Videogame and Computer Intervention Effects on Older Adults' Mental Rotation Performance.

Objective: This article examined older adults' performance on two components of a mental rotation task (reaction time and rotation rate) in a home-based intervention study of videogame (Crazy Taxi [CT]) and computerized cognitive training (PositScience InSight). Materials and Methods: Participants were randomized to one of three groups: one group played an off-the-shelf videogame (i.e., CT), the second group engaged in a computerized training program focused on fast perceptual comparisons, visuospatial working memory, rapid scanning of a visual array and pattern recognition, visual discrimination, and selective and divided attention and processing speed (i.e., InSight), and the third (control) group received no training. Training in the two intervention conditions consisted of 60 training sessions of 1 hour each, which were completed in 3 months (5 hours a week). As part of a larger study, participants received mental rotation testing, which was administered immediately before (baseline), after (post-test), and 3 months after (follow-up) training. Results: Although the InSight group showed greater improvements in rotation rate at the immediate post-test, by the 3-month follow-up, the combined treatment groups (CT and InSight) had improved more than controls. Conclusion: The improvements in mental rotation performance found at 3-month follow-up add additional support to previous research, showing visuospatial benefits of both videogame play and cognitive training in older adults. Common elements of both interventions may include expansion of the attentional field of view and faster visual comparison efficiency.

Computer and Videogame Interventions for Older Adults' Cognitive and Everyday Functioning.

OBJECTIVE: This study compared older adults' gains in cognitive and everyday functioning after a 60-session home-based videogame intervention with gains seen under formal cognitive training and usual care/no intervention. MATERIALS AND METHODS: Participants were randomized to one of three groups: one group played an off-the-shelf videogame (i.e., Crazy Taxi), the second group engaged in a computerized training program focused on visual attention and processing speed (i.e., PositScience InSight), and the third group received no training. Training in the two intervention conditions consisted of 60 training sessions of 1 hour each, which were completed in 3 months (5 hours a week). Participants received a broad battery of cognitive and everyday functioning assessments immediately before (pretest), after (post-test), and 3 months after (follow-up) training. RESULTS: Both training conditions improved on direct assessments of trained outcomes. In the InSight-trained group, we found transfer to untrained measures of visual attention and processing speed that were similar to the trained tasks, and these gains endured for up to 3 months. Participants in the videogame condition showed small additional benefits, not emerging until 3 months after intervention completion, on a measure of both attention and mood. No trained groups showed gain on visuospatial skills or memory. CONCLUSION: Training effects were highly specific to the target of training. Training effects to visual attention and processing speed were, as expected, larger for InSight-trained participants but were also seen for videogame participants. Given that past research has shown that videogame training leads to greater engagement than cognitive training, videogame interventions may represent a choice for more modest gains in a more engaging context.

Older Adults' Engagement During an Intervention Involving Off-the-Shelf Videogame.

OBJECTIVE: The overall goal of our current study was to examine older adults' experience of Flow (i.e., subjective engagement) during the course of a home-based cognitive training program. MATERIALS AND METHODS: In this study, participants took part in a home-based training program. They were randomized to one of the two training groups. One group played an off-the-shelf videogame (i.e., Crazy Taxi), and the other group played a brain training game (i.e., Insight). Training consisted of 60 training sessions of 1 hour each, which were completed in 3 months (5 hours a week). After each training session, participants completed a Flow questionnaire to measure their engagement with the training. RESULTS: The analysis was performed with a linear growth curve model. The results indicate that on average, there was no change in flow for the Insight group between time points. There was no difference between the initial flow status of the Insight group and the Crazy Taxi group. However, the interaction between group membership and time was statistically significant, indicating that the participants in the Crazy Taxi group increased their scores at each week at a rate that was 0.99 larger than those in the Insight group. CONCLUSION: The analyses revealed that both groups experienced increase in Flow over the period, but only participants in the Crazy Taxi group significantly improved in Flow. This has long-term implications since we would expect participation to go beyond 12 weeks in a real-world scenario.

Interdisciplinary rehabilitation approach for functional neurological symptom (conversion) disorder: A case study.

OBJECTIVE: To describe a coordinated interdisciplinary approach to the treatment of functional neurological symptom (conversion) disorder (FNSD), mixed symptoms, including motor dysfunction, in a rehabilitation setting. DESIGN: Adult patient was admitted with worsening neurological symptoms in the absence of contributory clinical pathology. Interdisciplinary diagnostic and treatment approach included physiatry, neuro- and rehabilitation- psychology, occupational, physical, recreational, and speech therapy. Providers coordinated care and delivered psychologically informed therapies consistent with the standards appropriate to the setting. RESULTS: Diagnosis of FNSD was made 5 weeks after admission. The patient achieved symptom remission at 13 weeks after admission. He remained symptom free at 6 months postdischarge. IMPLICATIONS: Rehabilitation settings are uniquely suited to the treatment of FNSD.

Ten-year longitudinal trajectories of older adults' basic and everyday cognitive abilities.

OBJECTIVE: To examine the longitudinal trajectories of everyday cognition and longitudinal associations with basic (i.e., laboratory and experimentally measured) cognitive abilities, including verbal memory, inductive reasoning, visual processing speed, and vocabulary. METHOD: Participants were healthy older adults drawn from the no-treatment control group (N = 698) of the Advanced Cognitive Training for the Independent and Vital Elderly (Willis et al., 2006) randomized trial and were assessed at baseline and 1, 2, 3, 5, and 10 years later. Analyses were conducted using latent growth models. RESULTS: Modeling revealed an overall inverted-U shape (quadratic) trajectory across cognitive domains. Among basic cognitive predictors, level and slope in reasoning demonstrated the closest association to level and slope of everyday cognition, and accounted for most of the individual differences in linear gain in everyday cognition. CONCLUSION: Everyday cognition is not buffered against decline, and is most closely related to inductive reasoning in healthy older adults. To establish the clinical utility of everyday cognitive measures, future research should examine these associations in samples with more cognitive impairment.

Video game training to improve selective visual attention in older adults.

The current study investigated the effect of video game training on older adult's useful field of view performance (the UFOV® test). Fifty-eight older adult participants were randomized to receive practice with the target action game (Medal of Honor), a placebo control arcade game (Tetris), a clinically validated UFOV training program, or into a no contact control group. Examining pretest-posttest change in selective visual attention, the UFOV improved significantly more than the game groups; all three intervention groups improved significantly more than no-contact controls. There was a lack of difference between the two game conditions, differing from findings with younger adults. Discussion considers whether games posing less challenge might still be effective interventions for elders, and whether optimal training dosages should be higher.

Cognitive longitudinal predictors of older adults' self-reported IADL function.

OBJECTIVE: To examine basic and everyday cognitive predictors of older adults' self-reported instrumental activities of daily living (IADL). METHOD: Basic and everyday cognitive predictors of self-reported IADL were examined in a sample of healthy, community-dwelling older adults (n = 698) assessed over 5 years of measurement. RESULTS: Multilevel longitudinal analyses revealed linear and quadratic change trends for self-reported IADL function, with steeper declines at higher ages. Within-person, when participants exhibited lower cognitive performance, they also reported more IADL impairment. Everyday cognition remained a significant unique predictor of self-reported IADL after controlling for attrition, resampling effects, temporal gradients, and baseline levels and changes in demographic, sensory, functional, and basic cognitive measures. DISCUSSION: By itself, everyday cognition appears to be an important predictor of self-reported IADL, and maintains a unique predictive contribution after many covariates are controlled. Future research should consider the inclusion of everyday cognitive measures in functional assessment batteries.

Older adults' engagement with a video game training program.

OBJECTIVES: The current study investigated older adults' level of engagement with a video game training program. Engagement was measured using the concept of Flow (Csikszentmihalyi, 1975). METHODS: Forty-five older adults were randomized to receive practice with an action game (Medal of Honor), a puzzle-like game (Tetris), or a gold-standard Useful Field of View (UFOV) training program. RESULTS: Both Medal of Honor and Tetris participants reported significantly higher Flow ratings at the conclusion, relative to the onset of training. DISCUSSION: Participants are more engaged in games that can be adjusted to their skill levels and that provide incremental levels of difficulty. This finding was consistent with the Flow theory (Csikszentmihalyi, 1975).

Language and sociability: insights from Williams syndrome.

One of the most compelling features of Williams syndrome (WS) is the widely reported excessive sociability, accompanied by a relative proficiency in expressive language, which stands in stark contrast with significant intellectual and nonverbal impairments. It has been proposed that the unique language skills observed in WS are implicated in the strong drive to interact and communicate with others, which has been widely documented in WS. Nevertheless, this proposition has yet to be empirically examined. The present study aimed at investigating the relationship between a brain index of language processing and judgments of approachability of faces, as a proxy for sociability, in individuals with WS as contrasted to typical controls. Results revealed a significant and substantial association between the two in the WS, but not in the control group, supporting the hitherto untested notion that language use in WS might be uniquely related to their excessive social drive.

Contrasting patterns of language-associated brain activity in autism and Williams syndrome.

Two neurodevelopmental disorders, Williams syndrome (WS) and autism, are both commonly described as having opposite social profiles: social avoidance in autism vs hypersociability in individuals with WS. The goal of this study was to contrast the brain activity associated with language processing in these two populations, in order to understand the very likely interplay between the use of language and the sociability dimension, on which these disorders diverge. Towards this aim, the N400 component of the event-related potentials was used to quantify the processing of semantic integration in these two populations. Results revealed that individuals with WS showed a significantly larger N400 effect, as compared to both typical controls and individuals with autism, while the latter group demonstrated the smallest N400 effect. The findings demonstrate quite opposite profiles of neural correlates of language processing in WS and autism, mirroring their contrasting social phenotypes.

Affiliative behavior in Williams syndrome: social perception and real-life social behavior.

A frequently noted but largely anecdotal behavioral observation in Williams syndrome (WS) is an increased tendency to approach strangers, yet the basis for this behavior remains unknown. We examined the relationship between affect identification ability and affiliative behavior in participants with WS relative to a neurotypical comparison group. We quantified social behavior from self-judgments of approachability for faces, and from parent/other evaluations of real life. Relative to typical individuals, participants with WS were perceived as more sociable by others, exhibited perceptual deficits in affect identification, and judged faces of strangers as more approachable. In WS, high self-rated willingness to approach strangers was correlated with poor affect identification ability, suggesting that these two findings may be causally related. We suggest that the real-life hypersociability in WS may arise at least in part from abnormal perceptual processing of other people's faces, rather than from an overall bias at the level of behavior. While this did not achieve statistical significance, it provides preliminary evidence to suggest that impaired social-perceptual ability may play a role in increased approachability in WS.

Cross-modal influences of affect across social and non-social domains in individuals with Williams syndrome.

The Williams syndrome (WS) cognitive profile is characterized by relative strengths in face processing, an attentional bias towards social stimuli, and an increased affinity and emotional reactivity to music. An audio-visual integration study examined the effects of auditory emotion on visual (social/non-social) affect identification in individuals with WS and typically developing (TD) and developmentally delayed (DD) controls. The social bias in WS was hypothesized to manifest as an increased ability to process social than non-social affect, and a reduced auditory influence in social contexts. The control groups were hypothesized to perform similarly across conditions. The results showed that while participants with WS exhibited indistinguishable performance to TD controls in identifying facial affect, DD controls performed significantly more poorly. The TD group outperformed the WS and DD groups in identifying non-social affect. The results suggest that emotionally evocative music facilitated the ability of participants with WS to process emotional facial expressions. These surprisingly strong facial-processing skills in individuals with WS may have been due to the effects of combining social and music stimuli and to a reduction in anxiety due to the music in particular. Several directions for future research are suggested.

Atypical hemispheric asymmetry in the perception of negative human vocalizations in individuals with Williams syndrome.

Williams syndrome is a neurological condition associated with high levels of auditory reactivity and emotional expression combined with impaired perception of prosody. Yet, little is currently known about the neural organization of affective auditory processing in individuals with this disorder. The current study examines auditory emotion processing in individuals with Williams syndrome. Hemispheric organization for positive and negative human non-linguistic sound processing was compared in participants with and without the disorder using a dichotic listening paradigm. While controls exhibited an expected right cerebral hemisphere advantage for processing negative sounds, those with Williams syndrome showed the opposite pattern. No differences between the groups emerged for the positive stimuli. The results suggest aberrant processing of negative auditory information in Williams syndrome.

Genetic influences on sociability: heightened amygdala reactivity and event-related responses to positive social stimuli in Williams syndrome.

Williams syndrome (WS) is a genetic disorder caused by a hemizygous microdeletion on chromosome 7q11.23. WS is associated with a compelling neurocognitive profile characterized by relative deficits in visuospatial function, relative strengths in face and language processing, and enhanced drive toward social engagement. We used a combined functional magnetic resonance imaging (fMRI) and event-related potential (ERP) approach to examine the neural basis of social responsiveness in WS participants to two types of social stimuli, negative (fearful) and positive (happy) emotional facial expressions. Here, we report a double dissociation consistent across both methods such that WS participants exhibited heightened amygdala reactivity to positive (happy) social stimuli and absent or attenuated amygdala reactivity to negative (fearful) social stimuli, compared with controls. The fMRI findings indicate that atypical social processing in WS may be rooted in altered development of disparate amygdalar nuclei that subserve different social functions. The ERP findings suggest that abnormal amygdala reactivity in WS may possibly function to increase attention to and encoding of happy expressions and to decrease arousal to fearful expressions. This study provides the first evidence that the genetic deletion associated with WS influences the function of the amygdala to be particularly responsive to socially appetitive stimuli.