A Cognitive Training Program Based on Principles of BrainPlasticity: Results from the Improvement in Memory withPlasticity-based Adaptive Cognitive Training (IMPACT) Study
Glenn E. Smith, PhD,
Patricia Housen, PhD,
Kristine Yaffe, MD,
Ronald Ruff, PhD,
Robert F. Kennison, PhD,
Henry W. Mahncke, PhD,
and Elizabeth M. Zelinski, PhD
To investigate the efﬁcacy of a novel brainplasticity–based computerized cognitive training programin older adults and to evaluate the effect on untrained mea-sures of memory and attention and participant-reportedoutcomes.
Multisite randomized controlled double-blindtrial with two treatment groups.
Communities in northern and southern Cali-fornia and Minnesota.
Community-dwelling adults aged 65and older (N
487) without a diagnosis of clinically sig-niﬁcant cognitive impairment.
Participantswererandomizedtoreceivea broadly-available brain plasticity–based computerized cog-nitive training program (intervention) or a novelty- and in-tensity-matched general cognitive stimulation programmodeling treatment as usual (active control). Duration of trainingwas1hourperday,5daysperweek,for8weeks,fora total of 40 hours.
The primary outcome was a compos-ite score calculated from six subtests of the RepeatableBattery for the Assessment of Neuropsychological Statusthat use the auditory modality (RBANS Auditory Memory/ Attention). Secondary measures were derived from perfor-mance on the experimental program, standardized neuro-psychological assessments of memory and attention, andparticipant-reported outcomes.
RBANS Auditory Memory/Attention improve-ment was signiﬁcantly greater (
.02) in the experimentalgroup (3.9 points, 95% conﬁdence interval (CI)
2.7–5.1)than in the control group (1.8 points, 95% CI
0.6–3.0).Multiple secondary measures of memory and attentionshowed signiﬁcantly greater improvements in the experi-mentalgroup(wordlisttotalscore,wordlistdelayedrecall,digits backwards, letter–number sequencing;
.05), asdid the participant-reported outcome measure (
.001).No advantage for the experimental group was seen in nar-rative memory.
The experimental program improvedgeneralized measures of memory and attention more thanan active control program.
J Am Geriatr Soc 2009.
Key words: clinical trial; cognitive decline; computerizedcognitive training; participant-reported outcomes; brainplasticity
ognitive decline is associated with risk for functionaldecline, nursing home placement, and mortality.
Inolder individuals, concerns about forgetfulness are wide-spread and are associated with depression and anxiety.
Interventions that reliably improve cognitive function thushave the opportunity to substantially improve the healthand quality of life of older individuals.Two general approaches for maintaining or improvingcognitive function in older adults have emerged. The ﬁrstapproach is focused on direct instruction of putatively use-ful strategies.
Although improvement on cognitive testsis generally seen after direct strategy instruction, perfor-
Portions of this research were presented as a poster presentation at the60th Annual Scientiﬁc Meeting of the Gerontological Society of America,November 16–20, 2007, San Francisco, CA; 36th Annual Scientiﬁc Meetingof the International Neuropsychological Society, February 6–9, 2008,Waikoloa, HI; Annual Meeting of the American Academy of Neurology,April 12–19, 2008, Chicago, IL; 2008 American Geriatrics Society AnnualScientiﬁcMeeting(Encore),April30–May5,2008,Washington,DC;and6thInternational Conference of the International Society for Gerotechnology, June 4–6, 2008, Pisa, Italy.Addresscorrespondence toGlennE.Smith,MayoClinic,200FirstStreetSW,Rochester, MN 55905. E-mail: email@example.comDOI: 10.1111/j.1532-5415.2008.02167.xFrom the
Department of Psychiatry and Psychology, Mayo Clinic, Roches-ter, Minnesota;
Leonard Davis School of Gerontology, University of South-ern California, Los Angeles, California; Departments of
Epidemiology, University of California, SanFrancisco, San Francisco, California;
Division of Physical Medicine andRehabilitation, Stanford University, Stanford, California;
Department of Psychology, California State University, Los Angeles, California; and
Posit Science Corporation, San Francisco, California.
2009, Copyright the Authors Journal compilation
2009, The American Geriatrics Society