Cognitive remediation interventions are widely developing, but have clearly been shown to induce minimal effects on real world functioning without concurrent skills training. Current skills training protocols are also limited in terms of effectiveness with cognitively impaired populations.
65+, 85+, and 65+ with MCI
There are numerous age-related changes in cognitive abilities, such as memory, attention and decision-making that are well documented and highly relevant to learning new skills and tasks and the performance of everyday activities. However, the degree of cognitive aging is highly variable and varies tremendously across individuals due to factors such as health status, lifestyle, socioeconomic status and genetics. Age-related cognitive changes also vary for different cognitive abilities; some aspects of cognition decline with age while others show improvement or remain stable until the much later decades of life. Needless to say, many older adults face challenges in the routine performance of everyday tasks, especially those that are technology-driven, as these tasks require new learning. Aging is also associated with a greater predisposition to cognitive impairments such as mild cognitive impairment (MCI) and dementia.
In this regard, a great deal of research has been directed towards understanding the implications of these cognitive changes for independent living as well as to the development of interventions to remediate cognitive and functional declines. In this respect, recently much attention has been focused on cognitive remediation, and yet, to date, existing research has shown that this type of intervention has limited transfer to everyday functional skills.
Cognitive Aging: Progress in Understanding and Opportunities for Action
“The challenges of cognitive aging may be more apparent in environments that require individuals to engage in highly technical and fast-paced or timed tasks, in situations that involve new learning, and in stressful situations (i.e., emotional, physical, or health-related), and may be less apparent in highly familiar situations.” (pg. 22)
“A wide variety of tools and measures are available to test for cognitive change; however, not all may be relevant to real-world activities.” (Pg. 5) - Published by The National Academies Press
Cognitive plasticity in older adults: effects of cognitive training and physical exercise
“Results from cognitive training studies suggest that despite performance improvement in trained tasks, transfer effects appeared very limited.” - Published in Annals of the New York Academy of Sciences
Exploring Interventions to Reduce Cognitive Decline in Aging
“Future research must more consistently evaluate the impact of cognitive training on ADLs and IADLs to identify interventions that promote everyday competence and independence that will make meaningful contributions to the quality of life of aging adults.” - Published in Journal of Psychosocial Nursing and Mental Health Services
Severe Mental Illness (SMI)
Large-scale data analyses have suggested that combined cognitive remediation and skills training approaches are required to improve real-world functioning. 1 Even in-person skills training delivered by qualified trainers leads to gains in relatively few people with schizophrenia. 2
Cognitive remediation is often used alone because of its low cost. However, despite the low cost and the fact that schizophrenia patients can self-administer the training 3 , both self-administered and in-person treatments with cognitive remediation do not improve everyday functioning 4.
A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes.
“Significantly stronger effects on functioning were found when cognitive remediation therapy was provided together with other psychiatric rehabilitation, and a much larger effect was present when a strategic approach was adopted together with adjunctive rehabilitation.” - Published in The American Journal of Psychiatry
Combined cognitive remediation and functional skills training for schizophrenia: effects on cognition, functional competence, and real-world behavior.
“Cognitive remediation is an efficacious treatment for schizophrenia and, when used within broader psychosocial treatments, improves transfer to real-world behavior change.” - Published in The American Journal of Psychiatry
Neuroplasticity-based auditory training via laptop computer improves cognition in young individuals with recent onset schizophrenia.
“Neuroscience-informed cognitive training via laptop computer represents a promising treatment approach for cognitive dysfunction in early schizophrenia. An individual's baseline motivational system functioning (reward anticipation), and ability to engage in auditory processing speed improvement, may represent important predictors of treatment outcome.” - Published in Schizophrenia Bulletin
Neuroscience-informed Auditory Training in Schizophrenia: A Final Report of the Effects on Cognition and Serum Brain-Derived Neurotrophic Factor.
“Participants with chronic schizophrenia made significant cognitive gains after 50 hours of intensive computerized training delivered as a stand-alone treatment” - Published in Schizophrenia Research: Cognition
Traumatic Brain Injury (TBI)
Nearly 20 years ago, a consensus conference from the National Institute of Health suggested that combined cognitive and skills training approaches should be used to treat Traumatic Brain Injury. In the following 16 years, a total of 17 studies were conducted examining computerized skills training approaches and none used a randomized design that directly compared skills training and cognitive remediation. Although cognitive remediation has been shown to improve cognitive test performance in TBI, there is little evidence for functional gains. Skills training combined with CRT has been lacking in general, and people with persistent TBI often have functional skills deficits that could benefit from skills training.
Rehabilitation of persons with traumatic brain injury
“Since TBI may result in lifelong impairment of an individual's physical, cognitive, and psychosocial functioning and prevalence is estimated to be 2.5 million to 6.5 million individuals, TBI is a disorder of major public health significance.” - Consensus Development Conference, NIH
Virtual reality and cognitive rehabilitation: a review of current outcome research
“Innovations requiring further study include the use of enriched virtual environments that provide haptic sensory input in addition to visual and auditory inputs and the use of commercially available gaming systems to provide tele-rehabilitation services.” - Published in NeuroRehabilitation