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Strategy-Based Cognitive Training for Improving Executive Functions in Older Adults: a Systematic Review

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Abstract

Given projected increases in dementia prevalence, emphasising earlier stages of cognitive impairment in older adults enables targeted early intervention strategies. Strategy-based cognitive training (SCT) is a remedial approach involving guidance and practice in compensatory techniques to improve cognition, including memory and attention. It may also be effective for improving executive functions (EF) integral to everyday tasks. This review systematically evaluates SCT effects on EF in older adults without dementia. Following PRISMA guidelines, we reviewed eligible trials according to pre-defined criteria, differentiating SCT from other cognitive interventions and stipulating total EF-focused intervention time, study design and target population (healthy older adults or mild cognitive decline). We then evaluated trials according to design, methodological quality and outcomes. Unfortunately, with too few studies in mild cognitive impairment, we refocused our review only on healthy older adults. Thirteen studies with 4120 participants in total were included, primarily targeting inductive reasoning. Despite heterogeneous study designs and SCT programs, 11/13 trials reported significant EF improvements, generally of moderate effect size (Hedges’ g > 0.3). Four studies reported sustained benefits from one month to 10 years. There was some evidence of far transfer. We conclude that there is promising evidence for SCT as a targeted intervention for EF in healthy older adults and preliminary evidence for maintaining effects over time. Fewer trials have investigated far transfer (e.g. improved everyday functioning) or capacity to delay/prevent dementia, which are most relevant to clinical utility. Limitations include the inability to calculate effect sizes for four studies and absence of statistical meta-analysis.

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Acknowledgments

We would like to acknowledge the assistance of Miss Stacey West in extracting descriptive study data as well as Mr. Harry Hallock in completing effect size calculations.

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Authors and Affiliations

  1. Healthy Brain Ageing Program, University of Sydney, Sydney, Australia

    L. Mowszowski, C. C. Walton & S. L. Naismith

  2. School of Psychology, University of Sydney, Sydney, Australia

    L. Mowszowski, A. Lampit & S. L. Naismith

  3. Brain and Mind Centre, University of Sydney, Sydney, Australia

    L. Mowszowski, A. Lampit, C. C. Walton & S. L. Naismith

  4. Regenerative Neuroscience Group, University of Sydney, Sydney, Australia

    A. Lampit

  5. Charles Perkins Centre, University of Sydney, Sydney, Australia

    S. L. Naismith

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  1. L. Mowszowski
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Correspondence to L. Mowszowski.

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Dr L. Mowszowski and Dr A. Lampit are each supported by a National Health and Medical Research Council (NHMRC) – Australian Research Council Dementia Research Development Fellowship. Mr C.C. Walton is supported by an Australian Postgraduate Award from the University of Sydney. Prof S.L. Naismith is supported by a NHMRC Career Development Fellowship.

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Dr A. Lampit receives in-kind research support in the form of no-cost software from BrainTrain (USA) and Synaptikon (Germany) for projects unrelated to this work. The other authors declare that they have no conflicts of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Mowszowski, L., Lampit, A., Walton, C.C. et al. Strategy-Based Cognitive Training for Improving Executive Functions in Older Adults: a Systematic Review. Neuropsychol Rev 26, 252–270 (2016). https://doi.org/10.1007/s11065-016-9329-x

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