The effect of high vs. low intensity neuropsychological treatment on working memory in patients with acquired brain injury.

AIM: To evaluate the combined effect of compensation therapy and functional training on working memory (WM) in patients with acquired injury and chronic cognitive deficits by investigating the dose-response relationship and specificity of transfer effects. RESEARCH DESIGN: Double-blind randomized controlled trial. METHODS: All patients underwent 4 weeks of compensation therapy in a day-care setting. In addition, they received either 20 sessions of computer-based WM training (n = 11) or attention training (n = 9). Transfer effects on cognition and their functional relevance in daily life were assessed before treatment, after 2 weeks (10 additional training sessions), and after 4 weeks (20 additional training sessions) of therapy. RESULTS: The combined treatment led to significant improvements in WM performance, verbal memory, and self-reported changes in daily life. The amount of training was identified to modulate efficacy: Significant improvements showed only in the later training phase. We observed no differences between the two training schemes (WM vs. attentional training). CONCLUSIONS: Even in the chronic phase after brain lesion WM performance can be enhanced by the combination of compensation therapy and computerized cognitive training when applied intensely; both a more general attention and a specific WM training regimen are effective.

Benefits of Higher Cardiovascular and Motor Coordinative Fitness on Driving Behavior Are Mediated by Cognitive Functioning: A Path Analysis.

Driving is an important skill for older adults to maintain an independent lifestyle, and to preserve the quality of life. However, the ability to drive safely in older adults can be compromised by age-related cognitive decline. Performing an additional task during driving (e.g., adjusting the radio) increases cognitive demands and thus might additionally impair driving performance. Cognitive functioning has been shown to be positively related to physical activity/fitness such as cardiovascular and motor coordinative fitness. As such, a higher fitness level might be associated with higher cognitive resources and may therefore benefit driving performance under dual-task conditions. For the first time, the present study investigated whether this association of physical fitness and cognitive functioning causes an indirect relationship between physical fitness and dual-task driving performance through cognitive functions. Data from 120 healthy older adults (age: 69.56 ± 3.62, 53 female) were analyzed. Participants completed tests on cardiovascular fitness (cardiorespiratory capacity), motor coordinative fitness (composite score: static balance, psychomotor speed, bimanual dexterity), and cognitive functions (updating, inhibition, shifting, cognitive processing speed). Further, they performed a virtual car driving scenario where they additionally engaged in cognitively demanding tasks that were modeled after typical real-life activities during driving (typing or reasoning). Structural equation modeling (path analysis) was used to investigate whether cardiovascular and motor coordinative fitness were indirectly associated with lane keeping (i.e., variability in lateral position) and speed control (i.e., average velocity) while dual-task driving via cognitive functions. Both cardiovascular and motor coordinative fitness demonstrated the hypothesized indirect effects on dual-task driving. Motor coordinative fitness showed a significant indirect effect on lane keeping, while cardiovascular fitness demonstrated a trend-level indirect effect on speed control. Moreover, both fitness domains were positively related to different cognitive functions (processing speed and/or updating), and cognitive functions (updating or inhibition), in turn, were related to dual-task driving. These findings indicate that cognitive benefits associated with higher fitness may facilitate driving performance. Given that driving with lower cognitive capacity can result in serious consequences, this study emphasizes the importance for older adults to engage in a physically active lifestyle as it might serve as a preventive measure for driving safety.

Shedding Light on the Effects of Moderate Acute Exercise on Working Memory Performance in Healthy Older Adults: An fNIRS Study.

Numerous studies have reported the beneficial effects of acute exercise on executive functions. Less is known, however, about the effects of exercise on working memory as one subcomponent of executive functions and about its effects on older adults. We investigated the effects of acute moderate-intensity exercise on working memory performance, the respective cortical hemodynamic activation patterns, and the development and persistence of such effects in healthy older adults. Forty-four participants (M: 69.18 years ± 3.92; 21 females) performed a letter 2-back task before and at three time points after (post 15 min, post 30 min, and post 45 min) either listening to an audiobook or exercising (15 min; 50% VO2-peak). Functional near-infrared spectroscopy (fNIRS) was used to assess cortical hemodynamic activation and brain-behavior correlations in the fronto-parietal working memory network. Overall, we found no group differences for working memory performance. However, only within the experimental group, 2-back performance was enhanced 15 min and 45 min post-exercise. Furthermore, 15 min post-exercise frontal activation predicted working memory performance, regardless of group. In sum, our results indicate slight beneficial effects of acute moderate-intensity exercise on working memory performance in healthy older adults. Findings are discussed in light of the cognitive aging process and moderators affecting the exercise-cognition relationship.

WOME: Theory-Based Working Memory Training - A Placebo-Controlled, Double-Blind Evaluation in Older Adults.

Background: Scientifically evaluated cognitive intervention programs are essential to meet the demands of our increasingly aging society. Currently, one of the "hottest" topics in the field is the improvement of working memory function and its potential impact on overall cognition. The present study evaluated the efficacy of WOME (WOrking MEmory), a theory-based working memory training program, in a double-blind, placebo-controlled, and randomized controlled trial (www.drks.de, DRKS00013162). Methods:N = 60 healthy older adults were allocated to (1) the WOME intervention, (2) an active low-level intervention, or (3) a passive control group. Overall, the intervention groups practiced twelve sessions of 45 min within 4 weeks of their respective training. Transfer effects were measured via an extensive battery of neuropsychological tests and questionnaires both pre-/post-training and at a 3-month follow-up. Results:WOME led to a significant improvement in working memory function, demonstrated on a non-trained near transfer task and on two different composite scores with moderate to large effect sizes. In addition, we found some indication of relevant impact on everyday life. The effects were short-term rather than stable, being substantially diminished at follow-up with only little evidence suggesting long-term maintenance. No transfer effects on other cognitive functions were observed. Conclusion:WOME is an appropriate and efficient intervention specifically targeting the working memory system in healthy older adults. Trial Registration: German Clinical Trials Register (DRKS), Identifier: DRKS00013162.