Cognitive training in the rural elderly: A randomized trial to evaluate the efficacy and accessibility of a new approach.

Background: Cognitive training is an important determinant of successful aging but rural areas of Canada are uniquely deprived from accessing such speciality services. A need exists to examine the application of cognitive training through a rural lens. Objectives: 1. To develop a novel collaborative approach to improving access to cognitive training in rural settings. 2. To evaluate the efficacy of a multicomponent cognitive training program for improving cognition in normal elderly persons. Treatment Conditions: Experimental training (ET) consisted of three modules: (1) Executive Functioning, (2) Memory, and (3) Psychosocial Training. Active control (AC) consisted of word searches, reading short stories and answering multiple-choice questions. Method: A multisite, randomized control, double-blind trial was conducted with 28 experimental participants (Mage = 70.68 ± 8.89) and 28 active controls (Mage = 74.39 ± 9.39). Treatments were self-administered 1 hour/ 5 days a week for 4 weeks. Pre-and post-training neuropsychological measures were utilized as determinants of program success. Results: Compared to the AC group, the ET group displayed significant gains on targeted abilities, executive (p = .002) and memory (p < .001), but not psychosocial (p =.105) ability. Training-induced benefits were also observed for the ET group on untrained measures of global (BCRS, p = .002) and functional abilities (DAD, p < .001; FRS, p = .042). Performance improvements were more reliable for the ET than AC for executive (55.5% vs. 12.5%), memory (55% vs. 19.5%) and functional ability (41% vs. 7.5%). Participant recruitment and compliance rates were enhanced by the involvement of a physician. Conclusion: Results support the efficacy of multicomponent cognitive training in reliably improving targeted and functional abilities. Physicians are critical players to the delivery of regimented cognitive training for older adults both in terms of recruitment and compliance. ii