Should One Use Medications in Combination With Cognitive Training? If So, Which Ones?

Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, USA.
The Journals of Gerontology Series B Psychological Sciences and Social Sciences (Impact Factor: 3.21). 07/2007; 62 Spec No 1(Special Issue 1):11-8. DOI: 10.1093/geronb/62.special_issue_1.11
Source: PubMed


In this article, we review current research regarding diagnosis of cognitive impairment in nondemented adults and discuss why medications and cognitive training together may be more beneficial than either alone. We also review potential cognitive enhancers and future research challenges. There are major reasons for such research: (a) Large numbers of older adults without dementia but with cognitive problems are not treatable with current cognitive training techniques; (b) some medications offer a rationale (i.e., cognitive enhancement) and some evidence that they might be a useful adjunct; and (c) there are unanswered questions about which population to target, which medications to use, how to administer them, and issues regarding tolerance and use of appropriate (active) placebo controls. As the number of cognitively impaired older adults grows, it is likely that there will be pressure to treat more broadly with both medications and cognitive training.

10 Reads
  • Source
    • "Several areas of future research are indicated by the present meta - analysis . This study did not consider approaches that combined memory training with forms of pharmacotherapy ( Yesavage et al . , 2007 ) , exercise ( Colcombe & Kramer , 2003 ) , or nutrition ( Gonzaíez - Gross , Marcos , & Pietrzik , 2001 ) . Such combinations of approaches may be more effective than any single training program for promoting memory performance among older adults , a topic on which future investi - gation is merited ( Hertzog et al . , 2008 ; Studenski"
    [Show abstract] [Hide abstract]
    ABSTRACT: A systematic review and meta-analysis of memory training research was conducted to characterize the effect of memory strategies on memory performance among cognitively intact, community-dwelling older adults, and to identify characteristics of individuals and of programs associated with improved memory. The review identified 402 publications, of which 35 studies met criteria for inclusion. The overall effect size estimate, representing the mean standardized difference in pre-post change between memory-trained and control groups, was 0.31 standard deviations (SD; 95% confidence interval (CI): 0.22, 0.39). The pre-post training effect for memory-trained interventions was 0.43 SD (95% CI: 0.29, 0.57) and the practice effect for control groups was 0.06 SD (95% CI: 0.05, 0.16). Among 10 distinct memory strategies identified in studies, meta-analytic methods revealed that training multiple strategies was associated with larger training gains (p=0.04), although this association did not reach statistical significance after adjusting for multiple comparisons. Treatment gains among memory-trained individuals were not better after training in any particular strategy, or by the average age of participants, session length, or type of control condition. These findings can inform the design of future memory training programs for older adults.
    Aging and Mental Health 03/2012; 16(6):722-34. DOI:10.1080/13607863.2012.667783 · 1.75 Impact Factor
  • Source
    • "cognitive difficulties is of increasing importance. There is some evidence that pharmacological intervention in MCI could delay the onset of dementia, or slow its progression (Aisen, 2008; Doody et al., 2009; Petersen et al., 2005; Yesavage et al., 2007). An accurate prognosis can help patients and their family plan for the care of the patient and make long-term financial decisions. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Impairments in executive cognition (EC) may be predictive of incident dementia in patients with mild cognitive impairment (MCI). The present study examined whether specific EC tests could predict which MCI individuals progress from a Clinical Dementia Rating (CDR) score of 0.5 to a score ≥1 over a 2-year period. Eighteen clinical and experimental EC measures were administered at baseline to 104 MCI patients (amnestic and non-amnestic, single- and multiple-domain) recruited from clinical and research settings. Demographic characteristics, screening cognitive measures and measures of everyday functioning at baseline were also considered as potential predictors. Over the 2-year period, 18% of the MCI individuals progressed to CDR ≥ 1, 73.1% remained stable (CDR = 0.5), and 4.5% reverted to normal (CDR = 0). Multiple-domain MCI participants had higher rates of progression to dementia than single-domain, but amnestic and non-amnestic MCIs had similar rates of conversion. Only three EC measures were predictive of subsequent cognitive and functional decline at the univariate level, but they failed to independently predict progression to dementia after adjusting for demographic, other cognitive characteristics, and measures of everyday functioning. Decline over 2 years was best predicted by informant ratings of subtle functional impairments and lower baseline scores on memory, category fluency, and constructional praxis.
    Journal of the International Neuropsychological Society 12/2010; 17(2):277-88. DOI:10.1017/S1355617710001621 · 2.96 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Measurement of health inequalities based on self-reports may be biased if individuals use response scales in systematically different ways. We use anchoring vignettes to test and adjust for reporting differences by education, race/ethnicity, and gender in self-reported health in 6 domains (pain, sleep, mobility, memory, shortness of breath, and depression). Using data from the 2006 U.S. Health and Retirement Study (HRS) and the 2007 Disability Vignette Survey, we estimated generalized ordered probit models of the respondent's rating of each vignette character's health problem, allowing cut-points to vary by age, gender, education, and race/ethnicity. We then used one-step hierarchical ordered probit (HOPIT) models to jointly estimate the respondent's cut-points from the vignettes and the severity of the respondent's own health problems based on these vignette cut-points. We found strong evidence of reporting differences by age, gender, education, and race/ethnicity, with the magnitude depending on the specific health domain. Overall, traditional models not accounting for reporting differences underestimated the magnitude of health inequalities by education and race/ethnicity. These results suggest caution in relying on self-reported health measures to quantify and explain health disparities by socioeconomic status and race/ethnicity/ethnicity in the United States. The findings support expansion of the use of anchoring vignettes to properly account for reporting differences in self-reports of health.
    The Journals of Gerontology Series B Psychological Sciences and Social Sciences 06/2011; 66(4):478-89. DOI:10.1093/geronb/gbr050 · 3.21 Impact Factor

Similar Publications