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.

Cognitive enrichment through art: a randomized controlled trial on the effect of music or visual arts group practice on cognitive and brain development of young children.

BACKGROUND: The optimal stimulation for brain development in the early academic years remains unclear. Current research suggests that musical training has a more profound impact on children's executive functions (EF) compared to other art forms. What is crucially lacking is a large-scale, long-term genuine randomized controlled trial (RCT) in cognitive neuroscience, comparing musical instrumental training (MIP) to another art form, and a control group (CG). This study aims to fill this gap by using machine learning to develop a multivariate model that tracks the interconnected brain and EF development during the academic years, with or without music or other art training. METHODS: The study plans to enroll 150 children aged 6-8 years and randomly assign them to three groups: Orchestra in Class (OC), Visual Arts (VA), and a control group (CG). Anticipating a 30% attrition rate, each group aims to retain at least 35 participants. The research consists of three analytical stages: 1) baseline analysis correlating EF, brain data, age, gender, and socioeconomic status, 2) comparison between groups and over time of EF brain and behavioral development and their interactions, including hypothesis testing, and 3) exploratory analysis combining behavioral and brain data. The intervention includes intensive art classes once a week, and incremental home training over two years, with the CG receiving six annual cultural outings. DISCUSSION: This study examines the potential benefits of intensive group arts education, especially contrasting music with visual arts, on EF development in children. It will investigate how artistic enrichment potentially influences the presumed typical transition from a more unified to a more multifaceted EF structure around age eight, comparing these findings against a minimally enriched active control group. This research could significantly influence the incorporation of intensive art interventions in standard curricula. TRIAL REGISTRATION: The project was accepted after peer-review by the Swiss National Science Foundation (SNSF no. 100014_214977) on March 29, 2023. The study protocol received approval from the Cantonal Commission for Ethics in Human Research of Geneva (CCER, BASEC-ID 2023-01016), which is part of Swiss ethics, on October 25, 2023. The study is registered at clinicaltrials.gov (NCT05912270).

Adversity specificity and life period exposure on cognitive aging.

This study set out to examine the role of different adversities experienced at different life course stages on cognitive aging (i.e., level and change). Data from the longitudinal study: Survey of Health, Ageing, and Retirement in Europe (SHARE) with the selection of participants over 60 years were used (N = 2662, Mdnage = 68, SDage = 5.39) in a Structural Equation Modeling. In early life, the experience of hunger predicted lower delayed recall (ß = - 0.10, p < 0.001) and verbal fluency (ß = - 0.06, p = 0.001) performance in older age, whereas financial hardship predicted lower verbal fluency (ß = - 0.06, p = 0.005) performance and steeper decline in delayed recall (ß = - 0.11, p < 0.001). In early adulthood, financial hardship and stress predicted better delayed recall (financial hardship: ß = 0.08, p = 0.001; stress: ß = 0.07, p = 0.003) and verbal fluency performance (financial hardship: ß = 0.08, p = 0.001; stress ß = 0.10, p < 0.001), but no adversities were associated with a change in cognitive performance. In middle adulthood, no adversities were associated with the level of cognitive performance, but financial hardship predicted lower decline in delayed recall (ß = 0.07, p = 0.048). This study highlights the importance of disentangling the period effect from the specific effect of the adversity experienced in the association between adversity and cognition in older age. Moreover, differential results for delayed recall and verbal fluency measures suggest that it is also important to consider the cognitive outcome domains examined.

Aging and time-based prospective memory in the laboratory: a meta-analysis on age-related differences and possible explanatory factors.

In older adults' everyday life, time-based prospective memory (TBPM) is relevant as health-related intentions are often part of daily activities. Nonetheless, it is still unclear which task-related factors can potentially moderate the magnitude of age-related differences, such as duration of the PM target time (the time-window within which an individual must complete a given TBPM task), the frequency of the TBPM tasks, and the criterion chosen to compute PM accuracy. The present meta-analysis aimed to quantify age-related differences in laboratory TBPM tasks, and to investigate how specific task-related factors potentially moderate the magnitude of age effects. The results showed that age effects consistently emerged among the studies, with older adults showing lower TBPM performance and checking the clock less often than younger adults, especially for shorter intervals (e.g., ≤ 4 min). Furthermore, the results indicated that the duration of the PM target time interacted with the frequency of the PM task, suggesting that learning effects may attenuate the magnitude of age differences in TBPM performance. The results are discussed in terms of potential implications about the possible cognitive processes involved in TBPM and aging, as well as in terms of robustness of the TBPM laboratory paradigm in aging research.

Musical and psychomotor interventions for cognitive, sensorimotor, and cerebral decline in patients with Mild Cognitive Impairment (COPE): a study protocol for a multicentric randomized controlled study.

BACKGROUND: Regular cognitive training can boost or maintain cognitive and brain functions known to decline with age. Most studies administered such cognitive training on a computer and in a lab setting. However, everyday life activities, like musical practice or physical exercise that are complex and variable, might be more successful at inducing transfer effects to different cognitive domains and maintaining motivation. "Body-mind exercises", like Tai Chi or psychomotor exercise, may also positively affect cognitive functioning in the elderly. We will compare the influence of active music practice and psychomotor training over 6 months in Mild Cognitive Impairment patients from university hospital memory clinics on cognitive and sensorimotor performance and brain plasticity. The acronym of the study is COPE (Countervail cOgnitive imPairmEnt), illustrating the aim of the study: learning to better "cope" with cognitive decline. METHODS: We aim to conduct a randomized controlled multicenter intervention study on 32 Mild Cognitive Impairment (MCI) patients (60-80 years), divided over 2 experimental groups: 1) Music practice; 2) Psychomotor treatment. Controls will consist of a passive test-retest group of 16 age, gender and education level matched healthy volunteers. The training regimens take place twice a week for 45 min over 6 months in small groups, provided by professionals, and patients should exercise daily at home. Data collection takes place at baseline (before the interventions), 3, and 6 months after training onset, on cognitive and sensorimotor capacities, subjective well-being, daily living activities, and via functional and structural neuroimaging. Considering the current constraints of the COVID-19 pandemic, recruitment and data collection takes place in 3 waves. DISCUSSION: We will investigate whether musical practice contrasted to psychomotor exercise in small groups can improve cognitive, sensorimotor and brain functioning in MCI patients, and therefore provoke specific benefits for their daily life functioning and well-being. TRIAL REGISTRATION: The full protocol was approved by the Commission cantonale d'éthique de la recherche sur l'être humain de Genève (CCER, no. 2020-00510) on 04.05.2020, and an amendment by the CCER and the Commission cantonale d'éthique de la recherche sur l'être humain de Vaud (CER-VD) on 03.08.2021. The protocol was registered at clinicaltrials.gov (20.09.2020, no. NCT04546451).

Do executive functions explain older adults' health-related quality of life beyond event-based prospective memory?

Previous work has shown that event-based prospective memory (EBPM) predicted health-related quality of life (HrQoL). In the present study, we aimed to examine whether the relationship between EBPM and HrQoL extended to life satisfaction, and whether it persisted after controlling for other cognitive functions related to EBPM, namely executive functions and retrospective memory. We tested two models using structural equation modeling with latent variables in a sample of older adults. In the first model, we assessed whether EBPM predicted life satisfaction and HrQoL; in the second model, we controlled for retrospective memory and executive functions. The first model indicated that EBPM was related to HrQoL. However, in the second model, this relationship was eliminated by executive functions; life satisfaction was not related to any of the cognitive variables. Findings corroborated the link between HrQoL and EBPM, suggesting that such relationship stems from executive functions rather than retrospective memory.

Cumulative life course adversity, mental health, and cognition in the UK biobank.

The association between adversity and cognition varies according to the specific adversity, when the adversity was experienced, and the cognitive domains investigated. Disentangling the effect of adversity and the underlying mechanistic pathway is therefore difficult. The association between adversity (i.e., maltreatment) accumulated over the life course and cognitive flexibility, as well as two potential mediators (i.e., intra-individual variability in reaction time and depression) of this association, were investigated. Data stem from the baseline population of the UK Biobank study (N = 73,489, Mdnage = 56, SDage = 7.628, 55.740% of women). Cumulative life course adversity (specifically maltreatment) was measured with items based on the Childhood Trauma Questionnaire (CTS-5) and items adapted from the British Crime Survey. Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9). Intra-individual variability in reaction time was measured with a reaction time test "snap game" and the Trail Making Test A and B were used as a measure of cognitive flexibility. A path analysis was performed on these data. Higher cumulative adverse experiences were associated with lower performance in cognitive flexibility (ß = .016, p < .001, 95% CI [0.009, 0.024]), and this effect was partly mediated by the level of depression (22.727% of the total effect of cumulative life course adversity on cognitive flexibility was mediated by depression (ß = .005, p < .001, 95% CI [0.004, 0.007])). No association between cumulative life course adverse experiences and intra-individual variability in reaction time was found, nor was any indirect association between cumulative life course adversity and performance in cognitive flexibility via intra-individual variability in reaction time. The association between cumulative life course adversity, depression, and performance in cognitive flexibility has been highlighted. In contrast, no indirect effect between cumulative life course adversity and performance in cognitive flexibility via intra-individual variability in reaction time was found, suggesting that it is not a potential mechanism underlying the association between cumulative life course adversity and executive function.

Online assessment of cognitive functioning across the adult lifespan using the eCOGTEL: a reliable alternative to laboratory testing.

As the population ages, risks for cognitive decline threaten independence and quality of life of older adults. Classically, psychological assessment tools that evaluate cognitive functioning are administered in face-to-face laboratory sessions, which are time- and resource-consuming. The present study set out to examine whether the eCOGTEL-an online adaptation of the Cognitive Telephone Screening Instrument (COGTEL; Kliegel et al. in J Psychol 141(2):147-170, 2007)-represents a reliable measure of cognitive performance in adulthood. Therefore, an age-stratified adult lifespan sample of 253 participants (aged 19-86 years) completed a face-to-face assessment in the laboratory and a self-administered online version, at their homes. A second, independent sample of 176 younger adults (aged 19-30 years) performed a test-retest assessment of the eCOGTEL. Results showed strong correlations between overall cognitive scores assessed online and in the laboratory, as well as a high test-retest reliability. Further, comparable data distributions between both assessment modes underline the feasibility of the eCOGTEL across the adult lifespan and particularly in older age. Our findings thereby indicate that the eCOGTEL can reliably measure cognitive performance across the lifespan at reduced costs, which may help detecting individuals at risk of developing age-related cognitive decline. Due to these strengths, the eCOGTEL represents a valuable contemporary approach for the resource-efficient online assessment of cognition, which may benefit a broad array of fundamental and applied research fields, such as clinical and organizational psychology. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-021-00667-x.

The Geneva Space Cruiser: a fully self-administered online tool to assess prospective memory across the adult lifespan.

The current study aimed to examine whether the Geneva Space Cruiser - a new online adaptation of the Cruiser - represents a valid, reliable and useful tool to assess prospective memory (PM) across the adult lifespan via fully self-administered online testing. Therefore, an adult lifespan sample of 252 adults (19-86 years old) performed the Geneva Space Cruiser in the laboratory and online, at home, and also performed a more traditional laboratory PM task. A second sample of 224 young adults (19-35 years old) participated in a test-retest online assessment of the Geneva Space Cruiser. Bayesian analyses showed that the Geneva Space Cruiser yielded similar results when administered in the laboratory versus online, both in terms of data distribution as well as of key outcome measures (i.e., PM performance and monitoring). Results further showed very good test-retest reliability and acceptable construct validity. Finally, the online tool was sensitive for detecting age-differences similar to those typically observed in laboratory studies. Together, our findings suggest that the Geneva Space Cruiser represents a rather valid, moderately to highly reliable, and generally useful tool to assess PM in online testing across wide ranges of the adult lifespan, with certain limitations for the oldest participants and for women.

Investigating prospective memory via eye tracking: No evidence for a monitoring deficit in older adults.

Prospective memory (PM) refers to remembering to perform intended actions in the future. Older adults in particular have been shown to be negatively affected by PM tasks that require a high amount of attentional resources (i.e., nonfocal tasks). This age-related PM deficit has been attributed to reduced target monitoring in this age group older adults. However, this conclusion was based on indirect measures of monitoring, such as costs of the ongoing task. The present study set out to 1) investigate older adults' PM target monitoring by, for the first time, employing a direct measure (i.e., eye tracking), 2) assess differences in monitoring between PM tasks that differ in their focality, and 3) examine whether differences in PM monitoring can indeed explain older adults' reduced PM performance in nonfocal tasks. Results demonstrate that while older, but not younger adults, showed reduced performance in a nonfocal PM task, overt monitoring (eye movements) of these groups did not differ between focality conditions. Further analyses showed that older adults' performance was still reduced on the strategically more demanding task after controlling for overt target monitoring (i.e., including only trials in which the participant monitored). In contrast to indirect measures of cue monitoring, our findings illustrate that older adults' deficits on nonfocal PM tasks cannot (exclusively) be explained by reduced monitoring. Instead, processing that takes place after target monitoring are discussed as possible mechanisms underlying older adults' reduced PM performance in nonfocal tasks.

Intraindividual reaction time variability predicts prospective memory failures in older adults.

This study investigated the relationship between intraindividual variability (IIV) in reaction time and prospective memory errors in older adults using data from the Zurich Longitudinal Study of Cognitive Aging (n = 336 individuals aged 66-81 years). The results indicated that increased IIV measured from independent tasks was associated with a greater proportion of prospective memory errors. These significant findings were not influenced by age and did not vary according to prospective memory cue type. Variability is thought to reflect fluctuations in attentional and executive control and these attentional processes may also impact on prospective memory through failure to detect the target cue. The findings suggest, therefore, that measures of variability may have some potential in the identification of older persons who are more vulnerable to everyday errors such as prospective memory failures.

Prospective memory in patients with juvenile myoclonic epilepsy and their healthy siblings.

OBJECTIVE: Prospective memory (PM) describes the ability to fulfill previously planned intentions and is highly dependent on executive functions. Previous studies have shown deficits in executive functions in patients with juvenile myoclonic epilepsy (JME) and in their unaffected siblings. JME has a strong genetic predisposition and it is hypothesized that cognitive deficits are also genetically determined. The present study aimed at investigating potential differences in PM between patients with JME, their siblings, and healthy controls. METHODS: Nineteen patients with JME, 21 siblings, and 21 healthy controls were examined with a complex PM paradigm allowing us to evaluate the different phases of PM (i.e., intention formation, intention retention, intention initiation, intention execution). RESULTS: Patients with JME and siblings showed specific deficits during intention formation and intention execution of PM. Patients with JME were more impaired than both siblings and healthy controls. Correlation analysis revealed an influence of planning on prospective memory abilities in patients with JME. CONCLUSION: The results of this study support the hypothesis of frontal dysfunctions being part of the epileptic syndrome and therefore genetically determined. As in this study patients with JME are more severely cognitively impaired than their siblings, additional influencing factors, such as side effects of anticonvulsants or cognitive effects of subclinical epileptic discharges, might contribute to patients' performance.

[Development of the Saxon Health Target "Active aging - aging in health, autonomy, and participation"]. / Entwicklung des Sächsischen Gesundheitsziels "Aktives Altern - Altern in Gesundheit, Autonomie und Mitverantwortlichkeit."

In Saxony, the consequences of demographic aging are observable already today. To manage the implications on the health sector, the Saxon Health Targets Steering Committee decided in March 2008 to develop a health target "Active Aging - Aging in Health, Autonomy, and Participation". Target development was based on a 7-level approach (fields of action, main goals, target areas, targets, strategies, intervention measures, indicators for evaluation). A quantitative content analysis was used to reveal 10 potential relevant fields of action, three of which were selected for target development. Targets were developed by 53 stakeholders in multiprofessional working groups. Criteria-based analyses were performed to assure appropriate scientific evidence and feasibility of targets and intervention measures. Over a period of 9 months, 24 targets were defined referring to the main goals "needs-based health care structures", "multiprofessional qualification", "self-rated health" and "intergenerational solidarity". Thirteen targets were developed into recommendations for specific intervention measures. Most of the proposed interventions aim to modify health-related structures or psychosocial determinants of health in the elderly. The best recommendations for intervention measures shall be implemented in cooperation with interested decision-makers.

Continuous subcutaneous insulin infusion leads to immediate, stable and long-term changes in metabolic control.

BACKGROUND: Evaluations of continuous subcutaneous insulin infusion (CSII) usually focus on one pre- and one post-CSII measurement to assess metabolic therapy outcome. AIM: Extending this research, the aim of the present study was to provide a more fine-grained analysis of achieved glycaemic control. METHODS: In 52 patients with type 1 diabetes (mean age of 37.85 years at CSII begin; s.d. +/- 12.41), haemoglobin A(1c) (HbA(1c)) levels were assessed every 3 months over a period of 5 years (1 year before and 4 years after the introduction of CSII). Mixed models were utilized to describe changes in glycaemic control. RESULTS: The pre-post course showed that already in the first quarter, a statistically significant lower HbA(1c) level was obtained [7.30%, in contrast to 8.21% at the last quarter with intensified conventional therapy (ICT)]. In the following 15 quarters, the mean HbA(1c) levels remained constantly lower than that with ICT. Overall, the aggregated mean HbA(1c) level of patients with CSII therapy was 7.19%, in contrast to 8.08% with ICT; thus, an overall decrease by 11% was achieved. In addition, individual differences in blood glucose level and age of diabetes onset as a predictor for therapy success were analysed. CONCLUSIONS: The data show an immediate, stable and long-term effect of CSII on HbA(1c). In addition, a significant relationship between metabolic control and age of diabetes onset was found, as well as a reduction of variance in HbA(1c) levels between subjects after change to CSII.

Planning and realisation of complex intentions in patients with Parkinson's disease.

BACKGROUND: There is some evidence that patients with Parkinson's disease may impaired in prospective memory performance (planning and self initiated realisation of delayed intentions). Little is known about the effect of the disease on distinct phases of prospective memory and the potential mechanisms underlying these effects. OBJECTIVE: To investigate intention formation, intention retention, intention initiation, and intention execution of patients with Parkinson's disease and test for the mediating influence of working memory, inhibition, short term retrospective memory, and divided attention. METHODS: 16 patients with Parkinson's disease and 16 age and education matched normal controls were given a complex event based prospective memory task which differentiates four phases of prospective remembering. In addition, participants completed tasks assessing potential cognitive mediators. RESULTS: On the prospective remembering task, Parkinson patients were impaired in the intention formation phase and showed a trend towards impairment in the intention initiation. In contrast, there were no impairments of retrospective intention retention or the fidelity with which the patients executed their previously developed plan. The group effects were related to interindividual differences in working memory span. CONCLUSIONS: The results suggest that the planning phase of prospective remembering is specifically impaired in Parkinson's disease, and that the impairment is related to working memory deficit. In contrast, even when complex intentions have to be remembered, the retrospective storage of intentions to be performed is not impaired.

Life-long intellectual activities mediate the predictive effect of early education on cognitive impairment in centenarians: a retrospective study.

The purpose of this study was to examine the hypothesis of whether early education and/or maintaining intellectual activities over the life-course have the power to protect against cognitive impairment even in extremely old adults. Ninety centenarians from the population-based Heidelberg Centenarian Study were assessed with a modified version of the Mini Mental State Exam (MMSE). Data about education, occupational status, and life-long intellectual activities in four selected domains were obtained. Results demonstrated that 52% of the sample showed mild-to-severe cognitive impairment. Analyzing the influence of early education, occupational status, and intellectual activities on cognitive status we applied several (logistic) regression analyses. Results revealed independent, significant and strong influence of both formal school education and intellectual activities on the cognitive status in very late life, even after controlling for occupational status. However, about one fourth of the effect of early education on cognitive status was exerted indirectly via the assessed intellectual activities. In summary, the present study provides first evidence for the conclusion that even with regard to cognitive performance in very old age, both early education and life-long intellectual activities seem to be of importance.

[Learning in old age: The importance of self-initiated structuring]. / Lernen im Alter: Die Bedeutung der selbstständigen Strukturierung des Lernmaterials.

The purpose of the present study was to assess the role of memory, inhibition efficiency and self-initiated structuring of learning material in predicting age-related effects in learning performance. 47 young ( M = 23.3; SD = 3.8) and 52 old adults ( M = 64.5; SD = 5.2) took part in the current study. Tests assessing memory span, inhibition efficiency and a recall test requiring the participants to structure their learning material were administered. The results reveal that most of the age-related variance in learning performance can be explained by inhibition efficiency, memory span and-particularly-by the quality of structuring learning material. Furthermore, the results indicate that in order to recall the content of categories it is important to remember the categories formed during the learning period. The study emphasizes the importance of teaching strategies for organizing learning material in the context of cognitive trainings for the elderly.

[Similarities and differences between self-rated and proxy-rated health in extreme old age]. / Ubereinstimmungen und Unterschiede in der selbst- und fremdeingeschätzten Gesundheit bei extrem Hochaltrigen.

Especially in old age, the global well-being of persons is strongly influenced by their health situation. Due to functional limitations, research on the development of persons in extreme old age often uses proxy ratings of health instead of self-ratings common in younger age groups. However, it is not known whether self- and proxy-ratings provide comparable information about the health status of extremely old persons. The current study with 53 centenarians and 53 proxies examines similarities and differences between self and proxy-ratings of health. The results indicate a high degree of similarity in some health ratings, an overestimation of ADL capacities by the centenarians, and that self-ratings to a large degree reflect the current mood levels of individuals. Findings are discussed with respect to the differences in the kind of information used for general health ratings.

[Functional competence and nursing care in centenarians. The importance of the cognitive status]. / Funktionale Kompetenz und Pflegebedürftigkeit nach SGB XI bei HundertjährigenDie besondere Bedeutung des kognitiven Status.

The maintenance of autonomy and independence in the oldest old population is at high risk due to the inevitable aging process, which primarily affects functional and cognitive capacities. In this study, we investigate centenarians to assess the extent in which they have lost their ability to live independently. This is done with a classification system for dependency that considers both functional and cognitive limitations and determines the level of functional competence in this population. Based on this system, we evaluate the necessity for nursing care and investigate to which extent their actual needs are covered by the German Long-term Care Insurance. An important and relevant question is whether this system even addresses the evaluation of cognitive impairment. For this reason, 85 centenarians and their proxies were assessed with standardized instruments and the results show a severe loss of independence. The necessity for at least daily contact with nursing care was identified in 91 percent of the centenarians due to their dramatically limited capacities. Forty-four percent of the centenarians need more support than they actually receive from the German Long-term Care Insurance. Therefore, considering cognitive impairment is a crucial component in the evaluation, which would lead to more support by the official system in 20 percent of the centenarians. The considerable differences between the granted and the necessary nursing care demonstrate that co-operation from family members must be heavily relied upon.