Long-term studies in cognitive training for older adults: a systematic review

Silva, Thais Bento Lima da; Bratkauskas, Jéssica Souza; Barbosa, Maurício Einstoss de Castro; Silva, Guilherme Alves da; Zumkeller, Mariana Garcia; Moraes, Luiz Carlos de; Lessa, Patrícia Prata; Cardoso, Neide Pereira; Ordonez, Tiago Nascimento; Brucki, Sonia Maria Dozzi

doi:10.1590/1980-5764-DN-2021-0064

Thais Bento Lima da Silva Correspondence: Thais Bento Lima-Silva; Email: gerontologathais@gmail.com.

Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, São Paulo SP, Brazil.

Instituto Supera de Educação, São José dos Campos SP, Brazil.

http://orcid.org/0000-0001-6034-0988

Jéssica Souza Bratkauskas

Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, São Paulo SP, Brazil.

http://orcid.org/0000-0001-6613-0527

Maurício Einstoss de Castro Barbosa

Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, São Paulo SP, Brazil.

http://orcid.org/0000-0003-2444-4434

Guilherme Alves da Silva

Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, São Paulo SP, Brazil.

http://orcid.org/0000-0003-3693-7869

Mariana Garcia Zumkeller

Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, São Paulo SP, Brazil.

http://orcid.org/0000-0003-1113-8550

Luiz Carlos de Moraes

Instituto Supera de Educação, São José dos Campos SP, Brazil.

http://orcid.org/0000-0003-3727-9781

Patrícia Prata Lessa

Instituto Supera de Educação, São José dos Campos SP, Brazil.

http://orcid.org/0000-0002-2298-9257

Neide Pereira Cardoso

Instituto Supera de Educação, São José dos Campos SP, Brazil.

http://orcid.org/0000-0001-9256-6439

Tiago Nascimento Ordonez

Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, São Paulo SP, Brazil.

http://orcid.org/0000-0003-0307-5895

Sonia Maria Dozzi Brucki

Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Grupo de Neurologia Cognitiva e Comportamental, São Paulo SP, Brazil.

http://orcid.org/0000-0002-8303-6732

Correspondence: Thais Bento Lima-Silva; Email: gerontologathais@gmail.com.

Authors’ contributions. TBLS, JSB, MECB, GAS, MGZ, LCM, PPL, NPC, TNO, SMDB: conceptualization, investigation, methodology, visualization, writing – original draft, and writing – review & editing. TBLS, LCM, PPL, SMDB: funding acquisition. TBLS, TNO, SMDB: project administration, supervision, and writing – review & editing.

Disclosure: The authors report no conflicts of interest.

Authors	Sample	Objectives	Main intervention	Results found	Downs and Black
Willis et al.⁴¹41 Willis SL, Tennstedt SL, Marsiske M, Ball K, Elias J, Koepke KM, et al. ACTIVE Study Group. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA. 2006;296(23):2805-14. https://doi.org/10.1001/jama.296.23.2805 https://doi.org/10.1001/jama.296.23.2805...	n=2,832 (mean age, 73.6 years)	To determine the effects of cognitive training on daily function and durability of training on cognitive abilities.	Ten-session training for memory (verbal episodic memory), reasoning (inductive reasoning), or speed of processing (visual search and identification); four-session booster training at 11 and 35 months after training in a random sample of those who completed training.	Reasoning training resulted in less functional decline in self-reported IADL. CT cognitive training improved cognitive abilities specific to the abilities trained that continued 5 years after initiation of intervention.	24
Gross and Rebok⁴⁰40 Gross AL, Rebok GW. Memory training and strategy use in older adults: results from the ACTIVE study. Psychol Aging. 2011;26(3):503-17. https://doi.org/10.1037/a0022687 https://doi.org/10.1037/a0022687...	n=1,401 (mean age, 73.8 years)	To report long-term impact of memory training on strategy use and longitudinal associations between strategy clustering, memory performance, and everyday functioning.	Data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (n=1,401) were used to describe strategy use in a community-dwelling sample of older adults. Strategy clustering scores on verbal list learning tasks of episodic memory were used to test the impact of memory training on strategy use and study longitudinal associations between strategy clustering, memory performance, and everyday functioning.	Memory training improved strategy use. Effects were maintained for up to 5 years. The strategies were positively associated with memory performance and everyday functioning.	24
Ball et al.⁴³43 Ball KK, Ross LA, Roth DL, Edwards JD. Speed of processing training in the ACTIVE study: how much is needed and who benefits? J Aging Health. 2013;25(8 Supl):65S-84S. https://doi.org/10.1177/0898264312470167 https://doi.org/10.1177/0898264312470167...	n=2,802 (mean age, 73.6 years)	To examine the longitudinal impact of dosage (number of training sessions) on improvement and maintenance of cognitive abilities and everyday functions.	Participants were randomly assigned to one of four groups: 10-session group training for memory (verbal episodic memory; n=711), or reasoning (ability to solve problems that follow a serial pattern; n=705), or speed of processing (visual search and identification; n=712); or a no-contact control group (n=704). For the three treatment groups, four-session booster training was offered to a 60% random sample 11 months later.	Initial SOPT effects were maintained over 5 years and amplified by booster sessions. A single booster session counteracted 4.92 months of age-related processing speed decline.	24
Borella et al.³⁶36 Borella E, Carretti B, Zanoni G, Zavagnin M, De Beni R. Working memory training in old age: an examination of transfer and maintenance effects. Arch Clin Neuropsychol. 2013;28(4):331-47. https://doi.org/10.1093/arclin/act020 https://doi.org/10.1093/arclin/act020...	n=36 (above 75 years of age)	To examine whether WM training can improve WM performance in old-old individuals and produce and maintain transfer effects on untrained tasks.	2 weeks, 60 min per session, memory training (n=18), active control (n=18); assessments: pre and post-test; follow-up: after 8 months; tests: CWMS task, Dot Matrix, Forward and Backward Digit Span, Cattell, pattern comparison task, and Stroop Color task.	The WM training program produced benefits maintained over time even in old-old adults, confirming there is still room for plasticity in the basic mechanisms of cognition in advanced old age.	22
Gross et al.³⁷37 Gross AL, Rebok GW, Brandt J, Tommet D, Marsiske M, Jones RN. Modeling learning and memory using verbal learning tests: results from ACTIVE. J Gerontol B Psychol Sci Soc Sci. 2013;68(2):153-67. https://doi.org/10.1093/geronb/gbs053 https://doi.org/10.1093/geronb/gbs053...	n=1,401 (mean age, 73.8 years)	To investigate the influence of memory training on initial recall and learning.	Each ACTIVE intervention was administered in 10 small-group training sessions, each lasting 60–75 min, offered over a course of 10 weeks. The first of 10 sessions provided didactic training on how memory works and how to maximize benefits of training.	Memory strategy training was associated with significant long-term gains in learning, stemming from both the highly significant effect of the training and from a slower decline, for up to 5 years, in memory span.	24
Jones et al.⁴²42 Jones RN, Marsiske M, Ball K, Rebok G, Willis SL, Morris JN, et al. The ACTIVE cognitive training interventions and trajectories of performance among older adults. J Aging Health. 2013;25(8 Suppl):186S-208S. https://doi.org/10.1177/0898264312461938 https://doi.org/10.1177/0898264312461938...	n=1,659 (mean age, 73.7 years)	To determine the influence of CT in the ACTIVE study on the pace of cognitive aging.	Briefly, older adults (aged 65–94) were randomly assigned to one of the three cognitive training or no contact control arms. Training lasted 5–6 weeks, and participants were assessed pre- and post-intervention, and at 1, 2, 3, 5, and 10 years after post-test. This analysis considers outcomes through 5 years, as the 10-year main results are currently under analysis.	Reasoning training attenuated aging-related training. Memory gains were maintained but about half of reasoning and speed gains were lost. All trained groups performed better than controls at 5 years. Performance differences at end of follow-up were equivalent to about 6, 4, and 8 years of aging for memory, reasoning, and speed training, respectively.	24
Kwok et al.³³33 Kwok TC, Bai X, Li JC, Ho FK, Lee TM. Effectiveness of cognitive training in Chinese older people with subjective cognitive complaints: a randomized placebo-controlled trial. Int J Geriatr Psychiatry. 2012;28(2):208-15. https://doi.org/10.1002/gps.3812 https://doi.org/10.1002/gps.3812...	n=223 (mean age, 75.4 years)	To examine the short- and long-term effects of a cognitive training (CT) program in enhancing cognitive function of older people with subjective memory complaints.	A single-blind randomized placebo-controlled trial was carried out in a sample of 223 older adults aged 65 years or above with subjective memory complaints in Hong Kong. They were randomly assigned to either receive CT (intervention group, n=111) or attend health-related educational lectures only (control group, n=112). Participants’ cognitive abilities were assessed by the Chinese version of Mattis Dementia Rating Scale at baseline, immediately after the training, and 9 months after the training.	Cognitive training was effective in enhancing the overall cognitive functioning of less educated older adults with subjective memory complaints. The positive effect was durable for at least 9 months in conceptualization and memory.	23
Sisco et al.³⁹39 Sisco SM, Marsiske M, Gross AL, Rebok GW. The influence of cognitive training on older adults’ recall for short stories. J Aging Health. 2013;25(8 Suppl):230S-48S. https://doi.org/10.1177/0898264313501386 https://doi.org/10.1177/0898264313501386...	n=1,912 (mean age, 72.9 years)	To investigate how a multicomponent memory intervention affected memory for prose.	Participants were randomized into one of the three training arms (i.e., memory, reasoning, and speed of processing) or a no-contact control group; about half of the trained participants received additional booster training 1 and 3 years post intervention.	Multi-factorial memory training can improve verbatim recall for prose, but the effect does not last without continued intervention.	24
Gross et al.⁴⁴44 Gross AL, Brandt J, Bandeen-Roche K, Carlson MC, Stuart EA, Marsiske M, et al. Do older adults use the method of loci? Results from the ACTIVE study. Exp Aging Res. 2014;40(2):140-63. https://doi.org/10.1080/0361073X.2014.882204 https://doi.org/10.1080/0361073X.2014.88...	n=1,401 (mean age, 73.3 years)	To evaluate whether training can increase the use of MoL and whether MoL is associated with better memory maintained over time.	The authors analyzed skip patterns on response forms for the Auditory Verbal Learning Test (AVLT) in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE; n=1,401) trial using 5 years of longitudinal follow-up.	The use of MoL was associated with improved memory sustained over time. Changes in strategies resulted in differences in memory performance.	25
Linde et al.³⁵35 Linde K, Alfermann D. Single versus combined cognitive and physical activity effects on fluid cognitive abilities of healthy older adults: a 4-month randomized controlled trial with follow-up. J Aging Phys Act. 2014;22(3):302-13. https://doi.org/10.1123/japa.2012-0149 https://doi.org/10.1123/japa.2012-0149...	n=70 (mean age, 66.8 years)	To analyze the short- and long-term effects of PT, combined CT, and PT plus CT programs on age-sensitive fluid cognitive abilities.	70 healthy senior citizens (age 60–75) were allocated to a physical, cognitive, combined physical plus cognitive, and waiting control group. The trial assessed information processing speed, short-term memory, spatial relations, concentration, reasoning, and cognitive speed.	Physical, cognitive, and combined physical plus cognitive activity can be seen as cognition-enrichment behaviors in healthy older adults that show different rather than equal intervention effects.	21
Rebok et al.¹⁰10 Rebok GW, Ball K, Guey LT, Jones RN, Kim HY, King JW, et al. ACTIVE Study Group. Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults. J Am Geriatr Soc. 2014;62(1):16-24. https://doi.org/10.1111/jgs.12607 https://doi.org/10.1111/jgs.12607...	n=2,832 (mean age,73.6 years)	To determine the effects of cognitive training on cognitive abilities and everyday function over 10 years.	Ten training sessions for memory, reasoning, or speed of processing; four sessions of booster training 11 and 35 months after initial training.	Ten training sessions for memory, reasoning, or speed of processing, four sessions of booster training 11 and 35 months after initial training tests; tests: RAVLT, HVLT, RBPR, Letter Series, Letter Sets, Word Series, UFOV, MDS-HC, EPT, OTDL, CRT, and TIADL.	24
Eggenberger et al.³²32 Eggenberger P, Schumacher V, Angst M, Theill N, Bruin ED. Does multicomponent physical exercise with simultaneous cognitive training boost cognitive performance in older adults? A 6-month randomized controlled trial with a 1-year follow-up. Clin Interv Aging. 2015;17(10):1335-49. https://doi.org/10.2147/CIA.S87732 https://doi.org/10.2147/CIA.S87732...	n=89 (mean age, 78.9 years)	To evaluate synergistic effects of multicomponent PT complemented with novel simultaneous CT on cognition in older adults.	Seniors, older than 70 years, without cognitive impairment, were randomly assigned to either: (1) virtual reality video game dancing (DANCE), (2) treadmill walking with simultaneous verbal memory training (MEMORY), or (3) treadmill walking (PHYS). Each program was complemented with strength and balance exercises. Two 1-h training sessions per week over 6 months were applied.	Particular executive functions benefit from simultaneous cognitive–physical training compared to exclusively physical multicomponent training. Cognitive–physical training programs may counteract widespread cognitive impairments in the elderly.	22
Li et al.³⁴34 Li T, Yao Y, Cheng Y, Xu B, Ca X, Waxman D, et al. Cognitive training can reduce the rate of cognitive aging: a neuroimaging cohort study. BMC Geriatr. 2016;16:12. https://doi.org/10.1186/s12877-016-0194-5 https://doi.org/10.1186/s12877-016-0194-...	n=270 (mean age, 69.8 years)	To examine the relationship between changes in spontaneous brain activity and cognitive performance that occur after CT.	Participants were trained for 1 h, twice a week, for 12 weeks. Cognition was assessed in all participants and magnetic resonance images were obtained at baseline and 1 year after training. To assess spontaneous fluctuations in brain activity, we acquired resting-state fMRI data. Two indices—functional entropy and time-domain entropy—were used to measure the effects of training. Functional entropy increases with aging and indicates disruptions in functional connectivity. Time-domain entropy decreases with aging and indicates structural alterations in the brain and blood-flow reduction.	Seventy participants completed the study: 26 in the multidomain cognitive training group (70.38±3.30 years), 27 in single-domain group (70.48±3.93 years), and 17 in a control group (68.59±3.24 years). Functional entropy increased significantly less in the multi-domain (p=0.047) and single-domain groups (p=9.51×10⁻⁴) compared with the control group. In the multi-domain group, this was true in the paracentral lobule (p=0.004, Bonferroni corrected p<0.05). Time-domain entropy also improved with training. Compared with controls, time-domain entropy in the multi-domain group decreased less in the inferior frontal gyrus pars opercularis (p=3.59×10⁻⁴), the medial part of superior frontal gyrus (p=1.17×10⁻⁵), and the thalamus (p=4.72×10⁻⁵), while that in the single-domain group decreased less in the cuneus (p=2.58×10⁻⁴, Bonferroni corrected p<0.05).	24
Ross et al.³⁸38 Ross LA, Sprague BN, Phillips CB, O’Connor ML, Dodson JE. The impact of three cognitive training interventions on older adults’ physical functioning across 5 years. J Aging Health. 2018;30(3):475-98. https://doi.org/10.1177/0898264316682916 https://doi.org/10.1177/0898264316682916...	n=2,802 (mean age, 73.6 years)	To assess the impact of three CT programs on objective measures of physical functioning across 5 years.	Older adults randomized into a processing speed (n=702), reasoning (n=694), or memory (n=703) training intervention were compared to those randomized into a no-contact control condition (n=698). Intention-to-treat (ITT) and treatment-received (time-varying number of training sessions) analyses were conducted.	There were no transfer effects in the ITT analyses. Treatment-received models demonstrated that training sessions (i.e., higher dosage) across all intervention arms transferred to better maintained Digit Symbol Copy and Turn 360 performance relative to the control group. More reasoning training transferred to better grip strength.	23

Authors	Sample	Objectives	Main intervention	Results found	Downs and Black
Rozzini et al.⁴⁹49 Rozzini L, Costardi D, Chilovi VB, Franzoni S, Trabucchi M, Padovani A. Efficacy of cognitive rehabilitation in patients with mild cognitive impairment treated with cholinesterase inhibitors. Int J Geriatr Psychiatry. 2007;22(4):356-60. https://doi.org/10.1002/gps.1681 https://doi.org/10.1002/gps.1681...	n=59 (between 63 and 78 years of age)	To evaluate the efficacy of an NPT in patients with MCI treated with ChEIs, compared with patients MCI treated only with ChEIs, in a longitudinal, one year follow-up study.	ChEIs, ChEIs+NPT, control; assessments: pre-test; follow-up 3 months after intervention; tests: MMSE, category fluency and letter fluency, Raven’s colored matrices, Rey’s figure – delayed recall and copy, NPI-Q, GDS, BADL, and IADL.	Subjects treated with TNP+ChEIs showed improvements in episodic memory, abstract reasoning and behavioral disturbances, long-term NPT in ChEIs-treated MCI subjects induces additional cognitive and mood benefits.	21
Valdes et al.⁵¹51 Valdes EG, O’Connor ML, Edwards JD. The effects of cognitive speed of processing training among older adults with psychometrically- defined mild cognitive impairment. Curr Alzheimer Res. 2012;9(9):999-1009. https://doi.org/10.2174/156720512803568984 https://doi.org/10.2174/1567205128035689...	n=2,802 (mean age, 77.6 years)	To examine the longitudinal effects of SOPT among older adults with psychometrically defined MCI from the ACTIVE trial	SOPT (n=702), reasoning training (n=694), memory training (n=703), control (n=698); booster: Participants completed eight or more training sessions, four sessions before assessments at years 1 and 3, training and control groups; assessments: pre-test and post-test (2 months later); follow-up: 1, 2, 3, and 5 years after pre-test.	Immediate improvement in participants with MCI, particularly the non-amnestic subtype. Initial training gains were maintained, where all subtypes showed similar trajectories across 5 years, with no significant changes in performance. SOPT proved effective and promoted durable effects.	24
Rojas et al.⁴⁸48 Rojas GJ, Villar V, Iturry M, Harris P, Serrano CM, Herrera JA, et al. Efficacy of a cognitive intervention program in patients with mild cognitive impairment. Int Psychogeriatr. 2013;25(5):825-31. https://doi.org/10.1017/S1041610213000045 https://doi.org/10.1017/S104161021300004...	n=46 (mean age, 76.5 years)	To examine the efficacy of a CIP in patients with MCI and to assess patients’ condition at 1-year follow-up.	CT (n=24), control (n=22); assessments: pre-test; follow-up: 1 year; tests: MMSE, CDR, Signoret’s memory battery, BNT, verbal fluency, WASI-II, TMT-A, WAIS-III, TMT-B, QoL questionnaire, NPI, and the IADL scale.	Persons with MCI can improve their performance on cognitive and functional measures, and effects could persist in the long term. CT in MCI may prevent cognitive decline or slow conversion to dementia.	20
Law et al.⁵⁰50 Law LL, Barnett F, Yau MK, Grey MA. Effects of functional tasks exercise on older adults with cognitive impairment at risk of Alzheimer’s disease: a randomised controlled trial. Age Ageing. 2014;43(6):813-20. https://doi.org/10.1093/ageing/afu055 https://doi.org/10.1093/ageing/afu055...	n=83 (mean age, 73.6 years)	The aim of this study was to compare the effects of a functional tasks exercise program to a cognitive training program in older adults with mild cognitive impairment.	Participants were randomized into either a functional task exercise group (n=43) or an active cognitive training group (n=40) for 10 weeks. All outcome measures were undertaken at baseline, post-intervention, and 6-month follow-up using Neurobehavioral Cognitive Status Examination, Trail Making Test, Chinese Version Verbal Learning Test, Category Verbal Learning Test, Lawton Instrumental Activities of Daily Living Scale, and Problems in Everyday Living Test.	The FcTSim promoted significant sustained improvements in general cognitive functions, executive function, and problem-solving ability, as well as promoting brain plasticity.	22
Ngandu et al.⁶6 Ngandu T, Lehtisalo J, Solomon A, Levälahti E, Ahtiluoto S, Antikainen R, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet. 2015;385(9984):2255-63. https://doi.org/10.1016/S0140-6736(15)60461-5 https://doi.org/10.1016/S0140-6736(15)60...	n=1,260 (mean age, 69.4 years)	To assess a 2-year multidomain intervention in elderly people from the general population at risk for cognitive problems.	Multi-domain intervention (n=631), control (n=629); assessments: pre-test, post-test; follow-up: 1, 2, and 7 years after intervention; tests: NTB, Zung scale, SPPB, and CAIDE.	Results suggested a multi-domain intervention could improve or maintain cognitive functioning in elderly people at risk for cognitive problems.	25
Bahar-Fuchs et al.⁴⁶46 Bahar-Fuchs A, Webb S, Bartsch L, Clare L, Rebok G, Cherbuin N, et al. Tailored and adaptive computerized cognitive training in older adults at risk for dementia: a randomized controlled trial. J Alzheimers Dis. 2017;60(3):889-911. https://doi.org/10.3233/JAD-170404 https://doi.org/10.3233/JAD-170404...	n=44 (mean age, 74.6 years)	To evaluate the extent to which CCT benefits older adults with MCI and MrNPS and examine its effects on meta-cognitive and non-cognitive outcomes.	CCT (n=21), active control (n=23); assessments: pre and post-test; follow-up: 3 months; tests: NIA-AA, BADL, NPI-Q, and ANZCTR.	Home-based CCT with adaptive difficulty and personal tailoring appears superior to more generic CCT in relation to both cognitive and non-cognitive outcomes.	23
Zhao et al.⁴⁵45 Zhao J, Li H, Lin R, Wei Y, Yang A. Effects of creative expression therapy for older adults with mild cognitive impairment at risk of Alzheimer’s disease: a randomized controlled clinical trial. Clin Interv Aging. 2018;13:1313-20. https://doi.org/10.2147/CIA.S161861 https://doi.org/10.2147/CIA.S161861...	n=93 (mean age, 70.1 years)	To explore the effects of a CrExp program on cognitive functioning in older adults with MCI.	CrExp (n=48), control (n=45); assessments: pre and post-test; follow-up: 6 months; tests: MoCA, CVAVLT, CVCVFT, DST, TMT-A, TMT-B, CVADL, and MSQ.	CrExp therapy has greater positive effects on cognitive functions and daily living ability than standard cognitive training. This unique therapy may serve as a cost-effective adjunct to standard interventions for older adults with mild cognitive impairment.	22
Belleville et al.⁴⁷47 Belleville S, Hudon C, Bier N, Brodeur C, Gilbert B, Grenier S, et al. MEMO+: efficacy, durability and effect of cognitive training and psychosocial intervention in individuals with mild cognitive impairment. J Am Geriatr Soc. 2018;66(4):655-63. https://doi.org/10.1111/jgs.15192 https://doi.org/10.1111/jgs.15192...	n=145 (mean age, 72.2 years)	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 can be obtained from psychosocial intervention.	Memory training (n=49), psychosocial intervention (n=49), control (n=47); booster intervention: one session after assessment at 3 months; assessments: pre and post-test; follow-up: 3 and 6 months; tests: GAI, GDS, GWBS, MMQ, QAM, ADL-PI, Free and Cued Recall memory test, EPI, EPR, Inventaire d’Activities Physiques, and GSE.	CT group showed an improvement on delayed memory and use of strategy use in everyday life, maintained at follow-up. Participants in psychosocial intervention group did not show any significant improvement.	24

Authors	Sample characteristics	Objectives	Main intervention	Results	Downs and Black
Jobe et al.³¹31 Jobe JB, Smith DM, Ball K, Tennstedt SL, Marsiske M, Willis SL, et al. ACTIVE: a cognitive intervention trial to promote independence in older adults. Contemp Clin Trials. 2001;22(4):453-79. https://doi.org/10.1016/s0197-2456(01)00139-8 https://doi.org/10.1016/s0197-2456(01)00...	n=2,832 (mean age, 73.6 years)	To determine the effects of three different CIP on improvement in performance of cognitively based measures under laboratory or field conditions and on measures of cognitively demanding everyday functioning associated with independent living.	SOPT, reasoning training, memory training, control; booster intervention: Participants shall complete eight training sessions or more, 11 months after the end of the primary training, 4 sessions, 3 weeks; assessments: pre- and post-test; follow-up: 12 and 24 months after pre-test; tests: MMSE, RAVLT, HVLT, RBMT, TIADL, Related Word Lists, RBMT, RBPR, UFOV, Word Series, Letter series, Letter Sets, DSST, DSC, EPT, OTDL, CRT, MDS-HC, SF-36, Turn 360, Grip Strength, and CES-D.	Primary outcomes focus on measures of cognitively demanding everyday functioning, including financial management, food preparation, medication use, and driving. Secondary outcomes include health-related quality of life, mobility, and health-service utilization.	24
Kivipelto et al.³⁰30 Kivipelto M, Solomon A, Ahtiluoto S, Ngandu T, Lehtisalo J, Antikainen R, et al. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER): study design and progress. Alzheimers Dement. 2013;9(6):657-65. https://doi.org/10.1016/j.jalz.2012.09.012 https://doi.org/10.1016/j.jalz.2012.09.0...	n=1,200 (25–74 years)	To investigate to what extent a multidomain intervention can prevent/delay cognitive impairment in elderly with an elevated risk of MCI.	Nutritional guidance, PT, CT (2 6-month periods, 3 times/week, 10–15 min/session, 72 training sessions/period), social activity, intensive monitoring, and management of metabolic and vascular risk factors, control group (regular health advice). Assessments: pre-test, 1 year after pre-test and post-test; tests: mNTB, CWST, and TMT (A and B).	All 1,200 persons are enrolled and the intervention is ongoing as planned. Baseline clinical characteristics indicate that several vascular risk factors and unhealthy lifestyle-related factors are present, creating a window of opportunity for prevention. The intervention completed during 2014.	25
Lee et al.²⁵25 Lee YY, Wu CY, Teng CH, Hsu WC, Chang KC, Chen P, et al. Evolving methods to combine cognitive and physical training for individuals with mild cognitive impairment: study protocol for a randomized controlled study. Trials. 2016;17(1):526. https://doi.org/10.1186/s13063-016-1650-4 https://doi.org/10.1186/s13063-016-1650-...	n=80 (age ≥60 years)	To determine whether combined therapies, sequential, or simultaneous are a feasible approach for training older individuals with MCI and whether they can induce superior results compared with a single intervention mode and to compare which approach is best for cognitive functions, physical fitness, ADL, and QoL.	CT, PT, sequential training, or dual-task training. Assessments: pre- and post-test; follow-up: 6 months; tests: MoCA, Stroop test, WAIS, WMS, 10-m Walk Test, BBT, TUG, CST, IPAQ, ActiGraph GX3, DAD, BI, IADL, QoLAD, CBI, GDS, and CIQ.	The results of this proposed study provide important information regarding the feasibility and intervention effects of combining physical exercise and cognitive training for older individuals with MCI.	24
Woods et al.²⁴24 Woods AJ, Cohen R, Marsiske M, Alexander GE, Czaja SJ, Wu S, et al. Augmenting cognitive training in older adults (The ACT Study): Design and Methods of a Phase III tDCS and cognitive training trial. Contemp Clin Trials. 2017;65:19-32. https://doi.org/10.1016/j.cct.2017.11.017 https://doi.org/10.1016/j.cct.2017.11.01...	n=360 (age ≥65 years)	To examine whether tDCS of frontal cortices enhances neurocognitive outcomes achieved from cognitive training in older adults experiencing age-related cognitive decline: the Augmenting Cognitive Training in Older Adults study (ACT).	CT+tDCS, CT+placebo, training control+tDCS, training control+placebo; assessments: Initial pre-training, after 12 weeks of CT/training control+stimulation/simulation; follow-up: 1 year after training; tests: NIH Toolbox Cognitive Function Battery, neuroimaging, SF-36, AUDIT-10, DAST-10, 10-m walk test, Beck Depression Inventory-II, State Trait Anxiety Inventory, Starkstein Apathy Scale, UCLA Loneliness Scale, Lubben Social Network Scale, Pittsburgh Sleep Quality Index, and Graded Chronic Pain Scale.	The findings from this study have the potential to significantly enhance efforts to ameliorate cognitive aging and slow dementia.	25
Montero-Odasso et al.²³23 Montero-Odasso M, Almeida QJ, Burhan AM, Camicioli R, Doyon J, Fraser S, et al. SYNERGIC TRIAL (SYNchronizing Exercises, Remedies in Gait and Cognition) a multi-Centre randomized controlled double blind trial to improve gait and cognition in mild cognitive impairment. BMC Geriatr. 2018;18(1):93. https://doi.org/10.1186/s12877-018-0782-7 https://doi.org/10.1186/s12877-018-0782-...	n=200 (age ≥60 years)	To ascertain whether combined AE and RT have better effect on cognition that a BAT intervention in older adults with MCI.	(1) AE and RT+CT+vitamin D, (2) AE and RT+CT+placebo D, (3) control AE and RT+CT+vitamin D, (4) Control AE and RT+CT+placebo D, (5) control BAT+CT+placebo D; assessments: pre-test and post-test (6 months after pre-test); follow-up: 1 year; tests: ADAS-Cog 13, ADAS-Cog plus, MRI, TMT-A, TMT-B, DSST, Digit Span forward & backward, and Category Fluency, MoCA, Color Word Interference Test, 6-MWT, SPPB, SF-36, IADL, CDR, GDS-30, and GAD-7.	The SYNERGIC Trial established the efficacy and feasibility of a multimodal intervention to improve cognitive performance and mobility outcomes in MCI.	26
Sipilä et al.²²22 Sipilä S, Tirkkonen A, Hänninen T, Laukkanen P, Alen M. Fielding RA, et al. Promoting safe walking among older people: the effects of a physical and cognitive training intervention vs. physical training alone on mobility and falls among older community-dwelling men and women (the PASSWORD study): design and methods of a randomized controlled trial. BMC Geriatr. 2018;18(1):215. https://doi.org/10.1186/s12877-018-0906-0 https://doi.org/10.1186/s12877-018-0906-...	n=314 (70–85 years old)	To determine whether a combination of PT and CT has greater effects on walking speed, dual-task cost in walking speed, fall incidence, and executive functions compared to PT alone.	(1) PT, (2) PT+CT; assessments: pre-test; follow-up: 6 and 12 months after; tests: Stroop Test, TMT-A, TMT-B, CERAD, and Letter Verbal Fluency Test.	When completed, this study will provide new knowledge on the effects of physical and cognitive training on the prevention of walking limitations and rate of falls in older people. The expected results will be of value in informing strategies designed to promote safe walking among older people and may have a significant health and socioeconomic impact.	22
Ten Brinke et al.²⁸28 Ten Brinke LF, Best JR, Crockett RA, Liu-Ambrose T. The effects of an 8-week computerized cognitive training program in older adults: a study protocol for a randomized controlled trial. BMC Geriatr. 2018;18(1):31. https://doi.org/10.1186/s12877-018-0730-6 https://doi.org/10.1186/s12877-018-0730-...	n=379 (65–85 years old)	To examine the effect of a CCT program, alone and preceded by a brisk walk, on cognitive function and explore the underlying neural mechanism in community – dwelling older adults.	Eight weeks sessions, three times week for 1 h+3 three times 1-h session at home; study groups: (1) computerized (FBT), (2) exercise plus CCT (Ex-FBT), and (3) active control (BAT). Assessments: pre-test and post-intervention (8 weeks); follow-up: after 1 year; tests: MoCA, MMSE, IADL, FCI, RAVLT; Toolbox Cognition Battery, Stroop Color-Word Test, TMT-A, TMT-B, DSST, SPPB; 6-MWT, PASE, and Neuroimaging.	If results from this study show benefits for cognition at trial completion, CCT programs, alone or in combination with walking, might be a strategy to promote healthy cognitive aging in older adults. In addition, results from the 1-year follow-up measurement could provide important information regarding the long-term benefits of these CCT programs.	22
VanVleet et al.²⁹29 VanVleet T, Voss M, Dabit S, Mitko A, DeGutis J. Randomized control trial of compute7r-based training targeting alertness in older adults: the ALERT trial protocol. BMC Psychol. 2018;6(1):22. https://doi.org/10.1186/s40359-018-0233-4 https://doi.org/10.1186/s40359-018-0233-...	n=120 (age≥65 years)	To test the effectiveness of a longer computer-based version of the TAPAT for improving cognitive abilities, functional status, and QoL in individuals with cognitive decline.	TAPAT (versions 1 and 2) (n=60), active control (n=60); evaluations: pre-test, halfway through the intervention, post-test; follow-up: after 3 months; tests: TMT-B, DKEFS Verbal Fluency, Auditory Consonant Trigrams, WAIS Digit Span, Attention Blink Task, Category Change Task, Gradual Start Continuous Performance Task, Stop Signal Task, flanker task, Stroop cross-modal, WAIS IV Digit Span, WM task, Reinforcement Learning Task, WMS IV Logical Memory I and II immediate and late recall, measurement of walking behavior, self-efficacy assessment, Fall Effectiveness Scale, TUG, SF- 12, Cognitive Failure Questionnaire, Pittsburg Sleep Quality Index, MAAS, and Breath Counting Task.	The strengths of this protocol are that it tests an innovative, in-home administered treatment that targets a fundamental deficit in adults with age-related cognitive decline; employs highly sensitive computer-based assessments of cognition as well as functional abilities, and incorporates a large sample size in an RCT design.	24
Zülke et al.²⁶26 Zülke A, Luck T, Pabst A, Hoffmann W, Thyrian JR, Gensichen J, et al. AgeWell.de - study protocol of a pragmatic multi-center cluster-randomized controlled prevention trial against cognitive decline in older primary care patients. BMC Geriatr. 2019;19(1):203. https://doi.org/10.1186/s12877-019-1212-1 https://doi.org/10.1186/s12877-019-1212-...	n=1,152 (60–77 years)	To evaluate the effectiveness of a multi-component intervention in preventing or delaying cognitive decline in older adults at risk for dementia and to assess the effects of the intervention on mortality, nursing home placement, functioning in everyday activities, QoL, depressive symptoms, social inclusion, and cost-effectiveness of the intervention.	Compared to previous trials, AgeWell.de covers an even broader set of interventions suggested to be beneficial for the intended outcomes. The findings will add substantial knowledge on modifiable lifestyle factors to prevent or delay cognitive decline. (1) nutritional counseling, PT, CT, optimization of medication, management of vascular risk factors, social activity, and further interventions targeting grief and depression; (2) control; follow-up: 2 years; tests: TMT A and B, Word List Memorization – CERAD subtest, Verbal Fluency Test – Animals – CERAD subtest, Constructional Praxis – CERAD subtest, Reading the Mind in the Eyes Test – revised version, and MoCA.	Compared to previous trials, AgeWell.de covers an even broader set of interventions suggested to be beneficial for the intended outcomes. The findings will add substantial knowledge on modifiable lifestyle factors to prevent or delay cognitive decline.	25
Yoon et al.²⁷27 Yoon JS, Roque NA, Andringa R, Harrell ER, Lewis KG, Vitale T, et al. Intervention Comparative Effectiveness for Adult Cognitive Training (ICE-ACT) Trial: Rationale, design, and baseline characteristics. Contemp Clin Trials. 2019;78:76-87. https://doi.org/10.1016/j.cct.2019.01.014 https://doi.org/10.1016/j.cct.2019.01.01...	n=230 (mean age, 72.0 years)	To compare the effect of broad and directed (narrow) technology-based training on basic perceptual and cognitive abilities in older adults and on the performance of simulated tasks of daily living including driving and fraud avoidance.	Web-based brain game suite (Brain HQ) and strategy video game (Rise of Nations) or to directed training for IADL training using web-based programs for both driving and fraud avoidance training, active control; assessments: pre- and post-test; follow-up: 1 year after training; tests: ability tests of IADL (driving simulator test for hazard perception, and a financial fraud recognition test), UFOV, DSST, RAPM, Letter sets, HVLT, RAVLT, and UMCFAB.	The baseline results support that randomization was successful across the intervention conditions.	23

Checklist of Downs and Black ¹⁸18 Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377-84. https://doi.org/10.1136/jech.52.6.377 https://doi.org/10.1136/jech.52.6.377...	n	Mean	SD	Minimum	Median	Maximum
Report (converted)	32	0.84	0.04	0.82	0.82	0.91
External validity (converted)	32	0.77	0.32	0.33	1.00	1.00
Internal validity and result bias (converted)	32	0.74	0.07	0.57	0.71	0.86
Confounding factors (converted)	32	1.00	0.00	1.00	1.00	1.00
Power (converted)	32	0.75	0.44	0.00	1.00	1.00
Total (converted)	32	0.84	0.05	0.71	0.86	0.93
Total (original, no conversion)	32	23.41	1.39	20.00	24.00	26.00

[1] Correspondence: Thais Bento Lima-Silva; Email: gerontologathais@gmail.com.

Brasil

Brasil

Long-term studies in cognitive training for older adults: a systematic review

ESTUDOS DE LONGA DURAÇÃO DE TREINO COGNITIVO PARA IDOSOS: UMA REVISÃO SISTEMÁTICA

ABSTRACT.

Objective:

Methods:

Results:

Conclusions: