Cognitive Stimulation Technique May Prevent Decline in Healthy Elderly
Medscape Medical News 2008. © 2008 Medscape
July 10, 2008 — Swiss researchers have developed a computer-based
cognitive training technique that appears to significantly increase
cognitive performance, specifically working memory, in healthy elderly
The training tool, dubbed BrainStim by the authors, used by subjects 4
times per week over 4 weeks, was associated with a significant increase
in working-memory function over their baseline scores in a small pilot
"In healthy aging people, we could see that with the training, they
improved significantly, and this improvement was seen both in
neuropsychological testing and in their daily living," first author Iris
K. Penner, PhD, from the University of Basel, in Switzerland, told
Medscape Neurology & Neurosurgery.
Their results were presented at the 18th Meeting of the European
Neurological Society, in Nice, France.
Working Memory the Key
During aging, cognitive decline is a natural process that primarily
affects mental speed, short-term memory, and working memory, the authors
write. The training model they have developed is based on the work of
Baddeley and Hitch, published in 1974, that proposed that working memory
is a kind of temporary storage used in everyday life, Dr. Penner
explained. "So if, for example, you go to the supermarket, and you would
like to remember what to buy, that is stored for a short period in
This decline is seen not only in healthy aging but in neurodegenerative
and inflammatory diseases, including multiple sclerosis, dementia, and
schizophrenia, she noted. "We call it a key feature in cognition. If you
have a decline there, if there is a problem with working memory, in the
future you may have problems in other cognitive domains," Dr. Penner
said. "That's why we focus the training on that central function."
There is evidence from several studies, the authors write, that
neuroplasticity can be induced by cognitive intervention. In this pilot
study, the researchers tested the hypothesis that their cognitive
training technique might induce neuroplasticity and improve
working-memory function in healthy elderly subjects.
"When we looked in the literature, there was no computer-based training
available, and therefore we developed our own," Dr. Penner said. The
training tool, called BrainStim, currently consists of 3 modules:
* City map module — In this task, aimed at training spatial orientation,
subjects must find their way on a city map, after having been shown the
route visually or given verbal instructions that must be recalled.
* Find pairs module — Based on the child's card game Memory, subjects
must find matching pairs in an array of cards placed face down, turning
2 cards at each turn. Functions trained by this task include visual
object memory and the updating function of the central executive
component of working memory.
* Memorize numbers module — In this task, subjects must recall numbers
that are given at baseline, then carry out an arithmetic "distractor"
task, then reproduce the numbers given at the outset. "If you have 2
numbers, it's easy, but if you have 10 numbers and then a distractor
task, your working memory is working very hard to get this information,"
Dr. Penner notes.
Keep It Simple
In each module, training difficulty is adaptive to the individual,
becoming less difficult when performance drops below certain criteria
and increasingly difficult when performance exceeds those criteria.
The design is "not that sophisticated," she adds, but they wanted to
keep it simple and focus specifically on the working-memory functions,
in addition to evaluating the effects scientifically. Based on the Java
programming language, it can run on any computer with the Java runtime
environment installed. "This is a great advantage compared with most
commercial training tools available," they note, including
gaming-system-based tools. Those types of programs are more
sophisticated from a programming standpoint, she said, but are not
targeted specifically for working memory, not have they been evaluated
in this way.
In the current pilot study, 9 healthy elderly subjects, 2 female and 7
male, with a mean age of 70 years, took part. All underwent a
comprehensive neuropsychological examination, with various subtests
examining visual and verbal short-term memory, attention, concentration,
and information processing speed, among others.
After baseline, subjects used the training program 4 times per week for
4 weeks, with each training session lasting 45 minutes. After the 16
sessions, testing was repeated.
They found a significant increase in cognitive performance with the
training procedure, with a steep increase at the outset followed by a
plateauing of the training effect. Statistically, Dr. Penner said, "this
could best be described by an exponential function with asymptotic
course, meaning that at the beginning you can see most of the training
effects and . . . a stability over time is reached."
On the neuropsychological-outcome measures, they found significant
changes on several working-memory outcome measures, but only results on
the Paced Serial Addition Test (PASAT) showed a significant change in
performance after simple learning effects from baseline to posttraining
were controlled for. "This test is immune against learning effects but a
specific test for higher cognitive functions and working memory, so we
could see, independent of learning effects, a specific training effect
on working memory," she said.
"The results of our first pilot study indicate that working-memory
performance increased after 4 weeks of computerized specific
working-memory training," the authors conclude. "In this concern,
BrainStim seems to positively influence brain functionality in healthy
elderly subjects and might therefore be a useful tool in prevention."
Since completing this pilot study, they have carried out a study in
multiple sclerosis patients with similar results, Dr. Penner noted.
Currently, they are running a study in patients with schizophrenia.
They are hoping to develop further modules, and there is some interest
from a major German bookseller to commercialize the training program,
Dr. Penner reports no conflict of interest relevant to this presentation.
18th Meeting of the European Neurological Society: Abstract P485.
Presented Monday, June 9, 2008.