Training of executive functions in healthy elderly: Results of a pilot study

Lima-Silva, Thaís Bento; Fabrício, Aline Teixeira; Silva, Laís dos Santos Vinholi e; Oliveira, Glaúcia Martins de; Silva, Wesley Turci da; Kissaki, Priscilla Tiemi; Silva, Anna Pereira Fernandes da; Sasahara, Tamiris Fessel; Ordonez, Tiago Nascimento; Oliveira, Thalita Bianchi de; Aramaki, Flávia Ogava; Buriti, Adriana; Yassuda, Mônica Sanches

doi:10.1590/S1980-57642012DN06010006

ABSTRACT

Executive functions (EF) refer to the cognitive skills necessary to formulate a goal, plan, execute plans effectively, and to perform self-monitoring and self-correction. Several aspects of EF change during the normal aging process.

Objectives: To train skills associated with executive functions in the elderly and to detect possible impact on objective EF tests and self-reports of functional status.

Methods: A cross-sectional study involving an intervention and pre and post testing was carried out. Study participants included 26 seniors assigned to an experimental group (EG) and given six sessions of cognitive intervention, and 17 seniors assigned to a control group (CG) who completed pre and post testing only. All participants were enrolled in an Open University for the Third Age. The following tests were used to measure outcome: the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), the Story subtest of the Rivermead Behavioral Memory Test (RBMT) (versions A and B), semantic verbal fluency fruit category, and verbal fluency with phonological constraints (FAS), WAIS-III Digit Span, Clock Drawing Test (CDT), Trail Making Part A and the Pfeffer Functional Assessment Questionnaire (PFAQ). Delta scores were calculated (post-test score minus pretest score) to assess the impact of the intervention.

Results: In the post test, the CG showed significant improvement on the RBMT Story recall and Digit Span but a decline in verbal fluency. The EG remained stable in terms of pre and post test scores.

Conclusions: The intervention did not enhance performance on the EF tests. It is noteworthy that the EG received only a small number of sessions which may not have been sufficient to generate improvement. Alternatively, the lack of group differences observed could be associated to participation in other workshops offered at the university.

Key words: elderly; executive functions; cognitive training

RESUMO

As funções executivas (FE) representam as capacidades cognitivas necessárias para formular um objetivo, planejar, executar planos de modo eficiente, monitorizar-se e autocorrigir-se. As FE sofrem alterações durante o processo de envelhecimento normal.

Objetivos: Treinar habilidades relacionadas às funções executivas em idosos e detectar impactos em testes objetivos de FE e em autorrelato de desempenho funcional.

Métodos: Trata-se de um estudo transversal, com intervenção e pré e pós testagem. Participaram do estudo 26 idosos que compuseram o grupo experimental (GE) que receberam intervenção cognitiva de seis sessões e 17 idosos do grupo controle (GC) que completaram apenas pré e pós testagem, matriculados em atividades em uma Universidade Aberta à Terceira Idade. Como medida de eficácia foram usados o Mini-Exame do Estado Mental (MEEM), Escala de Depressão Geriátrica (EDG), o subteste História do Teste Comportamental de Memória de Rivermead (versões A e B), fluência verbal categoria semântica frutas (FV), e com restrição fonológica (FAS), Dígitos da bateria WAIS-III, o Teste do Desenho do Relógio (TDR), Trilha A e o Questionário de Avaliação Funcional de Pfeffer (PFAQ). Para a avaliação do impacto da intervenção foram calculados deltas (escore do pós-teste menos o escore do pré-teste).

Resultados: No pós-teste o GC apresentou melhora no resgate da História e no desempenho nos Dígitos, entretanto, apresentou pior desempenho em fluência verbal. A pontuação do GE permaneceu inalterada.

Conclusões: Os dados sugerem que a intervenção não gerou impacto nos testes associados ao conceito de FE. Destaca-se que os idosos do GE receberam um número limitado de sessões que pode não ter sido suficiente para gerar alterações. Alternativamente, a ausência de diferença entre os grupos pode estar associada à participação em outras oficinas oferecidas na universidade.

Palavras-chave: idosos; funções executivas; treino cognitivo; envelhecimento

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REFERENCES

Lezak MD, Howieson DB, Loring DW. Neuropsychological assessment. New York: Oxford University Press; 2004.
Baddeley AD, Wilson B. Frontal amnesia and the executive syndrome. Brain Cog 1988;7:212-230.
Kelly TP, Borril HS, Maddell DL. Development and assessment of executive function in children. Child Psychol Psychiat Rev 1996;1:46-51.
Yassuda MS, Abreu VPS. Avaliação Cognitiva. In: Freitas EV, Py L, Neri AL, Cançado FAXC, Gorzoni ML, Doll J. Tratado de geriatria e gerontologia. Rio de Janeiro: Guanabra Koogan, 2006;132:1252-1259.
Malouin F, Belleville S, Richards CL, Desrosiers J, Doyon J. Working memory and mental practice outcomes after stroke. Arch Physical Med Rehab 2004;85: 177-183.
Dahlin E, Bäckman L, Neely AS, Nyberg L. Training of the executive component of working memory: subcortical areas mediate transfer effects. Restor Neurol Neurosci 2009;27:405-419.
Vance DE, Webb NM, Marceaux JC, Viamonte SM, Foote AW, Ball KK. Mental stimulation, neural plasticity, and aging: directions for nursing research and practice. J Neurosci Nurs 2008;40:241-249.
Burgess PW, Shallice T. Executive dysfunction. In: Goldestein, L, McNell J , Org. Clinical Neuropsychology: A pratical guide to assessment and management for clinicians, England; 2004:185-270.
Verhaeghen P, Salthouse T. Meta-analyses of age-cognition relations in adulthood: Estimates of linear and non-linear age effects and structural models. Psychol Bull 1997;122:231-249.
Carvalho FCR, Neri AL, Yassuda MS. Treino de memória episódica com ênfase em categorização para idosos sem demência e depressão. Psicol Reflex Crit 2010;23:317-323.
Salmazo-Silva H, Yassuda MS. Memory training for older adults with low education: mental images versus categorization. Educ Gerontol 2009;35:890-905.
Brum PS, Forlenza OV, Yassuda MS. Cogntive training in Mild Cognitive Impairment, Dement Neuropsychol 2009;3:127-131.
Lima-Silva TB, Ordonez TN, Dias-Santos G, Fabrício AT. Effects of cognitive training based on metamemory and mental images, Dement Neuropshycol 2010;4:114-119.
Vallat-Azouvi C, Pradat-Diehl P, Azouvi P. Rehabilitation of the central executive of working memory after a severe traumatic brain injury: two single-case studies. Brain Inj 2009;23:585-594.
Engvig A, Fjell AM, Westlye LT, et al. Effects of memory training on cortical thickness in the elderly. Neuroimage, 2010;52:1667-1676.
Westerberg H, Jacobaeus H, Hirvikoski T, et al. Computerized working memory training after stroke: a pilot study. Brain Inj 2007;21:21-29.
Cicerone KD, Dahlberg C, Malec JF, et al. Evidence-based cognitive rehabilitation: Updated review of the literature from 1998 through 2002. Arch Phys Med Rehabil 2006;86:1681-1692.
Almeida O, Almeida SA. Reability of the Brasilian version of the geriatric scale (GDS) short form. Arq Neuropsiquiatr 1999;57:421-426.
Paradela EMP, Lourenço RA, Veras R. Validação da escala de depressão geriátrica em um ambulatório geral. Rev Saúde Pública 2005; 39:918-923.
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
Yassuda MS, Flaks MK, Viola LF, et al. Psychometric characteristics of the Rivermead Behavioural Memory Test (RBMT) as an early detection instrument for dementia and mild cognitive impairment in Brazil. Int Psychogeriatr 2010;22:1003-1111.
Wechsler D. Escala de Inteligência Wechsler para adultos, manual para administração e avaliação, 1º Ed, São Paulo: Casa do Psicólogo 1997:123-125.
Aprahamian I, Martinelli JE, Neri AL, Yassuda MS. Clock Drawing Test accuracy compared to standard screening tests in Alzheimer s disease: results from a study in a sample of Brazilian elderly with heterogeneous educational background. Int Psychogeriatr 2010;22:64-71.
Schulman KI, Shedletsky R, Silver IL. The challenge of time: click-drawing and cognitive function in the elderly. Int J Geriatr Psychiatry 1986;1:135-140.
Montiel JM, Capovilla AGS. Teste de Trilhas - Partes A e B. Em AGS Capovilla (Org.), Teoria e pesquisa em avaliação neuropsicológica. São Paulo: Memnon. (no prelo).
Pfeffer RI, Kurosaki TT, Harrah CH, et al. Mensurement of functional activities in older adults in the community. J Gerontol, 1982;37:323-329.
Cabeza R, Daselaar SM, Dolcos F, Prince SE, Budde M, Nyberg L. Task-independent and task-specific age effects on brain activity during working memory, visual attention and episodic retrieval. Cereb Cortex 2004;14:364-375.
Borella E, Carretti B, Riboldi F, De Beni R. Working Memory Training in older adults: Evidence of transfer and maintenance effects. Psychol Aging 2010; 25: 767-78.
Buschkuehl M, Jaeggi SM, Hutchison S, et al. Impact of working memory training on memory performance in old-old adults. Psychol Aging 2008;23:743-753.
Düzel S, Münte TF, Lindenberger U, et al. Basal forebrain integrity and cognitive memory profile in healthy aging. Brain Res 2010;1308:124-136.
Serino A, Ciaramelli E, Santantonio AD, Malagù S, Servadei F, Làdavas E. A pilot study for rehabilitation of central executive deficits after traumatic brain injury. Brain Inj 2007;21:11-19.
Pris PMJ, Dovis S, Ponsioen A, Brink ET, Saskia S, Van der Oord S. Does computerized working memory training with game elements enhand motivation and training efficacy in children with ADHD? Cyberpsychol Behav Soc Netw 2011;14:91-96.
Spikman JM, Boelen DHE, Lamberts KF, Brower WH, Fasotti L. Effects of a multifaceted treatment program for executive dysfunction after acdquirid brain injury on indications of executive functioning in daily life. J Int Neuropsychol Soc 2010;16:118-129.
Carthery-Goulart MT, Areza-Fegyveres R, Schultz RR, Okamoto I, Bertolucci PHF, Nitrini R. Adaptação transcultural da escala de avaliação de incapacidade em demência (Disability Assessment for Dementia-DAD). Arq Neuropsiquiatr 2002;65:916-919.
Bressan LA, Vale FAC, Speciali JG. The daily life of patients with dementia, a comparative study between the information provided by the care giver and direct patient assessment, Dement Neuropsychol 2007; 3:288-295.
Converso ME, Iartelli L. Caracterização e análise do estado mental e funcional de idosos institucionalizados em instituições públicas de longa permanência. J Bras Psiquiatr 2007;56:448-454.
Lebrão ML, Duarte YAO. Desafios de um estudo longitudinal: o Projeto SABE. Saúde Coletiva (Barueri); 2008;24:166-167.
Ramos LR. Fatores determinantes do envelhecimento saudável em idosos residentes em centro urbano: Projeto Epidoso, São Paulo. Cad Saúde Pública 2003;19:793-797.

Publication Dates

Publication in this collection
Jan-Mar 2012

History

Received
12 Dec 2011
Accepted
10 Feb 2012

This is an open-access article distributed under the terms of the Creative Commons Attribution License

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[2] Baddeley AD, Wilson B. Frontal amnesia and the executive syndrome. Brain Cog 1988;7:212-230.

[3] Kelly TP, Borril HS, Maddell DL. Development and assessment of executive function in children. Child Psychol Psychiat Rev 1996;1:46-51.

[4] Yassuda MS, Abreu VPS. Avaliação Cognitiva. In: Freitas EV, Py L, Neri AL, Cançado FAXC, Gorzoni ML, Doll J. Tratado de geriatria e gerontologia. Rio de Janeiro: Guanabra Koogan, 2006;132:1252-1259.

[5] Malouin F, Belleville S, Richards CL, Desrosiers J, Doyon J. Working memory and mental practice outcomes after stroke. Arch Physical Med Rehab 2004;85: 177-183.

[6] Dahlin E, Bäckman L, Neely AS, Nyberg L. Training of the executive component of working memory: subcortical areas mediate transfer effects. Restor Neurol Neurosci 2009;27:405-419.

[7] Vance DE, Webb NM, Marceaux JC, Viamonte SM, Foote AW, Ball KK. Mental stimulation, neural plasticity, and aging: directions for nursing research and practice. J Neurosci Nurs 2008;40:241-249.

[8] Burgess PW, Shallice T. Executive dysfunction. In: Goldestein, L, McNell J , Org. Clinical Neuropsychology: A pratical guide to assessment and management for clinicians, England; 2004:185-270.

[9] Verhaeghen P, Salthouse T. Meta-analyses of age-cognition relations in adulthood: Estimates of linear and non-linear age effects and structural models. Psychol Bull 1997;122:231-249.

[10] Carvalho FCR, Neri AL, Yassuda MS. Treino de memória episódica com ênfase em categorização para idosos sem demência e depressão. Psicol Reflex Crit 2010;23:317-323.

[11] Salmazo-Silva H, Yassuda MS. Memory training for older adults with low education: mental images versus categorization. Educ Gerontol 2009;35:890-905.

[12] Brum PS, Forlenza OV, Yassuda MS. Cogntive training in Mild Cognitive Impairment, Dement Neuropsychol 2009;3:127-131.

[13] Lima-Silva TB, Ordonez TN, Dias-Santos G, Fabrício AT. Effects of cognitive training based on metamemory and mental images, Dement Neuropshycol 2010;4:114-119.

[14] Vallat-Azouvi C, Pradat-Diehl P, Azouvi P. Rehabilitation of the central executive of working memory after a severe traumatic brain injury: two single-case studies. Brain Inj 2009;23:585-594.

[15] Engvig A, Fjell AM, Westlye LT, et al. Effects of memory training on cortical thickness in the elderly. Neuroimage, 2010;52:1667-1676.

[16] Westerberg H, Jacobaeus H, Hirvikoski T, et al. Computerized working memory training after stroke: a pilot study. Brain Inj 2007;21:21-29.

[17] Cicerone KD, Dahlberg C, Malec JF, et al. Evidence-based cognitive rehabilitation: Updated review of the literature from 1998 through 2002. Arch Phys Med Rehabil 2006;86:1681-1692.

[18] Almeida O, Almeida SA. Reability of the Brasilian version of the geriatric scale (GDS) short form. Arq Neuropsiquiatr 1999;57:421-426.

[19] Paradela EMP, Lourenço RA, Veras R. Validação da escala de depressão geriátrica em um ambulatório geral. Rev Saúde Pública 2005; 39:918-923.

[20] Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[21] Yassuda MS, Flaks MK, Viola LF, et al. Psychometric characteristics of the Rivermead Behavioural Memory Test (RBMT) as an early detection instrument for dementia and mild cognitive impairment in Brazil. Int Psychogeriatr 2010;22:1003-1111.

[22] Wechsler D. Escala de Inteligência Wechsler para adultos, manual para administração e avaliação, 1º Ed, São Paulo: Casa do Psicólogo 1997:123-125.

[23] Aprahamian I, Martinelli JE, Neri AL, Yassuda MS. Clock Drawing Test accuracy compared to standard screening tests in Alzheimer s disease: results from a study in a sample of Brazilian elderly with heterogeneous educational background. Int Psychogeriatr 2010;22:64-71.

[24] Schulman KI, Shedletsky R, Silver IL. The challenge of time: click-drawing and cognitive function in the elderly. Int J Geriatr Psychiatry 1986;1:135-140.

[25] Montiel JM, Capovilla AGS. Teste de Trilhas - Partes A e B. Em AGS Capovilla (Org.), Teoria e pesquisa em avaliação neuropsicológica. São Paulo: Memnon. (no prelo).

[26] Pfeffer RI, Kurosaki TT, Harrah CH, et al. Mensurement of functional activities in older adults in the community. J Gerontol, 1982;37:323-329.

[27] Cabeza R, Daselaar SM, Dolcos F, Prince SE, Budde M, Nyberg L. Task-independent and task-specific age effects on brain activity during working memory, visual attention and episodic retrieval. Cereb Cortex 2004;14:364-375.

[28] Borella E, Carretti B, Riboldi F, De Beni R. Working Memory Training in older adults: Evidence of transfer and maintenance effects. Psychol Aging 2010; 25: 767-78.

[29] Buschkuehl M, Jaeggi SM, Hutchison S, et al. Impact of working memory training on memory performance in old-old adults. Psychol Aging 2008;23:743-753.

[30] Düzel S, Münte TF, Lindenberger U, et al. Basal forebrain integrity and cognitive memory profile in healthy aging. Brain Res 2010;1308:124-136.

[31] Serino A, Ciaramelli E, Santantonio AD, Malagù S, Servadei F, Làdavas E. A pilot study for rehabilitation of central executive deficits after traumatic brain injury. Brain Inj 2007;21:11-19.

[32] Pris PMJ, Dovis S, Ponsioen A, Brink ET, Saskia S, Van der Oord S. Does computerized working memory training with game elements enhand motivation and training efficacy in children with ADHD? Cyberpsychol Behav Soc Netw 2011;14:91-96.

[33] Spikman JM, Boelen DHE, Lamberts KF, Brower WH, Fasotti L. Effects of a multifaceted treatment program for executive dysfunction after acdquirid brain injury on indications of executive functioning in daily life. J Int Neuropsychol Soc 2010;16:118-129.

[34] Carthery-Goulart MT, Areza-Fegyveres R, Schultz RR, Okamoto I, Bertolucci PHF, Nitrini R. Adaptação transcultural da escala de avaliação de incapacidade em demência (Disability Assessment for Dementia-DAD). Arq Neuropsiquiatr 2002;65:916-919.

[35] Bressan LA, Vale FAC, Speciali JG. The daily life of patients with dementia, a comparative study between the information provided by the care giver and direct patient assessment, Dement Neuropsychol 2007; 3:288-295.

[36] Converso ME, Iartelli L. Caracterização e análise do estado mental e funcional de idosos institucionalizados em instituições públicas de longa permanência. J Bras Psiquiatr 2007;56:448-454.

[37] Lebrão ML, Duarte YAO. Desafios de um estudo longitudinal: o Projeto SABE. Saúde Coletiva (Barueri); 2008;24:166-167.

[38] Ramos LR. Fatores determinantes do envelhecimento saudável em idosos residentes em centro urbano: Projeto Epidoso, São Paulo. Cad Saúde Pública 2003;19:793-797.