systematic reviews and meta-analyses on the various types of technology used in cognitive interventions (namely, computerized cognitive training, virtual-reality interventions and robot-assisted interventions) and the empirical evidence on the effects of these technologies on global and specific cognitive functions in healthy and clinical populations of older adults (e.g., older adults with mild cognitive impairment or dementia). We also describe older adults' perceptions, experiences and acceptance of these technologies. Finally, we discuss the limitations, challenges and future avenues of research in this field.

Cognitive-Behavioral Treatment of Obsessive-Compulsive Disorder: The Results of a Naturalistic Outcomes Study.

Cognitive−behavioral therapy is a well-established treatment for obsessive−compulsive disorder (OCD). There are a variety of cognitive and behavioral strategies, and it is necessary to analyze the outcomes of the treatments. The aim of the present study is to verify the effectiveness of a treatment that combines evidence-based procedures and specific cognitive interventions highlighting the issue of acceptance. Forty patients with OCD were recruited and underwent a specific treatment procedure. All patients had a psychodiagnostic assessment for OCD using the Y−BOCS (Yale−Brown obsessive−compulsive scale) performed twice: before treatment (t0) and after nine months (t1). Data analysis showed a decrease in the scores between t0 and t1 according to the Y−BOCS in terms of the interference, severity, and impairment of obsessive−compulsive symptoms. A repeated-measures ANOVA showed a significant reduction in symptoms after treatment, with values of F (1, 39) = 137.56, p < 0.001, and η2 = 0.78. The ANOVA results were corroborated by a Wilcoxon signed-rank test. A reliable change index analysis indicated that 33 participants reported improvements in symptoms, of which 23 were clinically significant. The results showed clinical relevance for OCD treatment and highlighted how this cognitive procedure favored positive outcomes.

Combined Tai Chi and cognitive interventions for older adults with or without cognitive impairment: A meta-analysis and systematic review.

BACKGROUND AND PURPOSE: Evidence from the field of cognitive interventions indicates that nonpharmaceutical interventions seem more promising in enhancing cognition. The number of clinical trials that examine the cognitive benefits of combined physical exercise with cognitive intervention on older adults has recently increased. Tai Chi (TC) has been recommended as an effective and safe exercise for older adults aged 60 and over. However, there is a lack of conclusion about whether combined TC with cognitive interventions can show more benefits than a single intervention for older adults. Thus, this review aimed to evaluate the effects of combined TC and cognitive interventions on older adults. METHODS: PubMed, Embase, PsycINFO, and Web of Science were searched for English peer-reviewed papers from inception until November 12, 2021. Data were extracted by two independent reviewers. RESULTS: A total of 1524 records were generated and nine studies were included. The pooled results showed that combined TC and cognitive interventions showed significantly large gains on memory [standardised mean difference (SMD) = 0.87, 95% confidence interval (CI): (0.01, 1.74), P 0.05], moderate gains on cognition [SMD = 0.74, 95% CI:(0.19, 1.29), P 0.05], and small size effects on balance. No statistically significant difference was found in executive function, depression, risk of falls, or well-being. CONCLUSION: Combined TC and cognitive interventions have positive effects on improving cognition and balance in older adults, but their superiority over the single intervention, as well as their additional effects on the physical and psychological function, are required further investigation.

Visuospatial Working Memory Tasks May Not Reduce the Intensity or Distress of Intrusive Memories.

Cognitive interventions involving visuospatial tasks, such as the game "Tetris" have demonstrated efficacy in reducing the frequency of intrusive memories. However, it remains unclear whether these tasks also reduce the perceived intensity and distress of these memories. We investigated whether either of two visuospatial tasks: a Tetris intervention or Digital Corsi task, following the viewing of an analog trauma (film) resulted in decreased intensity and distress for intrusive memories over the following week, when compared to a control condition. Participants (n = 110) were randomly assigned to task conditions after viewing the film. Linear mixed models indicated no between-group differences for reductions in intensity or distress over the course of the week. These findings highlight an important boundary to the benefits of such visuospatial tasks, in that while they may be associated with reductions in intrusion memory frequency, individuals may nonetheless continue to experience distress when intrusions do occur.

CogTale: an online platform for the evaluation, synthesis, and dissemination of evidence from cognitive interventions studies.

Systematic reviews and meta-analyses are critical in health-related decision-making, and are considered the gold standard in research synthesis methods. However, with new trials being regularly published and with the development of increasingly rigorous standards of data synthesis, systematic reviews often require much expertise and long periods of time to be completed. Automation of some of the steps of evidence synthesis productions is a promising improvement in the field, capable of reducing the time and costs associated with the process.This article describes the development and main characteristics of a novel online repository of cognitive intervention studies entitled Cognitive Treatments Article Library and Evaluation (CogTale). The platform is currently in a Beta Release phase, as it is still under development. However, it already contains over 70 studies, and the CogTale team is continuously coding and uploading new studies into the repository. Key features include advanced search options, the capability to generate meta-analyses, and an up-to-date display of relevant published studies.

Effectiveness of cognitive interventions on cognitive outcomes of adult intensive care unit survivors: A scoping review.

BACKGROUND: Cognitive impairments have been identified as significant under-recognised negative sequelae of postintensive care syndrome. No treatment guidelines exist for cognitive interventions addressing the devastating consequences of impairments and their potential impact on outcomes of intensive care unit (ICU) survivors. AIM: The aim of the study was to identify all available cognitive interventions and measurable outcomes for the cognitive rehabilitation of adult ICU survivors, as reported in published articles. Secondary aims included to critically synthesise existing evidence in improving adult ICU survivors' cognitive outcomes after ICU discharge and to extract implications for future research. METHODS: A scoping review was conducted based on a rigorous literature search (CINAHL, Embase, MEDLINE, PubMed, SCOPUS, Cochrane Library, and Google Scholar) using predefined keywords. The protocol was based on current guidelines. Eligibility criteria included published (i) experimental and quasi-experimental studies reporting the effects of cognitive interventions on cognitive outcomes of adult critical illness survivors after hospital discharge and (ii) protocols identifying cognitive interventions with predefined cognitive outcome measures. RESULTS: Seven studies were included: three experimental studies, two quasi-experimental studies, and two published protocols. Significant heterogeneity in the type of interventions, outcome measures, and assessment tools was noted. Interventions included variations of goal management training and an integrated multidisciplinary model. The setting, delivery, and duration of interventions varied. Cognitive outcomes included variations of global cognitive function and executive function. Overall, the evidence on the effects of cognitive interventions, as compared with routine care, in improving global cognitive function is inconclusive. More evidence support exists with respect to improving executive function. CONCLUSION: Although various cognitive intervention approaches have shown some positive effects on outcomes of ICU survivors after hospital discharge, the high risk of bias and high heterogeneity across studies preclude conclusions about the most appropriate post-ICU care to rehabilitate cognitive deficits in critical care survivors. This review highlighted a number of methodological limitations that require further investigation.

Preventing dementia? Interventional approaches in mild cognitive impairment.

Mild cognitive impairment (MCI) is defined as an intermediate state between normal cognitive aging and dementia. It describes a status of the subjective impression of cognitive decline and objectively detectible memory impairment beyond normal age-related changes. Activities of daily living are not affected. As the population ages, there is a growing need for early, proactive programs that can delay the consequences of dementia and improve the well-being of people with MCI and their caregivers. Various forms and approaches of intervention for older people with MCI have been suggested to delay cognitive decline. Pharmacological as well as non-pharmacological approaches (cognitive, physiological, nutritional supplementation, electric stimulation, psychosocial therapeutic) and multicomponent interventions have been proposed. Interventional approaches in MCI from 2009 to April 2019 concerning the cognitive performance are presented in this review.

Cognitive Training Attenuates Decline in Physical Function Across 10 Years.

OBJECTIVES: Poor physical function is associated with negative health and cognitive outcomes. Although nine studies demonstrated that cognitive training reduces age-related declines in physical function, only one study has examined the effects beyond immediate posttest changes. The first aim of this study was to assess the impact of three cognitive training programs on physical function measures across 10 years and the second aim was to examine whether baseline cognitive self-efficacy or depressive symptoms moderated training effects. METHOD: Using data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized controlled trial, older adults in a no-contact control condition (n = 698) were compared to those receiving processing speed (n = 702), memory (n = 703), or reasoning (n = 694) training. Intention-to-treat (ITT) and dosage analyses were conducted for grip strength and Turn 360. Participants were followed up to 10 years posttest. RESULTS: There were no significant ITT effects of processing speed, memory, or reasoning training assignment to any physical function outcome (p > .05). Dosage models indicated that there were small age-related attenuation effects in Turn 360 decline with more processing speed training (b = -.011, p < .001), memory training (b = -.011, p < .001), and reasoning training (b = -.012, p < .001). There was no significant transfer to grip strength. These training gains were greater for those with more baseline depressive symptoms who received more processing speed training (b = -.001, p < .001). DISCUSSION: This is the first study to demonstrate the effects of cognitive training to complex physical function across 10 years.

A Structured Cognitive Intervention Pathway as a decision-support tool for non-pharmacological interventions within a dementia care service (Innovative practice).

Individual cognitive interventions for Alzheimer's disease have been shown to be beneficial and cost effective when evaluated as sole interventions. However, there is a need for a systematic, person-centric, structured approach to guide non-pharmacological intervention selection based on disease stage, symptoms, outcome assessment, and individual requirements. Our Structured Cognitive Intervention Pathway aims to facilitate the selection of first-line, or subsequent, non-pharmacological management for people with Alzheimer's disease living at home and in elderly care facilities. We discuss the Pathway's conceptual basis and evaluation of implementation as a decision-support tool within a dementia care service in China.

Who benefits from cognitive intervention in older age? The role of executive function.

Objective: In the context of the positive impact of cognitive interventions for age-related memory concerns, clinicians are seeking information about variables that predict optimum client response. In this study of older adults, the aim was to investigate baseline predictors of gain in memory performance, i.e. prospective memory, following a memory intervention.Methods: One hundred and one healthy older adults (H0A) and 73 older people with amnestic mild cognitive impairment (aMCI) were evaluated at 6-months after participating in a 6-week memory group intervention (LaTCH). The outcome measure was a clinic-based prospective memory task. Baseline predictors included demographic variables (age, gender, education), baseline prospective memory, and cognitive resources (retrospective memory, executive function).Results: Thirty percent of the HOA and 16% of the aMCI cohorts demonstrated reliable training effects on prospective memory test performance at 6-month assessment. Through hierarchical regressions in the HOA cohort, executive function (working memory, attention set shifting) rather than retrospective memory was the best predictor of change in prospective memory. Moderated regression did not demonstrate any interactions between retrospective memory and executive function. For the memory impaired cohort (aMCI), better baseline retrospective memory predicted greater gain in prospective memory but only when executive function was also high.Conclusions: Memory groups can improve performance on clinic-based prospective memory tests in older people with concerns about memory performance, suggesting the value of further translation studies to demonstrate functional real-world gains and quality of life improvement after training. These interventions may be especially effective for those older people with better executive function (working memory, attention set shifting).