A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VI. COGNITIVE HEALTH <s> Objective: This was a cross-sectional study of the ability of independently living healthy elders to follow a medication regimen. Participants were divided into a group with High Cognitive Function (HCF) or Low Cognitive Function (LCF) based on their scores on the ADAS-Cog. Method: Thirty-eight participants aged 65 or older and living independently in the community followed a twice-daily vitamin C regimen for 5 weeks. Adherence was measured using an electronic 7-day pillbox. Results: The LCF group had significantly poorer total adherence than the HCF group (LCF: 63.9 ± 11.2%, HCF: 86.8 ± 4.3%, t 36 = 2.57, p = .007), and there was a 4.1 relative risk of non-adherence in the LCF group as compared to the HCF group. Discussion: This study has important implications for the conduct of clinical drug trials, as it provides strong evidence that even very mild cognitive impairment in healthy elderly has a detrimental impact on medication adherence. <s> BIB001 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VI. COGNITIVE HEALTH <s> OBJECTIVES ::: To investigate the efficacy of a novel brain plasticity-based computerized cognitive training program in older adults and to evaluate the effect on untrained measures of memory and attention and participant-reported outcomes. ::: ::: ::: DESIGN ::: Multisite randomized controlled double-blind trial with two treatment groups. ::: ::: ::: SETTING ::: Communities in northern and southern California and Minnesota. ::: ::: ::: PARTICIPANTS ::: Community-dwelling adults aged 65 and older (N=487) without a diagnosis of clinically significant cognitive impairment. ::: ::: ::: INTERVENTION ::: Participants were randomized to receive a broadly-available brain plasticity-based computerized cognitive training program (intervention) or a novelty- and intensity-matched general cognitive stimulation program modeling treatment as usual (active control). Duration of training was 1 hour per day, 5 days per week, for 8 weeks, for a total of 40 hours. ::: ::: ::: MEASUREMENTS ::: The primary outcome was a composite score calculated from six subtests of the Repeatable Battery for the Assessment of Neuropsychological Status that use the auditory modality (RBANS Auditory Memory/Attention). Secondary measures were derived from performance on the experimental program, standardized neuropsychological assessments of memory and attention, and participant-reported outcomes. ::: ::: ::: RESULTS ::: RBANS Auditory Memory/Attention improvement was significantly greater (P=.02) in the experimental group (3.9 points, 95% confidence interval (CI)=2.7-5.1) than in the control group (1.8 points, 95% CI=0.6-3.0). Multiple secondary measures of memory and attention showed significantly greater improvements in the experimental group (word list total score, word list delayed recall, digits backwards, letter-number sequencing; P<.05), as did the participant-reported outcome measure (P=.001). No advantage for the experimental group was seen in narrative memory. ::: ::: ::: CONCLUSION ::: The experimental program improved generalized measures of memory and attention more than an active control program. <s> BIB002 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VI. COGNITIVE HEALTH <s> Several studies have demonstrated age-related declines in general executive function and memory. In this study, we examined cross-sectional and longitudinal age effects in more specific cognitive processes that constitute executive function and memory. We postulated that, whereas some components of executive and memory functions would show age differences and longitudinal declines, other specific abilities would be maintained or even improve with repeated testing. In a sample of individuals ≥55 years old from the Baltimore Longitudinal Study of Aging, we found longitudinal declines in inhibition, manipulation, semantic retrieval, phonological retrieval, switching, and long-term memory over a maximum of 14 years follow-up. In contrast, abstraction, capacity, chunking, discrimination, and short-term memory were maintained or even improved longitudinally, probably due in part to repeated testing. Moreover, whereas several different abilities were correlated across participants’ cross-sectional performance, longitudinal changes in performance showed more heterogeneous trajectories. Finally, compared with cross-sectional performance, longitudinal trajectories showed better distinction between participants with and those without later cognitive impairment. These results show that longitudinal cognitive aging of executive and memory functions is not a uniform process but a heterogeneous one and suggest that certain executive and memory functions remain stable despite age-related declines in other component processes. <s> BIB003 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VI. COGNITIVE HEALTH <s> Background ::: The beneficial effects of brain training games are expected to transfer to other cognitive functions, but these beneficial effects are poorly understood. Here we investigate the impact of the brain training game (Brain Age) on cognitive functions in the elderly. <s> BIB004 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VI. COGNITIVE HEALTH <s> Deficient selection against irrelevant information has been proposed to underlie age-related cognitive decline. We recently reported evidence for maintained early sensory selection when older and younger adults used spatial selective attention to perform a challenging task. Here we explored age-related differences when spatial selection is not possible and feature-selective attention must be deployed. We additionally compared the integrity of feedforward processing by exploiting the well established phenomenon of suppression of visual cortical responses attributable to interstimulus competition. Electroencephalogram was measured while older and younger human adults responded to brief occurrences of coherent motion in an attended stimulus composed of randomly moving, orientation-defined, flickering bars. Attention was directed to horizontal or vertical bars by a pretrial cue, after which two orthogonally oriented, overlapping stimuli or a single stimulus were presented. Horizontal and vertical bars flickered at different frequencies and thereby elicited separable steady-state visual-evoked potentials, which were used to examine the effect of feature-based selection and the competitive influence of a second stimulus on ongoing visual processing. Age differences were found in feature-selective attentional modulation of visual responses: older adults did not show consistent modulation of magnitude or phase. In contrast, the suppressive effect of a second stimulus was robust and comparable in magnitude across age groups, suggesting that bottom-up processing of the current stimuli is essentially unchanged in healthy old age. Thus, it seems that visual processing per se is unchanged, but top-down attentional control is compromised in older adults when space cannot be used to guide selection. <s> BIB005 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VI. COGNITIVE HEALTH <s> Introduction: A number of studies have shown the impact of cognitive abilities on instrumental activities of daily living, in particular executive functions. Nevertheless, it is not clear to what extent these results can be generalized, given that most samples studied have not included people with a low educational level. Objectives: The current study aims to investigate the association between cognitive abilities and activities of daily living in older adults - with and without dementia - from a middle-income country. Sample: The sample consisted of 48 healthy older adults and 29 people with dementia, who were evaluated in an Outpatient Care Unit in a University Reference Center in Rio de Janeiro. Results: Regression analyses indicated that the best predictors for activities of daily living were performance in immediate verbal memory in the case of controls and in a categorical fluency task in the patient group. The educational level itself was not a significant predictor of functional ability in either sample, but showed moderate correlation with the predictors. Conclusions: These results suggest that educational level may be a mediating factor in the association of cognitive variables and activities of daily living, and indicate a potential dissociation in terms of predictors according to the diagnostic status, pointing to relevant treatment directions. <s> BIB006 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VI. COGNITIVE HEALTH <s> This paper presents the results of research that applies cognitive therapies associated with memory and mathematical problem-solving in elderly people. The exercises are programmed in an iPad and can be performed both from the Tablet and in an interactive format with a LEGO robot. The system has been tested with 2 men and 7 women over the age of 65 who have slight physical and cognitive impairment. Evaluation with the SUS resulted in a mean of 48.45 with a standard deviation of 5.82. The score of overall satisfaction was 84.37 with a standard deviation of 18.6. Interaction with the touch screen caused some usability problems due to the elderly people's visual difficulties and clicking accuracy. Future versions will include visualization with more color contrast and less use of the keyboard. <s> BIB007 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VI. COGNITIVE HEALTH <s> Abstract A tablet computer is considered as a useful tool for elderly people to improve their everyday life and even to have training to enhance their cognitive ability. In this study, the authors conducted a preliminary experiment to see how different background colors of a tablet computer screen can affect the attention of elderly people while they are performing a task on the tablet computer. Ten Japanese subjects over sixty-five years old performed circle-counting tasks on a tablet computer screen with white, blue and light blue backgrounds. For these three background colors, three different symbols including circles were presented in black, and the subjects were directed to count the number of circles in a short period of time. The average percentages of correct answers for the circle-counting tasks that the subjects performed were higher with the blue and light blue backgrounds than with the white background. These results suggest that white color may not be the best choice for a background color of a tablet computer screen for elderly people. <s> BIB008 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VI. COGNITIVE HEALTH <s> In this longitudinal intervention study with experimental and control groups, we investigated the effects of video game training on the visuospatial working memory and episodic memory of healthy older adults. Participants were 19 volunteer older adults, who received 15 1-hr video game training sessions with a series of video games selected from a commercial package (Lumosity), and a control group of 20 healthy older adults. The results showed that the performance of the trainees improved significantly in all the practiced video games. Most importantly, we found significant enhancements after training in the trained group and no change in the control group in two computerized tasks designed to assess visuospatial working memory, namely the Corsi blocks task and the Jigsaw puzzle task. The episodic memory and short-term memory of the trainees also improved. Gains in some working memory and episodic memory tasks were maintained during a 3-month follow-up period. These results suggest that the aging brain still retains some degree of plasticity, and that video game training might be an effective intervention tool to improve working memory and other cognitive functions in older adults. <s> BIB009 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VI. COGNITIVE HEALTH <s> ObjectivesResearch suggests that older adults who remain socially active and cognitively engaged have better cognitive function than those who are isolated and disengaged. This study examined the efficacy of learning and using an online social networking website, Facebook.com, as an intervention to maintain or enhance cognitive function in older adults.MethodForty-one older adults were assigned to learn and use Facebook (n = 14) or an online diary website (active control, n = 13) for 8 weeks or placed on a waitlist (n = 14). Outcome measures included neuropsychological tests of executive functions, memory, and processing speed and self-report questionnaires about social engagement.ResultsThe Facebook group showed a significant increase in a composite measure of updating, an executive function factor associated with complex working memory tasks, compared to no significant change in the control groups. Other measures of cognitive function and social support showed no differential improvement in the Facebook group.DiscussionLearning and using an online social networking site may provide specific benefits for complex working memory in a group of healthy older adults. This may reflect the particular cognitive demands associated with online social networking and/or the benefits of social engagement more generally. <s> BIB010
A number of cognitive abilities such as memory BIB003 , attention BIB005 , executive functions BIB003 and processing speed  show signs of decline with age. Even though the majority of older adults experience mild cognitive decline, every older adult needs a good cognitive health to live independently. The decreased ability to perform certain tasks or lack of mental stimulation can become a source of constant stress and consternation. It can also progress into serious conditions whereby an individual's ability to engage in various health maintenance behaviors such as medication adherence BIB001 or activities of daily living BIB006 is severely impacted. Finally, cognitive limitations can increase older adults' dependence on caregivers that can become expensive over time  . Fortunately, our understanding of age-related changes in basic cognitive functions, interrelationships among them and their ability to predict higher order cognitive functions is quite advanced. The field of cognitive neuroscience claims that appropriate cognitive training and therapeutic tech-niques can not only slow cognitive decline but they also may reverse/improve cognitive functions of affected older adults BIB002 . Therefore, for the past three decades, researchers have explored two main approaches for improving and maintaining cognitive and neural functions in older adults. The first approach seeks to target specific cognitive functions through computer-based cognitive training exercises. The second approach is concerned with influencing social, intellectual, and emotional engagement to improve neural and cognitive functions. Over the past decades, video games have been extensively studied for their impact on cognitive health of older adults. Researchers have been able to establish that playing video games has numerous cognitive advantages for older adults. Video games have been shown to produce domain-specific improvements in cognitive abilities of older adults BIB009 . The improvement effects have been shown to transfer to other untargeted cognitive domains that have similar or different processing requirements BIB004 . The acceptance factor of video games is also high due to their interactive nature. However, video game research has faced its share of limitations. One major limitation of the video game studies is that they have not shown improvement in episodic memory -a cognitive function that has the most profound influence on an individual's health behaviors. Recently, interest in using tablets to improve cognitive health of older adults has been growing. Researchers have found that learning tablet skills and maintaining sustained tablet engagement involve some of the most desirable cognitive functions in older adults i.e. episodic memory, executive function, long-term memory, working memory and reasoning. Chan et al. studied the effects of learning tablet skills in older adults by comparing three conditions  . The intervention group consisted of eighteen older adults who received extensive training in using a tablet and associated applications for 15 hours per week for three months. The remaining participants were divided into two control groups. The first control group (Placebo) engaged in passive tasks requiring little new learning, whereas the second control group (Social) had regular social interactions and no new learning. Researchers found that, compared to both control groups, the intervention group experienced a greater improvement in episodic memory and processing speed. The interaction modality and real-estate limitations of tablet computers require researchers to pay attention to the usability aspects of the interfaces. Therefore, LopezSamaniego et al.'s study specifically assessed the usability of their system as opposed to measuring its impact on the targeted domains of memory and processing speed BIB007 . Their game consisted of memory and mathematical problemsolving tasks that could be played using the tablet touchscreen or a LEGO robot. Nine older adults (65 years and older) with moderate physical limitations and cognitive impairment provided qualitative feedback on their experience with both the modalities. Even though participants were satisfied with the game and found it enjoyable, they faced some difficulties in using the touchscreen and game's interface. In particular, applying pressure on the screen and targeting the exact touch spots (such as alphabets on keyboard) were challenging. On the game's interface, participants desired to see graphical as opposed to textual instructions, and a higher color contrast. The issue of background screen color was also explored by Yamazaki and Eto BIB008 . In particular, they explored the effect of screen's background colors on older adults' ability to pay attention while performing an attention seeking task. The study participants were asked to count circles on different background colors of a tablet screen. The results indicated that performance was best when black circles were displayed on a blue screen. Tablet-based training programs have also been developed for cognitive rehabilitation of older dementia patients. A noteworthy example is Padua Rehabilitation Tool (PRT). This application was evaluated for both its effectiveness and usability in fifteen older adults with dementia by comparing three treatment conditions: traditional (paper-based), tabletbased, and no treatment  . Both traditional and tablet groups showed significant improvements in their cognitive functioning but some differences were observed. The tablet group showed improvement in other associated psychological conditions while the traditional group did not. The traditional group maintained the effects of the intervention one month after the intervention but tablet group did not. In terms of its usability, the tablet group was enthused by the application, and found it easy to use and engaging. Researchers believe that the main success of PRT was its graphical user interface that was designed in consultation with the target population. The interface provided visual and auditory feedback at the completion of every task. The difficulty levels of the tasks were adjusted according to user's abilities, keeping the users engaged in the training. This study also established the importance of personalization in interface and algorithm design for cognitive health in older adults. Studies with video games have shown that personalized and adaptive designs improve cognitive functioning of older adults BIB002 ,  . Research also suggests that domain-specific cognitive benefits can be obtained from social interactions in the context of cognitive training. This is specifically demonstrated in Myhre et al. study where a group older adults using Facebook was compared with a control group using an online diary BIB010 . The experimental group was trained to use Facebook and the control group was trained to use an online diary by Penzu.com in the first week of the study. During the following seven weeks, experimental group logged onto their Facebook page everyday and posted at least one status update (on their own pages) and one comment (on another participant's page). The purpose was to engage participants in back-and-forth dialogues among themselves. During this time, the control group was expected to login to their Penzu account everyday and write no more than three to five sentences to emulate the brevity of messages typically posted on Facebook. Results revealed significant improvement in processing speed and executive function associated with working memory in the Facebook group. The researchers hypothesized that learning the complex interface of Facebook is responsible for directly improving the working memory in Facebook group and this improvement might have also transferred to another cognitive domain, i.e. memory update.