Cognitive Training Improves Sleep Quality and Cognitive Function among Older Adults with Insomnia

<div><p>Study Objectives</p><p>To investigate the effect of an eight-week, home-based, personalized, computerized cognitive training program on sleep quality and cognitive performance among older adults with insomnia.</p> <p>Design</p><p>Participants (n = 51) were randomly allocated to a cognitive training group (n = 34) or to an active control group (n = 17). The participants in the cognitive training group completed an eight-week, home-based, personalized, computerized cognitive training program, while the participants in the active control group completed an eight-week, home-based program involving computerized tasks that do not engage high-level cognitive functioning. Before and after training, all participants' sleep was monitored for one week by an actigraph and their cognitive performance was evaluated.</p> <p>Setting</p><p>Community setting: residential sleep/performance testing facility.</p> <p>Participants</p><p>Fifty-one older adults with insomnia (aged 65–85).</p> <p>Interventions</p><p>Eight weeks of computerized cognitive training for older adults with insomnia.</p> <p>Results</p><p>Mixed models for repeated measures analysis showed between-group improvements for the cognitive training group on both sleep quality (sleep onset latency and sleep efficiency) and cognitive performance (avoiding distractions, working memory, visual memory, general memory and naming). Hierarchical linear regressions analysis in the cognitive training group indicated that improved visual scanning is associated with earlier advent of sleep, while improved naming is associated with the reduction in wake after sleep onset and with the reduction in number of awakenings. Likewise the results indicate that improved “avoiding distractions” is associated with an increase in the duration of sleep. Moreover, the results indicate that in the active control group cognitive decline observed in working memory is associated with an increase in the time required to fall asleep.</p> <p>Conclusions</p><p>New learning is instrumental in promoting initiation and maintenance of sleep in older adults with insomnia. Lasting and personalized cognitive training is particularly indicated to generate the type of learning necessary for combined cognitive and sleep enhancements in this population.</p> <p>Trial Registration</p><p>ClinicalTrials.gov NCT00901641<a href="http://clinicaltrials.gov/ct2/show/NCT00901641" target="_blank"></a></p> </div

Summary of Measures Taken in Each Phase of the Study.

<p>Summary of Measures Taken in Each Phase of the Study.</p

Mixed models statistics for within-group, baseline and between-group differences on cognitive abilities for the two study groups after adjusting for age.

1<p>AM = Auditory (non-linguistic) memory; DA = Divided Attention; DS = Avoiding Distractions; GC = Hand-eye co-ordination.</p><p>GM = General Memory; IN = Inhibition; NM = Naming; PL = Planning; RT = Response Time; SH = Shifting; SP = Spatial Perception; TE = Time estimation; VM = Visual Working Memory; VP = Visual Perception; VS = Visual Scanning; WM = Working Linguistic-Auditory Memory.</p>2<p>Significance levels:</p>*<p> = significant at the level of 0.05,</p>**<p> = significant at the level of 0.01,</p>***<p> = significant at the level of 0.001.</p>3<p>Cohen's d effect sizes:</p>∧<p> = small-sized effect,</p>∧∧<p> = medium-sized effect,</p>∧∧∧<p> = large-sized effect.</p

Participant Flowchart.

<p>Participant Flowchart.</p

Mixed models statistics for within-group, baseline and between-group differences on sleep quality parameters for the two study groups after adjusting for age.

1<p>SOL = Sleep Onset Latency (minutes); SE = Sleep Efficiency (%); Total Sleep Time (minutes); WASO = Wake After Sleep Onset (minutes); NA = Number of Awakenings.</p>2<p>Significance levels:</p>*<p> = significant at the level of 0.05,</p>**<p> = significant at the level of 0.01,</p>***<p> = significant at the level of 0.001.</p>3<p>Cohen’s d effect sizes:</p>∧<p> = small-sized effect,</p>∧∧<p> = medium-sized effect,</p>∧∧∧<p> = large-sized effect.</p

Number of Visits to the Participants' Homes and Purpose of Each Visit.

<p>Number of Visits to the Participants' Homes and Purpose of Each Visit.</p

Linear regression between Mean Difference (post-intervention mean minus baseline mean) in Number of Awakening (dependent) and Mean Difference (post-intervention mean minus baseline mean) in Naming (independent).

<p>Linear regression between Mean Difference (post-intervention mean minus baseline mean) in Number of Awakening (dependent) and Mean Difference (post-intervention mean minus baseline mean) in Naming (independent).</p

Linear regression between Mean Difference (post-intervention mean minus baseline mean) in Sleep Onset Latency (dependent) and Mean Difference (post-intervention mean minus baseline mean) in Visual Scanning (independent).

<p>Linear regression between Mean Difference (post-intervention mean minus baseline mean) in Sleep Onset Latency (dependent) and Mean Difference (post-intervention mean minus baseline mean) in Visual Scanning (independent).</p

Linear regression between Mean Difference (post-intervention mean minus baseline mean) in Wake after Sleep Onset (dependent) and Mean Difference (post-intervention mean minus baseline mean) in Naming (independent).

<p>Linear regression between Mean Difference (post-intervention mean minus baseline mean) in Wake after Sleep Onset (dependent) and Mean Difference (post-intervention mean minus baseline mean) in Naming (independent).</p