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Article

Emma V. Ward and David R. Shanks

It is well documented that explicit (declarative, conscious) memory declines in normal aging. Studies have shown a progressive reduction in this form of memory with age, and healthy older adults (typically aged 65+ years) usually perform worse than younger adults (typically aged 18–30 years) on laboratory tests of explicit memory such as recall and recognition. In contrast, it is less clear whether implicit (procedural, unconscious) memory declines or remains stable in normal aging. Implicit memory is evident when previous experiences affect (e.g., facilitate) performance on tasks that do not require conscious recollection of those experiences. This can manifest in rehearsed motor skills, such as playing a musical instrument, but is typically indexed in the laboratory by the greater ease with which previously studied information is processed relative to non-studied information (e.g., repetition priming). While a vast amount of research has accumulated to suggest that implicit memory remains relatively stable over the adult lifespan, and is similar in samples of young and older adults, other studies have in contrast revealed that implicit memory is subject to age-related decline. Improving methods for determining whether implicit memory declines or remains stable with age is an important goal for future research, as the issue not only has significant implications for an aging society regarding interventions likely to ameliorate the effects of age-related explicit memory decline, but can also inform our theoretical understanding of human memory systems.

Article

Lori E. James and Sara Anne Goring

The questions of whether and why language processes change in healthy aging require complicated answers. Although comprehension appears to be more stable across adulthood than does production, there is evidence for age-related changes and also for constancy within both input and output components of language. Further, these changes can be considered at various levels of the language hierarchy, such as sensory input, words, sentences, and discourse. As concluded in several other comprehensive reviews, older adults’ language production ability declines much more noticeably than does their comprehension, presumably because comprehension is able to benefit from contextual processing in a way that production cannot. Specifically, lexical and orthographic retrieval become more difficult during normal aging, and these changes appear to represent the most noticeable age-related declines in language production. Some theories of age-related decline focus on global deterioration of cognitive function, whereas other theories predict changes in specific processes related to language function. Both types of theories have received empirical support as applied to language performance, although additional theoretical development is still needed to capture the patterns of effects. Further, in order to truly understand how cognitive aging impacts the ability to understand and produce language, it is necessary to examine how age-related shifts in goals, expertise, and compensatory strategies influence language processes. There are important implications of research on language and cognitive aging, in that language can play a role in physical health and psychological well-being. In summary, our review of the existing literature on language and cognitive aging supports previous claims that language ability is asymmetrically impacted by age, with smaller overall effects of aging on comprehension than production processes.

Article

Determining the mechanisms that underlie neurocognitive aging, such as compensation or dedifferentiation, and facilitating the development of effective strategies for cognitive improvement is essential due to the steadily rising aging population. One approach to study the characteristics of healthy aging comprises the assessment of functional connectivity, delineating markers of age-related neurocognitive plasticity. Functional connectivity paradigms characterize complex one-to-many (or many-to-many) structure–function relations, as higher-level cognitive processes are mediated by the interaction among a number of functionally related neural areas rather than localized to discrete brain regions. Task-related or resting-state interregional correlations of brain activity have been used as reliable indices of functional connectivity, delineating age-related alterations in a number of large-scale brain networks, which subserve attention, working memory, episodic retrieval, and task-switching. Together with behavioral and regional activation studies, connectivity studies and modeling approaches have contributed to our understanding of the mechanisms of age-related reorganization of distributed functional networks; specifically, reduced neural specificity (dedifferentiation) and associated impairment in inhibitory control and compensatory neural recruitment.

Article

Life is filled with goals or intentions that people hope to realize. Some of these are rather mundane (e.g., remembering to purchase a key ingredient for a recipe when stopping at the market), while others are more significant (e.g., remembering to pick up one’s child from school at the end of the day). Prospective memory represents the ability to form and then realize intentions at an appropriate time. A fundamental aspect of prospective memory is that one is engaged in one or more tasks (i.e., ongoing activities) between the formation of an intention and the opportunity to realize the goal. For instance, in the shopping example, one might form the intention at home and then travel to the market and collect several other items before walking past the desired ingredient. Considerable research has demonstrated that the efficiency of prospective memory declines with age, although age-related differences are not universal. The neurocognitive processes underpinning age-related differences in the formation and realization of delayed intentions have been investigated in studies using event-related brain potentials. This research reveals that age-related differences in prospective memory arise from the disruption of neural systems supporting the successful encoding of intentions, the detection of prospective memory cues, and possibly processes supporting the retrieval of intentions from memory when a cue is encountered or efficiently shifting from the ongoing activity to the prospective element of the task. Therefore, strategies designed to ameliorate age-related declines in prospective memory should target a variety of processes engaged during the encoding, retrieval, and enactment of delayed intentions.

Article

Aleksandra Kudlicka and Linda Clare

The number of people living with dementia is growing, and with limited pharmacological treatment options the importance of psychosocial interventions is increasingly recognized. Cognitive rehabilitation is particularly well placed to address the needs of people living with mild and moderate dementia and their family supporters, as it offers a range of tools to tackle the complexity of the condition. It utilizes powerful approaches of problem solving and goal setting combined with evidence-based rehabilitative techniques for managing cognitive impairments. It also incorporates strategies to address emotional and motivational aspects of dementia that may affect a person’s well-being. It is provided on an individual basis, usually in people’s homes, making it directly applicable to everyday life. It is also genuinely person-centered and flexible as the therapy goals are agreed in a collaborative process between the therapist, person with dementia, and family members. Cognitive rehabilitation does not claim to address underlying pathology, but instead focuses on a person’s functional ability and enjoyment of life. Evidence for effectiveness of cognitive rehabilitation in the context of mild and moderate dementia, mostly Alzheimer’s disease (AD), is gradually accumulating with a number of randomized control trials demonstrating that people with mild and moderate dementia can significantly improve their functioning in targeted areas. For example, the GREAT trial with 475 people with mild to moderate Alzheimer’s, vascular, and mixed dementia completed in 2017 in the United Kingdom demonstrated that cognitive rehabilitation improves everyday functioning in relation to individual therapy goals. There is a growing interest in cognitive rehabilitation and the focus shifts to extending evidence to less-common forms of dementia, particularly in people with non-amnestic presentation. Future efforts need to concentrate on promoting the approach and optimizing application in real-life settings with the aim of maximizing benefits for people living with dementia and their families.

Article

Healthy aging is associated with changes in sensory, motor, cognitive, and emotional functions. Such changes depend on various factors. In particular, physical activity not only improves physical and motor but also cognitive and emotional functions. Observational (i.e., associations) and cross-sectional studies generally show a positive effect of regular physical exercise on cognition in older adults. Most longitudinal randomized controlled intervention studies also show positive effects, but the results are inconsistent due to large heterogeneity of methodological setups. Positive changes accompanying physical activity mainly impact executive functions, memory functions, and processing speed. Several factors influence the impact of physical activity on cognition, mainly the type and format of the activity. Strength training and aerobic training yield comparable but also differential benefits, and all should be used in physical activities. Also, a combination of physical activity with cognitive activity appears to enhance its effect on cognition in older age. Hence, such combined training approaches are preferable to homogeneous trainings. Studies of brain physiology changes due to physical activity show general as well as specific effects on certain brain structures and functions, particularly in the frontal cortex and the hippocampus, which are those areas most affected by advanced age. Physical activity also appears to improve cognition in patients with mild cognitive dysfunction and dementia and often ameliorates the disease symptoms. This makes physical training an important intervention for those groups of older people. Apart from cognition, physical activity leads to improvement of emotional functions. Exercise can lead to improvement of psychological well-being in older adults. Most importantly, exercise appears to reduce symptoms of depression in seniors. In future intervention studies it should be clarified who profits most from physical activity. Further, the conditions that influence the cognitive and emotional benefits older people derive from physical activity should be investigated in more detail. Finally, measures of brain activity that can be easily applied should be included as far as possible.

Article

Cognitive neuroimaging studies often report that older adults display more activation of neural networks relative to younger adults, referred to as overactivation. Greater or more widespread activity frequently involves bilateral recruitment of both cerebral hemispheres, especially the frontal cortex. In many reports, overactivation has been associated with superior cognitive performance, suggesting that this activity may reflect compensatory processes that offset age-related decline and maintain behavior. Several theories have been proposed to account for age differences in brain activation, including the Hemispheric Asymmetry Reduction in Older Adults (HAROLD) model, the Posterior-Anterior Shift in Aging (PASA) theory, the Compensation-Related Utilization of Neural Circuits Hypothesis (CRUNCH), and the Scaffolding Theory of Aging and Cognition (STAC and STAC-r). Each model has a different explanatory scope with regard to compensatory processes, and each has been highly influential in the field. HAROLD contrasts the general pattern of bilateral prefrontal activation in older adults with that of more unilateral activation in younger adults. PASA describes both anterior (e.g., frontal) overactivation and posterior (e.g., occipital) underactivation in older adults relative to younger adults. CRUNCH emphasizes that the level or extent of brain activity can change in response to the level of task demand at any age. Finally, STAC and STAC-r take the broadest perspective to incorporate individual differences in brain structure, the capacity to implement functional scaffolding, and life-course neural enrichment and depletion factors to predict cognition and cognitive change across the lifespan. Extant empirical work has documented that compensatory overactivation can be observed in regions beyond the prefrontal cortex, that variations in task difficulty influence the degree of brain activation, and that younger adults can show compensatory overactivation under high mental demands. Additional research utilizing experimental designs (e.g., transcranial magnetic stimulation), longitudinal assessments, greater regional precision, both verbal and nonverbal material, and measures of individual difference factors will continue to refine our understanding of age-related activation differences and adjudicate among these various accounts of neurocognitive aging.

Article

Megan S. Barker, Emily C. Gibson, and Gail A. Robinson

The term “acquired brain injury” refers to any type of brain damage that occurs after birth. Two main types of acquired brain injury are stroke and traumatic brain injury (TBI). A stroke occurs when there is a blockage or bleed in the vascular system of the brain, while a TBI results from an external force to the head. Older adults are at a higher risk of both stroke and TBI; thus, overall incidence is increasing as the proportion of older adults in the population is growing. Stroke and TBI result in immediate and long-term cognitive changes. Impairments in the domains of language, attention, memory, executive functions, perception, and social cognition have been documented following stroke and TBI. However, strokes tend to cause focal or selective cognitive disorders, while cognitive deficits following TBI are widespread and can be generalized. Individuals who have suffered a stroke or TBI may also experience psychosocial changes; for example, symptoms of depression and anxiety are common. Functional outcomes, including independence in activities, are varied and are associated with a range of factors including age, injury severity, cognitive disorders, and psychosocial factors. To achieve optimal outcomes for individuals following stroke and TBI, and to reduce the impact of the injury on everyday functioning, a multidisciplinary rehabilitation process is recommended.

Article

Ye In (Jane) Hwang, Kitty-Rose Foley, Samuel Arnold, and Julian Trollor

Autism spectrum disorder (ASD), or autism, is a neurodevelopmental disorder that is typically recognized and diagnosed in childhood. There is no established biological marker for autism; rather, the diagnosis is made based on observation of behavioral traits, including (a) persistent deficits in social interaction and communication, and (b) restricted, repetitive patterns of behavior, interests, or activities. Because autism is a spectrum disorder, autistic individuals are a highly heterogeneous group and differ widely in the presentation and severity of their symptoms. The established prevalence of ASD is approximately 1% of the population. Information about autism in adulthood is limited; most of the literature examines childhood and adolescence. While the term “later life” has traditionally been associated with those over the age of 65, a dire lack of understanding exists for those on the autism spectrum beyond early adulthood. Individuals remain on the spectrum into later life, though some mild improvements in symptoms are observed over time. Autistic adults experience high levels of physical and mental health comorbidities. Rates of participation in employment and education are also lower than that of the general population. Quality of life is reportedly poorer for autistic adults than for nonautistic peers, though this is not affected by age. More robust studies of the health, well-being, and needs of autistic adults are needed, especially qualitative investigations of adulthood and aging and longitudinal studies of development over the lifespan.

Article

Healthy aging is accompanied by decrements in episodic memory and working memory. Significant efforts have therefore been made to augment episodic and working memory in healthy older adults. Two principal approaches toward memory rehabilitation adults are restorative approaches and compensatory approaches. Restorative approaches aim to repair the affected memory processes by repeated, adaptive practice (i.e., the trained task becomes more difficult as participants improve), and have focused on recollection training, associative memory training, object-location memory training, and working memory training. The majority of these restorative approaches have been proved to be efficacious, that is, participants improve on the trained task, and there is considerable evidence for maintenance of training effects weeks or months after the intervention is discontinued. Transfer of restorative training approaches has been more elusive and appears limited to other tasks relying on the same domains or processes. Compensatory approaches to memory strive to bypass the impairment by teaching people mnemonic and lifestyle strategies to bolster memory performance. Specific mnemonic strategy training approaches as well as multimodal compensatory approaches that combine strategy training with counseling about other factors that affect memory (e.g., memory self-efficacy, relaxation, exercise, and cognitive and social engagement) have demonstrated that older adults can learn new mnemonics and implement them to the benefit of memory performance, and can adjust their views and expectations about their memory to better cope with the changes that occur during healthy aging. Future work should focus on identifying the personal characteristics that predict who will benefit from training and on developing objective measures of the impact of memory rehabilitation on older adults’ everyday functioning.