Promoting healthy ageing with cognitive exercise: the Pace Study

Dementia is one of the most frequent mental health disorders of older people and a leading cause of years of life lost due to disability in Australia. There is increasing evidence that the onset of dementia can be delayed by targeting potentially modifiable risk factors and focusing on at risk groups. Much emphasis has been placed on the benefits of mentally stimulating leisure activities and the role of cognitive interventions to maintain cognition and prevent, or at least delay, decline. One group of target individuals are older adults with a diagnosis of mild cognitive impairment (MCI), a clinical state considered potentially predictive of future cognitive decline.

The purpose of this research was to determine whether a structured cognitive activity (CA) strategy training program, specifically designed for individuals with MCI, could prevent cognitive decline. Baseline neuropsychological assessments were completed with 160 community dwelling older adults, aged 65 years and over, who were randomised to participate in either a program of CA strategy training or a control, education program. Upon completion of the five-week intervention, participants were re-assessed and were subsequently followed up at additional 12-month and 24-month time intervals.

Despite the intervention being perceived as favourable by all study participants and the intervention delivered in a consistent manner, inspection of performance upon the primary outcome measure, the CAMGOG-R, revealed no significant differences between the groups at post intervention follow-up assessments. There was also no convincing evidence of benefit across secondary outcome measures addressing more specific aspects of cognition (attention, memory, executive abilities), lifestyle (physical and leisure activities) and well being (mood and functional status).

The findings were not supportive of the application of this type of intervention for decreasing the rate of cognitive decline amongst older adults with MCI. The outcomes may have been influenced by a number of potential design factors, including the content and length of the interventions, the social nature of the group application and the chosen outcome measures. Replication and, ideally, larger scale multi-modal interventions with lengthy follow-up intervals allowing for detection of conversion to dementia, would assist in clarifying the potential value of cognition-focused interventions (CFI) for at risk, older adult populations. However, the cost-effectiveness trade-off also requires consideration.