Department of Psychiatry, Weill Cornell Medicine, 525 E 68th St, New York, NY, 10065, USA.
Weill Cornell Institute of Geriatric Psychiatry, 21 Bloomingdale Road, White Plains, NY, 10605, USA.
Curr Psychiatry Rep. 2022 Sep;24(9):441-450. doi: 10.1007/s11920-022-01348-x. Epub 2022 Jul 15.
We review recent work on applications of non-pharmacologic strategies to promote cognitive health in older adulthood and discuss potential network mechanisms, limitations, and considerations for improving intervention uptake and efficacy.
In healthy older adults and patients with mild cognitive impairment, cognitive training produces global and domain-specific cognitive gains, though effect sizes tend to be modest and transfer is variable. Non-invasive brain stimulation has shown moderate success in enhancing cognitive function, though the optimum approach, parameters, and cortical targets require further investigation. Physical activity improves cognitive functions in late life, with emerging trials highlighting key intervention components that may maximize treatment outcomes. Multimodal interventions may be superior to single-component interventions in conferring cognitive gains, although interpretation is limited by modest sample sizes and variability in training components and parameters. Across modalities, individual differences in patient characteristics predict therapeutic response. These interventions may advance cognitive health by modulating functional networks that support core cognitive abilities including the default mode, executive control, and salience networks. Effectiveness of cognitive enhancement strategies may be increased with clinician-led coaching, booster sessions, gamification, integration of multiple intervention modalities, and concrete applications to everyday functioning. Future trials involving rigorous comparisons of training components, parameters, and delivery formats will be essential in establishing the precise approaches needed to maximize cognitive outcomes. Novel studies using patient-level clinical and neuroimaging features to predict individual differences in training gains may inform the development of personalized intervention prescriptions to optimize cognitive health in late life.
我们回顾了近期关于非药物策略在促进老年认知健康方面应用的研究，并讨论了潜在的网络机制、局限性以及改善干预措施接受度和效果的考虑因素。
在健康的老年人和轻度认知障碍患者中，认知训练可产生整体和特定领域的认知收益，尽管效果大小往往较小且转移效果不稳定。非侵入性脑刺激在增强认知功能方面已取得一定成效，但最佳方法、参数和皮质靶点仍需进一步研究。身体活动可改善晚年的认知功能，新的试验强调了可能使治疗效果最大化的关键干预成分。多模态干预可能优于单一成分干预，从而带来认知收益，但由于训练成分和参数的样本量较小且存在变异性，因此解释受到限制。在各种干预措施中，患者特征的个体差异可预测治疗反应。这些干预措施可能通过调节支持核心认知能力的功能网络来促进认知健康，包括默认模式、执行控制和突显网络。通过临床医生主导的辅导、强化课程、游戏化、多种干预方式的整合以及将其应用于日常功能，认知增强策略的有效性可能会提高。未来的试验涉及对训练成分、参数和传递格式的严格比较，对于确定最大化认知结果所需的确切方法至关重要。使用患者水平的临床和神经影像学特征来预测训练收益中的个体差异的新研究，可能为制定个性化干预方案以优化晚年认知健康提供信息。
