韓 笑 石岱青 周曉文 楊穎華 朱祖德

(1華南師范大學(xué)心理學(xué)院, 廣州 510631) (2江蘇師范大學(xué)語言科學(xué)與藝術(shù)學(xué)院; 語言能力協(xié)同創(chuàng)新中心;江蘇省語言科學(xué)與神經(jīng)認(rèn)知工程重點(diǎn)實(shí)驗(yàn)室, 徐州 221116)

1 引言

認(rèn)知能力是指人腦加工、儲(chǔ)存、提取信息的能力, 是保證人們成功完成活動(dòng)的重要心理?xiàng)l件。大量研究表明, 隨著年齡增長(zhǎng)成年人的認(rèn)知能力逐漸出現(xiàn)衰退, 如反應(yīng)遲緩、記憶力衰退、抗干擾能力減弱等等(L?vdén, B?ckman, Lindenberger,Schaefer, & Schmiedek, 2010)。認(rèn)知能力的老化直接影響到老年人的日常生活, 如做飯、理財(cái)、就醫(yī)、外出等(彭華茂, 王大華, 2012)。部分老年人的認(rèn)知功能下降甚至可能會(huì)進(jìn)一步發(fā)展為輕度認(rèn)知障礙(mild cognitive impairment, MCI)、阿茨海默病(Alzheimer disease, AD)。這些問題隨著中國老年化比率逐年上升而日益突出(劉頌, 2014)。

值得慶幸的是, 越來越多的研究表明, 認(rèn)知訓(xùn)練能夠緩解認(rèn)知衰退的趨勢(shì)(Kelly et al., 2014;李旭, 杜新, 陳天勇, 2014)。認(rèn)知訓(xùn)練要求被試完成一定時(shí)間的認(rèn)知任務(wù)以提高個(gè)體某種認(rèn)知能力。已有研究發(fā)現(xiàn), 認(rèn)知訓(xùn)練能夠提升老年人的認(rèn)知能力(李旭等, 2014)。早期的研究大多試圖提升老年人加工速度, 或使用再認(rèn)、回想等記憶任務(wù)和記憶策略以提高老年人的記憶能力(Ball,Edwards, & Ross, 2007; Deary, Johnson, & Starr,2010; Engvig et al., 2012)。近幾年來, 隨著研究發(fā)現(xiàn)認(rèn)知訓(xùn)練能夠有效遷移到流體智力上(Sternberg, 2008), 針對(duì)老年人開展的認(rèn)知控制訓(xùn)練(Anguera et al., 2013), 如工作記憶更新、注意轉(zhuǎn)換、雙任務(wù)切換等的研究日益增多。有研究發(fā)現(xiàn)認(rèn)知訓(xùn)練能提升未訓(xùn)練認(rèn)知任務(wù)的成績(jī)(Lustig,Shah, Seidler, & Reuter-Lorenz, 2009; Vaughan &Giovanello, 2010), 甚至對(duì)老年人的日常生活能力產(chǎn)生長(zhǎng)久的積極影響(Rebok et al., 2014)。

本文通過對(duì)近7年來關(guān)于老年人認(rèn)知能力干預(yù)研究的梳理總結(jié), 比較了認(rèn)知干預(yù)的時(shí)間、使用的訓(xùn)練范式、涉及的訓(xùn)練領(lǐng)域等; 并探討了干預(yù)的具體效果, 包括對(duì)訓(xùn)練效果、訓(xùn)練對(duì)未訓(xùn)練任務(wù)的遷移及訓(xùn)練效果保持的比較。最后, 對(duì)未來的研究方向進(jìn)行了總結(jié)和展望。

2 文獻(xiàn)來源

2.1 文獻(xiàn)搜索

自2008年Sternberg發(fā)表評(píng)論文章提出認(rèn)知訓(xùn)練能夠遷移到流體智力上后, 認(rèn)知訓(xùn)練的相關(guān)研究迅速增多。為此, 本文統(tǒng)計(jì)分析了從2008年到 2014 年間發(fā)表的關(guān)于健康老年人認(rèn)知能力訓(xùn)練的英文文獻(xiàn), 使用的數(shù)據(jù)庫主要有 PubMed、LISTA (Library, Information Science & Technology Abstracts)、Library of Congress、Web of Science,用到的關(guān)鍵詞有：ageing或aging或healthy elderly和cognitive training或intervention 或stimulation或brain training等。

2.2 納入標(biāo)準(zhǔn)

(1) 研究主要關(guān)注對(duì)老年人的認(rèn)知干預(yù)是否有效, 包括具體的認(rèn)知訓(xùn)練方法, 訓(xùn)練持續(xù)時(shí)間、訓(xùn)練組和相匹配的控制組、訓(xùn)練結(jié)果等信息。

(2) 研究中的被試為健康老年人。

(3) 研究中含有一致的訓(xùn)練前后的認(rèn)知能力評(píng)估指標(biāo)。

2.3 排除標(biāo)準(zhǔn)

(1) 研究中沒有涉及認(rèn)知干預(yù)方法, 或不是以對(duì)老年人的認(rèn)知訓(xùn)練為主要研究目的。

(2) 研究中的被試為輕度認(rèn)知障礙、老年抑郁、老年癡呆患者等非健康老年人。

(3) 研究中的被試群體為特殊群體, 如退役軍人(部分有戰(zhàn)爭(zhēng)創(chuàng)傷)。

(4) 研究為個(gè)案研究。

2.4 搜索結(jié)果

根據(jù)以上文獻(xiàn)搜索和篩選, 整理出 101篇關(guān)于健康老年人的認(rèn)知能力訓(xùn)練的研究。在前人研究的基礎(chǔ)上, 本文主要關(guān)注認(rèn)知干預(yù)的具體訓(xùn)練方法、不同方法起到的訓(xùn)練和遷移效果是否存在差異, 以探討更加適用于老年人且更加貼近老年人日常生活的認(rèn)知干預(yù)手段。

3 研究結(jié)果

從 2008年到 2014年間, 針對(duì)老年人認(rèn)知能力的各類認(rèn)知干預(yù)研究逐漸增多, 研究數(shù)量呈增長(zhǎng)趨勢(shì), 這些研究中老年人的年齡范圍集中在49～84歲, 平均年齡為 70.3歲。本研究對(duì)每篇文獻(xiàn)所做分析總結(jié)見本文電子版附表1中。

3.1 認(rèn)知訓(xùn)練的具體方法

3.1.1 訓(xùn)練時(shí)間

本研究整理了這101篇文章的訓(xùn)練時(shí)間。以小時(shí)為單位提取文章中的訓(xùn)練時(shí)間, 發(fā)現(xiàn)訓(xùn)練持續(xù)時(shí)間最短為0.5小時(shí), 最長(zhǎng)為150小時(shí), 平均為20.7小時(shí), 中位數(shù)和眾數(shù)都是12小時(shí)(見圖1)。

3.1.2 訓(xùn)練組的設(shè)置

大部分研究設(shè)置了訓(xùn)練組和控制組, 這避免了“安慰劑效應(yīng)”等無關(guān)因素的干擾?？刂平M又分為無接觸控制組(no contact control group)和積極控制組(active control group)兩種。無接觸控制組指被試僅參與前后測(cè)的認(rèn)知評(píng)估, 在實(shí)驗(yàn)期間沒有進(jìn)行與訓(xùn)練相關(guān)的活動(dòng)。積極控制組指被試除了參與前后測(cè)評(píng)估, 在實(shí)驗(yàn)期間也進(jìn)行訓(xùn)練活動(dòng),但與訓(xùn)練組的區(qū)別是積極控制組所進(jìn)行的活動(dòng)認(rèn)知負(fù)荷低或進(jìn)行的是與訓(xùn)練任務(wù)無關(guān)的活動(dòng)(Ball et al., 2002)。101篇文章中有88篇設(shè)置了控制組,其中52篇設(shè)置了積極控制組, 36篇設(shè)置了無接觸控制組, 其中有10篇文章同時(shí)包括積極控制組和無接觸控制組。近年來, 越來越多的研究選用積極控制組作為實(shí)驗(yàn)組的對(duì)照(見圖2)。本文所分析的研究均采用隨機(jī)分組(randomized controlled trials)的方法分配被試。

圖1 選取文章中采用的訓(xùn)練時(shí)長(zhǎng)

圖2 選取文章中采用自適應(yīng)任務(wù)和積極控制組的文章數(shù)量

3.1.3 訓(xùn)練任務(wù)難度的設(shè)定

有 73篇文章采用了自適應(yīng)方式(adaptive training)設(shè)置任務(wù)難度, 即在整個(gè)訓(xùn)練過程中, 根據(jù)被試任務(wù)成績(jī)變化相應(yīng)調(diào)整任務(wù)難度的高低,個(gè)體當(dāng)前的任務(wù)操作完成得越好, 下一階段的任務(wù)難度就越大。近年來, 采取自適應(yīng)范式的研究逐漸增多, 見圖2所示。有研究認(rèn)為, 與固定任務(wù)難度水平的訓(xùn)練相比, 這種自適應(yīng)性的訓(xùn)練任務(wù)更加有利于訓(xùn)練效應(yīng)的發(fā)生(Brehmer, Westerberg,& B?ckman, 2012)。

3.1.4 涉及到的訓(xùn)練領(lǐng)域

以訓(xùn)練目的和訓(xùn)練任務(wù)為標(biāo)準(zhǔn), 這 101篇文章所涉及的訓(xùn)練領(lǐng)域大約可以劃分為5個(gè)：關(guān)于加工速度訓(xùn)練的文章5篇; 記憶訓(xùn)練的文章11篇;認(rèn)知控制訓(xùn)練的文章 32篇; 身體鍛煉的文章 10篇; 綜合認(rèn)知能力訓(xùn)練的文章33篇, 同時(shí)包括身體鍛煉和認(rèn)知能力訓(xùn)練的文章10篇(見圖3、電子版附表1)。其中, 近幾年來, 關(guān)于認(rèn)知控制訓(xùn)練和綜合認(rèn)知訓(xùn)練的研究較多, 身體鍛煉和認(rèn)知訓(xùn)練相結(jié)合的干預(yù)方式呈現(xiàn)出明顯的增長(zhǎng)。

(1) 加工速度

加工速度與認(rèn)知老化關(guān)系密切(Lindenberger,Mayr, & Kliegl, 1993)。一般認(rèn)為加工速度包括感覺運(yùn)動(dòng)速度、知覺速度和認(rèn)知速度三個(gè)層次, 在實(shí)驗(yàn)研究中一般通過測(cè)量個(gè)體的感覺運(yùn)動(dòng)速度和知覺速度來反映其加工速度(李德明, 劉昌, 陳天勇, 李貴蕓, 2003)。

圖3 選取文章中涉及到的訓(xùn)練領(lǐng)域

早期關(guān)于老年人認(rèn)知功能衰退的理論認(rèn)為,成人的認(rèn)知操作速度隨年齡增長(zhǎng)而減慢是流體認(rèn)知功能發(fā)生老化的主要原因(Salthouse, 1995)。在此基礎(chǔ)上, 研究者進(jìn)行了相應(yīng)的關(guān)于老年人加工速度的干預(yù)訓(xùn)練, 一般使用視覺搜索(visual search)、動(dòng)態(tài)目標(biāo)追蹤(target tracking speed)、視/聽差異刺激辨別(discrimination)等訓(xùn)練范式, 即訓(xùn)練老年人的視聽覺加工速度和相應(yīng)的感知覺靈敏度(Anderson, White-Schwoch, Choi, & Kraus,2014; Berry et al., 2010; Edwards et al., 2015)。

(2) 記憶

記憶是在頭腦中積累和保存?zhèn)€體經(jīng)驗(yàn)的心理過程, 即人腦對(duì)外界輸入信息的編碼、儲(chǔ)存、提取過程, 與其他心理活動(dòng)密切相關(guān), 是個(gè)體認(rèn)知功能的重要組成部分(彭聃齡, 2001)。而在老年人出現(xiàn)老化和下降的認(rèn)知功能中, 記憶的衰退最為明顯, 甚至對(duì)于部分罹患老年癡呆的老年人來說,記憶力的損傷程度和衰退速度都更為嚴(yán)重(Grady,2012)?；诖? 老年人的記憶訓(xùn)練研究在認(rèn)知訓(xùn)練研究中占有重要地位。當(dāng)前記憶訓(xùn)練主要是練習(xí)如何使用各種具體的記憶策略, 旨在提升認(rèn)知資源的使用技巧, 包括視覺材料的延遲再認(rèn)(verbal delayed-response)、地圖作業(yè)訓(xùn)練或位置法(visualize mental landmarks or loci)、復(fù)述訓(xùn)練(memory task of rehearse)等(見電子版附表1)。

(3) 認(rèn)知控制

認(rèn)知控制(cognitive control)是指?jìng)€(gè)體在完成復(fù)雜的認(rèn)知任務(wù)時(shí), 對(duì)各種基本認(rèn)知過程進(jìn)行協(xié)調(diào)和控制的過程, 包含工作記憶的提取協(xié)調(diào)、對(duì)自動(dòng)化提取的抑制、提取策略的不斷更新、注意控制和選擇等多個(gè)子成分(Duncan & Owen, 2000)。認(rèn)知控制衰退假說是認(rèn)知老化的主要理論之一,它認(rèn)為認(rèn)知控制的衰退是引起認(rèn)知老化的主要原因(陳天勇, 韓布新, 羅躍嘉, 李德明, 2004)。

近年來, 隨著認(rèn)知控制及相關(guān)理論的提出,對(duì)工作記憶、任務(wù)切換等各種認(rèn)知控制的訓(xùn)練干預(yù)逐漸成為一個(gè)新的研究熱點(diǎn)(杜新, 陳天勇,2010)。已有研究表明, 老年人的認(rèn)知控制及其相關(guān)腦區(qū)(主要為前額葉)存在可塑性, 通過一定的認(rèn)知訓(xùn)練可以緩解老年人認(rèn)知控制的衰退, 并引發(fā)相應(yīng)的大腦結(jié)構(gòu)和功能改變(Anguera et al.,2013; Blumen, Gopher, Steineman, & Stern, 2010;Dahlin, Nyberg, B?ckman, & Neely, 2008; Wang,Chang, & Su, 2011)。部分研究也發(fā)現(xiàn)認(rèn)知控制訓(xùn)練可以對(duì)其他認(rèn)知能力產(chǎn)生一定的遷移效應(yīng)(Cassavaugh & Kramer, 2009; Mozolic, Long, Morgan,Rawley-Payne, & Laurienti, 2011; Richmond, Morrison,Chein, & Olson, 2011; Smith et al., 2009)。

(4) 身體鍛煉

根據(jù)鍛煉時(shí)的心率標(biāo)準(zhǔn), 身體鍛煉可以分為有氧鍛煉(aerobic exercise)和無氧鍛煉(anaerobic exercise)兩類。前者指人體在氧氣充分供應(yīng)的情況下, 動(dòng)用身體的主要肌群進(jìn)行有規(guī)律的長(zhǎng)時(shí)間運(yùn)動(dòng), 心率基本保持在 150次/分鐘, 所耗能量主要來自細(xì)胞內(nèi)的有氧代謝, 如跳舞、慢跑、騎自行車等(Coubard, Duretz, Lefebvre, Lapalus, & Ferrufino, 2010;Li et al., 2014); 后者指人體在“缺氧”狀態(tài)下的高速劇烈運(yùn)動(dòng), 耗用能量來自身體糖分的無氧酵解,如短跑沖刺、投擲、肌力訓(xùn)練等(Treuth et al., 1994;Vandewalle, Péerès, & Monod, 1987)。長(zhǎng)期以來對(duì)老年人的體能鍛煉的研究多以快走、慢跑、健身操等有氧運(yùn)動(dòng)為主(鍛煉負(fù)荷一般為最大心率的 50%～65%, 即適宜心率為110次/分鐘) (許浩等, 2009)。

盡管身體鍛煉本身不是認(rèn)知訓(xùn)練, 但已有研究認(rèn)為, 有規(guī)律地參加鍛煉, 不僅能促進(jìn)身體健康, 提高運(yùn)動(dòng)能力, 而且有利于減緩老年人認(rèn)知功能的衰退(Chapman et al., 2013; Nouchi et al.,2014), 甚至引發(fā)與訓(xùn)練相關(guān)的神經(jīng)可塑性變化,如通過促進(jìn)與認(rèn)知功能相關(guān)腦區(qū)的激活及功能網(wǎng)絡(luò)的聯(lián)結(jié)(Burdette et al., 2010)、增加大腦特定區(qū)域血流量(Chapman et al., 2013)、維持老年人大腦灰質(zhì)和白質(zhì)完整性(Boyke, Driemeyer, Gaser,Büchel, & May, 2008)等, 對(duì)延緩認(rèn)知老化和改善老年人的行為表現(xiàn)有著積極影響(杜新, 陳天勇,2010; 張連成, 高淑青, 2014)。此外, 研究者也提出了其它可能的機(jī)制, 如身體鍛煉通過提升身體資源(如改善飲食和睡眠; 減少慢性疾病), 改善心理資源(如減緩抑郁、焦慮及慢性壓力; 提高自我效能)等途徑對(duì)老年人的認(rèn)知功能產(chǎn)生積極影響(Elavsky & McAuley, 2005; 郭璐, 毛志雄,2014)。在研究身體鍛煉對(duì)認(rèn)知老化的緩解作用時(shí)也應(yīng)考慮到這些機(jī)制可能存在的影響, 考察其是否是訓(xùn)練效果的中介或調(diào)節(jié)變量。

(5) 綜合認(rèn)知訓(xùn)練

老年人隨年齡增長(zhǎng)往往出現(xiàn)多種認(rèn)知能力的衰退, 一些研究采用綜合認(rèn)知訓(xùn)練以改善老年人的認(rèn)知能力, 即訓(xùn)練任務(wù)同時(shí)包含對(duì)加工速度、認(rèn)知控制、記憶等兩個(gè)或兩個(gè)以上認(rèn)知能力的訓(xùn)練, 或同時(shí)進(jìn)行身體鍛煉。

相比于單一的認(rèn)知能力訓(xùn)練, 多種認(rèn)知領(lǐng)域相結(jié)合的訓(xùn)練方式更貼近于日常生活中需要同時(shí)調(diào)用多種認(rèn)知能力的實(shí)際情境, 且對(duì)老年人認(rèn)知能力的整體協(xié)調(diào)性和功能全面性要求較高, 有利于有效減緩年老化相關(guān)的認(rèn)知功能衰退, 并為訓(xùn)練效果對(duì)日常生活能力的遷移奠定了良好基礎(chǔ)(Peretz et al., 2011; Whitlock, McLaughlin, &Allaire, 2012; Zelinski, Peters, Hindin, Petway, &Kennison, 2014)。

2.1 建園栽植 栽樹前對(duì)全園進(jìn)行深翻處理，深度60～70 cm，每畝施入腐熟有機(jī)肥3 m3加硫酸鉀復(fù)合肥50 kg。按照4 m×1.5～2 m的株行距起壟栽植。栽植后立即澆透水，5天后再澆1次透水，然后覆蓋黑色地膜。

3.2 訓(xùn)練效果

3.2.1 認(rèn)知可塑性

本文主要從訓(xùn)練效應(yīng)、效應(yīng)的保持和遷移三個(gè)方面考察訓(xùn)練效果, 即個(gè)體能否通過訓(xùn)練提高認(rèn)知任務(wù)的行為成績(jī)。首先, 在訓(xùn)練效應(yīng)上, 納入的101篇文章在對(duì)健康老年人的認(rèn)知干預(yù)中都獲得了較好的訓(xùn)練效應(yīng), 即訓(xùn)練組的老年人經(jīng)過一定時(shí)間的認(rèn)知干預(yù)后其認(rèn)知能力都有一定程度的提高。其次, 有27篇文章報(bào)告有訓(xùn)練效應(yīng)的保持。這些研究有10篇采用了認(rèn)知控制訓(xùn)練, 9篇采用了綜合認(rèn)知能力訓(xùn)練, 2篇采用了加工速度訓(xùn)練, 3篇采用了身體鍛煉, 3篇采用了記憶訓(xùn)練。大部分實(shí)驗(yàn)在考查效果保持時(shí)都采用了較短的時(shí)間間隔(1年以內(nèi)的有 19篇)進(jìn)行測(cè)量, 少數(shù)研究采用了較長(zhǎng)的時(shí)間間隔(3～5年的7篇, 10年的1篇)。其中, 考慮到隨著年齡增長(zhǎng)老年人認(rèn)知老化的程度會(huì)進(jìn)一步加重, 對(duì)其一般認(rèn)知能力的評(píng)估容易出現(xiàn)地板效應(yīng), 一些長(zhǎng)時(shí)間間隔的研究還以基本生活能力(如使用日常生活能力量表 Activity of Daily Living Scale進(jìn)行測(cè)量)考察認(rèn)知訓(xùn)練的作用, 且有研究發(fā)現(xiàn)訓(xùn)練對(duì)老年人基本生活能力衰退的延緩作用甚至可以持續(xù)10年之久(Rebok et al., 2014)。

訓(xùn)練時(shí)間的長(zhǎng)短可能對(duì)訓(xùn)練效果產(chǎn)生不同的影響。為此我們將文獻(xiàn)相對(duì)較多的認(rèn)知控制訓(xùn)練和綜合認(rèn)知能力訓(xùn)練的研究按訓(xùn)練時(shí)間分為長(zhǎng)于12小時(shí)和短于12小時(shí)兩組(12小時(shí)為統(tǒng)計(jì)出的訓(xùn)練時(shí)間的中位數(shù)), 結(jié)果發(fā)現(xiàn), 訓(xùn)練時(shí)間較長(zhǎng)的研究更多地報(bào)告了訓(xùn)練效應(yīng)的保持(11篇, 8篇)、近遷移(25篇, 14篇)和遠(yuǎn)遷移(16篇, 6篇)。這一結(jié)果與前人的元分析研究中發(fā)現(xiàn)的訓(xùn)練時(shí)間較長(zhǎng)的研究其效果量較小(Li et al, 2010; Toril, Reales, &Ballesteros, 2014)的結(jié)論不一致, 這種差異可能是由于我們根據(jù)定性數(shù)據(jù)(是否有保持或遷移)統(tǒng)計(jì)文章數(shù)量, 而元分析研究中采用定量數(shù)據(jù)(即每篇文章的效果量)進(jìn)行分析。

訓(xùn)練效果的遷移效應(yīng)主要指由訓(xùn)練帶來的目標(biāo)能力的改善能否運(yùn)用到新的任務(wù)情景中去。根據(jù)遷移的范圍大小, 把遷移劃分為：近遷移與遠(yuǎn)遷移(Karbach & Kray, 2009)兩種類型。近遷移(near transfer)是指遷移任務(wù)與訓(xùn)練任務(wù)涉及的認(rèn)知能力相同; 遠(yuǎn)遷移(far transfer)是指遷移任務(wù)與訓(xùn)練任務(wù)所涉及的認(rèn)知能力不同, 或者是對(duì)日常生活能力的遷移(杜新, 陳天勇, 2010)。以往研究認(rèn)為, 大多數(shù)認(rèn)知訓(xùn)練產(chǎn)生的遷移較少, 且大多限于某一認(rèn)知加工的近遷移(Redick et al., 2013)。在101篇文章中, 有47篇報(bào)告了近遷移效應(yīng), 27篇報(bào)告了遠(yuǎn)遷移效應(yīng), 且不同的訓(xùn)練方法在遷移效應(yīng)上存在一定的差異。如圖 4所示, 在記憶、身體鍛煉的訓(xùn)練上出現(xiàn)的近、遠(yuǎn)遷移都較少, 而加工速度、認(rèn)知控制、綜合認(rèn)知訓(xùn)練出現(xiàn)的近、遠(yuǎn)遷移較多。其中采用認(rèn)知控制訓(xùn)練的研究報(bào)告了最多的近遷移和遠(yuǎn)遷移。

為了更進(jìn)一步探明不同訓(xùn)練任務(wù)對(duì)遷移效應(yīng)的具體影響, 根據(jù)文章中研究者對(duì)近遷移、遠(yuǎn)遷移的分類, 把遷移效果進(jìn)一步細(xì)分到加工速度、認(rèn)知控制、記憶、身體鍛煉和綜合認(rèn)知訓(xùn)練這 5個(gè)認(rèn)知領(lǐng)域, 并與其訓(xùn)練任務(wù)相對(duì)應(yīng), 結(jié)果見圖5。圖5 A、B分別顯示了不同訓(xùn)練任務(wù)對(duì)不同認(rèn)知領(lǐng)域產(chǎn)生的近遷移和遠(yuǎn)遷移, 結(jié)果發(fā)現(xiàn), 對(duì)于加工速度來說, 認(rèn)知控制訓(xùn)練、身體鍛煉和綜合認(rèn)知訓(xùn)練能夠產(chǎn)生較多的近遷移和遠(yuǎn)遷移效應(yīng);對(duì)于認(rèn)知控制來說, 認(rèn)知控制領(lǐng)域內(nèi)的訓(xùn)練項(xiàng)目、記憶訓(xùn)練和綜合認(rèn)知訓(xùn)練能夠產(chǎn)生較多的近遷移和遠(yuǎn)遷移; 綜合認(rèn)知能力和日常生活能力的提升主要來自認(rèn)知控制和綜合認(rèn)知訓(xùn)練; 而對(duì)于記憶來說, 主要從認(rèn)知控制訓(xùn)練得到一些近遷移效果。需要指出的是, 近遷移和遠(yuǎn)遷移的劃分在不同的研究中可能存在不同的劃分標(biāo)準(zhǔn), 如對(duì)某項(xiàng)認(rèn)知能力的評(píng)估究竟應(yīng)該劃分為近遷移還是遠(yuǎn)遷移, 不同的研究者可能有不同的判斷標(biāo)準(zhǔn), 因此在對(duì)訓(xùn)練的遷移效應(yīng)進(jìn)行比較和分析的同時(shí)還需結(jié)合實(shí)際情況和文獻(xiàn)研究謹(jǐn)慎得出結(jié)論。

圖4 各個(gè)訓(xùn)練領(lǐng)域報(bào)告出訓(xùn)練保持和遷移效應(yīng)的文章比例

圖5 訓(xùn)練對(duì)不同領(lǐng)域的遷移效應(yīng)

3.2.2 神經(jīng)可塑性

除了在行為水平上表現(xiàn)出來的認(rèn)知可塑性,研究者利用多種技術(shù)手段如腦電(Electroencephalography, EEG或event-related potentials, ERPs),正電子斷層掃描(positron emission tomography,PET)、功能和結(jié)構(gòu)核磁共振(functional/ structural magnetic resonance imaging, MRI)和彌散張量成像(diffusion tensor imaging, DTI)等, 結(jié)合多種指標(biāo), 如腦電波幅、腦血流量(cerebral blood flow,CBF)、局部腦活動(dòng)強(qiáng)度、功能聯(lián)結(jié)或功能網(wǎng)絡(luò)、灰質(zhì)密度(gray matter density)或厚度(cortical thickness)、白質(zhì)纖維(white matter)完整性等, 在腦的功能水平和結(jié)構(gòu)水平上發(fā)現(xiàn)了與訓(xùn)練相關(guān)的神經(jīng)可塑性證據(jù)(杜新, 陳天勇, 2010)。

如電子版附表 2所示, 研究發(fā)現(xiàn)認(rèn)知訓(xùn)練引發(fā)的相關(guān)神經(jīng)指標(biāo)的變化主要包括ERP波幅的變化(Anguera et al., 2013; Mishra, de Villers-Sidani,Merzenich, & Gazzaley, 2014; Wild-Wall, Falkenstein,& Gajewski, 2012; Berry et al., 2010)、灰質(zhì)密度/厚度增加(Boyke et al., 2008; Engvig et al., 2010;L?vdén et al., 2012; Mozolic, Hayaska, & Laurienti,2010; Pieramico et al., 2012)、白質(zhì)纖維完整性增強(qiáng)(Engvig et al., 2012; L?vdén et al., 2010; L?vdén et al., 2012)、功能網(wǎng)絡(luò)聯(lián)結(jié)增強(qiáng)(Burdette et al.,2010; Li et al., 2014; Voss et al., 2010)等。此外也有研究發(fā)現(xiàn)認(rèn)知訓(xùn)練提升了大腦血流量(Burdette et al., 2010; Chapman et al., 2013; Mozolic et al.,2010)和能量代謝水平(Shah et al., 2014)。在功能激活上, 有些研究發(fā)現(xiàn)了大腦局部活動(dòng)強(qiáng)度的增加(Belleville, Mellah, de Boysson, Demonet, & Bier,2014; Brehmer et al., 2011; Kirchhoff, Annderson,Smith, Barch, & Jacoby, 2012; Miotto et al., 2014;Voelcker-Rehage, Godde, & Staudinger, 2011), 也有研究發(fā)現(xiàn)大腦活動(dòng)強(qiáng)度的減低(Belleville et al.,2014; Brehmer et al., 2011; Voelcker-Rehage et al.,2011)。值得注意的是, 認(rèn)知訓(xùn)練所引發(fā)的這些大腦功能和結(jié)構(gòu)變化與行為成績(jī)改變或訓(xùn)練水平提升存在著顯著相關(guān)性, 詳見本文電子版附表2。此外,訓(xùn)練前的大腦功能和結(jié)構(gòu)基線水平也影響到了訓(xùn)練的提升(Yin et al., 2014)和遷移(Wolf et al., 2014)。

4 總結(jié)和展望

4.1 訓(xùn)練方法的多樣性

對(duì)健康老年人的認(rèn)知訓(xùn)練涵蓋多領(lǐng)域的認(rèn)知訓(xùn)練方法和多種實(shí)現(xiàn)途徑。隨著網(wǎng)絡(luò)技術(shù)的發(fā)展,使用傳統(tǒng)紙筆式、卡片式訓(xùn)練方法的研究越來越少, 而采用電子游戲訓(xùn)練的研究越來越多, 即采取一定的認(rèn)知訓(xùn)練任務(wù)設(shè)計(jì)電子游戲軟件, 使老年人可以在家通過個(gè)人電腦、平板電腦或手機(jī)等終端進(jìn)行訓(xùn)練(Smith et al., 2009; Peretz et al., 2011;van Muijden, Band, & Hommel, 2012)。而在訓(xùn)練的認(rèn)知領(lǐng)域方面, 從加工速度、記憶策略、認(rèn)知控制到綜合認(rèn)知能力都有所涵蓋, 其中認(rèn)知控制訓(xùn)練和綜合認(rèn)知能力訓(xùn)練所占的比重越來越大。

從身體鍛煉的研究來看, 鍛煉提高了大腦血流量和功能聯(lián)結(jié)強(qiáng)度, 甚至有利于改善老年人的認(rèn)知能力, 未來的干預(yù)研究在訓(xùn)練老年人認(rèn)知能力的同時(shí)也可以適當(dāng)增加身體鍛煉作為輔助。與單一認(rèn)知能力的訓(xùn)練任務(wù)相比, 多種能力相結(jié)合的綜合性訓(xùn)練更有利于遷移效應(yīng)的發(fā)生。另外,宜結(jié)合電子游戲設(shè)計(jì)出具有一定生活情境、與日常生活能力相關(guān)的訓(xùn)練任務(wù), 以提高訓(xùn)練的生態(tài)效度, 更好地促進(jìn)訓(xùn)練效果對(duì)日常生活能力的遷移。

4.2 訓(xùn)練評(píng)價(jià)指標(biāo)的多元性

多數(shù)研究都認(rèn)為認(rèn)知訓(xùn)練可以延緩老年人認(rèn)知功能衰退, 當(dāng)用于評(píng)估訓(xùn)練效果的實(shí)驗(yàn)任務(wù)涉及到流體智力如認(rèn)知控制, 或與訓(xùn)練任務(wù)要求的認(rèn)知過程較一致時(shí), 容易發(fā)現(xiàn)訓(xùn)練效果(Park &Bischof, 2013)。當(dāng)訓(xùn)練任務(wù)能夠不斷挑戰(zhàn)個(gè)體認(rèn)知能力時(shí), 個(gè)體的認(rèn)知能力才會(huì)提高(Park,Gutchess, Meade, & Stine-Morrow, 2007)。但由于認(rèn)知功能特別是認(rèn)知控制包含不同的子成分, 不同研究采用的認(rèn)知功能的評(píng)定指標(biāo)和測(cè)量方法的差異較大, 從本文的總結(jié)來看, 報(bào)告近遷移和遠(yuǎn)遷移的文章數(shù)量并未占據(jù)絕對(duì)優(yōu)勢(shì), 說明對(duì)訓(xùn)練效果的評(píng)估仍然存在分歧。

這種分歧在一定程度上與大部分研究都采用行為成績(jī)作為實(shí)驗(yàn)效果的評(píng)價(jià)標(biāo)準(zhǔn)有關(guān)。盡管行為成績(jī)作為評(píng)定標(biāo)準(zhǔn)具有易操作、易被訓(xùn)練者認(rèn)知等優(yōu)勢(shì), 但行為成績(jī)本身也容易受到個(gè)體動(dòng)作技能衰退的影響, 如老年人的肌肉退化等, 可能會(huì)混入對(duì)老年人認(rèn)知功能的評(píng)估中。此外, 大部分的訓(xùn)練研究持續(xù)時(shí)間相對(duì)較短, 訓(xùn)練效果可能已經(jīng)發(fā)生但還無法體現(xiàn)在行為成績(jī)上。

事實(shí)上, 行為成績(jī)上未能觀察到的訓(xùn)練效果可在認(rèn)知神經(jīng)指標(biāo)上觀察到。近年來, 隨著認(rèn)知神經(jīng)科學(xué)的發(fā)展, 特別是腦電和功能磁共振成像的發(fā)展和應(yīng)用, 為更加精細(xì)量化地探測(cè)認(rèn)知老化的神經(jīng)機(jī)制及其可塑性提供了安全、有效的技術(shù)支持, 并為進(jìn)一步研究大腦在認(rèn)知過程中的活動(dòng)特征提供了較好的生理探測(cè)手段(李婷, 李春波,2013)。

根據(jù)電子版附表 2對(duì)相關(guān)文獻(xiàn)的總結(jié), 發(fā)現(xiàn)采用了神經(jīng)生理指標(biāo)的研究多數(shù)都報(bào)告了陽性結(jié)果, 即認(rèn)知訓(xùn)練引發(fā)神經(jīng)生理指標(biāo)的顯著改變。這些改變說明訓(xùn)練所引發(fā)的認(rèn)知功能變化具有一定的神經(jīng)基礎(chǔ)。這些神經(jīng)機(jī)制表現(xiàn)在功能活動(dòng)的增強(qiáng)或減弱, 結(jié)構(gòu)完整性的增強(qiáng), 血流量和能量代謝的提升等(Chapman et al., 2015)。根據(jù)補(bǔ)償理論(Cabeza & Dennis, 2012), 成功的補(bǔ)償意味著局部功能強(qiáng)度或腦區(qū)功能網(wǎng)絡(luò)聯(lián)結(jié)的增強(qiáng)與行為表現(xiàn)呈正相關(guān), 而根據(jù)大腦認(rèn)知儲(chǔ)備的觀點(diǎn)(Stern,2009), 當(dāng)功能強(qiáng)度下降與行為成績(jī)?cè)鰪?qiáng)相聯(lián)系則可能反映了加工效率的增強(qiáng)。從電子版附表 2整理的功能變化與行為表現(xiàn)的相關(guān)結(jié)果來看, 這種與行為表現(xiàn)的相關(guān), 可能通過局部腦區(qū)活動(dòng)(Kirchhoff, Anderson, Barch, & Jacoby, 2012)或多腦區(qū)功能聯(lián)結(jié)(Li et al., 2014)的增強(qiáng)實(shí)現(xiàn), 也可能通過大腦加工效率的提升實(shí)現(xiàn), 如 N1波幅的下降與記憶增強(qiáng)相關(guān)(Berry et al., 2010)。此外, 大腦功能活動(dòng)的增加與降低可能與腦區(qū)所負(fù)責(zé)的功能相關(guān), 也可能受到任務(wù)性質(zhì)的調(diào)節(jié)。

在檢驗(yàn)遷移效果這一問題上, 采用神經(jīng)指標(biāo)的研究主要檢測(cè)了神經(jīng)指標(biāo)與訓(xùn)練內(nèi)容相似的認(rèn)知功能變化的相關(guān)性, 也有研究檢測(cè)了神經(jīng)指標(biāo)與遷移引發(fā)的認(rèn)知功能變化的相關(guān)性(Voss et al.,2010)。需要指出的是, 當(dāng)前僅有少數(shù)研究對(duì)訓(xùn)練效果得到保持的神經(jīng)機(jī)制進(jìn)行了探索。如Chapman等人(2013)發(fā)現(xiàn), 訓(xùn)練引發(fā)的大腦血流量提升與訓(xùn)練所保持的認(rèn)知成績(jī)呈正相關(guān),Anguera等人(2013)發(fā)現(xiàn)訓(xùn)練引發(fā)的功能聯(lián)結(jié)變化與6個(gè)月后所保持的認(rèn)知能力成正相關(guān)。未來的研究應(yīng)考慮在采用認(rèn)知測(cè)量手段評(píng)估訓(xùn)練效果是否得到保持的基礎(chǔ)上, 加強(qiáng)對(duì)相應(yīng)神經(jīng)機(jī)制的探索。

4.3 訓(xùn)練過程中的個(gè)體差異

訓(xùn)練中的個(gè)體差異主要表現(xiàn)為三個(gè)方面。首先, 在認(rèn)知干預(yù)的過程中, 由于訓(xùn)練組和控制組任務(wù)的強(qiáng)度和難度不同, 訓(xùn)練組和控制組被試對(duì)訓(xùn)練任務(wù)的預(yù)期和參與程度也不同, 被試的動(dòng)機(jī)、情緒、認(rèn)知策略等個(gè)體因素可能在一定程度上受到任務(wù)設(shè)置的影響并造成訓(xùn)練效果的差異(Boot, Simons, Stothart, & Stutts, 2013)。實(shí)驗(yàn)任務(wù)中, 采用自適應(yīng)任務(wù)范式的設(shè)置, 有利于較好地調(diào)動(dòng)被試動(dòng)機(jī)并增加其參與任務(wù)的積極性, 降低練習(xí)效應(yīng)等個(gè)體因素對(duì)訓(xùn)練效果的影響。訓(xùn)練過程中積極控制組的設(shè)置, 有利于調(diào)整控制組被試的預(yù)期, 即通過設(shè)置與干預(yù)任務(wù)相似強(qiáng)度的對(duì)照任務(wù)調(diào)節(jié)控制組被試對(duì)實(shí)驗(yàn)任務(wù)的預(yù)期, 以更好的控制安慰劑效應(yīng), 增加實(shí)驗(yàn)的生態(tài)效度。但也有研究認(rèn)為, 積極控制組的設(shè)置對(duì)訓(xùn)練效果的影響較小(Toril et al., 2014)。其次, 老年人所處的年齡階段對(duì)訓(xùn)練效果也有不同影響。不同的研究采用的老年被試的年齡標(biāo)準(zhǔn)不同, 而不同年齡段的老年人在認(rèn)知能力和神經(jīng)可塑性水平上存在差異,未來研究應(yīng)考慮到年齡作為中介或調(diào)節(jié)變量對(duì)訓(xùn)練效果的影響, 即考察認(rèn)知可塑性是否隨年齡增長(zhǎng)發(fā)生變化。

再次, 個(gè)體差異也表現(xiàn)在個(gè)體基線水平對(duì)訓(xùn)練的影響上。大部分的研究通過比較訓(xùn)練組與控制組被試任務(wù)成績(jī)的平均值考察訓(xùn)練效果, 在一定程度上掩蓋了被試的個(gè)體差異。事實(shí)上, 即便是青年人也存在顯著的個(gè)體差異, 而這種個(gè)體差異在老年人身上由于老化的原因表現(xiàn)得更為突出。有研究發(fā)現(xiàn), 老年被試基線狀態(tài)的靜息功能聯(lián)結(jié)強(qiáng)度能夠預(yù)測(cè)訓(xùn)練提升的水平(Yin et al.,2014), 而訓(xùn)練前的白質(zhì)完整性也能夠預(yù)測(cè)遷移效果(Wolf et al., 2014)。也有研究發(fā)現(xiàn)訓(xùn)練前的功能聯(lián)結(jié)強(qiáng)度能夠預(yù)測(cè)工作記憶訓(xùn)練遷移到短時(shí)記憶和注意的效果(Kundu, Sutterer, Emrich, & Postle,2013)。這些研究對(duì)于證實(shí)老年被試認(rèn)知功能的可訓(xùn)練性具有重要意義, 這種可訓(xùn)練性同時(shí)表現(xiàn)在訓(xùn)練過程中被試的參與度和被試在訓(xùn)練前的基線水平上。未來研究中, 可根據(jù)被試的基線差異優(yōu)化訓(xùn)練方法, 更進(jìn)一步考察個(gè)體差異對(duì)被試可訓(xùn)練性的影響。

綜上所述, 本文通過對(duì) 101篇關(guān)于健康老年人認(rèn)知能力干預(yù)文章的梳理匯總, 探索更加適合老年人的認(rèn)知干預(yù)手段, 對(duì)于豐富該領(lǐng)域的研究視角、合理安排老年人認(rèn)知功能干預(yù)的內(nèi)容具有良好的參考和借鑒作用。未來對(duì)老年人進(jìn)行認(rèn)知干預(yù)的研究中, 應(yīng)注重從相關(guān)理論出發(fā), 認(rèn)知訓(xùn)練與神經(jīng)測(cè)量手段相結(jié)合, 設(shè)計(jì)更多貼近老年人實(shí)際生活問題的訓(xùn)練任務(wù)及評(píng)估手段。與此同時(shí),通過不斷對(duì)健康老年人認(rèn)知干預(yù)手段的完善、加強(qiáng)干預(yù)的有效性和適用性, 也有望對(duì)一些病理性老化如輕度認(rèn)知障礙和老年癡呆患者的干預(yù)和治療產(chǎn)生積極的借鑒作用。

帶*的文獻(xiàn)為參加研究分析的文獻(xiàn)

陳天勇, 韓布新, 羅躍嘉, 李德明. (2004). 認(rèn)知年老化與執(zhí)行衰退假說.心理科學(xué)進(jìn)展, 12(5), 729–736.

杜新, 陳天勇. (2010). 老年執(zhí)行功能的認(rèn)知可塑性和神經(jīng)可塑性.心理科學(xué)進(jìn)展, 18(9), 1471–1480.

郭璐, 毛志雄. (2014). 體力活動(dòng)對(duì)老年人認(rèn)知功能影響的研究述評(píng).體育科研, 35(2), 32–36.

李德明, 劉昌, 陳天勇, 李貴蕓. (2003). 加工速度和工作記憶在認(rèn)知年老化過程中的作用.心理學(xué)報(bào), 35(4),471–475.

李婷, 李春波. (2013). 認(rèn)知老化的神經(jīng)機(jī)制及假說.上海交通大學(xué)學(xué)報(bào) (醫(yī)學(xué)版), 33(7), 1030–1034.

李旭, 杜新, 陳天勇. (2014). 促進(jìn)老年人認(rèn)知健康的主要途徑(綜述).中國心理衛(wèi)生雜志, 28(2), 125–132.

劉頌. (2014). 近 10年我國老年心理研究綜述.人口與社會(huì), 30(1), 44–48.

彭聃齡. (2001).普通心理學(xué). 北京: 北京師范大學(xué)出版社, 206.

彭華茂, 王大華. (2012). 基本心理能力老化的認(rèn)知機(jī)制.心理科學(xué)進(jìn)展, 20(8), 1251–1258.

許浩, 邵慧秋, 黃暉明, 繆愛琴, 李森, 陳春健. (2009).有氧運(yùn)動(dòng)和力量訓(xùn)練對(duì)中老年人體適能的影響.體育與科學(xué), 30(3), 63–70.

張連成, 高淑青. (2014). 身體鍛煉對(duì)認(rèn)知老化的延遲作用:來自腦科學(xué)的證據(jù).天津體育學(xué)院學(xué)報(bào), 29(4), 309–312.

*Anderson, S., White-Schwoch, T., Choi, H. J., & Kraus, N.(2014). Partial maintenance of auditory-based cognitive training benefits in older adults.Neuropsychologia, 62,286–296.

*Anderson, S., White-Schwoch, T., Parbery-Clark, A., &Kraus, N. (2013). Reversal of age-related neural timing delays with training.Proceedings of the National Academy of Sciencesof the United States of America, 110(11),4357–4362.

*Anguera, J. A., Boccanfuso, J., Rintoul, J. L., Al-Hashimi,O., Faraji, F., Janowich, J., ... Gazzaley, A. (2013). Video game training enhances cognitive control in older adults.Nature, 501(7465), 97–101.

*Bailey, H., Dunlosky, J., & Hertzog, C. (2010). Metacognitive training at home: Does it improve older adults’ learning?.Gerontology, 56(4), 414–420.

Ball, K., Berch, D. B., Helmers, K. F., Jobe, J. B., Leveck, M.D., Marsiske, M., ... ACTIVE Study Group. (2002). Effects of cognitive training interventions with older adults: A randomized controlled trial.JAMA, 288(18), 2271–2281.

Ball, K., Edwards, J. D., & Ross, L. A. (2007). The impact of speed of processing training on cognitive and everyday functions.The Journals of Gerontology. Series B: Psychological Sciences and Social Sciences, 62(Special Issue 1), 19–31.

*Ballesteros, S., Prieto, A., Mayas, J., Toril, P., Pita, C., de León, L. P., ... Waterworth, J. (2014). Brain training with non-action video games enhances aspects of cognition in older adults: A randomized controlled trial.Frontiers in Aging Neuroscience, 6, 277.

*Belchior, P., Marsiske, M., Sisco, S. M., Yam, A., Bavelier,D., Ball, K., & Mann, W. C. (2013). Video game training to improve selective visual attention in older adults.Computers in Human Behavior, 29(4), 1318–1324.

*Belleville, S., Mellah, S., de Boysson, C., Demonet, J. F., &Bier, B. (2014). The pattern and loci of training-induced brain changes in healthy older adults are predicted by the nature of the intervention.PLoS One, 9(8), e102710.

*Berry, A. S., Zanto, T. P., Clapp, W. C., Hardy, J. L.,Delahunt, P. B., Mahncke, H. W., & Gazzaley, A. (2010).The influence of perceptual training on working memory in older adults.PloS One, 5(7), e11537.

*Blumen, H. M., Gopher, D., Steinerman, J. R., & Stern, Y.(2010). Training cognitive control in older adults with the space fortress game: The role of training instructions and basic motor ability.Frontiers in Aging Neuroscience, 2,145.

Boot, W. R., Simons, D. J., Stothart, C., & Stutts, C. (2013).The pervasive problem with placebos in psychology: Why active control groups are not sufficient to rule out placebo effects.Perspectives on Psychological Science, 8(4), 445–454.

*Borella, E., Carretti, B., Riboldi, F., & De Beni, R. (2010).Working memory training in older adults: Evidence of transfer and maintenance effects.Psychology and Aging,25(4), 767–778.

*Borella, E., Carretti, B., Zanoni, G., Zavagnin, M., & De Beni, R. (2013). Working memory training in old age: An examination of transfer and maintenance effects.Archives of Clinical Neuropsychology, 28(4), 331–47.

*Boyke, J., Driemeyer, J., Gaser, C., Büchel, C., & May, A.(2008). Training-induced brain structure changes in the elderly.The Journal of Neuroscience, 28(28), 7031–7035.

*Brehmer, Y., Rieckmann, A., Bellander, M., Westerberg, H.,Fischer, H., & B?ckman, L. (2011). Neural correlates of training-related working-memory gains in old age.NeuroImage,58(4), 1110–1120.

*Brehmer, Y., Westerberg, H., & B?ckman, L. (2012).Working-memory training in younger and older adults:Training gains, transfer, and maintenance.Frontiers in Human Neuroscience, 6, 63.

*Burdette, J. H., Laurienti, P. J., Espeland, M. A., Morgan,A., Telesford, Q., Vechlekar, C. D., ... Rejeski, W. J. (2010).Using network science to evaluate exercise-associated brain changes in older adults.Frontiers in Aging Neuroscience,2, 23.

*Buschkuehl, M., Jaeggi, S. M., Hutchison, S., Perrig-Chiello, P.,D?pp, C., Müller, M., ... Perrig, W. J. (2008). Impact of working memory training on memory performance in old-old adults.Psychology and Aging, 23(4), 743–753.

*Bürki, C. N., Ludwig, C., Chicherio, C., & de Ribaupierre,A. (2014). Individual differences in cognitive plasticity:An investigation of training curves in younger and older adults.Psychological Research, 78(6), 821–835.

Cabeza, R., & Dennis N. A. (2012). Frontal lobes and aging:Deterioration and compensation. In D. T. Stuss & R. T.Knight (Eds.),Principles of frontal lobe function(2nd ed.,pp. 628–652). New York: Oxford University Press.

*Carretti, B., Borella, E., Zavagnin, M., & de Beni, R. (2013).Gains in language comprehension relating to working memory training in healthy older adults.International Journal of Geriatric Psychiatry, 28(5), 539–546.

*Cassavaugh, N. D., & Kramer, A. F. (2009). Transfer of computer-based training to simulated driving in older adults.Applied Ergonomics, 40(5), 943–952.

*Chambon, C., Herrera, C., Romaiguere, P., Paban, V., &Alescio-Lautier, B. (2014). Benefits of computer-based memory and attention training in healthy older adults.Psychology and Aging, 29(3), 731–743.

*Chan, M. Y., Haber, S., Drew, L. M., & Park, D. C. (2014).Training older adults to use tablet computers: Does it enhance cognitive function?.The Gerontologist, doi:10.1093/geront/gnu057.

*Chapman, S. B., Aslan, S., Spence, J. S., DeFina, L. F.,Keebler, M. W., Didehbani, N., & Lu, H. Z. (2013).Shorter term aerobic exercise improves brain, cognition,and cardiovascular fitness in aging.Frontiers in Aging Neuroscience, 5, 75.

Chapman, S. B., Aslan, S., Spence, J. S., Hart, J. J., Bartz, E.K., Didehbani, N., ... Lu, H. Z. (2015). Neural mechanisms of brain plasticity with complex cognitive training in healthy seniors.Cerebral Cortex, 25(2),396–405.

*Coubard, O. A., Duretz, S., Lefebvre, V., Lapalus, P., &Ferrufino, L. (2011). Practice of contemporary dance improves cognitive flexibility in aging.Frontiers in Aging Neuroscience, 3, 13.

*Dahlin, E., Nyberg, L., B?ckman, L., & Neely, A. S. (2008).Plasticity of executive functioning in young and older adults: Immediate training gains, transfer, and long-term maintenance.Psychology and Aging, 23(4), 720–730.

Deary, I. J., Johnson, W., & Starr, J. M. (2010). Are processing speed tasks biomarkers of cognitive aging?.Psychology and Aging, 25(1), 219–228.

*De Bruin, E. D., van Het Reve, E., & Murer, K. (2013). A randomized controlled pilot study assessing the feasibility of combined motor–cognitive training and its effect on gait characteristics in the elderly.Clinical Rehabilitation,27(3), 215–225.

*Duff, K., Beglinger, L. J., Moser, D. J., Schultz, S. K., &Paulsen, J. S. (2010). Practice effects and outcome of cognitive training: Preliminary evidence from a memory training course.The American Journal of Geriatric Psychiatry,18(1), 91.

Duncan, J., & Owen, A. M. (2000). Common regions of the human frontal lobe recruited by diverse cognitive demands.Trends in Neurosciences, 23(10), 475–483.

*Edwards, J. D., Valdés, E. G., Peronto, C., Castora-Binkley,M., Alwerdt, J., Andel, R., & Lister, J. J. (2015). The efficacy of InSight cognitive training to improve useful field of view performance: A brief report.The Journals of Gerontology. Series B: Psychological Sciences and Social Sciences, 70, 417–422.

Elavsky, S., & McAuley, E. (2005). Physical activity,symptoms, esteem, and life satisfaction during menopause.Maturitas, 52(3-4), 374–385.

*Engvig, A., Fjell, A. M., Westlye, L. T., Moberget, T.,Sundseth, ?., Larsen, V. A., & Walhovd, K. B. (2010).Effects of memory training on cortical thickness in the elderly.Neuroimage, 52(4), 1667–1676.

*Engvig, A., Fjell, A. M., Westlye, L. T., Moberget, T.,Sundseth, ?., Larsen, V. A., & Walhovd, K. B. (2012).Memory training impacts short-term changes in aging white matter: A Longitudinal Diffusion Tensor Imaging Study.Human Brain Mapping, 33(10), 2390–2406.

*Feng, W., Li, C. B., Chen, Y., Cheng, Y., & Wu, W. Y.(2014). Five-year follow-up study of multi-domain cognitive training for healthy elderly community members.Shanghai Archives of Psychiatry, 26(1), 30–41.

*Gajewski, P. D., & Falkenstein, M. (2012). Training-induced improvement of response selection and error detection in aging assessed by task switching: Effects of cognitive,physical, and relaxation training.Frontiers in Human Neuroscience, 6, 130.

*Grady, C. (2012). The cognitive neuroscience of ageing.Nature Reviews Neuroscience, 13(7), 491–505.

*Gross, A. L., Brandt, J., Bandeen-Roche, K., Carlson, M. C.,Stuart, E. A., Marsiske, M., & Rebok, G. W. (2014). Do older adults use the Method of Loci? Results from the ACTIVE Study.Experimental Aging Research, 40(2),140–163.

*Gross, A. L., Rebok, G. W., Brandt, J., Tommet, D.,Marsiske, M., & Jones, R. N. (2013). Modeling learning and memory using verbal learning tests: Results from ACTIVE.The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 68(2), 153–167.

*Hars, M., Herrmann, F. R., Gold, G., Rizzoli, R., &Trombetti, A. (2014). Effect of music-based multitask training on cognition and mood in older adults.Age and Ageing,43(2), 196–200.

*Heinzel, S., Schulte, S., Onken, J., Duong, Q. L., Riemer, T.G., Heinz, A., ... Rapp, M. A. (2014). Working memory training improvements and gains in non-trained cognitive tasks in young and older adults.Aging, Neuropsychology,and Cognition, 21(2), 146–173.

*H?tting, K., Holzschneider, K., Stenzel, A., Wolbers, T., &R?der, B. (2013). Effects of a cognitive training on spatial learning and associated functional brain activations.BMC Neuroscience, 14(1), 73.

*Jones, R. N., Marsiske, M., Ball, K., Rebok, G., Willis, S.L., Morris, J. N., & Tennstedt, S. L. (2013). The ACTIVE cognitive training interventions and trajectories of performance among older adults.Journal of Aging and Health, 25(8 Suppl), 186S–208S.

*Joyce, J., Smyth, P. J., Donnelly, A. E., & Davranche, K.(2014). The simon task and aging: Does acute moderate exercise influence cognitive control?.Medicine and Science in Sports and Exercise, 46(3), 630–639.

*Kayama, H., Okamoto, K., Nishiguchi, S., Yamada, M.,Kuroda, T., & Aoyama, T. (2014). Effect of a Kinect-based exercise game on improving executive cognitive performance in community-dwelling elderly: Case control study.Journal of Medical Internet Research, 16(2), e61.

Kelly, M. E., Loughrey, D., Lawlor, B. A., Robertson, I. H.,Walsh, C., & Brennan, S. (2014). The impact of cognitive training and mental stimulation on cognitive and everyday functioning of healthy older adults: A systematic review and meta-analysis.Ageing Research Reviews, 15, 28–43.

*Kirchhoff, B. A., Anderson, B. A., Barch, D. M., & Jacoby,L. L. (2012). Cognitive and neural effects of semantic encoding strategy training in older adults.Cerebral Cortex,22(4), 788–799.

*Kirchhoff, B. A., Anderson, B. A., Smith, S. E., Barch, D.M., & Jacoby, L. L. (2012). Cognitive training-related changes in hippocampal activity associated with recollection in older adults.NeuroImage, 62(3), 1956–1964.

Kundu, B., Sutterer, D. W., Emrich, S. M., & Postle, B. R.(2013). Strengthened effective connectivity underlies transfer of working memory training to tests of short-term memory and attention.The Journal of Neuroscience,33(20), 8705–8715.

*Kray, J., Lucenet, J., & Blaye, A. (2010). Can older adults enhance task-switching performance by verbal selfinstructions? The influence of working-memory load and early learning.Frontiers in Aging Neuroscience, 2, 147.

*Kwok, T. C., Bai, X., Li, J. C., Ho, F. K., & Lee, T. M.(2013). Effectiveness of cognitive training in Chinese older people with subjective cognitive complaints: A randomized placebo-controlled trial.International Journal of Geriatric Psychiatry, 28(2), 208–215.

*Lee, T. S., Goh, S. J. A., Quek, S. Y., Phillips, R., Guan, C.,Cheung, Y. B., ... Krishnan, K. R. R. (2013). A brain-computer interface based cognitive training system for healthy elderly: A randomized control pilot study for usability and preliminary efficacy.PLoS One, 8(11), e79419.

*Legault, I., Allard, R., & Faubert, J. (2013). Healthy older observers show equivalent perceptual-cognitive training benefits to young adults for multiple object tracking.Frontiers in Psychology, 4, 323.

*Legault, I., & Faubert, J. (2012). Perceptual-cognitive training improves biological motion perception: Evidence for transferability of training in healthy aging.Neuroreport,23(8), 469–473.

*Li, K. Z., Roudaia, E., Lussier, M., Bherer, L., Leroux, A.,& McKinley, P. A. (2010). Benefits of cognitive dual-task training on balance performance in healthy older adults.The Journals of Gerontology. Series A: Biological Sciences and Medical Sciences, 65(12), 1344–1352.

*Li, R., Zhu, X. Y., Yin, S. F., Niu, Y. N., Zheng, Z. W.,Huang, X., ... Li, J. (2014). Multimodal intervention in older adults improves resting-state functional connectivity between the medial prefrontal cortex and medial temporal lobe.Frontiers in Aging Neuroscience, 6, 39.

*Li, S. C., Schmiedek, F., Huxhold, O., R?cke, C., Smith, J.,& Lindenberger, U. (2008). Working memory plasticity in old age: Practice gain, transfer, and maintenance.Psychology and Aging, 23(4), 731–742.

Lindenberger, U., Mayr, U., & Kliegl, R. (1993). Speed and intelligence in old age.Psychology and Aging, 8(2),207–220.

L?vdén, M., B?ckman, L., Lindenberger, U., Schaefer, S., &Schmiedek, F. (2010). A theoretical framework for the study of adult cognitive plasticity.Psychological Bulletin,136(4), 659–676.

*L?vdén, M., Bodammer, N. C., Kühn, S., Kaufmann, J.,Schütze, H., Tempelmann, C., ... Lindenberger, U. (2010).Experience-dependent plasticity of white-matter microstructure extends into old age.Neuropsychologia, 48(13), 3878–3883.

*L?vdén, M., Schaefer, S., Noack, H., Bodammer, N. C.,Kühn, S., Heinze, H. J., ... Lindenberger, U. (2012).Spatial navigation training protects the hippocampus against age-related changes during early and late adulthood.Neurobiology of Aging, 33(3), 620.e9–620.e22.

*Lussier, M., Gagnon, C., & Bherer, L. (2012). An investigation of response and stimulus modality transfer effects after dual-task training in younger and older.Frontiers in Human Neuroscience, 6, 129.

Lustig, C., Shah, P., Seidler, R., & Reuter-Lorenz, P. A.(2009). Aging, training, and the brain: A review and future directions.Neuropsychology Review, 19(4), 504–522.

*MacKay-Brandt, A. (2011). Training attentional control in older adults.Aging, Neuropsychology, and Cognition, 18(4),432–451.

*Maillot, P., Perrot, A., & Hartley, A. (2012). Effects of interactive physical-activity video-game training on physical and cognitive function in older adults.Psychology andAging, 27(3), 589–600.

*Mayas, J., Parmentier, F. B. R., Andrés, P., & Ballesteros, S.(2014). Plasticity of attentional functions in older adults after non-action video game training: A randomized controlled trial.PLoS One, 9(3), e92269.

*McAvinue, L. P., Golemme, M., Castorina, M., Tatti, E.,Pigni, F. M., Salomone, S., ... Robertson, I. H. (2013). An evaluation of a working memory training scheme in older adults.Frontiers in Aging Neuroscience, 5, 20.

*McDougall, S., & House, B. (2012). Brain training in older adults: Evidence of transfer to memory span performance and pseudo-Matthew effects.Aging, Neuropsychology, and Cognition, 19(1-2), 195–221.

*Milewski-Lopez, A., Greco, E., van den Berg, F., McAvinue,L. P., McGuire, S., & Robertson, I. H. (2014). An evaluation of alertness training for older adults.Frontiers in Aging Neuroscience, 6, 67.

*Miller, K. J., Siddarth, P., Gaines, J. M., Parrish, J. M.,Ercoli, L. M., Marx, K., ... Small, G. W. (2012). The memory fitness program: Cognitive effects of a healthy aging intervention.The American Journal of Geriatric Psychiatry, 20(6), 514–523.

*Miotto, E. C., Balardin, J. B., Savage, C. R., Martin, M. D.G. M., Batistuzzo, M. C., Amaro Junior, E., & Nitrini, R.(2014). Brain regions supporting verbal memory improvement in healthy older subjects.Arquivos de Neuro-Psiquiatria, 72(9), 663–670.

*Mishra, J., de Villers-Sidani, E., Merzenich, M., & Gazzaley, A.(2014). Adaptive training diminishes distractibility in aging across species.Neuron, 84(5), 1091–1103.

*Mozolic, J. L., Hayaska, S., & Laurienti, P. J. (2010). A cognitive training intervention increases resting cerebral blood flow in healthy older adults.Frontiers in Human Neuroscience, 4, 16.

*Mozolic, J. L., Long, A. B., Morgan, A. R., Rawley-Payne,M., & Laurienti, P. J. (2011). A cognitive training intervention improves modality-specific attention in a randomized controlled trial of healthy older adults.Neurobiology of Aging, 32(4), 655–668.

*Nouchi, R., Taki, Y., Takeuchi, H., Hashizume, H., Akitsuki,Y., Shigemune, Y., ... Kawashima, R. (2012). Brain training game improves executive functions and processing speed in the elderly: A randomized controlled trial.PLoS One, 7(1), e29676.

*Nouchi, R., Taki, Y., Takeuchi, H., Sekiguchi, A.,Hashizume, H., Nozawa, T., ... Kawashima, R. (2014).Four weeks of combination exercise training improved executive functions, episodic memory, and processing speed in healthy elderly people: Evidence from a randomized controlled trial.Age, 36(2), 787–799.

*O’Brien, J. L., Edwards, J. D., Maxfield, N. D., Peronto, C.L., Williams, V. A., & Lister, J. J. (2013). Cognitive training and selective attention in the aging brain: An electrophysiological study.Clinical Neurophysiology,124(11), 2198–2208.

*Osaka, M., Yaoi, K., Otsuka, Y., Katsuhara, M., & Osaka, N.(2012). Practice on conflict tasks promotes executive function of working memory in the elderly.Behavioural Brain Research, 233(1), 90–98.

Park, D. C., & Bischof, G. N. (2013). The aging mind:Neuroplasticity in response to cognitive training.Dialogues in Clinical Neuroscience, 15(1), 109–119.

Park, D. C., Gutchess, A. H., Meade, M. L., & Stine-Morrow,E. A. (2007). Improving cognitive function in older adults:Nontraditional approaches.The Journals of Gerontology.Series B: Psychological Sciences and Social Sciences,62(Special Issue 1), 45–52.

*Payne, B. R., Jackson, J. J., Hill, P. L., Gao, X., Roberts, B.W., & Stine-Morrow, E. A. (2012). Memory self-efficacy predicts responsiveness to inductive reasoning training in older adults.The Journals of Gerontology. Series B:Psychological Sciences and Social Sciences, 67(1), 27–35.

*Peretz, C., Korczyn, A. D., Shatil, E., Aharonson, V.,Birnboim, S., & Giladi, N. (2011). Computer-based,personalized cognitive training versus classical computer games: A randomized double-blind prospective trial of cognitive stimulation.Neuroepidemiology, 36(2), 91–99.

*Pieramico, V., Esposito, R., Sensi, F., Cilli, F., Mantini, D.,Mattei, P. A., ... Sensi, S. L. (2012). Combination training in aging individuals modifies functional connectivity and cognition, and is potentially affected by dopamine-related genes.PLoS One, 7(8), e43901.

*Rebok, G. W., Ball, K., Guey, L. T., Jones, R. N., Kim, H.Y., King, J. W., ... Willis, S. L. (2014). Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults.Journal of the American Geriatrics Society, 62(1), 16–24.

Redick, T. S., Shipstead, Z., Harrison, T. L., Hicks, K. L.,Fried, D. E., Hambrick, D. Z., ... Engle, R. W. (2013). No evidence of intelligence improvement after working memory training: A randomized, placebo-controlled study.Journal of Experimental Psychology: General, 142(2),359–379.

*Richmond, L. L., Morrison, A. B., Chein, J. M., & Olson, I.R. (2011). Working memory training and transfer in older adults.Psychology and Aging, 26(4), 813–822.

Setti, A., Finnigan, S., Sobolewski, R., McLaren, L.,Robertson, I. H., Reilly, R. B., … Newell, F. N. (2011).Audiovisual temporal discrimination is less efficient with aging: An event-related potential study.Neuroreport,22(11), 554–558.

*Setti, A., Stapleton, J., Leahy, D., Walsh, C., Kenny, R. A.,& Newell, F. N. (2014). Improving the efficiency of multisensory integration in older adults: Audio-visual temporal discrimination training reduces susceptibility to the sound-induced flash illusion.Neuropsychologia, 61,259–268.

*Shah, T., Verdile, G., Sohrabi, H., Campbell, A., Putland, E.,Cheetham, C., ... Martins, R. N. (2014). A combination of physical activity and computerized brain training improves verbal memory and increases cerebral glucose metabolism in the elderly.Translational Psychiatry, 4(12), e487.

*Shatil, E. (2013). Does combined cognitive training and physical activity training enhance cognitive abilities more than either alone? A four-condition randomized controlled trial among healthy older adults.Frontiers in Aging Neuroscience, 5, 8.

*Shatil, E., Mikulecká, J., Bellotti, F., & Bure?, V. (2014).Novel television-based cognitive training improves working memory and executive function.PLoS One, 9(7),e101472.

*Sisco, S. M., Marsiske, M., Gross, A. L., & Rebok, G. W.(2013). The influence of cognitive training on older adults’ recall for short stories.Journal of Aging and Health, 25(8 Suppl), 230S–248S.

*Smith, G. E., Housen, P., Yaffe, K., Ruff, R., Kennison, R.F., Mahncke, H. W., & Zelinski, E. M. (2009). A cognitive training program based on principles of brain plasticity:Results from the Improvement in Memory with Plasticitybased Adaptive Cognitive Training (IMPACT) study.Journal of the American Geriatrics Society,57(4), 594–603.

*Smith-Ray, R. L., Hughes, S. L., Prohaska, T. R., Little, D.M., Jurivich, D. A., & Hedeker, D. (2015). Impact of cognitive training on balance and gait in older adults.The Journals of Gerontology. Series B: Psychological Sciences and Social Sciences,70, 357–366.

*Steinmetz, J. P., & Federspiel, C. (2014). The effects of cognitive training on gait speed and stride variability in old adults: Findings from a pilot study.Aging Clinical and Experimental Research, 26(6), 635–643.

Stern, Y. (2009). Cognitive reserve.Neuropsychologia, 47(10),2015–2028.

Sternberg, R. J. (2008). Increasing fluid intelligence is possible after all.Proceedings of the National Academy of Sciencesof the United States of America, 105(19), 6791–6792.

*Strenziok, M., Parasuraman, R., Clarke, E., Cisler, D. S.,Thompson, J. C., & Greenwood, P. M. (2014). Neurocognitive enhancement in older adults: Comparison of three cognitive training tasks to test a hypothesis of training transfer in brain connectivity.Neuroimage, 85, 1027–1039.

*Theill, N., Schumacher, V., Adelsberger, R., Martin, M., &J?ncke, L. (2013). Effects of simultaneously performed cognitive and physical training in older adults.BMC Neuroscience, 14(1), 103.

Toril, P., Reales, J. M., & Ballesteros, S. (2014). Video game training enhances cognition of older adults: A meta-analytic study.Psychology and Aging, 29(3), 706–716.

*Tranter, L. J., & Koutstaal, W. (2008). Age and flexible thinking: An experimental demonstration of the beneficial effects of increased cognitively stimulating activity on fluid intelligence in healthy older adults.Aging,Neuropsychology, and Cognition, 15(2), 184–207.

Treuth, M. S., Ryan, A. S., Pratley, R. E., Rubin, M. A.,Miller, J. P., Nicklas, B. J., ... Hurley, B. F. (1994). Effects of strength training on total and regional body composition in older men.Journal of Applied Physiology, 77(2), 614–620.

*Trombetti, A., Hars, M., Herrmann, F. R., Kressig, R. W.,Ferrari, S., & Rizzoli, R. (2011). Effect of music-based multitask training on gait, balance, and fall risk in elderly people: A randomized controlled trial.Archives of Internal Medicine, 171(6), 525–533.

*Uchida, S., & Kawashima, R. (2008). Reading and solving arithmetic problems improves cognitive functions of normal aged people: A randomized controlled study.Age,30(1), 21–29.

Vandewalle, H., Péerès, G., & Monod, H. (1987). Standard anaerobic exercise tests.Sports Medicine, 4(4), 268–289.

*van Muijden, J., Band, G. P., & Hommel, B. (2012). Online games training aging brains: Limited transfer to cognitive control functions.Frontiers in Human Neuroscience, 6,221.

Vaughan, L., & Giovanello, K. (2010). Executive function in daily life: Age-related influences of executive processes on instrumental activities of daily living.Psychology and Aging, 25(2), 343–355.

*Voelcker-Rehage, C., Godde, B., & Staudinger, U. M.(2011). Cardiovascular and coordination training differentially improve cognitive performance and neural processing in older adults.Frontiers in Human Neuroscience, 5, 26.

*Voss, M. W., Prakash, R. S., Erickson, K. I., Basak, C.,Chaddock, L., Kim, J. S., ... Kramer, A. F. (2010).Plasticity of brain networks in a randomized intervention trial of exercise training in older adults.Frontiers in Aging Neuroscience, 2, 32.

*Wang, M. Y., Chang, C. Y., & Su, S. Y. (2011). What’s cooking?–Cognitive training of executive function in the elderly.Frontiers in Psychology, 2, 228.

*Whitlock, L. A., McLaughlin, A. C., & Allaire, J. C. (2012).Individual differences in response to cognitive training:Using a multi-modal, attentionally demanding game-based intervention for older adults.Computers in Human Behavior, 28(4), 1091–1096.

*Wild-Wall, N., Falkenstein, M., & Gajewski, P. D. (2012).Neural correlates of changes in a visual search task due to cognitive training in seniors.Neural Plasticity, 2012,Article ID 529057.

*Williams, K., Herman, R., & Smith, E. K. (2014). Cognitive interventions for older adults: Does approach matter?.Geriatric Nursing, 35(3), 194–198.

*Willis, S. L., & Caskie, G. I. (2013). Reasoning training in the ACTIVE study: How much is needed and who benefits?.Journal of Aging and Health, 25(8 suppl), 43S–64S.

*Wolf, D., Fischer, F. U., Fesenbeckh, J., Yakushev, I.,Lelieveld, I. M., Scheurich, A., ... Fellgiebel, A. (2014).Structural integrity of the corpus callosum predicts long-term transfer of fluid intelligence-related training gains in normal aging.Human Brain Mapping, 35(1), 309–318.

*Wolinsky, F. D., Mahncke, H., Vander Weg, M. W., Martin,R., Unverzagt, F. W., Ball, K. K., ... Tennstedt, S. L.(2010). Speed of processing training protects self-rated health in older adults: Enduring effects observed in the multi-site ACTIVE randomized controlled trial.International Psychogeriatrics, 22(3), 470–478.

*Wolinsky, F. D., Vander Weg, M. W., Howren, M. B., Jones,M. P., & Dotson, M. M. (2013). A randomized controlled trial of cognitive training using a visual speed of processing intervention in middle aged and older adults.PLoS One, 8(5), e61624.

*Yin, S. F., Zhu, X. Y., Li, R., Niu, Y. N., Wang, B. X.,Zheng, Z. W., ... Li, J. (2014). Intervention-induced enhancement in intrinsic brain activity in healthy older adults.Scientific Reports, 4, 7309.

*Zelinski, E. M., Spina, L. M., Yaffe, K., Ruff, R., Kennison,R. F., Mahncke, H. W., & Smith, G. E. (2011).Improvement in memory with plasticity-based adaptive cognitive training: Results of the 3-month follow-up.Journal of the American Geriatrics Society, 59(2), 258–265.

*Zelinski, E. M., Peters, K. D., Hindin, S., Petway, K. T., &Kennison, R. F. (2014). Evaluating the relationship between change in performance on training tasks and on untrained outcomes.Frontiers in Human Neuroscience, 8,617.

*Zimmermann, N., Netto, T. M., Amodeo, M. T., Ska, B., &Fonseca, R. P. (2014). Working memory training and poetry-based stimulation programs: Are there differences in cognitive outcome in healthy older adults?.NeuroRehabilitation, 35(1), 159–170.

*Zinke, K., Zeintl, M., Rose, N. S., Putzmann, J., Pydde, A.,& Kliegel, M. (2014). Working memory training and transfer in older adults: Effects of age, baseline performance,and training gains.Developmental Psychology, 50(1),304–315.