Cognitive Training

for an individual is not straightforward. Many changes in cognition are recognized only after the fact, when more severe impairment is identified, and subsequent efforts to prevent decline may be too late. Technology can help eliminate many of the inherent issues with current standard assessments by allowing real-time, frequent, unobtrusive, objective measures that allow detection of more subtle, presymptomatic changes. Recommendations for R&D to address the need to regularly assess reasoning, memory, and communication abilities include the following:  Determine the feasibility, validity, reliability, and health/social impacts of technological approaches for cognitive assessment. Evaluations of technologies should be based on their use by diverse, real-world populations. Research should particularly address older adults living within highly disadvantaged contexts or from low-resource groups.  Obtain data related to the cost effectiveness of these technologies as well as which groups are most likely to benefit from them.  Understand how remote technologies can be practically integrated into health system operations and healthcare delivery, as well as what format improves clinicians’ willingness and comfort using these technologies.  Assess whether the perceived benefits of monitoring technologies outweigh potential concerns regarding privacy, autonomy, and consent; determine who is permitted access to and use of the information gathered, especially for continuous monitoring; and clarify whois responsible for any action basedonthe information gathered.

Cognitive Training Enhance Baseline Ability. There is considerable interest in identifying methods that will improve cognition to help stave off decline. Thus far, most cognitive training technology available to the public has been developed for the direct-to-consumer market. Although there has been empirical support for modest improvements to narrowly-defined aspects of cognition following interventions in research settings, the efficacy of most products onthe market has not been supported by independent research.  Determine whether cognitive training, and which type of cognitive training, isan effective method to improve or delay age-related cognitive decline and/or onset of pathological cognitive impairment. Determine which domains of functioning are affected andfor how long. This research would clarify the potential benefits as considered by evidence-based reviews.19, 20  Promote development of novel and engaging cognitive training applications and rigorously assess evidence of long-term cognitive improvements that impact daily functioning. This research may be facilitated through the development and use of interventions that target a specific neural system/functional domain, making it easier to assess change. Augmenting existing technology platforms that are already accepted among older adults may lead to improved adherence.

Research programs with more training and longer follow-up timeframes are also needed.  Foster and improve evidence and research on cognitive training programs wherein training related to a particular cognitive domain, such as memory or information processing/speed, is readily generalizable to real-world situations and needs. Encourage research that addresses actual needs in terms of cognitive training, ideally tailored to individual needs and situations.

19 https://effectivehealthcare.ahrq.gov/topics/cognitive-decline/research-2017 20 https://www.nap.edu/catalog/21693/cognitive-aging-progress-in-understanding-and-opportunities-foraction