Attentional Control Training in Older Adults: Efficacy, Transfer and Brain Substrates

NCT ID: NCT03532113

Last Updated: 2020-01-23

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 90 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2017-10-19
• Study Completion Date: 2019-12-20

Brief Summary

Formal education and cognitively stimulating hobbies and profession have a protective effect against age-related cognitive decline and Alzheimer's disease. It is therefore possible that providing cognitively stimulating interventions at a later age increases neuroplasticity and brain resilience. Processes of updating and inhibition are both impaired by aging. Several studies have shown that updating can be improved but very few studies targeted inhibition in spite of the fact that it is impaired in older adults. The aim of this study is to assess the effect of cognitive interventions that will target either of these two components. The investigators will examine the effect on behavior, brain measures and transfer tasks. The investigators will also assess whether the efficacy varies as a function of personal variables such as prior cognitive profile, reserve proxies, genetic polymorphisms and brain markers.

Detailed Description

Formal education and cognitively stimulating hobbies and profession have a protective effect against age-related cognitive decline and Alzheimer's disease. The cognitive reserve model suggests that engaging in cognitively stimulating activities may induce brain processes and/or morphological characteristics that make individuals more resilient to the effects of brain damage. It is therefore possible that providing cognitive interventions at a later age amplify similar neuroplastic processes and thus reduce the deleterious effects of aging. Cognitive interventions refer to programs and/or strategies aimed at increasing or optimizing cognitive performance. Many of these programs target working memory (WM), which is defined as the ability to control attention in order to keep information active and accessible. Miyake's influential model proposes that WM relies on the coordinated functioning of a small set of attentional control components. Here the investigators will focus on two of these components: inhibition and updating. Training those two components might reveal critical as they are impaired in aging and subtend a range of more complex cognitive processes. Furthermore, they rely on distinct brain networks and are sensitive to cognitive lifestyle. Several studies have shown that updating capacities of older adults can be improved by cognitive training but very few studies targeted inhibition in spite of the fact that it is severly impaired by aging. The aim of this study is to assess the effect of cognitive interventions that will target either of these two components and compare their effect to that of an active control training. The investigators will examine their effect on behavior, brain measures and transfer tasks. The investigators will also assess whether the efficacy varies as a function of personal variables such as prior cognitive profile, reserve proxies, genetic polymorphisms and brain markers. The investigators will also examine the cumulative effect of training by measuring efficacy at three time points for the proximal outcomes and at five time points for the distal outcomes. Finally, a group of younger adults will be tested at baseline to assess whether training normalize performance, that is, whether the performance of older adults after training is improved to the level of typical young adults.

90 healthy older adults (60-85 years) will be recruited for this study, as well as thirty young adults (20-35 years) who will complete only the initial assessment (PRE). All participants will be recruited from the community and living in the Montreal area. A telephone interview will provide initial selection information. Eligible persons will be invited to come to the laboratory for a standardized clinical and neuropsychological battery in order to evaluate their clinical status and cognitive functioning. The older adults will be randomly assigned to one of three intervention conditions (Inhibition, Updating, Active control). Updating will be trained using N-back-like exercises whereas inhibition will be trained with Stroop-like exercises. Different types of stimuli will be used to facilitate transfer. The control intervention will include exercises on general knowledge and vocabulary. All training will be computerized. Training will be provided in 12 half-hours training sessions. Outcome measures will be taken no more than two weeks prior to training (PRE), between Session 6 and 7 (POST1) and no more than one week following Session 12 (POST2). Participants will be trained in small groups of 6 to 10 individuals recruited in about 6 waves. The first two waves will allow to pilot the procedure/team and will be accrued to the whole trial if the training procedure and outcome measures remain unchanged.

Conditions

Inhibition (Psychology); Updating; General Knowledge; No Training

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: SUPPORTIVE_CARE
• Blinding Strategy: DOUBLE

Study Groups

Updating

The Updating intervention aims to improve the ability to monitor and quickly add or delete of content of working memory.

Group Type: EXPERIMENTAL

Updating

Intervention Type: BEHAVIORAL

Updating is trained across 12 sessions using N-back-type exercises. Training is performed on a samsung galaxy tab2. Each session lasts 30 minutes. The difficult is reset and the nature of the stimuli (numbers vs. symbols) is changed halfway in each session.

Inhibition

The Inhibition intervention aims to improve the ability to supersede responses that are prepotent or automatic for a given situation.

Group Type: EXPERIMENTAL

Inhibition

Intervention Type: BEHAVIORAL

Inhibition is trained across 12 sessions with Stroop-like exercises. Training is performed on a samsung galaxy tab2. Each session lasts 30 minutes. The difficult is reset and the nature of stimuli (letters vs. numbers) is changed halfway in each session.

General Knowledge

The General knowledge intervention allows the learning of information on various topics. It does not involve attentional control but semantic knowledge.

Group Type: ACTIVE_COMPARATOR

General knowledge

Intervention Type: BEHAVIORAL

General Knowledge is trained across 12 sessions. Participants complete four-choice questions relating to general knowledge and vocabulary and are provided with the correct answer and a short explanation. Questions are displayed one by one on a computer screen with a maximum of 20 seconds per question. Each session lasts 30 minutes and includes 2 blocks of 40 new questions each (about 220 seconds per block). Questions with wrong answers are displayed again at the end of each block.

Interventions

Updating

Updating is trained across 12 sessions using N-back-type exercises. Training is performed on a samsung galaxy tab2. Each session lasts 30 minutes. The difficult is reset and the nature of the stimuli (numbers vs. symbols) is changed halfway in each session.

Intervention Type: BEHAVIORAL

Inhibition

Inhibition is trained across 12 sessions with Stroop-like exercises. Training is performed on a samsung galaxy tab2. Each session lasts 30 minutes. The difficult is reset and the nature of stimuli (letters vs. numbers) is changed halfway in each session.

Intervention Type: BEHAVIORAL

General knowledge

General Knowledge is trained across 12 sessions. Participants complete four-choice questions relating to general knowledge and vocabulary and are provided with the correct answer and a short explanation. Questions are displayed one by one on a computer screen with a maximum of 20 seconds per question. Each session lasts 30 minutes and includes 2 blocks of 40 new questions each (about 220 seconds per block). Questions with wrong answers are displayed again at the end of each block.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• French-speaking
• Right-handed
• Sufficient visual and auditory acuity to undergo neuropsychological tests and to do the interventions.
• Sufficient delayed recall score above the education-adjusted cut-offs (≥9 for 16+ years of education; ≥5 for 8-15 years of education; ≥3 for 0-7 years of education) at the Logical Memory test (Wechsler Memory Scale, maximum score 25).

Exclusion Criteria

• Answer 'Yes' to the two following questions: "Do you feel like your memory is becoming worse?" "Does this worry you?" (to exclude subjective cognitive decline).
• The presence of a disease or injury of the central nervous system: moderate to severe chronic static leukoencephalopathy (including previous traumatic injury), multiple sclerosis, a serious developmental handicap, subdural hematoma (past or current), subarachnoid haemorrhage (past or current), primary cerebral tumour or cerebral metastases, epilepsy (current), dementia or another neurodegenerative disease, and other rarer brain illnesses.
• Symptomatic stroke within the previous year.
• Alcoholism or substance abuse
• History of intracranial surgery.
• Major surgery within last 2 months.
• General anesthesia in the past 6 months.
• Serious comorbid condition that, in the opinion of the study investigator, is likely to result in death within a year.
• Major depression or anxiety.
• Schizophrenia or other major psychiatric disorder (e.g., bipolar disorder).
• Individuals where French is not sufficiently proficient for clinical assessment and neuropsychological testing.
• Unable to undergo MRI scan due to medical contraindications or inability to tolerate the procedure.
• Plans on moving outside the province within the next 2 months.

• Minimum Eligible Age: 60 Years
• Maximum Eligible Age: 85 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Natural Sciences and Engineering Research Council, Canada

OTHER

Sponsor Role: collaborator

Centre de Recherche de l'Institut Universitaire de Geriatrie de Montreal

OTHER

Sponsor Role: lead

Responsible Party

Sylvie Belleville

Research director of CRIUGM and full professor at University of Montreal

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Sylvie Belleville, PhD

Role: PRINCIPAL_INVESTIGATOR

Centre de Recherche de l'Institut Universitaire de Geriatrie de Montreal

Locations

CRIUGM

Montreal, Quebec, Canada

Countries

Canada

References

Verty LV, Mellah S, Maltezos S, Boujut A, Lussier M, Bherer L, Belleville S. Youth-like brain activation linked with greater cognitive training gains in older adults: Insights from the ACTOP study. Cortex. 2024 Jul;176:221-233. doi: 10.1016/j.cortex.2024.04.013. Epub 2024 May 17.

Reference Type: DERIVED

PMID: 38805784 (View on PubMed)

Boujut A, Verty LV, Maltezos S, Lussier M, Mellah S, Bherer L, Belleville S. Effects of Computerized Updating and Inhibition Training in Older Adults: The ACTOP Three-Arm Randomized Double-Blind Controlled Trial. Front Neurol. 2020 Dec 3;11:606873. doi: 10.3389/fneur.2020.606873. eCollection 2020.

Reference Type: DERIVED

PMID: 33343503 (View on PubMed)

Boujut A, Mellah S, Lussier M, Maltezos S, Verty LV, Bherer L, Belleville S. Assessing the Effect of Training on the Cognition and Brain of Older Adults: Protocol for a Three-Arm Randomized Double-Blind Controlled Trial (ACTOP). JMIR Res Protoc. 2020 Nov 24;9(11):e20430. doi: 10.2196/20430.

Reference Type: DERIVED

PMID: 33231556 (View on PubMed)

Other Identifiers

CRIUGM-005

Identifier Type: -

Identifier Source: org_study_id