strategies older adults

Physical evidence bilingualism delays onset of Alzheimer's symptoms

January, 2012
  • Brain scans reveal that active bilinguals can have nearly twice as much brain atrophy as monolinguals before cognitive performance suffers.

Growing evidence points to greater education and mentally stimulating occupations and activities providing a cognitive reserve that enables people with developing Alzheimer's to function normally for longer. Cognitive reserve means that your brain can take more damage before it has noticeable effects. A 2006 review found that some 30% of older adults found to have Alzheimer’s when autopsied had shown no signs of it when alive.

There are two relevant concepts behind the protection some brains have: cognitive reserve (which I have mentioned on a number of occasions), and brain reserve, which is more structural. ‘Brain reserve’ encapsulates the idea that certain characteristics, such as a greater brain size, help protect the brain from damage. Longitudinal studies have provided evidence, for example, that a larger head size in childhood helps reduce the risk of developing Alzheimer’s.

While cognitive reserve has been most often associated with education, it has also been associated with occupation, bilingualism, and music. A new study provides physical evidence for how effective bilingualism is.

The Toronto study involved 40 patients with a diagnosis of probable Alzheimer’s, of whom half were bilingual (fluent in a second language, and consistent users of both languages throughout their lives). Bilingual and monolingual patients were matched on a test of cognitive function (the Behavioral Neurology Assessment). The two groups were similar in education levels, gender, and performance on the MMSE and the clock drawing test. The groups did differ significantly in occupational status, with the monolinguals having higher job status than the bilinguals.

Notwithstanding this similarity in cognitive performance, brain scans revealed that the bilingual group had substantially greater atrophy in the medial temporal lobe and the temporal lobe. The two groups did not differ in measures of central and frontal atrophy, however — these regions are not associated with Alzheimer’s.

In other words, bilingualism seems to specifically help protect those areas implicated in Alzheimers, and the bilinguals could take much greater damage to the brain before it impacted their cognitive performance. It is suggested that the act of constantly switching between languages, or suppressing one language in favor of other, may help train the brain to be more flexible when the need comes to compensate for damaged areas.

The findings are consistent with previous observational studies suggesting that bilingualism delays the onset of Alzheimer's symptoms by up to five years.

Reference: 

[2712] Schweizer, T. A., Ware J., Fischer C. E., Craik F. I. M., & Bialystok E.
(2011).  Bilingualism as a contributor to cognitive reserve: Evidence from brain atrophy in Alzheimer’s disease.
Cortex.

Valenzuela MJ and Sachdev P. 2006. Brain reserve and dementia: A systematic review. Psychological Medicine, 36(4): 441e454.

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When age helps decision making

October, 2011

New study modifies findings that younger adults are better decision-makers by showing older adults are better when the scenarios involve multiple considerations.

Research has shown that younger adults are better decision makers than older adults — a curious result. A new study tried to capture more ‘real-world’ decision-making, by requiring participants to evaluate each result in order to strategize the next choice.

This time (whew!), the older adults did better.

In the first experiment, groups of older (60-early 80s) and younger (college-age) adults received points each time they chose from one of four options and tried to maximize the points they earned.  For this task, the younger adults were more efficient at selecting the options that yielded more points.

In the second experiment, the rewards received depended on the choices made previously.  The “decreasing option” gave a larger number of points on each trial, but caused rewards on future trials to be lower. The “increasing option” gave a smaller reward on each trial but caused rewards on future trials to increase.  In one version of the test, the increasing option led to more points earned over the course of the experiment; in another, chasing the increasing option couldn’t make up for the points that could be accrued grabbing the bigger bite on each trial.

The older adults did better on every permutation.

Understanding more complex scenarios is where experience tells. The difference in performance also may reflect the different ways younger and older adults use their brains. Decision-making can involve two different reward learning systems, according to recent thinking. In the model-based system, a cognitive model is constructed that shows how various actions and their rewards are connected to each other. Decisions are made by simulating how one decision will affect future decisions. In the model-free system, on the other hand, only values associated with each choice are considered.

These systems are rooted in different parts of the brain. The model-based system uses the intraparietal sulcus and lateral prefrontal cortex, while the model-free system uses the ventral striatum. There is some evidence that younger adults use the ventral striatum (involved in habitual, reflexive learning and immediate reward) for decision-making more than older adults, and older adults use the dorsolateral prefrontal cortex (involved in more rational, deliberative thinking) more than younger adults.

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Memory fitness program improves memory abilities of oldest adults

October, 2011

A six-week memory fitness program offered to older adults helped improve their ability to recognize and recall words.

In a study involving 115 seniors (average age 81), those who participated in a six-week, 12-session memory training program significantly improved their verbal memory. 15-20 seniors participated in each hour-long class, which included explanations of how memory works, quick strategies for remembering names, faces and numbers, basic memory strategies such as linking ideas and creating visual images, and information on a healthy lifestyle for protecting and maintaining memory.

Most of the study participants were women, Caucasian and had attained a college degree or higher level of education.

Reference: 

[2491] Miller, K. J., Siddarth P., Gaines J. M., Parrish J. M., Ercoli L. M., Marx K., et al.
(2011).  The Memory Fitness Program.
American Journal of Geriatric Psychiatry. 1 - 1.

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Errorless learning not always best for older brains

October, 2011

New evidence challenges the view that older adults learn best through errorless learning. Trial-and-error learning can be better if done the right way.

Following a 1994 study that found that errorless learning was better than trial-and-error learning for amnesic patients and older adults, errorless learning has been widely adopted in the rehabilitation industry. Errorless learning involves being told the answer without repeatedly trying to answer the question and perhaps making mistakes. For example, in the 1994 study, participants in the trial-and-error condition could produce up to three errors in answer to the question “I am thinking of a word that begins with QU”, before being told the answer was QUOTE; in contrast, participants in the errorless condition were simply told “I am thinking of a word that begins with QU and it is ‘QUOTE’.”

In a way, it is surprising that errorless learning should be better, given that trial-and-error produces much deeper and richer encoding, and a number of studies with young adults have indeed found an advantage for making errors. Moreover, it’s well established that retrieving an item leads to better learning than passively studying it, even when you retrieve the wrong item. This testing effect has also been found in older adults.

In another way, the finding is not surprising at all, because clearly the trial-and-error condition offers many opportunities for confusion. You remember that QUEEN was mentioned, for example, but you don’t remember whether it was a right or wrong answer. Source memory, as I’ve often mentioned, is particularly affected by age.

So there are good theoretical reasons for both positions regarding the value of mistakes, and there’s experimental evidence for both. Clearly it’s a matter of circumstance. One possible factor influencing the benefit or otherwise of error concerns the type of processing. Those studies that have found a benefit have generally involved conceptual associations (e.g. What’s Canada’s capital? Toronto? No, Ottawa). It may be that errors are helpful to the extent that they act as retrieval cues, and evoke a network of related concepts. Those studies that have found errors harm learning have generally involved perceptual associations, such as word stems and word fragments (e.g., QU? QUeen? No, QUote). These errors are arbitrary, produce interference, and don’t provide useful retrieval cues.

So this new study tested the idea that producing errors conceptually associated with targets would boost memory for the encoding context in which information was studied, especially for older adults who do not spontaneously elaborate on targets at encoding.

In the first experiment, 33 young (average age 21) and 31 older adults (average age 72) were shown 90 nouns presented in three different, intermixed conditions. In the read condition (designed to provide a baseline), participants read aloud the noun fragment presented without a semantic category (e.g., p­_g). In the errorless condition, the semantic category was presented with the target word fragment (e.g. a farm animal  p­_g), and the participants read aloud the category and their answer. The category and target were then displayed. In the trial-and-error condition, the category was presented and participants were encouraged to make two guesses before being shown the target fragment together with the category. The researchers changed the target if it was guessed. Participants were then tested using a list of 70 words, of which 10 came from each of the study conditions, 10 were new unrelated words, and 30 were nontarget exemplars from the TEL categories. Those that the subject had guessed were labeled as learning errors; those that hadn’t come up were labeled as related lures. In addition to an overall recognition test (press “yes” to any word you’ve studied and “no” to any new word), there were two tests that required participants to endorse items that were studied in the TEL condition and reject those studied in the EL condition, and vice versa.

The young adults did better than the older on every test. TEL produced better learning than EL, and both produced better learning than the read condition (as expected). The benefit of TEL was greater for older adults. This is in keeping with the idea that generating exemplars of a semantic category, as occurs in trial-and-error learning, helps produce a richer, more elaborated code, and that this is of greater to older adults, who are less inclined to do this without encouragement.

There was a downside, however. Older adults were also more prone to falsely endorsing prior learning errors or semantically-related lures. It’s worth noting that both groups were more likely to falsely endorse learning errors than related lures.

But the main goal of this first experiment was to disentangle the contributions of recollection and familiarity to the two types of learning. It turns out that there was no difference between young and older adults in terms of familiarity; the difference in performance between the two groups stemmed from recollection. Recollection was a problem for older adults in the errorless condition, but not in the trial-and-error condition (where the recollective component of their performance matched that of young adults). This deficit is clearly closely related to age-related deficits in source memory.

It was also found that familiarity was marginally more important in the errorless condition than the trial-and-error condition. This is consistent with the idea that targets learned without errors acquire greater fluency than those learned with errors (with the downside that they don’t pick up those contextual details that making errors can provide).

In the second experiment, 15 young and 15 older adults carried out much the same procedure, except that during the recognition test they were also required to mention the context in which the words were learned was tested (that is, were the words learned through trial-and-error or not).

Once again, trial-and-error learning was associated with better source memory relative to errorless learning, particularly for the older adults.

These results support the hypothesis that trial-and-error learning is more beneficial than errorless learning for older adults when the trials encourage semantic elaboration. But another factor may also be involved. Unlike other errorless studies, participants were required to attend to errors as well as targets. Explicit attention to errors may help protect against interference.

In a similar way, a recent study involving young adults found that feedback given in increments (thus producing errors) is more effective than feedback given all at once in full. Clearly what we want is to find that balance point, where elaborative benefits are maximized and interference is minimized.

Reference: 

[2496] Cyr, A-A., & Anderson N. D.
(2011).  Trial-and-error learning improves source memory among young and older adults.
Psychology and Aging. No Pagination Specified - No Pagination Specified.

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Long-term meditation fights age-related cognitive decline

August, 2011

Another study adds to the weight of evidence that meditating has cognitive benefits. The latest finding points to brain-wide improvements in connectivity.

Following on from research showing that long-term meditation is associated with gray matter increases across the brain, an imaging study involving 27 long-term meditators (average age 52) and 27 controls (matched by age and sex) has revealed pronounced differences in white-matter connectivity between their brains.

The differences reflect white-matter tracts in the meditators’ brains being more numerous, more dense, more myelinated, or more coherent in orientation (unfortunately the technology does not yet allow us to disentangle these) — thus, better able to quickly relay electrical signals.

While the differences were evident among major pathways throughout the brain, the greatest differences were seen within the temporal part of the superior longitudinal fasciculus (bundles of neurons connecting the front and the back of the cerebrum) in the left hemisphere; the corticospinal tract (a collection of axons that travel between the cerebral cortex of the brain and the spinal cord), and the uncinate fasciculus (connecting parts of the limbic system, such as the hippocampus and amygdala, with the frontal cortex) in both hemispheres.

These findings are consistent with the regions in which gray matter increases have been found. For example, the tSLF connects with the caudal area of the temporal lobe, the inferior temporal gyrus, and the superior temporal gyrus; the UNC connects the orbitofrontal cortex with the amygdala and hippocampal gyrus

It’s possible, of course, that those who are drawn to meditation, or who are likely to engage in it long term, have fundamentally different brains from other people. However, it is more likely (and more consistent with research showing the short-term effects of meditation) that the practice of meditation changes the brain.

The precise mechanism whereby meditation might have these effects can only be speculated. However, more broadly, we can say that meditation might induce physical changes in the brain, or it might be protecting against age-related reduction. Most likely of all, perhaps, both processes might be going on, perhaps in different regions or networks.

Regardless of the mechanism, the evidence that meditation has cognitive benefits is steadily accumulating.

The number of years the meditators had practiced ranged from 5 to 46. They reported a number of different meditation styles, including Shamatha, Vipassana and Zazen.

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Brains of those with MCI still flexible and trainable

April, 2011

A small study demonstrates that mild cognitive impairment doesn’t preclude retraining the brain to find new ways to perform cognitive tasks.

A training program designed to help older adults with MCI develop memory strategies has found that their brains were still sufficiently flexible to learn new ways to compensate for impairment in some brain regions. The study involved 30 older adults, of whom 15 had MCI. Participants’ brains were scanned 6 weeks prior to memory training, one week prior to training and one week after training.

Before training, those with MCI showed less activity in brain regions associated with memory. After training they showed increased activation in these areas as well as in areas associated with language processing, spatial and object memory and skill learning. In particular, new activity in the right inferior parietal gyrus was associated with improvement on a memory task.

The findings demonstrate that even once diagnosed with MCI (a precursor to Alzheimer’s disease), brains can still be ‘rewired’ to use undamaged brain regions for tasks customarily done by now-damaged regions.

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Bilingualism delays onset of Alzheimer's symptoms

January, 2011

A second study confirms the dramatic effect of being bilingual, with bilingual speakers being diagnosed with Alzheimer’s more than 4 years later than monoglots.

Clinical records of 211 patients diagnosed with probable Alzheimer's disease have revealed that those who have spoken two or more languages consistently over many years experienced a delay in the onset of their symptoms by as much as five years. It’s thought that lifelong bilingualism may contribute to cognitive reserve in the brain, enabling it to compensate for memory loss, confusion, and difficulties with problem-solving and planning.

Of the 211 patients of the Sam and Ida Ross Memory Clinic at Baycrest, 102 patients were classified as bilingual and 109 as monolingual. Bilingual patients had been diagnosed with Alzheimer's 4.3 years later than the monolingual patients on average, and had reported the onset of symptoms 5.1 years later. The groups were equivalent on measures of cognitive and occupational level, there was no apparent effect of immigration status, and there were no gender differences.

The findings confirm an earlier study from the same researchers, from the clinical records of 184 patients diagnosed with probable Alzheimer's and other forms of dementia.

Reference: 

[2039] Craik, F. I. M., Bialystok E., & Freedman M.
(2010).  Delaying the onset of Alzheimer disease.
Neurology. 75(19), 1726 - 1729.

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Brain fitness programs may help frail elderly walk faster

September, 2010
  • Walking speed and balance may be improved in seniors through a brain training program. Research has indicated that a common pathology underlies cognitive impairment and gait and balance problems.

On the subject of the benefits of walking for seniors, it’s intriguing to note a recent pilot study that found frail seniors who walked slowly (no faster than one meter per second) benefited from a brain fitness program known as Mindfit. After eight weeks of sessions three times weekly (each session 45-60 minutes), all ten participants walked a little faster, and significantly faster while talking. Walking while talking requires considerably more concentration than normal walking. The success of this short intervention (which needs to be replicated in a larger study) offers the hope that frail elderly who may be unable to participate in physical exercise, could improve their mobility through brain fitness programs. Poor gait speed is also correlated with a higher probability of falls.

The connection between gait speed and cognitive function is an interesting one. Previous research has indicated that slow gait should alert doctors to check for cognitive impairment. One study found severe white matter lesions were more likely in those with gait and balance problems. Most recently, a longitudinal study involving over 900 older adults has found poorer global cognitive function, verbal memory, and executive function, were all predictive of greater decline in gait speed.

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Music aids Alzheimer's patients in remembering new information

August, 2010

A small study has found that music can help patients with Alzheimer's disease recognize verbal information.

The study involved 13 patients and 14 controls, who listened to either spoken lyrics or lyrics sung with full musical accompaniment while reading the printed lyrics on a screen. The 40 lyrics were four-line excerpts of children’s songs, all characterized by having simple, unrepeated lyrics, repetitive melodies, and a perfect end-rhyme scheme for the four lines. The participants were then given these 40 lyrics mixed in with 40 other similar lyrics, and asked whether they had heard it earlier. Alzheimer’s patients were markedly more likely to recognize those they had heard sung (40% compared to 28% of the spoken). Interestingly, the controls showed no difference, although of course their performance was considerably better (77% and 74%).

It may be that setting new information, such as simple instructions, to music might help Alzheimer’s patients remember it.

On a side note, a recent study found that classical music (four short pieces by different composers) affected the heart rates of people in a vegetative state in the same way as they did those of healthy listeners, suggesting that music affects emotion at very deep level. (see http://www.newscientist.com/article/dn19123-classical-music-moves-the-he...)

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Brain fitness program produces working memory improvement in older adults

August, 2010

A new study shows improvement in visual working memory in older adults following ten hours training with a commercial brain training program. The performance gains correlated with changes in brain activity.

While brain training programs can certainly improve your ability to do the task you’re practicing, there has been little evidence that this transfers to other tasks. In particular, the holy grail has been very broad transfer, through improvement in working memory. While there has been some evidence of this in pilot programs for children with ADHD, a new study is the first to show such improvement in older adults using a commercial brain training program.

A study involving 30 healthy adults aged 60 to 89 has demonstrated that ten hours of training on a computer game designed to boost visual perception improved perceptual abilities significantly, and also increased the accuracy of their visual working memory to the level of younger adults. There was a direct link between improved performance and changes in brain activity in the visual association cortex.

The computer game was one of those developed by Posit Science. Memory improvement was measured about one week after the end of training. The improvement did not, however, withstand multi-tasking, which is a particular problem for older adults. The participants, half of whom underwent the training, were college educated. The training challenged players to discriminate between two different shapes of sine waves (S-shaped patterns) moving across the screen. The memory test (which was performed before and after training) involved watching dots move across the screen, followed by a short delay and then re-testing for the memory of the exact direction the dots had moved.

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