Training working memory and fluid intelligence in older adults

253 Pages·2013·3.15 MB·English

by  Hynes Sinead

SEPTEMBER 2012
Training working memory and fluid
intelligence in older adults:
Developing measures and exploring outcomes

Sinéad Hynes

This thesis is submitted for the degree of Doctor of Philosophy at the
University of Cambridge.
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Acknowledgements
Firstly I would like to thank my principal supervisor Dr. Tom Manly and my second supervisor
Dr. Jessica Fish for their guidance and support during the research process. I am thankful
for their patience and help throughout the course of my PhD. My thanks also go to staff and
researchers at the MRC Cognition and Brain Sciences Unit. I feel privileged to have had the
opportunity to complete my studies at the CBU. Thanks especially go to a few people in
particular. To Dr. Adam Hampshire for his generous help with developing, programming and
providing the training tasks used in chapters 4-7. To Prof. Barbara Wilson who allowed me
to work with her client S.M. – her passion for her work is extremely motivating for me to see
as a student. To Dr. Russell Thompson for providing the Feature Match task used in chapter
two and for his encouraging advice over cups of tea in the kitchen. And my thanks go to two
visiting students to the unit Veronica Montani and Sarah Griffiths who helped me with the
video ratings in chapter three. Without their help this chapter would not have been possible.
Financial support for my PhD was provided by the National University of Ireland and the
Cambridge European Trust. My sincere gratitude to these committees for funding me.
My thanks to Prof. Agnes Shiel in NUIG– “for the use of the parish hall” over the summer
months and for all the chats and encouraging words late into the evenings.
To my roastin’ woolly jumper-wearing mucksavage lab-mates Theresa, Davy and Oriel who
made my time at the unit sick, in the best possible way! I never expected to find such good
friends in such a small room. Without the support that I had from you guys as well as the
baking, singing, emails and advice sessions I can confidently say that this thesis would not
be completed. I feel truly blessed to have made such good friends in you and a gigantic
thanks and loads of love for making my time at the unit such a fun, bright and happy time.
My final year in Cambridge was one of the best for one big reason – 149 Catherine St. I was
so lucky to find the best housemates ever in Dee, Laura and Maeve. All the cups of tea,
bouncing castles, punch, BBQs and craic will be with me forever as some of the best
memories of my years in Cambridge. Thanks girlies. Thanks to all my friends and to Gear
and Eoghan; Theo (for all the match reports); and Adam.
And finally thanks millions to my mama and dada. Ye’ve been mighty, as I hope ye know. All
of your help has gotten me where I am and I love ye big-bits.
So if I may, I would like to dedicate this thesis to my Bu-Ti-Full Mama and Da.
“Briseann an dúchas trí shúile an chait”, mar a deir siad. Tá súil agam gur fíor seo!
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Preface

This dissertation is the result of my own work and includes nothing, which is the
outcome of work done in collaboration except where specifically indicated in the text.

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Dissertation summary
Name: Sinéad Hynes Title: Training Working Memory and Fluid
Intelligence in Older Adults: Developing measures and exploring outcomes
This thesis investigates computerised cognitive training in older adults, with a focus
on training working memory and fluid intelligence. A series of studies is reported,
with two broad aims. The first was to develop and validate outcome measures
appropriate for use in this population, and the second was to examine whether
established gains in cognitive functioning generalised to everyday life.
In relation to the first aim, two studies were conducted which concerned the
development of a sensitive measure of organisational abilities within a computerised
paradigm, the Games Evaluation Task (GET). A further study made use of an
existing naturalistic measure, the Multiple Errands Task (MET, Shallice & Burgess,
1991), and investigated whether it was possible to obtain reliable ratings of
performance on the basis of video footage taken from the participant’s perspective
by means of a body-worn camera. Both the GET and MET were used as outcome
measures in the subsequent training studies.
In relation to the second aim, three studies of cognitive training are reported. The
first is a case study of a man with problems in working memory and time perception
following a stroke. He underwent training on an intensive working memory package
within a single-case experimental design that incorporated an active control
condition. This approach was then extended in a larger sample of healthy older
adults, who trained intensively on tasks that focussed either on working memory, or
fluid intelligence and problem solving. In the final study participants trained on a
combination of both working memory and fluid intelligence tasks. In addition, they
watched training videos that focused on teaching various cognitive strategies. The
aim of this video supplement was to help participants draw links between the
computer training and real-life situations, and hence to foster generalisation of any
benefits to everyday life.
The thesis concludes with a general discussion which examines the major findings of
the studies presented, their clinical applications, the limitations of the research and
possible future directions.
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Table of Contents
Preface ....................................................................................................................... iii
Dissertation summary ................................................................................................. iv
Table of Contents ....................................................................................................... v
List of Tables ............................................................................................................. xii
List of Figures ........................................................................................................... xiii
Chapter One: .............................................................................................................. 1
Introduction ................................................................................................................ 1
Introduction ............................................................................................................. 1
Limited capacity and working memory ................................................................. 1
Limited capacity and general intelligence ............................................................ 2
Multiple demand regions: An overlap between WM and g? ................................. 3
Cognitive training .................................................................................................... 4
Strategy-based rehabilitation for executive impairment .......................................... 6
Working Memory Training ..................................................................................... 11
Studies of working memory training in neurologically healthy adults ................. 11
WMT in children with developmental disorders and poor working memory ....... 15
Studies of WM training in people with intellectual disabilities ............................ 20
Computerised working memory training with older adults .................................. 21
Studies of WMT in people with brain injury ........................................................ 24
Summary and aims of thesis ................................................................................. 26
Training fluid intelligence? ................................................................................. 27
Summary and rationale for the empirical sections of this thesis ............................ 28
Chapter Two: ............................................................................................................ 33
Developing a new computerised multi-tasking computer game and examining its
relationship with existing organisational measures .................................................. 33
Abstract ................................................................................................................. 33
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Introduction ........................................................................................................... 34
Existing measures ............................................................................................. 35
Study one ................................................................................................................. 36
Study aim .............................................................................................................. 36
Methodology ......................................................................................................... 38
Participants ........................................................................................................ 38
Instruction conditions ......................................................................................... 40
Main GET variables ........................................................................................... 45
Results .................................................................................................................. 46
General performance and score distributions on the Games Evaluation Test
(GET) ................................................................................................................. 46
The effect of instructions on Games Evaluation Test performance.................... 46
Selection of the principal GET outcome measure .............................................. 48
Checking the clock in the GET .......................................................................... 49
Discussion............................................................................................................. 49
Study two ................................................................................................................. 51
Methodology ......................................................................................................... 51
Participants ........................................................................................................ 51
Measures ........................................................................................................... 51
Results .................................................................................................................. 53
Discussion............................................................................................................. 54
Study Three .............................................................................................................. 56
Introduction ........................................................................................................... 56
Methodology ......................................................................................................... 57
Participants ........................................................................................................ 57
Measures ........................................................................................................... 57
Scoring .............................................................................................................. 59
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Results .................................................................................................................. 60
Discussion............................................................................................................. 61
General Discussion ............................................................................................... 62
Chapter Three: ......................................................................................................... 64
Using video ratings to assess multitasking performance in a naturalistic paradigm. 64
Abstract ................................................................................................................. 64
Introduction ........................................................................................................... 64
The development of the MET ............................................................................ 65
Empirical validation of METs ............................................................................. 69
Study aims ......................................................................................................... 70
Methodology ......................................................................................................... 71
Pilot .................................................................................................................... 72
The MET ............................................................................................................ 72
Scoring .............................................................................................................. 74
Raters ................................................................................................................ 74
Results .................................................................................................................. 75
Timing ................................................................................................................ 75
Tasks ................................................................................................................. 76
Difference between live and video ratings ......................................................... 80
Discussion............................................................................................................. 81
Chapter Four: ........................................................................................................... 85
Intensive working memory training: A single case study of a patient following a
cerebrovascular accident ......................................................................................... 85
Abstract ................................................................................................................. 85
Introduction ........................................................................................................... 85
Single-case experimental design in rehabilitation studies .................................. 85
Working memory training with clinical populations ............................................. 86
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Case Description ............................................................................................... 89
Previous problems and rehabilitation ................................................................. 90
Methodology ......................................................................................................... 91
Initial contact and summary of baseline screening assessment ........................ 91
Outcome measures ........................................................................................... 92
Procedure .......................................................................................................... 94
Training schedule .............................................................................................. 96
Results .................................................................................................................. 97
Discussion........................................................................................................... 102
Chapter Five: .......................................................................................................... 104
Working memory training in a healthy older adult population ................................. 104
Abstract ............................................................................................................... 104
Introduction ......................................................................................................... 104
Methodology ....................................................................................................... 107
Participants ...................................................................................................... 107
Screening measures ........................................................................................ 108
Outcome measures ......................................................................................... 108
Development of training tasks ......................................................................... 110
Training regime ................................................................................................ 111
Results ................................................................................................................ 112
Compliance ...................................................................................................... 112
Differences following training ........................................................................... 112
Practice Effects ................................................................................................ 114
Power and Effect Size ..................................................................................... 115
Discussion........................................................................................................... 117
Chapter Six: ........................................................................................................... 119
Problem solving training in a healthy older adult population ................................... 119
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Abstract ............................................................................................................... 119
Introduction ......................................................................................................... 119
Methodology ....................................................................................................... 122
Participants ...................................................................................................... 122
Outcome measures ......................................................................................... 124
Problem Solving Training tasks ....................................................................... 124
Procedures and training regime .......................................................................... 127
Results ................................................................................................................ 128
Direct effects of training ................................................................................... 128
Generalisation.................................................................................................. 128
Power and Effect Size ..................................................................................... 130
Discussion........................................................................................................... 131
Chapter Seven: ...................................................................................................... 133
Combined strategy training with a healthy older adult population .......................... 133
Abstract ............................................................................................................... 133
Introduction ......................................................................................................... 133
Methodology ....................................................................................................... 135
Participants ...................................................................................................... 135
The training videos .......................................................................................... 136
Adaptive Cognitive Training ............................................................................. 137
Outcome Measures ......................................................................................... 137
Procedure ........................................................................................................ 139
Results ................................................................................................................ 139
Compliance ...................................................................................................... 139
Improvement during training ............................................................................ 140
Outcome measures ......................................................................................... 140
Power and Effect Size ..................................................................................... 143
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