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Cognitive rehabilitation in the elderly: Effects on strategic behavior in relation to goal management

  • BRIAN LEVINE (a1) (a2) (a3), DONALD T. STUSS (a1) (a2) (a3) (a4), GORDON WINOCUR (a1) (a2) (a5) (a6), MALCOLM A. BINNS (a1), LOUISE FAHY (a1), MARINA MANDIC (a1), KRISTEN BRIDGES (a1) and IAN H. ROBERTSON (a1) (a7)...
Abstract

Executive functions are highly sensitive to the effects of aging and other conditions affecting frontal lobe function. Yet there are few validated interventions specifically designed to address executive functions, and, to our knowledge, none validated in a healthy aging sample. As part of a large-scale cognitive rehabilitation randomized trial in 49 healthy older adults, a modified Goal Management Training program was included to address the real-life deficits caused by executive dysfunction. This program emphasized periodic suspension of ongoing activity to establish goal hierarchies and monitor behavioral output. Tabletop simulated real-life tasks (SRLTs) were developed to measure the processes targeted by this intervention. Participants were randomized to two groups, one of which received the intervention immediately and the other of which was wait-listed prior to rehabilitation. Results indicated improvements in SRLT performance and self-rated executive deficits coinciding with the training in both groups. These gains were maintained at long-term follow-up. Future research will assess the specificity of these effects in patient groups (JINS, 2007, 13, 143–152.)

Copyright
Corresponding author
Correspondence and reprint requests to: Brian Levine, Ph.D., Rotman Research Institute, Baycrest, 3560 Bathurst St., Toronto, ON M6A 2E1, Canada. E-mail: blevine@rotman-baycrest.on.ca
References
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REFERENCES

Alderman, N., Burgess, P.W., Knight, C., & Henman, C. (2003). Ecological validity of a simplified version of the multiple errands shopping test. Journal of the International Neuropsychological Society, 9, 3144.
Burgess, P.W., Alderman, N., Evans, J., Emslie, H., & Wilson, B.A. (1998). The ecological validity of tests of executive function. Journal of the International Neuropsychological Society, 4, 547558.
Cicerone, K.D., Dahlberg, C., Kalmar, L., Langenbahn, D., Malec, J.F., Bergquist, T.F., Felicetti, T., Giacino, J.T., Harley, J.P., Harrington, D.E., Herzog, J., Kneipp, S., Laatsch, L., & Morse, P. (2000). Evidence-based cognitive rehabilitation: Recommendations for clinical practice. Archives of Physical Medicine and Rehabilitation, 81, 15961615.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.
Craik, F.I.M. & Grady, C.L. (2002). Aging, memory, and frontal lobe functioning. In D.T. Stuss & R. Knight (Eds.), Principles of frontal lobe function (pp. 528540). New York: Oxford University Press.
Craik, F.I.M., Winocur, G., Palmer, H., Binns, M.A., Edwards, M., Bridges, K., Glazer, P., Chavannes, R., & Stuss, D.T. (2007, this issue). Cognitive rehabilitation in the elderly: Effects on memory. Journal of the International Neuropsychological Society, 13, 132142.
Duncan, J. (1995). Attention, intelligence, and the frontal lobes. In M.S. Gazzaniga (Ed.), The cognitive neurosciences (pp. 721733). Cambridge, MA: MIT press.
Fleiss, J.L. (1981). Statistical methods for rates and proportions. Washington, DC: John Wiley & Sons, Inc.
Goel, V., Grafman, J., Tajik, J., Gana, S., & Danto, D. (1997). A study of the performance of patients with frontal lobe lesions in a financial planning task. Brain, 120, 18051822.
Grant, D.A. & Berg, E.A. (1948). A behavioral analysis of degree of reinforcement and ease of shifting to new responses in a Weigl-type card-sorting problem. Journal of Experimental Psychology, 38, 404411.
Green, R.E., Turner, G.R., & Thompson, W.F. (2004). Deficits in facial emotion perception in adults with recent traumatic brain injury. Neuropsychologia, 42, 133141.
Greenwood, P.M. (2000). The frontal aging hypothesis evaluated. Journal of the International Neuropsychological Society, 6, 705726.
Hashtroudi, S., Johnson, M.K., & Chrosniak, L.D. (1989). Aging and source monitoring. Psychology and Aging, 4, 106112.
Kausler, D.H. (1991). Thinking: Concept formation and identification. In Experimental psychology, cognition, and human aging (2nd ed.) (pp. 552595). New York: Springer-Verlag.
Levine, B., Robertson, I.H., Clare, L., Carter, G., Hong, J., Wilson, B.A., Duncan, J., & Stuss, D.T. (2000). Rehabilitation of executive functioning: An experimental-clinical validation of goal management training. Journal of the International Neuropsychological Society, 6, 299312.
Levine, B., Stuss, D.T., & Milberg, W.P. (1995). Concept generation: Validation of a test of executive functioning in a normal aging population. Journal of Clinical and Experimental Neuropsychology, 17, 740758.
Levine, B., Stuss, D.T., & Milberg, W.P. (1997). Effects of aging on conditional associative learning: Process analyses and comparison with focal frontal lesions. Neuropsychology, 11, 367381.
Levine, B., Stuss, D.T., Milberg, W.P., Alexander, M.P., Schwartz, M., & Macdonald, R. (1998). The effects of focal and diffuse brain damage on strategy application: Evidence from focal lesions, traumatic brain injury, and normal aging. Journal of the International Neuropsychological Society, 4, 247264.
Levine, B., Svoboda, E., Hay, J., Winocur, G., & Moscovitch, M. (2002). Aging and autobiographical memory: Dissociating episodic from semantic retrieval. Psychology and Aging, 17, 677689.
Raz, N. (2000). Aging of the brain and its impact on cognitive performance: Integration of structural and functional findings. In F.I.M. Craik & T.A. Salthouse (Eds.), The handbook of aging and cognition (2nd ed.) (pp. 190). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Robertson, I.H. (1996). Goal management training: A clinical manual. Cambridge, UK: PsyConsult.
Robertson, I.H. & Murre, J.M. (1999). Rehabilitation of brain damage: Brain plasticity and principles of guided recovery. Psychological Bulletin, 125, 544575.
Shallice, T. & Burgess, P.W. (1991). Deficits in strategy application following frontal lobe damage in man. Brain, 114, 727741.
Shrout, P.E. & Fleiss, J.L. (1979). Intraclass correlations: Uses in assessing rater reliability. Psychological Bulletin, 86, 420428.
Stuss, D.T. & Levine, B. (2002). Adult clinical neuropsychology: Lessons from studies of the frontal lobes. Annual Review of Psychology, 53, 401433.
Stuss, D.T., Levine, B., Alexander, M.P., Hong, J., Palumbo, C., Hamer, L., Murphy, K.J., & Izukawa, D. (2000). Wisconsin Card Sorting Test performance in patients with focal frontal and posterior brain damage: Effects of lesion location and test structure on separable cognitive processes. Neuropsychologia, 38, 388402.
Stuss, D.T., Robertson, I.H., Craik, F.I.M., Levine, B., Alexander, M.P., Black, S., Dawson, D., Binns, M.A., Palmer, H., Downey-Lamb, M., & Winocur G. (2007, this issue). Cognitive rehabilitation in the elderly: A randomized trial to evaluate a new protocol. Journal of the International Neuropsychological Society, 13, 120131.
Tranel, D., Anderson, S.W., & Benton, A. (1994). Development of the concept of “executive function” and its relationship to the frontal lobes. In F. Boller & J. Grafman (Eds.), Handbook of neuropsychology (Vol. 9) (pp. 125148). Amsterdam: Elsevier.
Turner, G.R. & Levine, B. (2004). Disorders of executive function and self-awareness. In J. Ponsford (Ed.), Rehabilitation of neurobehavioral disorders (pp. 224268). New York: Guilford Publications.
van Hooren, S.A.H., Valentijn, A.M., Bosma, H., Ponds, R.W.H.M., Boxtel, M.P.J.v., Levine, B., Robertson, I.H., & Jolles, J., (in press). Effect of a structured course involving Goal management training in older adults: A randomized controlled trial. Patient Education and Counseling.
Winocur, G., Craik, F.I.M., Levine, B., Robertson, I.H., Binns, M.A., Alexander, M.P., Black, S., Dawson, D., Palmer, H., Downey-Lamb, M., & Stuss, D.T. (2007b, this issue). Cognitive rehabilitation in the elderly: Overview and future directions. Journal of the International Neuropsychological Society, 13, 166171.
Winocur, G., Palmer, H., Dawson, D., Binns, M.A., Bridges, K., & Stuss, D.T. (2007a, this issue). Cognitive rehabilitation in the elderly: An evaluation of psychosocial factors. Journal of the International Neuropsychological Society, 13, 153165.
Zacks, R.T., Hasher, L., & Li, D.Z.H. (2000). Human memory. In F.I.M. Craik & T.A. Salthouse (Eds.), The handbook of aging and cognition (pp. 293357). Mahwah, NJ: Lawrence Erlbaum Associates.
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Journal of the International Neuropsychological Society
  • ISSN: 1355-6177
  • EISSN: 1469-7661
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