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Healthy aging is accompanied by decline in a broad range of functions, including episodic learning and memory, working memory, attention, processing speed, and executive functioning. Significant efforts have therefore been made to augment these functions in healthy older adults. Two principal rehabilitation approaches have been employed: restorative and compensatory. Restorative approaches aim to repair the affected cognitive processes by repeated, adaptive practice. The majority of these restorative approaches have proved to be efficacious, and there is considerable evidence for maintenance of training effects weeks or months after the intervention was concluded. Transfer of restorative training approaches has been more elusive, although recent work has shown training effects on aspects of everyday life such as driving and instrumental activities of daily living. Compensatory approaches strive to bypass the impairment by teaching people strategies to bolster performance. Multimodal compensatory approaches that combine strategy training with counseling about other factors that affect cognition have been shown to help older adults learn new strategies, implement them to the benefit of cognitive performance, and adjust their views and expectations to better cope with the changes that occur during healthy aging.
The relationship of higher order problem solving to basic neuropsychological processes likely depends on the type of problems to be solved. Well-defined problems (e.g., completing a series of errands) may rely primarily on executive functions. Conversely, ill-defined problems (e.g., navigating socially awkward situations) may, in addition, rely on medial temporal lobe (MTL) mediated episodic memory processes. Healthy young (N = 18; M = 19; SD = 1.3) and old (N = 18; M = 73; SD = 5.0) adults completed a battery of neuropsychological tests of executive and episodic memory function, and experimental tests of problem solving. Correlation analyses and age group comparisons demonstrated differential contributions of executive and autobiographical episodic memory function to well-defined and ill-defined problem solving and evidence for an episodic simulation mechanism underlying ill-defined problem solving efficacy. Findings are consistent with the emerging idea that MTL-mediated episodic simulation processes support the effective solution of ill-defined problems, over and above the contribution of frontally mediated executive functions. Implications for the development of intervention strategies that target preservation of functional independence in older adults are discussed. (JINS, 2013, 19, 1–10)
With time and experience, memories undergo a process of reorganization that involves different neuronal networks, known as systems consolidation. The traditional view, as articulated in standard consolidation theory (SCT), is that (episodic and semantic) memories initially depend on the hippocampus, but eventually become consolidated in their original forms in other brain regions. In this study, we review the main principles of SCT and report evidence from the neuropsychological literature that would not be predicted by this theory. By comparison, the evidence supports an alternative account, the transformation hypothesis, whose central premise is that changes in neural representation in systems consolidation are accompanied by corresponding changes in the nature of the memory. According to this view, hippocampally dependent, episodic, or context-specific memories transform into semantic or gist-like versions that are represented in extra-hippocampal structures. To the extent that episodic memories are retained, they will continue to require the hippocampus, but the hippocampus is not needed for the retrieval of semantic memories. The transformation hypothesis emphasizes the dynamic nature of memory, as well as the underlying functional and neural interactions that must be taken into account in a comprehensive theory of memory. (JINS, 2011, 17, 766–780)
Now available in paperback, this updated new edition summarizes the latest developments in cognitive neuroscience related to rehabilitation, reviews the principles of successful interventions and synthesizes new findings about the rehabilitation of cognitive changes in a variety of populations. With greatly expanded sections on treatment and the role of imaging, it provides a comprehensive reference for those interested in the science, as well as including the most up-to-date information for the practising clinician. It provides clear and practical guidance on why cognitive rehabilitation may or may not work. How to use imaging methods to evaluate the efficacy of interventions. What personal and external factors impact rehabilitation success. How biological and psychopharmacological changes can be understood and treated. How to treat different disorders of language and memory, and where the field is going in research and clinical application.