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Cognitive Training with Healthy Older Adults: Investigating the Effectiveness of the Brain Age Software for Nintendo DS Marquette University e-Publications@Marquette Dissertations, Theses, and Professional Dissertations (1934 -) Projects Cognitive Training With Healthy Older Adults: Investigating the Effectiveness of the Brain Age Software for Nintendo DS Shaun Michael English Marquette University Follow this and additional works at: https://epublications.marquette.edu/dissertations_mu Part of the Psychiatry and Psychology Commons Recommended Citation English, Shaun Michael, "Cognitive Training With Healthy Older Adults: Investigating the Effectiveness of the Brain Age Software for Nintendo DS" (2012). Dissertations (1934 -). 226. https://epublications.marquette.edu/dissertations_mu/226 COGNITIVE TRAINING WITH HEALTHY OLDER ADULTS: INVESTIGATING THE EFFECTIVENESS OF THE BRAIN AGETM SOFTWARE FOR NINTENDO By Shaun M. English, M.S. A Dissertation Submitted to the Faculty of the Graduate School, Marquette University, In Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Milwaukee, Wisconsin October 2012 ABSTRACT COGNITIVE TRAINING WITH HEALTHY OLDER ADULTS: INVESTIGATING THE EFFECTIVENESS OF THE BRAIN AGETM SOFTWARE FOR NINTENDO Shaun M. English, M.S. Marquette University, 2012 An increasing number of empirical studies have demonstrated the effectiveness of cognitive training (CT) with healthy, cognitively intact older adults. Less is known regarding the effectiveness of commercially available “brain training” programs. The current study investigated the impact of daily CT presented via the Brain Age® software for Nintendo DS on neurocognitive abilities in a sample of healthy, community-dwelling older adults. Over the six-week study, participants in the CT group completed training activities and were compared to an active control group who played card games on the Nintendo DS. At pre-test and post-test, a wide range of empirically validated neuropsychological outcome measures was administered to examine the proximal and distal transfer effects of training. Although within normal range, the average MMSE score was significantly higher in the control group at pre-test; no other baseline differences in demographics or performance on primary neuropsychological outcome measures were observed. In the CT group, estimated “brain age” decreased and performance on daily training tasks significantly improved over the six-week study period. Importantly however, performance improved from pre-test to post-test on measures of everyday verbal memory, visual working memory, and math fluency in both the CT and active control groups. Participants in the CT group rated usage of the Brain Age software as significantly more mentally challenging and endorsed greater subjective memory improvement at post-test than participants in the control group. These findings demonstrate that both CT and cognitive stimulation protocols produced transfer effects in the current study. That is, Brain Age software use led to enhanced cognitive performance over time, but it did not do in a manner that exceeded the effects achieved by general cognitive stimulation. Enhanced working memory in the CT group and executive attention in the control group are discussed as possible explanation for improved performance on the outcome measures. i ACKNOWLEDGMENTS Shaun M. English, M.S. I am grateful for all of the well wishes and emotional support I received during the writing of this dissertation. First and foremost, I would like to thank my wife, Angela, for her constant emotional support and patience as I balanced the responsibilities of being a new father to our beloved son, Harrison, while still pushing forward with the project. Second, I must thank my advisor, Dr. Kristy Nielson, for her intellectual contributions during the development of this project and all of her guidance over the years. Third, I extend thanks to my family for their love, support, and, of course, assistance with child care! My parents instilled me with a desire to learn and achieve academically from an early age and I thank them for their encouragement as I always looked towards the next goal on the horizon. Lastly, I am indebted to everyone else who made the completion of this project possible through their direct assistance and/or emotional support, including Steve Byers, all of the “AIM Army” research assistants, fellow grad students over the years, colleagues at the Milwaukee VA, and friends. ii TABLE OF CONTENTS ACKNOWLEDGMENTS…………………………………………………………………i LIST OF TABLES………………………………………………………………………..iv LIST OF FIGURES……………………………………………………………………….v CHAPTERS I. INTRODUCTION Overview…………………………………………………………………..1 Age-related Changes in Cognition………………………………………...3 Cognitive Rehabilitation Defined………………………………………..12 Major Approaches to Cognitive Intervention……………………………14 Memory Training with Older Adults…………………………………….17 Cognitive Training……………………………………………………….31 Computerized CT………………………………………………………...39 Methodological Limitations of Cognitive Remediation Studies………...58 Foundations for the Present Study……………………………………….62 Aims of the Present Study………………………………………………..68 Hypotheses……………………………………………………………….68 II. METHOD Design……………………………………………………………………71 Participants……………………………………………………………….71 Measures…………………………………………………………………72 Procedure………………………………………………………………...81 Statistical Analyses………………………………………………………85 iii III. RESULTS Demographic Characteristics and Baseline Measures…………………...86 Daily Training Activities………………………………………………...87 Neuropsychological Outcome Measures………………………………...89 Self-perceived Memory Ability………………………………………….94 Symptom Measures………………………………………………………94 Subjective Ratings of Gameplay Experience…………………………….95 IV. DISCUSSION Baseline Group Characteristics…………………………………………..97 Effectiveness of Brain Age Training…………………………………….98 Evaluation of Transfer Effects………………………………………….100 Effect of Training on Mood…………………………………………….111 Limitations……………………………………………………………...114 Future Directions……………………………………………………….117 V. REFERENCES……………………………………………………………...119 VI. FOOTNOTES………………………………………………………………137 VII. APPENDICES Appendix A: Rating Scale – Week One………………………………..161 Appendix B: Exit Questionnaire……………………………………….162 Appendix C: Available “Daily Training” Tasks………………………..165 Appendix D: Tests Used in the “Brain Age Check”……………………166 Appendix E: Available Card Games……………………………………167 iv LIST OF TABLES Table 1. Reliability coefficients of weekly scales rating Nintendo gameplay experience……………………………………………………………………………....138 Table 2. Comparison of demographic characteristics by group……………………….139 Table 3. Hours per week spent participating in cognitively-stimulating activities by group……………………………………………………………………………………140 Table 4. Baseline performance on neuropsychological measures……………………...141 Table 5. Baseline scores on symptom measures and subjective memory complaints by group……………………………………………………………………………………143 Table 6. Mean number of completed daily training tasks in cognitive training (CT) group… ………………………………………………………………………………..144 Table 7. Growth model trends in performance on daily training tasks over time……...145 Table 8. Total number of completed card games in active control group (n=21)…......146 Table 9. Effects of training on neuropsychological outcome measures………………..147 Table 10. Supplementary repeated measures analyses of training effects in cognitive training (CT) and active control (AC) groups………………………………………….149 v LIST OF FIGURES Figure 1. Overview of study design……………………………………………………150 Figure 2. Participant flow………………………………………………………………152 Figure 3. CT group Brain Age scores weeks 1 through 6……………………………...153 Figure 4. RBMT immediate recall performance by group……………………………..154 Figure 5. RBMT delayed recall performance by group………………………………..155 Figure 6. Longest spatial span forward (LSSF) performance by group……………….156 Figure 7. Longest spatial span backward (LSSB) performance by group……………..157 Figure 8. WJ-III Math Fluency accuracy performance by group………………………158 Figure 9. WJ-III Math Fluency time scores by group…………………………………159 Figure 10. Ratings of subjective memory improvement as a result of Nintendo DS usage by group………………………………………………………………………………..160 1 Cognitive Training with Healthy Older Adults: Investigating the Effectiveness of the Brain Age™ Software for Nintendo Overview During the course of normal aging, many older adults experience cognitive decline, often including reductions in memory performance. Memory problems and cognitive impairment can also arise and be exacerbated by neurological diseases associated with aging, most notably, Alzheimer’s disease (AD) and various other types of progressive dementia. In 2009, the population of individuals in the United States over the age of 65 numbered 39.6 million, or 12.9% of the total population; and this number is expected to grow to 72.1 million by 2030 (Administration on Aging, 2011). Given that the percentage of older adults in our society will continue to rise over the coming decades, there is a demand for low-cost, practical cognitive interventions to increase older adults’ ability to thrive in old age and maintain their independence. One of the most exciting new research directions to address this demand is in the area of cognitive rehabilitation, often referred to as neuropsychological rehabilitation. Cognitive rehabilitation draws upon the theoretical and empirical foundations of the cognitive sciences to develop interventions to treat cognitive dysfunction in many different diagnostic groups and healthy older adults with milder, undiagnosed cognitive impairment. The common medical approach to the treatment of
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