丰富化对成人认知发展的影响:老年人的功能能力能否得到保持和增强?

Enrichment Effects on Adult Cognitive Development: Can the Functional Capacity of Older Adults Be Preserved and Enhanced?

机构信息

Georgia Institute of Technology, Berlin

University of Illinois - Urbana-Champaign, Berlin.

出版信息

Psychol Sci Public Interest. 2008 Oct;9(1):1-65. doi: 10.1111/j.1539-6053.2009.01034.x. Epub 2008 Oct 1.

Abstract

In this monograph, we ask whether various kinds of intellectual, physical, and social activities produce cognitive enrichment effects-that is, whether they improve cognitive performance at different points of the adult life span, with a particular emphasis on old age. We begin with a theoretical framework that emphasizes the potential of behavior to influence levels of cognitive functioning. According to this framework, the undeniable presence of age-related decline in cognition does not invalidate the view that behavior can enhance cognitive functioning. Instead, the course of normal aging shapes a zone of possible functioning, which reflects person-specific endowments and age-related constraints. Individuals influence whether they function in the higher or lower ranges of this zone by engaging in or refraining from beneficial intellectual, physical, and social activities. From this point of view, the potential for positive change, or plasticity, is maintained in adult cognition. It is an argument that is supported by newer research in neuroscience showing neural plasticity in various aspects of central nervous system functioning, neurochemistry, and architecture. This view of human potential contrasts with static conceptions of cognition in old age, according to which decline in abilities is fixed and individuals cannot slow its course. Furthermore, any understanding of cognition as it occurs in everyday life must make a distinction between basic cognitive mechanisms and skills (such as working-memory capacity) and the functional use of cognition to achieve goals in specific situations. In practice, knowledge and expertise are critical for effective functioning, and the available evidence suggests that older adults effectively employ specific knowledge and expertise and can gain new knowledge when it is required. We conclude that, on balance, the available evidence favors the hypothesis that maintaining an intellectually engaged and physically active lifestyle promotes successful cognitive aging. First, cognitive-training studies have demonstrated that older adults can improve cognitive functioning when provided with intensive training in strategies that promote thinking and remembering. The early training literature suggested little transfer of function from specifically trained skills to new cognitive tasks; learning was highly specific to the cognitive processes targeted by training. Recently, however, a new generation of studies suggests that providing structured experience in situations demanding executive coordination of skills-such as complex video games, task-switching paradigms, and divided attention tasks-train strategic control over cognition that does show transfer to different task environments. These studies suggest that there is considerable reserve potential in older adults' cognition that can be enhanced through training. Second, a considerable number of studies indicate that maintaining a lifestyle that is intellectually stimulating predicts better maintenance of cognitive skills and is associated with a reduced risk of developing Alzheimer's disease in late life. Our review focuses on longitudinal evidence of a connection between an active lifestyle and enhanced cognition, because such evidence admits fewer rival explanations of observed effects (or lack of effects) than does cross-sectional evidence. The longitudinal evidence consistently shows that engaging in intellectually stimulating activities is associated with better cognitive functioning at later points in time. Other studies show that meaningful social engagement is also predictive of better maintenance of cognitive functioning in old age. These longitudinal findings are also open to important rival explanations, but overall, the available evidence suggests that activities can postpone decline, attenuate decline, or provide prosthetic benefit in the face of normative cognitive decline, while at the same time indicating that late-life cognitive changes can result in curtailment of activities. Given the complexity of the dynamic reciprocal relationships between stimulating activities and cognitive function in old age, additional research will be needed to address the extent to which observed effects validate a causal influence of an intellectually engaged lifestyle on cognition. Nevertheless, the hypothesis that an active lifestyle that requires cognitive effort has long-term benefits for older adults' cognition is at least consistent with the available data. Furthermore, new intervention research that involves multimodal interventions focusing on goal-directed action requiring cognition (such as reading to children) and social interaction will help to address whether an active lifestyle enhances cognitive function. Third, there is a parallel literature suggesting that physical activity, and aerobic exercise in particular, enhances older adults' cognitive function. Unlike the literature on an active lifestyle, there is already an impressive array of work with humans and animal populations showing that exercise interventions have substantial benefits for cognitive function, particularly for aspects of fluid intelligence and executive function. Recent neuroscience research on this topic indicates that exercise has substantial effects on brain morphology and function, representing a plausible brain substrate for the observed effects of aerobic exercise and other activities on cognition. Our review identifies a number of areas where additional research is needed to address critical questions. For example, there is considerable epidemiological evidence that stress and chronic psychological distress are negatively associated with changes in cognition. In contrast, less is known about how positive attributes, such as self-efficacy, a sense of control, and a sense of meaning in life, might contribute to preservation of cognitive function in old age. It is well known that certain personality characteristics such as conscientiousness predict adherence to an exercise regimen, but we do not know whether these attributes are also relevant to predicting maintenance of cognitive function or effective compensation for cognitive decline when it occurs. Likewise, more information is needed on the factors that encourage maintenance of an active lifestyle in old age in the face of elevated risk for physiological decline, mechanical wear and tear on the body, and incidence of diseases with disabling consequences, and whether efforts to maintain an active lifestyle are associated with successful aging, both in terms of cognitive function and psychological and emotional well-being. We also discuss briefly some interesting issues for society and public policy regarding cognitive-enrichment effects. For example, should efforts to enhance cognitive function be included as part of a general prevention model for enhancing health and vitality in old age? We also comment on the recent trend of business marketing interventions claimed to build brain power and prevent age-related cognitive decline, and the desirability of direct research evidence to back claims of effectiveness for specific products.

摘要

在这本专论中,我们探讨了各种智力、身体和社会活动是否会产生认知丰富效应,也就是说,它们是否会提高成年后不同阶段的认知表现,尤其是在老年阶段。我们首先提出了一个强调行为对认知功能产生潜在影响的理论框架。根据这个框架,不可否认的是,认知会随着年龄的增长而衰退,但这并不否定行为可以增强认知功能的观点。相反,正常衰老的过程塑造了一个可能的功能区域,这个区域反映了个体的特定禀赋和与年龄相关的限制。个体通过参与或避免有益的智力、身体和社会活动,影响自己在这个区域的较高或较低范围的功能。从这个角度来看,成人认知具有积极变化的潜力,即可塑性。神经科学的新研究支持了这一观点,该研究表明,中枢神经系统功能、神经化学和结构的各个方面都具有神经可塑性。与老年认知中静态观念相比,这种对人类潜力的看法认为,能力的下降是固定的,个体无法减缓其进程。此外,任何对日常生活中认知的理解都必须区分基本认知机制和技能(如工作记忆容量)与在特定情况下实现目标的认知功能的使用。实际上,知识和专长对于有效运作至关重要,并且现有证据表明,老年人有效地利用特定的知识和专长,并且在需要时可以获得新知识。总的来说,我们认为,现有证据支持这样一种假设,即保持智力投入和身体活跃的生活方式可以促进成功的认知老化。首先,认知训练研究表明,老年人可以通过接受促进思维和记忆的策略的强化训练来提高认知功能。早期的训练文献表明,特定技能的功能转移很少从专门训练的技能转移到新的认知任务中;学习高度特定于训练所针对的认知过程。然而,最近的一项新研究表明,提供需要执行协调技能的情境经验,例如复杂视频游戏、任务切换范式和注意力分散任务,训练策略控制认知,这种控制确实可以转移到不同的任务环境中。这些研究表明,老年人的认知能力有很大的储备潜力,可以通过训练来增强。其次,大量研究表明,保持智力刺激的生活方式可以更好地维持认知技能,并降低晚年患阿尔茨海默病的风险。我们的综述重点关注生活方式与增强认知之间的积极生活方式的纵向证据,因为这种证据比横断面证据更难以对观察到的效应(或缺乏效应)提出替代解释。纵向证据一致表明,从事智力刺激活动与以后的时间点的认知功能更好相关。其他研究还表明,有意义的社会参与也可以预测老年人认知功能的更好维持。这些纵向发现也可能存在重要的替代解释,但总的来说,现有证据表明,活动可以延缓、减轻或提供认知衰退的补偿,同时表明老年期的认知变化可能导致活动的减少。考虑到老年期活跃活动和认知功能之间复杂的动态相互关系,需要进一步的研究来确定观察到的效应在多大程度上验证了智力投入的生活方式对认知的因果影响。尽管如此,积极的生活方式需要认知努力,对老年人的认知有长期益处的假设至少与现有数据一致。此外,新的干预研究涉及针对需要认知的目标导向行动(例如阅读给孩子)和社会互动的多模态干预措施,将有助于解决积极的生活方式是否增强认知功能的问题。第三,有一个平行的文献表明,体育活动,特别是有氧运动,可以增强老年人的认知功能。与积极生活方式的文献不同,已经有大量的人类和动物群体的工作表明,运动干预对认知功能有实质性的益处,特别是对流体智力和执行功能的影响。最近关于这个主题的神经科学研究表明,运动对大脑形态和功能有很大的影响,代表了有氧锻炼和其他活动对认知影响的一个合理的大脑基础。我们的综述确定了一些需要进一步研究的关键问题领域。例如,有大量的流行病学证据表明,压力和慢性心理困扰与认知变化呈负相关。相比之下,人们对积极属性(如自我效能感、控制感和生活意义感)如何有助于保持老年人的认知功能知之甚少。众所周知,某些人格特征(如尽责性)可以预测对锻炼方案的坚持,但我们不知道这些特征是否也与预测认知功能的维持或认知衰退时的有效补偿有关,当认知衰退发生时。同样,我们需要更多关于鼓励老年人在面临生理衰退风险、身体机械磨损和疾病致残后果升高时保持积极生活方式的因素的信息,以及保持积极生活方式是否与认知功能以及心理和情感幸福感的成功老龄化有关。我们还简要讨论了与认知丰富效应相关的一些有趣的社会和公共政策问题。例如,是否应该将增强认知功能的努力纳入增强老年人健康和活力的一般预防模式?我们还评论了最近商业营销干预措施的趋势,这些措施声称可以增强大脑功能并预防与年龄相关的认知衰退,以及对特定产品有效性的直接研究证据的必要性。

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