The effects of multi-domain versus single-domain cognitive training in non-demented older people: a randomized controlled trial

Abstract

Background: Whether healthy older people can benefit from cognitive training (CogTr) remains controversial. This study explored the benefits of CogTr in community dwelling, healthy, older adults and compared the effects of single-domain with multi-domain CogTr interventions.

Methods: A randomized, controlled, 3-month trial of CogTr with double-blind assessments at baseline and immediate, 6-month and 12-month follow-up after training completion was conducted. A total of 270 healthy Chinese older people, 65 to 75 years old, were recruited from the Ganquan-area community in Shanghai. Participants were randomly assigned to three groups: multi-domain CogTr, single-domain CogTr, and a wait-list control group. Twenty-four sessions of CogTr were administrated to the intervention groups over a three-month period. Six months later, three booster training sessions were offered to 60% of the initial training participants. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS, Form A), the Color Word Stroop test (CWST), the Visual Reasoning test and the Trail Making test (TMT) were used to assess cognitive function.

Results: Multi-domain CogTr produced statistically significant training effects on RBANS, visual reasoning, and immediate and delayed memory, while single-domain CogTr showed training effects on RBANS, visual reasoning, word interference, and visuospatial/constructional score (all P < 0.05). At the 12-month posttest, the multi-domain CogTr showed training effects on RBANS, delayed memory and visual reasoning, while single-domain CogTr only showed effects on word interference. Booster training resulted in effects on RBANS, visual reasoning, time of trail making test, and visuospatial/constructional index score.

Conclusions: Cognitive training can improve memory, visual reasoning, visuospatial construction, attention and neuropsychological status in community-living older people and can help maintain their functioning over time. Multi-domain CogTr enhanced memory proficiency, while single-domain CogTr augmented visuospatial/constructional and attention abilities. Multi-domain CogTr had more advantages in training effect maintenance.

Clinical trial registration: Chinese Clinical Trial Registry.

Registration number: ChiCTR-TRC-09000732.

Figure 1

Flow of participants through the trial. 'Refused' due to lack of interest in continuing, repeatedly missed appointments, scheduling conflicts. 'Not Assessed' due to temporary health problems or scheduling conflicts, but willing to keep participating in our research. 'Out of touch' due to home phone or address change, stay out. 'Died' includes cancer, stroke, cardiac sudden death. 'Withdraw' indicates subjects withdrew for reasons including the death of a family member, poor health, lack of interest, had no time, changed contact, stressed. 'Completed Training' means subjects complete 80% of the training sessions (≥ 19 training sessions).

Figure 2

Attendance of each session.

Figure 3

Temporal trends of measure outcomes for each group. (A) RBANS total score. (B) Visual reasoning test score. (C) RBANS immediate memory index score. (D) RBANS delayed memory index score. (E) RBANS visuospatial/constructional index score. (F) RBANS language index score. (G) RBANS attention index score. (H) CWST word interference score. CWST, Color Word Stroop Test; RBANS, Repeatable Battery for the Assessment of Neuropsychological Status;.