Cognitive rehab & memory enhancement: evidence-based interventions (Part 1)

Cognitive rehab & memory enhancement: evidence-based interventions (Part 1)

Help older adults maximize memory ability and reduce the chance of dementia with a holistic approach that includes such things as cognitive exercise, physical exercise, nutrition and social engagement

by Rob Winningham, PhD


There is a lot of advice out there about how we can keep our minds sharp. People take fad supplements, play video games designed to improve brain functioning, and, of course, complete crossword puzzles. Many of the things people use to improve their memories, however, are not supported by scientific research. The good news is, if you look at the bigger picture, there are behaviors and interventions supported by research, and they can be succinctly summarized:

To maintain or even improve memory ability in older adulthood, we need to use a holistic approach that includes factors such as cognitive exercise, physical exercise, proper nutrition, adequate social engagement, healthy sleep habits, and reduced stress.


By themselves, any one of the factors has a modest effect on memory ability. But when these factors are combined, the effect is significant.


It is true that a little over half of our memory ability in older adulthood, as well as our chance of developing dementia, is related to our genetics.1 Unfortunately, there isn’t much we can do about our genetic makeup. If we take a glass-half-full perspective and focus on the nongenetic influences in our control, we can help the older adults we serve (and ourselves) improve the odds. How? We can increase the buffering factors associated with a reduced likelihood of memory problems (such as cognitive exercise, physical exercise, consumption of omega-3 fatty acids, and social engagement). We can also decrease the risk factors associated with an increased chance of memory problems (such as smoking, sedentary lifestyle, obesity, consumption of saturated fat, stress and poor sleep). In this article, we’ll focus mostly on the buffering factors, what the evidence shows about their impact, and how older adults can include them in their daily lives.


Cognitive stimulation

A significant amount of peer-reviewed, empirical and even randomized controlled research suggests that cognitive stimulation is associated with reliable decreases in the likelihood of developing dementia. The research can be messy. Many factors affect our cognitive ability, and those factors need to be controlled for, preferably with randomized controlled trials where people are assigned to an intervention group or a control group. Yet even studies using such methods have shortcomings because interventions often last a few weeks or months, rather than result in ongoing lifestyle change. Let’s look at some of the better designed studies that associate cognitive stimulation with better memory ability and lower chances of dementia.


In 2011 Zelinski et al. reported that cognitive training led to significant improvements in overall memory and attention and that those benefits persisted for several months after the training.


They also asserted that cognitive training benefits would last and would even affect areas not trained (e.g., medication compliance, remembering details of one’s day). They found that the benefits wane, however, so it is important that cognitive exercise be continued.2


At Western Oregon University, we conducted a study to assess the effectiveness of a cognitive stimulation program delivered three days a week to assisted-living residents relative to a control group in which we primarily exercised attention, word generation, and problem solving abilities. We were amazed by the results. The group engaged in the cognitive stimulation program had a 15% improvement in the ability to concentrate and make new memories.3


It appears that people with mild cognitive impairment4 and early stage dementia5 can also benefit from cognitive stimulation and training programs. In my experience, the type of cognitively stimulating activities people can do is affected by their level of memory impairment, and when people develop dementia, it is challenging for them to do the cognitive exercises that could help them. Therefore, time is of the essence. We need to identify people with earlier stages of memory impairment and give them opportunities to engage their minds. To this end, I recommend that every seniors center and senior living community, including assisted living and skilled nursing, offer a high-quality cognitive enhancement program and focus on motivating members to engage in activities. These types of programs are obviously good for older adults. In senior living environments, they also may attract more active residents, allow current residents to live at the same level of care longer, and be a powerful marketing tool that shows potential residents and their family members that the community cares about the well-being of those it serves.


This article is provided courtesy of the International Council on Active Aging