Objectives: Loneliness is a modifiable risk factor for depression and dementia in older age. Validated interventions are needed to mitigate the impact of loneliness in older adults. Some evidence suggests that mindfulness meditation may reduce stress, improve mood and cognitive function, and may also impact loneliness per se. Many meditation apps offer an accessible way to meditate at home. However, robust research is needed to assess the benefits of meditation using this technology for older adults. Muse is a meditation app that analyzes brain signals during meditation and provides users with real-time neurofeedback on their level offocus.

Methods: We conducted a pilot, randomized controlled trial to establish the acceptability and feasibility of a remote, mindfulness intervention using Muse in older adults, and to obtain preliminary data on its impact on mood and cognition. Twenty-six adults reporting feeling lonely were enrolled and randomized to an 8-week Muse- based meditation (MM) or a brain- training active control (BT) program. The MM group completed meditation sessions with real- time neurofeedback and guided meditation sessions using Muse. The BT group completed cognitively challenging games on the commercially available Peak app and listened to podcasts. The groups were matched on the amount of interactions with study staff and total program duration. Outcome measures included standardized self-report scales of loneliness, stress, depression, well-being, quality of life, sleep disturbance, resilience, and mindfulness. Staff blinded to program assignment administered cognitive tasks of episodic memory, working memory, and sustained attention, as well as a breath counting task. Assessments were taken at Pre, Mid, and Post intervention, and after a 2-month and 4-month (4M) follow-upperiod.

Results: Participants found both programs engaging and the remote assessments were feasible. The MM group showed a greater improvement in depressive symptoms, and psychological andphysical QOL, compared to the BT group, at Post and at 4M.

Conclusions: A Muse-based mindfulness program is an acceptable and accessible intervention for older adults. A large-scale randomized trial is warranted to evaluate the efficacy of this intervention in this group.

Background: The COVID-19 pandemic resulted in reduced patient access and deferral of medical services. Long wait times for patients to access specialized medical care became a challenge to health care systems. Baycrest is an academic health sciences centre in Toronto, Canada, that specializes in post-acute and ambulatory care for older adults. As a result of deferred care, wait times for the mental health services increased significantly. This compelled the ambulatory mental health program to apply quality improvement Methods to identify and prioritize care for the most unwell people on the waitlist, while avoiding duplication of referrals between hospitals. This study aimed to assess the utility and feasibility of this new process.

Methods: The quality process involved a Rapid Design Event approach, where the mental health programs created inclusion and exclusion eligibility criteria and established a priority system to assign patients to one of three categories based on need: high priority, routine, and decline. Identification of high priority referrals was meant to allow the most unwell patients to be seen sooner. The central navigation process was refined through quality improvement huddles and standard feedback mechanisms. After three weeks of trialing the process, a sustainability plan to move to operations was applied, and results were continuously monitored through reports and improvement board huddles.

Results: In the first 3 months of implementation, the percentage of patients receiving meaningful clinical contact within 14 days of referral increased from 3.8% to 82.3%, with contact by a clinician within an average of 4 days. Across the ambulatory mental health programs, wait times for psychogeriatric assessment for high priority patients improved from 141 days to 31.8days. Factors leading to the improvement will bediscussed.

Conclusions: The central navigation and extended triage processes were found to be feasible and of great utility. The high priority patients who needed to be assessed sooner were identified through an extended triage process. Meaningful clinical contact was made within days and wait times reduced for those most in need. This demonstrated how a quality improvement process can lead to significant improvements in health care delivery.

Objectives: Intraindividual variability increases with age, but the relative strength of association with cognitive domains is still unclear. The objective of this study was to examine the relation between cognitive domains and the shape and spread of response time (RT) distributions as indexed by intraindividual standard deviation (ISD), and ex-Gaussian parameters (μ, σ, τ). Methods: Healthy adults (40 young [aged 18–30 years], 40 young-old [aged 65–74 years], and 41 old-old [aged 75–85 years]) completed neuropsychological testing and a touch-screen attention task from which ISD and ex-Gaussian parameters were derived. The relation between RT performance and cognitive domains (memory, processing speed, executive functioning) was examined with structural equation modeling (SEM), and the predictive power of RT distribution indices over age was investigated with linear regression. Results:ISD, μ, and τ, but not σ, showed a linear increase with age group. An SEM showed that independent of age, τ was most strongly associated with executive functioning, while μ exhibited less critical associations. Linear regression indicated that μ and τ explained a significant portion of variance in processing speed and executive ability in addition to age group. Memory was more parsimoniously predicted by age, without any significant contribution of ex-Gaussian parameters. Conclusions: The findings suggest that exceptionally slow responses convey attention lapses through wavering of cognitive control, which strongly correspond to executive functioning tests. General slowing and extremely slow responses predicted processing speed and executive performance beyond age group, indicating that RT metrics are sensitive to differences in cognitive ability. (JINS, 2018, 24, 456–465)

The objective of the present study was to determine whether the consumption of ≥ 250 v. < 250 mg of the long-chain n-3 fatty acids (n-3 LCFA) per d is associated with a reduction in the risk of fatal and non-fatal CHD in individuals with no prior history of CHD. A comprehensive and systematic review of the published scientific literature resulted in the identification of eight prospective studies (seven cohorts and one nested case–control study) that met predefined inclusion criteria. Relative to the consumption of < 250 mg n-3 LCFA per d, the consumption of ≥ 250 mg/d was associated with a significant 35·1 % reduction in the risk of sudden cardiac death and a near-significant 16·6 % reduction in the risk of total fatal coronary events, while the risk of non-fatal myocardial infarction was not significantly reduced. In several meta-analyses, which were based on US studies, risk of CHD death was found to be dose-dependently reduced by the n-3 LCFA, with further risk reductions observed with intakes in excess of 250 mg/d. Prospective observational and intervention data from Japan, where intake of fish is very high, suggest that n-3 LCFA intakes of 900 to 1000 mg/d and greater may confer protection against non-fatal myocardial infarction. Thus, the intake of 250 mg n-3 LCFA per d may, indeed, be a minimum target to be achieved by the general population for the promotion of cardiovascular health.

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.)

This study reports the effects of a 12-week multimodular cognitive rehabilitation training program on memory performance in two groups of older adults. In the Memory Training module, participants were instructed on the nature of memory and how to improve memory performance; internal and external strategies were described and practiced over the training sessions. Memory performance was assessed by four tests: Alpha Span, Brown-Peterson, Hopkins Verbal Learning Test − Revised (HVLT-R), and Logical Stories. One group received training on entry into the study (Early Training Group, ETG), the other after a 3-month delay (Late Training Group, LTG). The results showed no training-related improvement in working memory (Alpha Span), primary memory (Brown-Peterson, HVLT-R), or recognition memory (HVLT-R). While the most direct analyses of a training effect (analyses of covariance) rarely demonstrated significant effects, exploratory analyses provided some evidence for a training benefit in several measures of secondary memory (Logical Stories; HVLT-R) and strategic processing (Brown-Peterson; Logical Stories; HVLT-R). Positive results were largely restricted to the ETG, possibly because the LTG lost motivation as a consequence of their delayed training. The results need to be treated with caution, but are promising for the rehabilitation of memory functioning in older adults (JINS, 2007, 13, 132–142.)

In this study, we report changes in psychosocial function in two groups of older adults that participated in the experimental trial of our cognitive rehabilitation program. The results, based on tests that measured a range of psychosocial attributes, showed that, following training, participants improved in terms of overall well-being, as well as in specific areas that included perceived happiness, coping strategies, and quality of life. An important finding was that improvements were also observed in long-term follow-up testing. Both groups benefited from training, but the effect was greater in the group that received training before undergoing a control procedure. The results, which show that the benefits of our rehabilitation program extend into the psychosocial domain, underscore the potentially important relationship between psychosocial factors and cognitive performance in older adults. (JINS, 2007, 13, 153–165.)

This study provides an introduction to, and overview of, several papers that resulted from a randomized control trial that evaluated a new cognitive rehabilitation protocol. The program was designed to improve general strategic abilities in ways that would be expressed in a broad range of functional domains. The trial, which was conducted on a sample of older adults who had experienced normal age-related cognitive decline, assessed performance in the following domains: memory, goal management, and psychosocial status. The general rationale for the trial, the overall experimental design, and the approach to statistical analyses that are relevant to each paper are described here. The results for each functional domain are reported in separate papers in this series (JINS, 2007, 13, 120–131.)

This study provides an overview of the papers emanating from the experimental trial that evaluated a new cognitive rehabilitation program in older adults who were experiencing normal cognitive decline. The main features of the design are summarized, along with evidence that the training produced long-lasting improvement in memory performance, goal management, and psychosocial status. The benefits were attributed to several factors, including the program's emphasis on techniques that promoted efficient strategic processing. Limitations of the program and directions for future research are discussed (JINS, 2007, 13, 166–171.)

Seventy-four patients with focal brain lesions were compared to a neurologically normal control group on tasks of letter-based and category-based list generation. When patients were divided only by right frontal, left frontal, or nonfrontal lesion sites, the pattern of fluency impairments confirmed prior claims. When more precise lesion sites within the frontal lobes were compared between groups classified based on their fluency performance, much more specific brain–behavior relations were uncovered. Damage to the right dorsolateral cortical or connecting striatal regions, the right posterior area, or the medial inferior frontal lobe of either hemisphere did not significantly affect letter-based fluency performance. Superior medial frontal damage, right or left, resulted in moderate impairment. Patients with left dorsolateral and/or striatal lesions were most impaired. Left parietal damage led to performance relatively equivalent to the superior medial and left dorsolateral groups. The same lesion sites produced impairments in category based fluency, but so did lesions of right dorsolateral and inferior medial regions. Task analysis and correlations with other measures revealed that different cognitive processes related to different brain regions underlie performance on verbal fluency tests. (JINS, 1998, 4, 265–278.)