Strategic Training to Optimize Neurocognitive Functions in Older Adults - Almost all older adults experience cognitive frailty with age, with around one-third of adults aged 85 or older
suffering from Alzheimer’s disease (AD). Cognitive frailty, particularly Alzheimer’s disease, threatens to
overwhelm medical resources in the United States and much of the developed world. Therefore, it is important
that we learn how to optimize and maintain cognitive performance in cognitively-frail older adults, particularly
those who are at high-risk of suffering from AD, such as adults over 70 years of age where more than half
express AD pathology. The present multi-arm randomized control trial takes a novel theory-driven approach to
enhancing cognition in older adults by training them to flexibly deploy attentional focus in working memory.
Flexibility in allocating and switching attentional resources will be trained by having participants respond to
unpredictable cues in working memory. The ability to flexibly and efficiently allocate attentional control
underlies successful performance on a broad array of cognitive tasks. Hence, training in this area may enhance
performance not only on related tasks (near transfer), but also on tasks that are perceptibly not related to the
training task (far transfer).
The current proposal utilizes game-based simulations in all training arms in healthy older adults. The
study has three training arms. The first two arms use experimenter-designed simulation games, where
participants will be trained on either predictable low attentional control (Arm 1) or unpredictable high
attentional control (Arm 2) working memory games. The third arm uses a commercially-available strategy
video game requiring highest level of attentional control, by adding multi-tasking to the unpredictable
attentional shifts in working memory. In all three training arms, neural and cognitive changes will be examined
immediately after intervention; cognitive changes will also be assessed at +6mo period after training
completion. Additionally, a single-session, baseline neuroimaging data will be collected in a comparison group
of younger adults (no training in this group). We expect that the high attentional control training arms will
greatly improve cognition in older adults, with cognitive frailty interacting with the extent to which attentional
control is trained. High attentional control training arms are also expected to heighten compensatory brain
activation after intervention, for both near and far in-scanner transfer tasks, mimicking the baseline activity of
younger brains. These training arms are also expected to positively impact brain structures that progressively
decline with aging. This clinical trial will result in development of behavioral intervention tools, which will have
the potential to delay the onset of memory-related disorders, such as AD, by instantiating durable
improvements in cognitive functions in older adults. Such interventions can not only improve an individuals’
quality of life, but also decrease the financial burden of a rapidly aging society.
