Cognitive training is recognized as an efficient approach to improve cognition in older adults at risk for dementia. Real-world interventions that are more globally stimulating could have a greater impact on cognition than typical cognitive training programs — particularly for individuals with lower levels of education, a key risk factor for dementia. Team 10 of the Canadian Consortium on Neurodegeneration in Aging developed ENGAGE. ENGAGE is a 4-month multifaceted program combining memory and attentional training with stimulating leisure activities. This study aimed to assess its efficacy in older adults with subjective cognitive decline or mild cognitive impairment. This was a randomized controlled preference trial (trial #alz104957). One hundred and twenty-eight participants were enrolled in two sites, CRIUGM (Montreal) and Baycrest (Toronto). There were two consecutive randomizations: a) randomization to ENGAGE-MUSIC/SPANISH intervention vs. an active control intervention (ENGAGE-DISCOVERY); b) randomization to SPANISH vs. MUSIC. The MUSIC and SPANISH conditions combined Music or Spanish learning with formal cognitive training. This was a preference trial, so patients could exclude Spanish or Music prior to randomization. A mixed linear model assessed PRE vs. POST changes on composite scores of memory and attention, cognition in everyday life, and use of memory strategies. Secondary analyses examined whether there were different intervention effects when comparing the MUSIC and SPANISH groups to the control intervention separately. The composite score of attention and the use of memory strategies in daily life showed larger pre-post-training effects in the ENGAGE-MUSIC/SPANISH intervention group than in the active control intervention, yielding a significant Intervention x Time interaction. The composite score of memory and the test of cognition in everyday life improved with time, but there was no significant interaction with intervention. Secondary analyses of the two leisure groups only identified differences in the attention composite, where SPANISH participants had a greater beneficial effect than the MUSIC participants. The ENGAGE program significantly improved attention and everyday memory strategy use, with differential effects of Spanish and Music. This indicates that interventions combining leisure activities with formal cognitive training have the potential for mitigating cognitive decline and reducing dementia risk.

INTRODUCTION:In a 5-year follow-up study, we investigated the enduring effects of cognitive training on older adults with mild cognitive impairment (MCI). METHODS:A randomized controlled single-blind trial involved 145 older adults with MCI, assigned to cognitive training (MEMO+), an active control psychosocial intervention, or a no-contact condition. Five-year effects were measured on immediate and delayed memory recall, the Montreal Cognitive Assessment screening test (MoCA), self-reported strategy use, and daily living difficulties. RESULTS:At follow-up, participants who received cognitive training showed a smaller decline in delayed memory and maintained MoCA scores, contrasting with greater declines in the control groups. Cognitive training participants outperformed controls in both delayed memory and MoCA scores at the 5-year time point. No significant group differences were observed in self-reported strategy use or difficulties in daily living. DISCUSSION:Cognitive training provides long-term benefits by mitigating memory decline and slowing clinical symptom progression in older adults with MCI. Highlights:Cognitive training reduced the 5-year memory decline of persons with MCI.Cognitive training also reduced decline on the Montreal Cognitive Assessment (MoCA).No intervention effect was found on strategy use or activities of daily living.

The Intervention mapping framework was used to plan and develop Brain Health PRO (BHPro), a 45-week, theory- and evidence-based online educational program co-created with users in English and French. The goal of the program is to improve dementia literacy, self-efficacy, and attitude toward dementia and ultimately have a positive impact on the dementia risk profile. A pilot study evaluated usability and acceptability using a shorter version of the online program, which informed changes for a full efficacy trial. A group of over 100 researchers contributed expert content targeting seven modifiable risk factors (physical activity, nutrition, cognitive engagement, sleep, social and psychological health, vascular health, vision and audition). 181, ten minute chapters were created in total. All chapters were reviewed and edited by the Citizen’s Advisory group, consisting of older adults in the community. Information and recommendations for lifestyle improvement are delivered incrementally through weekly email interactions, and the platform is designed based on e-learning principles. Participants complete online questionnaires to assess usability (eg: ease of use, ease of navigation, access, complexity), acceptability (eg: whether the program is interesting, whether they would use it again or recommend it) and level of risk at baseline for each of the seven modifiable risk factors. A pilot study of Brain Health PRO was conducted, including 20 older adults, 13 women and 7 men. They had 16.75 years of education on average and their mean score on Logical Memory Scale II was 10.90. Two focus groups were conducted with a randomly selected group of participants to inform about the usability and acceptability of the program. The focus groups along with user experience questionnaires indicated excellent usability, with all dimensions rated in the positive range. Feedback from the end users were incorporated into the program prior to the main efficacy study. BHPro was designed out of necessity to pivot in the changing environment brought by COVID-19. Early data indicate that the BHPro program meets the needs and abilities of older adults in a virtual setting. The platform is easy for older adults to learn and use and is considered relevant.

Cognitive training was found to have a positive effect on the memory of healthy older adults, including long‐term benefits (Rebok et al, 2014). This finding offers hope that cognitive training could contribute to prevention approaches. However, little is known regarding the long‐term benefits of cognitive training in older adults with mild cognitive impairment (MCI), many of whom are in the early phase of Alzheimer’s disease. In a prior randomized controlled trial (Belleville et al, 2018), we reported a short‐term benefit of cognitive training on the delayed recall of older adults with MCI. The objective of this study was to assess the impact five years later.

Background: Functional assessment is of paramount importance when mild cognitive impairment is suspected, but common assessment tools such as questionnaires lack sensitivity. An alternative and innovative approach consists in using sensor technology in smart apartments during scenario-based assessments of instrumental activities of daily living (IADL). However, studies that investigate this approach are scarce and the technology used is not always transposable in healthcare settings. Objective: To explore whether simple and wireless technology used in two different smart environments could add value to performance and rater-based measures of IADL when it comes to predicting mild cognitive impairment (MCI) in older adults. Methods: Twenty-six (26) cognitively healthy older adults (CH) and 22 older adults with MCI were recruited. Functional performance in a set of five scripted tasks was evaluated with sensor-based observations (motion, contact, and electric sensors) and performance-based measures (rated with videotapes). The five tasks could be performed in any order and were detailed on an instruction sheet given to participants. Results: Sensor-based observations showed that participants with MCI spent more time in the kitchen and looking into the fridge and kitchen cabinets than CH participants. Moreover, these measures were negatively associated with memory and executive performances of participants and significantly contributed to the prediction of MCI. Conclusion: Simple, wireless, and sensor-based technology holds potential for the detection of MCI in older adults as they perform daily tasks. However, some limits are discussed and we offer recommendations to improve the usefulness of this innovative approach.

Background Leisure activities can be both enjoyable and cognitively stimulating, and participation in such activities has been associated with reduced age-related cognitive decline. Thus, integrating stimulating leisure activities in cognitive training programs may represent a powerful and innovative approach to promote cognition in older adults at risk of dementia. The ENGAGE study is a randomized controlled, double-blind preference trial with a comprehensive cohort design that will test the efficacy and long-term impact of an intervention that combines cognitive training and cognitively stimulating leisure activities. Methods One hundred and forty-four older adults with a memory complaint will be recruited in Montreal and Toronto. A particular effort will be made to reach persons with low cognitive reserve. Participants will be randomly assigned to one of two conditions: cognitive + leisure training (ENGAGE-MUSIC/SPANISH) or active control (ENGAGE-DISCOVERY). The ENGAGE-MUSIC/SPANISH training will include teaching of mnemonic and attentional control strategies, casual videogames selected to train attention, and classes in music or Spanish as a second language. The ENGAGE-DISCOVERY condition will comprise psychoeducation on cognition and the brain, low-stimulating casual videogames and documentary viewing with discussions. To retain the leisure aspect of the activities, participants will be allowed to exclude either music or Spanish at study entry if they strongly dislike one of these activities. Participants randomized to ENGAGE-MUSIC/SPANISH who did not exclude any activity will be assigned to music or Spanish based on a second random assignment. Training will be provided in 24 2-h sessions over 4 months. Outcomes will be measured at baseline, at 4-month follow-up, and at 24-month follow-up. The primary outcome will be cognitive performance on a composite measure of episodic memory (delayed recall scores for words and face-name associations) measured at baseline and at the 4-month follow-up. Secondary outcomes will include a composite measure of attention (speed of processing, inhibition, dual tasking, and shifting), psychological health, activities of daily living, and brain structure and function and long-term maintenance measured at the 24-month follow-up. Information on cognitive reserve proxies (education and lifestyle questionnaires), sex and genotype (apolipoprotein (Apo)E4, brain-derived neurotrophic factor (BDNF), and catechol-O-methyltransferase (COMT)) will be collected and considered as moderators of training efficacy. Discussion This study will test whether a program combining cognitive training with stimulating leisure activities can increase cognition and reduce cognitive decline in persons at risk of dementia. Trial registration NCT03271190 . Registered on 5 September 2017.

Background/Objectives There is no consensus on the efficacy of cognitive training in persons with mild cognitive impairment ( MCI ) because of the paucity of well‐designed randomized controlled trials. The objective was to assess the effect of memory training on the cognitive functioning of persons with MCI and its durability and to evaluate whether this effect generalizes to daily life and whether positive effects could be obtained from psychosocial intervention. Design Single‐blind randomized controlled trial. Setting Research centers of the Institut Universitaire de Gériatrie de Montréal and Institut Universitaire en Santé Mentale de Québec. Participants Older adults meeting criteria for amnestic MCI (N = 145). Intervention Participants were randomized to cognitive training, a psychosocial intervention, or a no‐contact control condition. Interventions were provided in small groups in eight 2‐hour sessions. Measurement Outcome measures were immediate and delayed composite performance memory scores, psychological health (depression, anxiety, well‐being), and generalization effects of the intervention (strategy use in everyday life, difficulties in complex activities of daily living, memory complaints). Testing was administered before training and immediately, 3 months, and 6 months after training. Results Participants in the cognitive training condition improved on the delayed composite memory score and on strategy use in everyday life. Improvement was maintained at the 3‐ and 6‐month follow‐up assessments. Participants in the psychosocial and no‐contact conditions did not show any significant improvement. Conclusion Cognitive training improves the memory of persons with amnestic MCI . The effect persists over a 6‐month period, and learned strategies are used in everyday life. Cognitive training is a valid way to promote cognition in MCI .

La maladie d’Alzheimer est une pathologie neurodégénérative qui se caractérise dès les premiers stades de la maladie par une atteinte de la mémoire épisodique. Les personnes atteintes présentent ainsi des difficultés à gérer leurs rendez-vous, à se rappeler les activités à faire et les informations personnelles récentes (informations médicales, liste de médicaments). Des études de cas ont montré que l’application AP@LZ, développée sur téléphone intelligent comportant des applications informatiques spécifiquement conçues pour ces personnes, s’avère potentiellement un aide-mémoire efficace lorsque couplé à une méthode d’apprentissage très structurée, limitant la production d’erreurs. D’autres études pourraient valider son application dans des contextes différents. Le premier objectif de la présente étude de cas était de s’assurer que cette méthode d’apprentissage puisse se transférer à un autre contexte clinique avec d’autres intervenants. Le second objectif était d’explorer la possibilité qu’une utilisation moins stricte de cette méthode d’apprentissage soit tout autant bénéfique. Les résultats de M. C., un patient de 76 ans présentant une maladie d’Alzheimer à un stade débutant, démontrent l’efficacité de l’interface AP@LZ lorsque associée à un apprentissage structuré et sans erreurs. Par ailleurs, les présents résultats suggèrent qu’une utilisation moins stricte de la méthode d’apprentissage, permettant au clinicien d’investir moins de temps, demeure tout autant bénéfique pour le patient. Enfin, certains problèmes tels le branchement de l’appareil et l’importance de toujours le transporter avec soi sont discutés. En conclusion, cette étude montre le potentiel des technologies mobiles appliquées auprès des personnes atteintes de la maladie d’Alzheimer et suggère l’importance de poursuivre l’évaluation de l’efficacité des supports mnésiques technologiques pour le maintien à domicile.

ABSTRACTBackground:Several studies have suggested that cognitive training is a potentially effective way to improve cognition and postpone cognitive decline in older adults with mild cognitive impairment (MCI). The MEMO+ study is a randomized, controlled, single-blind trial designed to test the efficacy, specificity, and long-term effect of a cognitive training intervention and a psychosocial intervention in persons with MCI.Methods:One hundred and sixty-two participants with MCI will be recruited. They will be randomized into three groups: cognitive training, psychosocial intervention, and no-contact. Each intervention will last for eight weeks (one session per week) and a booster training session will be provided three months after the end of the intervention. Various proximal and distal outcomes will be measured at pre-intervention as well as at one week, three months, and six months post-training. Proximal outcomes include memory and psychological health measures. Distal outcomes focus on self-rated functioning in complex daily activities and strategies used in daily life to enhance function. Socio-demographic factors (age, gender, and education), general cognition, personality traits, engagement in activities, and self-efficacy will be used as moderators. Enrolment began in April 2012 and will be completed by December 2014.Conclusions:This study is likely to have a significant impact on the well-being of persons with MCI by contributing to the development of adapted and scientifically supported cognitive and psychosocial interventions.

OBJECTIVEThe primary aim of this study was to identify cognitive tests that differentiate between persons with mild cognitive impairment (MCI) who later develop cognitive decline and those who remain stable.METHODThis study used a prospective longitudinal design. One hundred twenty-two older adults with single-domain or multiple-domain amnestic MCI were recruited from memory clinics. They completed tests to measure baseline episodic memory, working memory, executive functions, perception, and language. They were then followed annually to determine with criteria independent from those tests whether they had remained stable or had developed dementia or significant cognitive decline. This was used as the reference standard to measure diagnostic test accuracy value.RESULTSANOVAs indicated that participants with progressive MCI showed more impaired performance than those with stable MCI at baseline on episodic memory (word and story recall), the Brown-Peterson working memory test, object naming, object decision, and position of gap test. Logistic regression derived a significant model with 87.8% overall predictive value. The model included delayed text memory, free recall, naming, orientation match, object decision, and alpha span. Its sensitivity was 86.2% and its specificity was 88.9%. Positive predictive value was 83.3%, and negative predictive value was particularly high at 90.9%.CONCLUSIONSIdentifying individuals with MCI who will progress to dementia or more severe cognitive impairment is a challenge. This study shows that cognitive measures provide valuable information regarding the predictive diagnosis of persons with MCI. Predictive accuracy of a cognitive battery might be optimized by selecting both memory and nonmemory measures.

Amnestic mild cognitive impairment (aMCI) represents a group of individuals who are highly likely to develop Alzheimer's disease (AD). Although aMCI is typically conceptualized as involving predominantly deficits in episodic memory, recent studies have demonstrated that deficits in executive functioning may also be present, and thorough categorization of cognitive functioning in MCI may improve early diagnosis and treatment of AD. We first provide an extensive review of neuropsychology studies that examined executive functioning in MCI. We then present data on executive functioning across multiple sub-domains (divided attention, working memory, inhibitory control, verbal fluency, and planning) in 40 aMCI patients (single or multiple domain) and 32 normal elderly controls (NECs). MCI patients performed significantly worse than NECs in all 5 sub-domains, and there was impairment (>1.0 SD below the mean of NECs) in all sub-domains. Impairment on each test was frequent, with 100% of MCI patients exhibiting a deficit in at least one sub-domain of executive functioning. Inhibitory control was the most frequently and severely impaired. These results indicate that executive dysfunction in multiple sub-domains is common in aMCI and highlights the importance of a comprehensive neuropsychological evaluation for fully characterizing the nature and extent of cognitive deficits in MCI.

Subjects with mild cognitive impairment are at risk of developing Alzheimer's disease. Cognitive stimulation is an emerging intervention in the field of neurology and allied sciences, having already been shown to improve cognition in subjects with mild cognitive impairment. Yet no studies have attempted to unravel the brain mechanisms that support such improvement. This study uses functional magnetic resonance imaging to measure the effect of memory training on brain activation in older adults with mild cognitive impairment and to assess whether it can reverse the brain changes associated with mild cognitive impairment. Brain activation associated with verbal encoding and retrieval was recorded twice prior to training and once after training. In subjects with mild cognitive impairment, increased activation was found after training within a large network that included the frontal, temporal and parietal areas. Healthy controls showed mostly areas of decreased activation following training. Comparison with pre-training indicated that subjects with mild cognitive impairment used a combination of specialized areas; that is, areas activated prior to training and new alternative areas activated following training. However, only activation of the right inferior parietal lobule, a new area of activation, correlated with performance. Furthermore, the differences between the brain activation patterns of subjects with mild cognitive impairment and those of healthy controls were attenuated by training in a number of brain regions. These results indicate that memory training can result in significant neural changes that are measurable with brain imaging. They also show that the brains of people with mild cognitive impairment remain highly plastic.

Diagnosis of different types of dementia is often based on clinical symptomatology rather than underlying pathology; therefore, accurate diagnosis depends on a thorough description of cognitive functioning in different dementias. Furthermore, direct comparison of cognitive functions between different types of dementia is necessary for differential diagnosis. Executive dysfunction is common in several types of dementia, including frontotemporal dementia (FTD) and Lewy body dementia (LBD); however, FTD and LBD patients have never been directly compared on measures of executive functioning. The authors compared the performance of 17 FTD and 15 LBD patients on 6 measures of executive functioning in terms of statistical group differences, mean severity of clinical impairment in comparison to normal controls, and frequency of impairment. Results indicated a remarkably similar pattern of performance across all areas examined in terms of mean performance, as well as degree and frequency of impairment. Only the Stroop test produced results that could potentially differentiate the patient groups. These findings suggest that both FTD and LBD should be considered disorders involving executive dysfunction.

The efficacy of cognitive training was assessed in persons with mild cognitive impairment (MCI) and persons with normal cognitive aging. Forty-seven participants were included in this study: 28 with MCI and 17 controls. Twenty-one participants received intervention (20 MCI and 9 controls) and 16 participants (8 MCI and 8 controls) received no intervention (waiting-list group). The intervention focused on teaching episodic memory strategies. Three tasks of episodic memory (list recall, face-name association, text memory) were used as primary outcome measures. Results were analyzed using analyses of variance. The intervention effect (pre- and post-intervention difference) was significant on two of the primary outcome measures (delayed list recall and face-name association). A significant pre-post-effect was also found on measures of subjective memory and well-being. There was no improvement in the performance of groups of individuals with MCI and normal elderly persons who did not receive the intervention. These results suggest that persons with MCI can improve their performance on episodic memory when provided with cognitive training.

The authors examined the nature of the working memory deficit in persons with Parkinson's disease (PD). Three hypotheses were tested: a limited storage capacity, an impaired executive component, and a reduction of psychomotor speed. Verbal working memory was assessed in 14 PD patients without dementia and 14 matched control participants. Participants were administered a classical verbal span test, working memory tasks that required either updating or manipulation capacities, and motor and psychomotor speed tasks. Patients' performance was comparable to that of control participants on the verbal span test. However, results on the working memory tasks indicated a deficit in manipulation with normal updating capacities. Motor and psychomotor slowing were found in the patient group, but slowing could not fully account for the impairment observed in the manipulation task. Results indicated that there is a genuine but selective working memory impairment in patients with PD.