Exploring the impact of attention training on attention difficulties of older adults

Exploring the impact of attention training on attention difficulties of older adults

Background: Attention – a central constituent of cognitive ability was researched. Attention difficulties affect different cognitive abilities. The Scaffolding Theory of Ageing and Cognition (STAC) supported the implementation of cognitive training (specifically Attention Training used in this study) that aimed to provide scaffolding against age-related attentional decline expected in older adults aged between 60 and 80 years.

Aim: The main aim of this study was to investigate changes in attention ability resulting from participants’ engagement in a structured attention training program.

Method: The two studies in this research investigated attention in a community of Healthy Older Adults (HOA) and in the elderly with Mild Cognitive Impairment (MCI), aged between 60 and 80 years. The intervention assessed in this study was Attention Training against a control condition namely -Relaxation Training. Sixty-three HOA’s participating in Study 1, were randomly allocated to the Intervention group (34 participants) and Active Control group (29 participants). Of the 29 Active- Control group participants, 24 completed the intervention training after completing their Relaxation Training. All trainings were delivered in small face- to- face groups of eight participants maximum, undergoing, ten, 2- hour weekly sessions. Study 2 comprised of four participants with MCI, from the Memory Clinic, receiving faceto- face attention training only. The MCI sample only received the Attention Training (Intervention) as the sample size was too small to qualify for a randomized control trial (RCT). All participants were tested before participation in the Attention or Relaxation Training (time 1) and after completion of both training programs (Attention Training for the intervention group and Relaxation Training for the active control group-time 2), followed by the completion of the Attention Training (time 3) by the Partial Crossover group (which was formed from the interested participants of the Active Control group), with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Test of Everyday Attention (TEA). From the RBANS, the overall RBANS index score measuring overall cognitive abilities and the Attention index score, and from the TEA, Map Search subtest (MS, ii in 1 minute) measuring visual selective attention, Visual Elevator subtest (VE1) measuring switching attention and Lottery subtest measuring sustained attention, were assessed.

Results: Study 1 hypothesized that (a) Intervention (Attention Training) would influence increases in attention and general cognition among HOA’s of the Intervention group in comparison to HOA’s of the Active Control group; and (b) improvement in attention and general cognition were expected from post- Relaxation Training to post- Attention Training (intervention) for the Partial Crossover group. (a) Analysis with 2x2 repeated ANOVA indicated statistically significant differences between the two groups for Attention index score (RBANS) and Map Search test (MS1 score of the TEA) measuring visual selective attention. In particular, both groups combined, performed better post- training for Attention index score (RBANS) but for visual selective attention both groups individually performed worse post- training with poorer performance noted in the Intervention group than the Active Control group. For (b) For the Partial Crossover group, a one-way repeated ANOVA indicated a statistically significant increment for the RBANS total index scores from time 1 (before participation in the Relaxation Training) to time 3 (after completion of the Attention Training) and also for the Attention index scores (RBANS) from time 1 (before participation in the Relaxation Training) to time 2 (after completion of the Relaxation Training), and contrastingly a statistically significant decrement in the visual selective attention measure of the TEA from time 1 (before participation in the Relaxation Training) to time 2 (after completion of the Relaxation Training) and time 1 (before participation in the Relaxation Training) to time 3 (after completion of the Attention Training).
Study 2 hypothesized that intervention will lead to improvements in attention and general cognition among participants with MCI post intervention. Results indicated a reliable change (increase) from time 1 to time 2 in 1 out of 4 participants with MCI for switching attention and a reliable change (decrement) from time 1 to time 2 for sustained attention in 2 out of 4 participants with MCI, as measured by the TEA.

Implications and conclusions: Different training programs are required for different groups of participants (healthy older adults and MCI). The positive impact of socialisation was evident from the overall findings of this research. The need for multidomain and multicomponent interventions are implicated as opposed to training in a single cognitive domain. The iii need for developing psychometrically sound cognitive assessment tools for the elderly aged 89 years and above, was also implicated because currently, it is rare to find any comprehensive psychometric assessments that measure cognition in the elderly above the age of 89 years.

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