INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY

Int J Geriatr Psychiatry 2008; 23: 11721174.

Published online 22 May 2008 in Wiley InterScience
(www.interscience.wiley.com) DOI: 10.1002/gps.2050

Evaluation of effect of cognitive intervention programs for

the community-dwelling elderly with subjective memory
complaints
Athena Yi-jung Tsai 1,2,3, Ming-Jen Yang 4, Chun-Fu Lan 1 and Cheng-Sheng Chen 2,5,6*
1
Institute of Public Health, National Yang-ming University, Taiwan
2
Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan
3
School of Occupational Therapy, Kaohsiung Medical University, Taiwan
4
Ming-Jen Yangs Clinic, Kaohsiung, Taiwan
5
Graduate Institute of Medicine, Kaohsiung Medical University, Taiwan
6
Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

SUMMARY
Purpose To compare the efcacy of cognitive training (CT) and cognitive stimulation (CS) programs for the community
elderly with subjective memory complaints (SMC).
Method The single-blind non-randomized controlled study was applied. The numbers of CTand CS participants were 14 and
11. The mean ages of CT and CS participants were 68.71 and 70.36. Memory training and problem solving strategies were
applied in the CT group. There were ten 2-hourly sessions of CT, held twice weekly. CS group met once weekly in a 1.5-h class
for eight classes. Cognitive performance tests of general cognitive performance, verbal memory and executive function were
measured before/after the training and at 6 months follow-up.
Results In both training conditions, the general cognitive performance were enhanced. The CT group showed improvement
in the verbal memory test. The CS group did not trigger any training effect in the verbal memory test but the executive function.
All cognitive progresses remained at follow-up.
Conclusion Both cognitive training and cognitive stimulation programs showed training effects and remained until 6
months. Copyright # 2008 John Wiley & Sons, Ltd.

key words cognitive intervention; subjective memory complaints; elderly

INTRODUCTION general, which needs less professional guidance. This

People with subjective memory complaints (SMC) are at
higher risk of converting into dementia or Alzheimers
disease (AD). Cognitive intervention may potentially
help their cognitive progression. Cognitive training (CT)
and cognitive stimulation (CS) are two commonly
applied cognitive interventions (Cameron, 2007). CT
applies tasks requiring various elements of cognition to
improve cognition. CS involves group activities and
discussion to enhance cognitive and social functions in
*Correspondence to: C.-S. Chen, Department of Psychiatry, Kaoh-
siung Medical University Hospital, #100 Tzyou 1st Rd, Kaohsiung
807, Taiwan. E-mail: sheng@cc.kmu.edu.tw
Copyright # 2008 John Wiley & Sons, Ltd.
study aimed at investigating the effects CT and CS
among community elders with SMC.
METHODS
Fourteen elders attended the CT group and 11 attended
the CS group. The inclusion criteria were: (1) age over
55; (2) self-reported memory complaints; (3) no
dementia, Clinical Dementia Rating (CDR) 0;
(4) independent ADL (Physical self-maintenance
scale) and IADL (Instrumental activities of daily
living scale) functions; and (5) can read and write in
basic Chinese. The average age of all participants was
Received 3 February 2008
Accepted 10 April 2008
 effects of cognitive intervention for elders with smc 1173

Table 1. Cognitive performance the Cognitive Training (CT) and Cognitive Stimulation (CS) conditions at T0, T1 and T2

CT (n 14) CS (n 11)

T0 T1 T2 T0 T1 T2

M SD M SD M SD M SD M SD M SD

ADAS-cog 7.88 3.15 3.20* 1.65 3.07 1.78 6.76 3.92 3.91* 1.73 2.38** 1.28
MMSE 26.71 1.85 28.64* 1.21 28.92 0.86 25.54 2.76 28.54* 1.12 28.91 1.13
SRT 8.42 2.68 9.71* 3.33 10.92** 2.13 10.00 1.51 10.00 1.73 10.64 1.74
CDT 16.00 0.00 15.42 1.34 15.23 2.48 14.27*** 2.32 16.00* 0.00 16.00 0.00
*
Signicant difference between T0 and T1 within groups with Wilcoxon signed-ranks test, p < 0.05.
**
Signicant difference between T1 and T2 within groups with Wilcoxon signed-ranks test, p < 0.05.
***
Signicant difference between CT and CS groups at T0 with MannWhitney analysis, p < 0.05.

69.4. The average years of education was 10.3. The
demographic data of the two groups was not different,
except that the CS group had less education. Our
treatment protocol was approved by the University
Institutional Review Board.
The CT group held ten 2-h classes twice weekly,
with the training foci in mnemonics and problem-
solving strategies. The training themes included health
education of dementia and cognitive aging, face-name
association, summary skills, imagery mnemonics,
visualization, association, method of loci, backward
problem-solving strategy, and problem-solving stra-
tegy at the supermarket and meditation. Homework
and after-class connection were applied. The CS group
met once weekly for 1.5-h for eight weeks and
performed exercises such as reality orientation, quiz
games and situational problem-solving activities with
actual community resources.
Cognition functions were assessed at baseline (T0),
after training (T1) and at 6-month follow-up (T2).
Cognitive measurement included the Cognitive
component of the Alzheimer Disease Assessment
Scale (ADAS-cog) (Rosen et al., 1984), Mini-Mental
State Examination (MMSE) (Folstein et al., 1975), Se-
lective Reminding Test (SRT) (Buschke, 1973), and
Clock-Drawing Test (CDT) (Wolf-Klein et al., 1989).
Due to the small sample size, the statistical analysis
applied was non-parametric tests.
(CDT). At follow-up, the effects of the CT and CS
groups remained constant. Moreover, the CS group
had further improvement in the ADAS-cog score and
the CT group had an increase in SRT. At baseline, the
CS group had lower average score in CDT. No
signicant group difference was noted in all tests at
post-test and follow-up.
CONCLUSIONS
The effects on general cognitive performance were
positive and similar in both CT and CS programs. The
CT group which trained the mnemonic strategies
demonstrated the effect of the corresponding capacity.
In the CS group, the effect of in situ problem-solving
exercises was also reected in CDT, a part of execu-
tive function. Study results conrmed the learning
potential of the SMC elderly. The progress created
may serve as a protection against future aging decline.
Beside memory, executive function is regarded as
an early warning sign of AD. Combining factors of
executive function in cognitive intervention may
generate broader outcomes. For further study,
measurement tools with higher sensitivity and com-
plexity should be considered for the SMC elderly
programs since ceiling scores were easily reached. We
suggest that the SMC population needs service and
assistance from the heath care professions.

RESULTS CONFLICT OF INTEREST

All cognitive measures are shown in Table 1. The CT None known.
group showed improvement in general cognitive
performance (ADAS-cog and MMSE), and memory
ACKNOWLEDGEMENTS
(SRT) at T1. Meanwhile, the CS group gained
improvement in general cognitive performance This study was sponsored by the Department of Health,
(ADAS-cog and MMSE) and executive function Taiwan, grant no: DOH-95-TD-M-113-070-(1/2).

Copyright # 2008 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2008; 23: 11721174.
DOI: 10.1002/gps
1174 a. y.-tsai
KEY POINTS

The cognitive training and cognitive stimulation
approaches can enhance the general cognitive
performance of community elderly with sub-
jective memory complaints.

Training of mnemonic strategies and problem-
solving exercises were reported to show progress
in corresponding capacity respectively.
Copyright # 2008 John Wiley & Sons, Ltd.
ET AL.
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Wolf-Klein GP, Silverstone FA, Levy AP, Brod MS. 1989. Screening
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Int J Geriatr Psychiatry 2008; 23: 11721174.
DOI: 10.1002/gps