Article

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

ABSTRACT

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.

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    • "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"
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    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.
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    • "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. "
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    • "Добавление психотерапевтических приемов в этих случаях приводит к более существенному улучшению социального функционирования и качества жизни пациентов, чем в случаях лекарственного лечения[89]. Сочетание фармакологических препаратов с различными видами психотерапии считается эффективным приемом и при проведении процедур, направленных на активизацию познавательной деятельности человека[140]. В целом рассмотренные данные показывают, что фармакологическая активация когнитивной деятельности человека в настоящее время возможна , хотя степень улучшения соответствующих аспектов этой деятельности, как правило, не превышает 10–20%. "
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