Running head: COGNITIVE TRAINING IN DEMENTIA REDUCTION

Reducing the Development of Dementia in Older Adults Using Cognitive Training

Addelyn Villalobos

University of South Florida

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Reducing the Development of Dementia in Older Adults Using Cognitive Training

Dementia is a life changing illness that commonly results in significant decline in mental

status, functional abilities, every day reasoning and memory loss (Dennis, 2012). Dementia can

also have a negative effect on the overall quality of life for those who have the disease. In the

United States, as many as five billion people suffer from dementia, and that number is expected

to double by the year 2050 due to the increased aging population (American Speech-Language-

Hearing Association, n.d.). This disease has an impact not only on the persons that have it, but

also on the caregivers and hospital staff that work with such patients. There are a variety of

medications that can treat the symptoms of dementia such as aggression and help to slow the

disease process, however, there is no cure for this illness and few current, clinically proven ways

to prevent the onset of dementia (Alzheimer’s Association, n.d.). Researchers have been

analyzing the impacts of early cognitive training and memory therapy on delaying the

development of dementia. Early interventions to retrain the brain or strengthen it prior to the

onset of dementia or early in the disease process may improve outcomes in developing the

disease. This paper addresses the clinical question of; In older adult patients, does implementing

cognitive training and therapy compared to standard care, result in a reduced risk of developing

dementia over the span of ten years following the training?

Literature Search

The database utilized to search for RCTs related to reducing dementia development as

well as a relevant clinical guideline was PubMed. Key search terms for RCTs and a clinical

guideline included dementia, reduced risk, early interventions, memory training, cognitive

training and cognitive impairment. Publication years between 2013 and 2018 were used.
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Literature Review

Three RCTs were used to analyze the effects of cognitive training on reducing the risk of

developing dementia and slowing the progression of the disease. Current clinical guidelines for

managing dementia and slowing the development of the disease recommend the use of a

cholinesterase inhibitor, memantine or a combination of the two medications to delay cognitive

decline in patients with dementia or some form of cognitive impairment (Eperly, 2017). A

recently updated guideline also recommends that physicians may implement cognitive training

for patients with mild cognitive impairment (MCI), a precursor disease for dementia (Peterson et

al., 2018).

A RCT by Edwards et al. (2017) examined various forms of cognitive training found that

ten years following each type of training, speed training had the greatest impact on reduction of

developing dementia. There was a total of 2,802 adults all over the age of 65 and deemed healthy

according to the initial MMSE. The participants were randomized into the intervention group to

receive a type of training (n=698) and a control group that received no training (n=695). Those

who received training were further divided into three subgroups to undergo either speed, memory

or reasoning training. Follow-up exams were given ten years following the study; all participants

completed a baseline cognitive function test prior to training and then repeated the same test ten

years after the training as well as dementia screening using the Mini-mental state examination

(MMSE). The risk of developing dementia was reduced by 29% (P=.049) using speed training.

The RCT also showed that the more training sessions each participant attended, the lower the

risk of dementia, regardless of which type of training was received (P=.38). There were no

significant weaknesses to this RCT.

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Similarly, Olchik et al. (2017), examined the effect of memory training in adults with

existing mild MCI. There was a total of 112 participants, age 60 and older, with varying degrees

of memory capabilities. Participants with considerable memory deficits according to Gauthier

and Touchon's criteria were randomized into an intervention group that received memory

training (MT), (n=39), and a control group that did not receive MT (n=36). Participants with no

memory deficits or cognitive impairments were placed into another control group and underwent

training (n=28). All participants were given an assessment consisting of functional tasks to

remember to assess baseline memory abilities. The intervention group received eight memory

training sessions as well as educational resources on memory and aging. The control group

received no training or additional resources. The comparison group received the same eight

training sessions as the intervention group. Results showed significantly high improvements in

memory task performance following training (p=.07). These results suggest that MT improves

memory capabilities in older adults with current memory impairments. Aside from unexplained

disenrollment of participants from the study (30 participants), there were no significant weakness

of this RCT.

On the other hand, a trial by Orell et al. (2017) examined if home delivered cognitive

simulation therapy had a positive effect on the cognition and quality of life for persons with

dementia as well as caregiver emotional health. A total of 356 participants were enrolled.

Participants were all classified as having some form of dementia according to the MMSE and all

participants had a caregiver involved in the study alongside them. Participants were randomized

into an intervention group and a control group. The intervention group participants were assigned

to receive cognitive stimulation therapy from each participants’ respective caregiver (n=180).

The control group received treatment as usual (TAU) (n=176). A MMSE was completed for all
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participants before, and thirteen weeks after the therapy sessions as well as a questionnaire called

the Quality of the Carer–Patient Relationship Scale (QCPR) to evaluate caregiver emotional

status and attitude towards their respective patient. Authors reported that participant cognition

and quality of life showed no significant improvements in either group. However, the total

QCPR score of the intervention group did significantly improve compared to the control group

receiving treatment as usual (p=.02). These results suggest that while cognitive stimulation may

not improve function in persons with dementia, caregiver delivered therapy may have a positive

outcome in the care-giver, patient relationship. Weaknesses of the study were that providers of

the therapy were aware of the intervention groups’ assignment and assessment tools were valid

but not reliable.

Synthesis

All three studies revealed a positive effect of cognitive training in some form. Dementia

risk was reduced in the study by Edwards at al. (2017) over a ten-year period and cognitive

function and memory was improved following the trainings implemented by Olchik at al. (2017).

Despite not having a significant effect on patient cognition, patient-caregiver relationship was

improved in the study by Orell et al. (2017). This result can be incorporated into determining the

most efficient way to deliver cognitive training to reduce the risk of developing dementia.

Further studies need to be conducted to evaluate whether a positive patient-caregiver relationship

influences dementia development and overall quality of life.

A common weakness of the above studies was assessment reliability. The pre- and post-

study assessments for the trials yielded different levels of participant cognitive function after

receiving therapy. An third additional assessment should have been completed after the initial

post-study assessments to screen for relapsing cognitive decline.

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Clinical Recommendations

Evidence from the studies suggests that early cognitive training, as well as training at the

onset of dementia or MCI may be an effective intervention to reduce the risk of developing

dementia. Cognitive training is supported by the recent updated clinical guideline to reduce even

mild cognitive impairment, which is a precursor for dementia (Peterson et al., 2018). Training

can be done in person or on a computer. Evidence suggests that in-person home delivered

cognitive stimulation therapy is a better method. The study by Orell et al. (2017) supports that

there is a benefit of home delivered therapy from a caregiver; an increased feeling of quality in

the care-giver, patient relationship. Early cognitive training can also improve overall memory as

shown in the study by Olchik et al. (2017). Certain types of cognitive training help to strengthen

cell synapses and connections, hence why this intervention may help to reduce the development

and effects of dementia on the brain over time. This was supported by the longitudinal study by

Edwards et al. (2017) that followed patients for 10-years and demonstrated significant reduction

in dementia.
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References

Alzheimer’s Association. (n.d.). What is dementia?. Retrieved from https://www.alz.org/what-is-

dementia.asp

American Speech-Language-Hearing Association. (n.d.). Dementia. Retrieved from

https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935289&section=Resources

Dennis, S. (2012). Prevention and risk of Alzheimer's and dementia. Alzheimer’s Association

Research Center. Retrieved from https://www.alz.org/research/science/alzheimers

_prevention_and_risk.asp

Edwards, J., Xu, H., Clark, D., Guey, L., Ross, L., & Unverzagt., F. (2017). Speed of processing

training results in lower risk of dementia. Alzheimer's & Dementia: Translational

Research & Clinical Interventions, 3(4), 603-611. doi: 10.1016/j.trci.2017.09.002

Eperly, T., Dunay, M., & Boice, J. (2017). Alzheimer’s disease: pharmacologic and

nonpharmacologic therapies for cognitive and functional symptoms. American Family

Physician 95(12):771-778.

Ogbru, O. (n.d.). Cholinesterase inhibitors side effects, uses and drug interactions. Medicine Net.

Retrieved from

https://www.medicinenet.com/cholinesterase_inhibitors/article.htm#what_are_cholinester

ase_inhibitors_cheis_how_do_they_work

Olchik, M., Farina, J., Steibel, N., Teixeira, A., & Yassuda, M. (2017). Memory training (MT) in

mild cognitive impairment (MCI) generates change in cognitive performance. Archives of

Gerontology and Geriatrics, 56(3), 442-447. doi: 10.1016/j.archger.2012.11.007

Orrell, M., Yates, L., Leung, P., Kang, S., Hoare, Z., Whitaker…Orgeta, V. (2017). The impact

of individual Cognitive Stimulation Therapy (iCST) on cognition, quality of life,

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caregiver health, and family relationships in dementia: A randomized controlled trial.

Public Library of Science & Medicine, 14(30). doi: 10.1371/journal.pmed.1002269

Peterson, R., Lopez, O., Armstrong, M., Getchius, T., Ganguli, M., Gloss, D….Rae-Grant, A.

(2018). Practice guideline update summary: mild cognitive impairment: report of the

guideline development, dissemination, and implementation subcommittee of the

American Academy of Neurology. American Academy of Neurology, 90(3). doi:

10.1212/WNL.0000000000004826