Cognitive Training to Improve Memory Just as Effective as Other Intellectual Activities

Kate Johnson

January 25, 2011

January 25, 2011 — Memory training designed to improve immediate and delayed recall in older adults is effective compared with no training and just as effective as other nonspecific intellectual pursuits, such as discussing art, according to a meta-analysis published in the January issue of the Cochrane Library.

The analysis of 24 trials, which included 2229 participants, provides "surprisingly little evidence for the effectiveness and specificity of cognitive training interventions," write the study authors, led by Mike Martin, PhD, professor of gerontopsychology and director of the Center of Gerontology at University of Zurich, Switzerland.

Dr. Mike Martin

However, the researchers add that "alternative interventions do just as well as cognitive interventions, and the training interventions cannot be regarded as effective," they conclude.

The investigators analyzed all randomized controlled trials published between 1970 and 2007 evaluating the effectiveness of cognitive training in healthy individuals 60 years or older or in those with mild cognitive impairment (MCI).

Cognitive training was defined as "an intervention providing structured practice on tasks relevant to aspects of cognitive functioning, such as memory, attention, language, or executive function."

Little Evidence?

After considering inclusion and exclusion criteria, 24 studies were included in the analysis.

Outcome measures in the studies were restricted to immediate and delayed (face-name) recall, visuospatial memory, short-term memory, and paired associate learning in healthy older individuals.

In participants with MCI, 3 studies were included, allowing analysis of only a single outcome — memory recall.

Control groups in the studies included no treatment controls, who received no cognitive training, and active controls who received "noncognitive activities" or "unspecific cognitive stimulation, such as art discussion." Study participants had an estimated mean age of 69.9 years.

In trials of cognitive training in healthy subjects, "immediate and delayed verbal recall improved significantly (P < 0.05) through training compared to a no-treatment control condition," the study authors report.

"For individuals with mild cognitive impairment, our analyses demonstrate that significant training gains were obtained for treatment compared to no contact control in immediate (P = 0.04) recall and delayed recall (P = 0.05)."

In both healthy and cognitively impaired subjects the improvements observed with cognitive training were nonspecific in that they did not exceed the improvements seen in active controls.

"Thus, it seems that alternative interventions do just as well as cognitive interventions, and the training interventions cannot be regarded as effective because they do not improve on the effects of active control conditions," the study authors write.

The conclusion is based on the fact that we have looked at 37 years of memory training research, and shown that only 2 types of training are effective. We consider this 'little' evidence.

"The conclusion is based on the fact that we have looked at 37 years of memory training research and shown that only 2 types of training are effective. We consider this 'little' evidence," Dr. Martin told Medscape Medical News.

Dr. Martin cautioned against drawing inaccurate conclusions from the findings because the Cochrane Reviews criteria are "very strict" and define evidence for effectiveness as superiority over controls.

Wrong Emphasis

Asked by Medscape Medical News to comment on the findings, Gary Small, MD, director, UCLA Center on Aging, the Memory & Aging Research Center, and the Geriatric Psychiatry Division at the David Geffen School of Medicine at the University of California, Los Angeles, said the study's conclusion that cognitive training doesn't work "didn't emphasize that cognitive training is as good as other [intellectual] approaches.

Multiple studies, as well as clinical experience have shown that cognitive training can be very effective when you use the right training for the individual.

"Multiple studies as well as clinical experience have shown that cognitive training can be very effective when you use the right training for the individual," he said.

Dr. Small cited a large, 5-year, follow-up study of 2832 older adults that showed cognitive training targeted at memory, reasoning, or speed of processing training was effective and durable (JAMA. 2006;296:2805-2814).

"When you look at studies like the JAMA study, we find that when we train the brain for specific cognitive activities there is specificity in the benefits and there are significant differences among the groups," he said.

Dr. Small suggested there could be many possible explanations for the Cochrane findings, including heterogeneity of training regimens and outcomes.

Indeed, the authors of the study conclude, "It remains an open question at this point if the heterogeneity of the populations tested or the quality of the interventions may have influenced the results, and we can only speculate as to whether more intensive and longer training may be needed to achieve effects larger than in active control conditions."

"The way we interpret our findings is that memory trainings may have to be redesigned," said Dr. Martin. "Instead of intensely training an elementary skill and hoping for a transfer effect on other abilities not directly targeted by the training, we should design activities that simultaneously activate multiple skills."

His group is currently piloting a series of such "goal-related cognitive activities" using a combination of motor activities and cognitive tasks ranging from classic memory training to language learning. "We use an approach that measures the individual needs and goals for improvement," he said.

In comparison, Dr. Small's group is "focusing on the most common age-related memory complaints: names and faces, the tip-of-the-tongue phenomenon. We teach practical methods to improve these skills and give exercises so people can transfer the skills to everyday life."

Perhaps the most obvious finding of the Cochrane Review comes at the end.

"A more standardized approach to examining the effectiveness of cognitive training is needed," write the study authors.

"Due to the heterogeneity of procedures, durations, intensities, methods of dealing with absent training participants, use of a variety of training contents, content combinations, and matching of evaluation instruments to training contents, the effects might be substantially larger if more similar studies could be pooled for the meta-analyses."

Dr. Martin has disclosed no relevant financial relationships. Dr. Small acknowledged the following sources of support: National Institute on Aging Program Project/R01 grants, Alzheimer's Disease Research Center, Department of Energy, Foundations (Ahmanson, Archstone, Brewster, Dana, Hillblom), Endowments (Elgart, Stark, Parlow-Solomon, Plott), and consulting/speaking fees from Dakim, Eisai, Forest, Mattel, Medivation, Novartis, and Pfizer. He is coinventor of and owns a patent for FDDNP-PET (previously licensed to Siemens by UCLA).

Cochrane Library. 2011:1. Abstract

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