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.

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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.
    Full-text · Article · Mar 2012 · Aging and Mental Health
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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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    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.
    Full-text · Article · Dec 2010 · Journal of the International Neuropsychological Society
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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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    ABSTRACT: Recent literature on human cognitive activity enhancement is reviewed and summarized. Two classes of pharmacological approaches are picked out, i.e. modern aspects of traditional substance utilization and application of specially developed drugs. Among non-pharmacological approaches a number of psychological, physiological, behavioral and biophysical methods to improve human cognition, memory and learning are analyzed. The most attention is paid to non-drug approaches that utilize bioelectric processes of the individual including characteristics of its brain electrical activity--electroencephalogram (EEG) to enhance different aspects of cognitive functioning. Some promising lines of these investigations are delineated.
    Full-text · Article · · Uspekhi fiziologicheskikh nauk
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