Cognitive Training

Current Trends and Propositions for the LLM service

The widely-documented age-related cognitive decline (e.g. Lusting et al, 2006; Mahncke et al., 2009) and the demographic trends which reveal that the earth’s population is growing and is expected to age further in the next decades (World Health Organisation) highlight the pressing social need for the design and evaluation of effective cognitive training programs that will maintain and improve older adults’ cognitive functions. To this end, several approaches have been used and a variety of computerized cognitive training exercises for senior citizens are now available.

Do they really work?
To answer this question one needs to define the proper evaluation criteria.

Recently, Owen et al. (2010) have specified such a criterion: “The central question is not whether performance on cognitive tests can be improved by training, but rather, whether those benefits transfer to other untrained tasks or lead to any general improvement in the level of cognitive functioning” (Owen et al., 2010, p. 1). In our opinion, transfer of learning is, indeed, the most critical result that any successful cognitive intervention program should be able to demonstrate. If societies and individual seniors are going to invest time and money on demanding and effortful activities, then it is reasonable to expect that this effort will improve considerably their cognitive functions, mood and everyday living.

In Owen et al.’s study (2010), viewers of a popular BBC series participated in a six-week online training program on various cognitive tasks (e.g. problem solving, reasoning, visuospatial processing etc). Different groups of participants were trained on different tasks. Results showed significant improvement in all the particular tasks they were trained with, but no improvement in neuropsychological tests assessing general cognitive functions of memory, reasoning etc.

Despite the severe methodological flaws of this study (e.g. the minimum training period of ten minutes a day, three times a week was too short for any reliable effects to emerge), it is in agreement with previous studies who show learning for the trained tasks but fail to produce transfer outcomes to novel settings.

For example, during strategy training interventions, seniors are directly taught putatively useful strategies in various cognitive processes such as memory, reasoning etc (e.g. Ball et al., 2002). These studies consistently show significant improvement in the trained and very similar transfer tasks but limited or no transfer of learning to different tasks and everyday activities (Lustig et al., 2009).

To achieve substantial gains and robust generalization of learning, alternative approaches are required.

A plasticity-based computerized training approach
Based on decades of research on brain plasticity (the ability of the brain to remodel itself throughout life in response to behaviourally important stimuli) in animals and humans (e.g. Mahncke et al., 2006), a training program with promising results has recently been developed.

The Brain Fitness Program is designed to speed up auditory processing, improve working memory, improve the accuracy and the speed with which the brain processes speech information and reengage the neuromodulatory systems that gate learning and memory. To reverse cognitive disuse and drive brain plasticity, the program strongly engages the brain with demanding exercises and an adaptive and reward-based daily training schedule. Cognitive exercises provided by it are divided into six interrelated categories, that, in aggregate, span the acoustic organization of speech:
• High or low: In this exercise, seniors hear sweep sounds and have to identify whether these sounds are rising or falling in their frequency (purpose: training basic sensory temporal discrimination).
• Tell us apart: Seniors have to discriminate two similar phonemes that are difficult to distinguish because they are specially synthesized (purpose: training on speech relevant sounds by using specifically processed challenging speech sounds).
• Sound replay: Seniors hear several syllables and have to remember and repeat them in the right order by pressing the corresponding buttons (purpose: training on auditory short-term memory)
• Match it: In this exercise, seniors have to click on rectangular buttons to hear syllables. The goal is to find two buttons that represent the same syllables and click on them one after the other so that they disappear (purpose: training on auditory memory with visual components).
• Listen & Do: Seniors follow instructions to select items in an order. Instructions become more difficult (phonetically and syntactically) progressively (purpose: training on following complex instructions with continuous processed speech).
• Storyteller: Seniors hear segments of stories and are asked to answer a set of questions concerning the details of the respective segment (purpose: training on story comprehension and memory)

This type of intervention was used in the recent study by Smith and colleagues (2009) which was the first double-blind large-scale clinical trial that demonstrated marked improvement not only in the trained task, but also in several generalized measures of memory and perception of cognitive performance in everyday life, relative to an active control group that received a frequency and intensity-matched cognitive stimulation program.

These positive results provide strong empirical and theoretical arguments for the selection of an effective and promising cognitive intervention program that improves senior citizens’ cognitive functions and everyday living.

Ball, K., Berch, D. B., Helmers, K. F., Jobe, J. B., Leveck, M. D., Marsiske, M., et al. (2002). Effects of cognitive training interventions with older adults: A randomized controlled trial. Journal of the American Medical Association, 288, 2271–2281.
Lustig, C., Shah, P., Seidler, R. and Reuter-Lorenz, P. A. (2009). Aging, training and
the brain: A review and future directions. Neuropsychology Review, 19(4), pp. 504-522.
Mahncke, H. W., Amy Bronstone, A., & Merzenich, M. M. (2006). Brain plasticity and functional losses in the aged: scientific bases for a novel intervention. Progress in Brain Research, 157, pp. 81-109.
Owen, A. M., Hampshire, A., Grahn, J. A., Stenton, R., Dajani, S., Burns, A. S., Howard, R. J., & Ballard, C. G. Putting brain training to the test. Nature, info:/DOI:10.11038.
Smith, G. E., Housen, P., Yaffe, K., Ruff, R., Kennison, R. F., Mahncke, H. W., & Zelinski, E. M. (2009). A Cognitive Training Program Based on Principles of Brain Plasticity: Results from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) Study. Journal of the American Geriatrics Society, 57(4), 594-603.
World Health Organisation [WHO]. Active Ageing: A Policy Framework. Available from www.who.int/hpr/ageing/ActiveAgeingPolicyFrame.pdf