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Article

Effects on Language and Verbal Fluency of a Cognitive Stimulation Program in Older Adults: Randomized Controlled Trial

by
Estela Calatayud
1,2,
Ana Belen Subiron-Valera
1,
Yolanda Marcén-Román
1,
Carlos Salavera
3,
Elena Andrade-Gómez
4,*,
Beatriz Rodríguez-Roca
1,* and
Isabel Gómez-Soria
1,2
1
Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
2
Institute for Health Research Aragon, 50009 Zaragoza, Spain
3
Department of Psychology, University of Zaragoza, 50009 Zaragoza, Spain
4
Department of Nursing, University of La Rioja, La Rioja, 26004 Logroño, Spain
*
Authors to whom correspondence should be addressed.
Sustainability 2023, 15(3), 2533; https://doi.org/10.3390/su15032533
Submission received: 4 January 2023 / Revised: 17 January 2023 / Accepted: 29 January 2023 / Published: 31 January 2023
(This article belongs to the Section Health, Well-Being and Sustainability)
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Abstract

:
The efficacy of cognitive stimulation programs for the elderly is sufficiently documented. However, few studies have addressed the effectiveness of language stimulation programs by cognitive levels in this population. This randomized controlled trial was conducted on 308 participants from a primary care center and followed the CONSORT guidelines. A stratified randomization was carried out. The primary variable was the MEC-35, validated Spanish version of the Mini-Mental State Examination (MMSE). The secondary outcome variable was set-test, which evaluates verbal fluency in four categories. These tests were assessed for all outcome measures at baseline, at 10 weeks, at 6 months, and 1 year after the intervention. The intervention consisted of 10 sessions of 45 min/week for 10 weeks through mental activation notebooks that comprehensively work on the different cognitive functions. The results show that the comparisons between the control and intervention group turn out to be significant (p < 0.05) at the three time points. The comprehensive cognitive stimulation program has made it possible to improve the global aspects of cognition, language proficiency, and verbal fluency. To optimize and maintain these results, it is necessary to consider other clinical, functional, psychological, and occupational aspects, as well as related educational aspects, which prevent mild cognitive impairment.

1. Introduction

The number of elderly people worldwide will approach 2.1 billion by the year 2050 [1]. Longevity represents a great achievement for humanity and a challenge for aging populations. Older people often look for novel ways to contribute after retirement. However, their contribution depends on their physical health, mental health, and well-being [2,3].
These challenges are even more concerning given that normal cognitive aging is associated with declines in key brain regions that are vital for cognitive function [4]. These are characterized by near-linear declines from early adulthood in speed and inhibitory control in task switching [5], and accelerating declines in memory and reasoning. However, vocabulary knowledge increases until the subjects are in their 60s [6].
Recent studies suggest that the link between action and language decreases with age [7]. Although lexicosemantic deficits are not typically seen in older adults, some studies indicate that age-related changes can occur in semantic processing [8]. It must be taken into account that impairment of language skills affects the level of functioning of an individual, interferes with effective communication, and can result in the development of disruptive behavior [9].
Verbal fluency is one of the first and most important cognitive functions to deteriorate during the aging process. Verbal fluency is defined as the skill and speed of finding words and finding semantic and phonetic connections between words [10]. The semantic verbal fluency test is generally administered by asking participants to generate words from a semantic category such as animals, fruits, or vegetables [11].
The findings from the Canadian Longitudinal Study on Aging indicate subtle changes in the way people perform this verbal fluency task as they age up [12]. Previous research had already suggested that verbal fluency is a function of people’s age regardless of cognitive functioning, and younger populations performed better on these verbal fluency tests compared to older adults [11]. However, it has been shown that people with mild cognitive impairment (MCI) achieve a lower verbal fluency score than the healthy population and also their score decreases more rapidly in the same time period [13]. Additionally, the linguistic deficit is the most frequent cognitive disturbance after memory disorders in Alzheimer’s disease (AD) semiology [14].
The findings emphasize the contribution of the right hemisphere regions to the performance of the fluency task [15]. This approach supports the value of introducing time-based measures to the assessment of verbal fluency in the context of this generative task differentiating subjects with MCI from those with intact cognition [16].
However, population studies indicate that between 50% and 80% of older people who perform within normal ranges on cognitive tests report subjective memory complaints (SMC). These are usually very common and have a risk of transformation to MCI and AD. Therefore, there is a need to develop an efficient and cost-effective therapeutic method for SMC in older adults [17].
Finally, cognitive stimulation programs for elderly people show positive results; however, few are the studies that have investigated the effectiveness of language stimulation programs for the health of this population [18]. In this regard, the cognitive reserve hypothesis has received much attention regarding how to avoid cognitive deterioration [19].

Statement of the Study

The aim of this study was to analyze, through a randomized clinical trial, the effects produced on language and verbal fluency over time, with a cognitive stimulation program by cognitive levels and with specific language activities, in older adults with SMC living in the community.

2. Materials and Methods

2.1. Design and Participants

This randomized controlled trial was conducted on elderly people in a primary care center in the city of Zaragoza (northeastern Spain). The reasons for choosing a primary care health center were firstly the fact that, in Spain, the figure of the occupational therapy professional is not yet included in the public health services, and somehow it was a pilot experience in our city. The initial sample consisted of 367 participants. After applying the inclusion criteria, the final sample consisted of 308 participants that were allocated into two groups: 131 participants in the intervention group and 177 participants in the control group. These participants were recruited in primary healthcare consultations and received normal medical and nursing care. The flow of participants and dropouts in the different phases of the study is shown in Figure 1.
Participants received information on the project from informative posters placed on the doors of all the medical consultation rooms and at their family doctor’s office. This study followed the CONSORT guidelines [20].

Inclusion and Exclusion Criteria

Individuals aged 65 years or older, scoring 24 points or more on the MEC-35 (validated Spanish version of the Mini-Mental State Examination, MMSE) [21] and presenting subjective memory complaints were included. We excluded individuals who had received cognitive stimulation in the last year (to avoid possible biases), those who were institutionalized, and those who presented functional (<60 points on the Barthel index and 3 or less points on Lawton), psychological (more than 6 points on the abbreviated Goldberg anxiety scale and 12 points or more on the Yesavage depression questionnaire) and major sensory (blindness and deafness) problems, as well as neuropsychiatric disorders. These exclusion criteria were taken into account in the face of physical, functional, psychological, or sensory impossibility to attend or adequately carry out the intervention sessions.
The withdrawal criteria consisted of the failure to attend assessments or decision to abandon, death, or entry into a geriatric center.
All the participants were informed about the nature of the study, its objectives, and the voluntary nature of their participation, and that they were free abandon it at any time without giving any explanations.

2.2. Sample Size

The sample size calculation was performed with G*3 Power 3.1 (Heinrich-Heine University Düsseldorf, Germany). The calculations were based on a standard deviation (SD) of 5.2 points, a between-group difference of 2 points (it was the minimal detectable change [MDC] of the MEC-35 [22], an alpha level of 0.05, and power of 80%. A total sample of 132 participants was estimated. Considering a dropout rate of 50% based on previous studies conducted with this type of population, an initial sample of 308 participants was necessary to reach 132 participants at follow-up, one year after the intervention.

2.3. Treatment Allocation

Participants were randomized into two groups: the intervention group (IG) and the control group (CG). A stratified randomization was carried out based on the scores obtained in the MEC-35 scale [21]: group 1 had scores between 32 and 35 points, group 2 had scores between 28 and 31 points [23,24], and group 3 had scores between 24 and 27 points, in accordance with the classification by Calero et al. [25]. For randomization, an opaque urn was used into which the participants’ file numbers were placed and an anonymous person drew the selected numbers. The first author verified the inclusion criteria of the participants. The randomization was carried out by a therapist who was independent from the study.

2.4. Outcomes Measures

Participants who confirmed their willingness to participate and fulfilled the inclusion criteria were enrolled in the study and assessed for all outcome measures at baseline (Pre), at 10 weeks (Post-intervention), at 6 months (Follow-up I), and one year after the intervention (Follow-up II). Each evaluation was performed by different occupational therapists who were blinded to the group allocation. Evaluators who performed the interventions carried out a 20 h specific theoretical–practical training program to guarantee homogeneous application of the evaluation criteria. Assessments were always performed at the same time and in the same place in order to preserve participant conditions as far as possible. Additionally, other factors such as changes in medication were also controlled.
Primary outcomes were the changes in the cognitive level, evaluated with the MEC-35. Secondary outcomes included the abbreviated form of the set test [26].

2.4.1. Variables

Sociodemographic, clinical, contextual, and environmental variables were examined. The sociodemographic variables studied were age, gender, civil status, education level, physical occupational status, and mental occupational status. Moreover, education level was divided into two subgroups (Primary/Higher). This is the most basic classification possible, given that this variable was not initially considered for the inference analysis of the results. The subdivision of physical occupational status and mental occupational status was made according to three levels: low, medium, and high for each of them, in accordance with the classification used by Grotz et al. [27].
The clinical state variables examined were high blood pressure (HBP), diabetes, hypercholesterolemia, obesity, and cerebrovascular accident (CVA).

2.4.2. Neuropsychological Assessment

The primary variable was the MEC-35, one of the most widely used short cognitive tests for the study of cognitive capacities in primary care. It evaluates eight components: temporal and spatial orientation (10 points), fixation memory (3 points), attention (3 points), calculation (5 points), short-term memory (3 points), language, and praxis (11 points). Its sensitivity is 85–90% and its specificity is 69% [21]. This questionnaire was used to assess the global cognition and cognitive functions of temporal orientation, spatial orientation, fixation memory, attention, calculation, short-term memory, language, and praxis. Unlike the MMSE, the MEC-35 includes a three-digit series to repeat two similar items in reverse order. Subtraction is performed three by three from 30, instead of 7 by 7 from 100, as in the version used by Folstein et al. [28]. In this version, as the number of items increases, the maximum score reaches 35 points as compared to 30 in the original one [29].
The presence of subjective memory complaints (SMC) was evaluated through the question: Do you have complaints about your memory? Dichotomous response (yes/no) [30,31].
The set test [26] evaluates verbal fluency in four categories: colors, animals, fruits, and cities. It has been proposed as a diagnostic aid in dementia in elderly patients. The cutoff value was 29 in adults and 27 in elderly people. A lower score is indicative of dementia. Sensitivity was 79% and specificity 82%, with 20% of incorrectly classified patients.

2.4.3. Intervention

The intervention was carried out at La Caridad Foundation in Zaragoza (collaborating entity). This foundation was close to the health center, which facilitated the participants’ access to it and had the appropriate facilities to carry out the intervention program (which the health center lacked).
All participants, who were blinded to the group allocation, were treated by two skilled occupational therapists. The intervention was carried on subgroups of 25–26 participants from group 1: 32–35 points and group 2: 28–31, as well as in subgroups of ten participants from group 3: 24–27 points [32], each using the notebook of mental activation [33], designed by cognitive level in accordance with MEC [23,24,25].
The intervention was carried out, adapting the stimulating activities to the life history, personal preferences, limitations, and potentialities of the patient [34]. The intervention was performed in each subgroup by two trained occupational therapists.
The intervention consisted of 10 sessions of 45 min/week for 10 weeks. Each session included four parts: (a) reality orientation: questions about date, time, and place, using calendars, clocks, and posters indicating the place and address where the participants were situated; (b) explanation of the cognitive aspect that was going to be focused on in each session, with alternatives including: (1) “memory” (changes with aging, types of memory, strategies such as association and categorization); (2) “orientation” (temporary, spatial, and personal); (3) “language”; (4) “praxis” (ideomotor, ideational, and constructive); (5) “gnosis”; (6) “calculation”; (7) “perception”; (8) “reasoning”; (9) “visual attention”; (10) “executive functions” (planning capacity, training in social skills, and association with activities of daily living); (c) individual practical work, in which four exercises of the cognitive aspect corresponding to each session were performed; (d) group correction of practical exercises.
Although the cognitive stimulation program was comprehensive, the exercises were performed in the different subgroups, according to the cognitive level, in the language area, as shown in Figure 2.

3. Results

The study participants’ sociodemographic and clinic characteristics are shown in Table 1.
This shows that 64.9% were women and 35.1% were men. Their mean age was 73.66, with an SD of 5.88. Generally, no statistically significant differences were observed in sociodemographic characteristics, clinical characteristics, and participant lifestyle, with the exception of the number of women and men (p = 0.008) and their age (p = 0.009). The profile was a married (67.2%) woman (64.9%), having a primary-level education (76.3%), a medium physical occupation (39.9%), and a low mental occupation (57.8%).
Regarding the clinical characteristics, the profile of our participants included 49% with arterial hypertension, 13.6% with diabetes, 39.3% with hypercholesterolemia, 13.3% with obesity, and 6.5% with cerebrovascular accident.
Table 2 and Table 3 show the effect of the intervention, at 10 weeks (Post-intervention), at 6 months (Follow-up I), and a year after the intervention (Follow-up II) with respect to the baseline evaluation, on the main variable MEC, and specifically, on the cognitive domain of language.
Likewise, we analyzed the effect of the intervention on the secondary outcome variable Set-test. As can be seen, all the comparisons between the control group and intervention group turn out to be significant (p < 0.05) at the three time points, for the variables MEC-35, language and Set- test. With respect to the language and praxis variable, this difference is significant in Post and the Follow-up II; however, it is not significant in Follow-up I (p = 0.068).
Table 4 shows the most adjusted model of the regression for the dependent variable language and Set- test in the post-intervention evaluation, and one year after the intervention with the rest of the variables studied. It was decided to perform this regression at these two moments in time to determine if the predictor variables can be modified over time.
The results show that at the post-intervention moment, the language variable presents the educational level and the set test as predictor variables with a positive relationship with the group (control or intervention), and a negative relationship with depression. According to ANOVA, there is a significant relationship (F = 8.478, p-value less than 0.001). One year after the intervention, this language variable is positively related with the group and mental occupation, and negatively with age and depression. According to the ANOVA, there is a significant relationship (F = 6.436, p-value less than 0.001).
Post-intervention, the Set- test variable is positively related to stroke and Lawton, and negatively to age. According to ANOVA, there is a significant relationship (F = 11.739, p-value less than 0.001). One year after the intervention, it is positively related to educational level, Lawton, and mental occupation, and negatively to age. According to the ANOVA, there is a significant relationship (F = 7.633, p-value less than 0.001).

4. Discussion

This research showed that in older people with subjective memory complaints, the addition of a comprehensive cognitive stimulation program according to the pre-existing cognitive level (measured with MEC-35) led to global cognitive improvements in the specific language domain and in the verbal fluency of the intervention group compared to the CG. Furthermore, these effects not only occured after the intervention, but were also maintained over time, both in Follow-up I (6 months) and on a longer-term in Follow-up II (one year after the intervention).
Similarly, other studies have shown cognitive benefits with different techniques in healthy older adults, regardless of their initial cognitive status [35,36,37,38,39,40,41,42,43,44,45]. This reflects a general view that lack of cognitive activity accelerates cognitive decline [46] and that cognitive stimulation could optimize cognitive function [47,48] producing an increase in neuronal volume [49].
However, we have identified only few studies that analyzed the effect of these programs on the cognitive subdomain of language. The study by Park et al. [40] also found significant differences in language skills with a similar number of sessions to our study, but with a pretest–posttest design and a multicomponent program. Regarding verbal fluency, we have identified three studies whose results agree with those obtained in our study: the global cognitive improvement in MMSE and the improvement of verbal fluency, with similar programs that work comprehensively on cognitive functions [37,45,49]. Both tests show moderate agreement in cognitive screening [50].
Therefore, the cognitive benefits that obtained globally, in language proficiency and in verbal fluency, have been corroborated in other studies [45,51,52], and with long-term effects [33]. These results suggest that engaging in memory training improves confidence in this memory ability [53,54] and generally promotes self-esteem and quality of life [45,52].
The results of the predictive models (regressions) show how, in older people with SMC, the level of education, verbal fluency, and mental occupation are positively related as predictors of language proficiency, and negatively with depression and age. Similarly, this study has shown how verbal fluency is positively related to stroke and instrumental activities of daily living (IADL), and negatively to age and mental occupation.
Consistent with this, other studies have indicated that linguistic skills and verbal fluency decrease with age [7,10], and that education dampens overall performance and language proficiency especially if SMC exists [55]. These complaints are also linked to depression and cognitive deficit in primary care settings [56]. However, other authors have found no relationship between SMC and verbal fluency in older people [57], but rather with mental occupation [58], the deterioration of AIDL [59,60], and the relationship with aphasia as a frequent complication after a stroke [61].
The literature indicates the relationship between SMC and the risk of MCI [62] and dementia [63]. If these complaints are multidomain (memory, language, executive), the risk increases [63]; therefore, in clinical practice all complaints [62,64] should be considered as possible early indicators of incipient dementia [65].
Therefore, CS from the field of occupational therapy is a cost-effective psychosocial intervention [47,66] to prevent and delay the onset of MCI and dementia [67,68], especially if work activities are considered to be stimulating [69]. Despite the effects of these programs improving emotional well-being and quality of life [43,70], there is a gap in their implementation in clinical practice [66].
In addition, the literature emphasizes, consistent with our study, the need to adapt interventions to individual needs and resources (person-centered care) [71] and address the practice of CS in a global or multi-domestic manner [68] to avoid that the interactions between the multiple cognitive processes necessary for a healthy mental state are lost [44,51,72,73,74], the results endure over time [49], and are extrapolated to functional and psychological areas [43].
Regarding this study’s limitations, in the first place, in this study we have not been able to compare the effects of the intervention with another group of elderly people without CMS. Second, we have not explored the transfer of the program to functional and psychological capacities.
This paper adds that programs that work comprehensively on cognitive functions improve verbal fluency. This study shows how verbal fluency is positively related to stroke and instrumental activities of daily living, and negatively to age and mental occupation. This research demonstrates that the addition of comprehensive cognitive stimulation programs in people with subjective memory complaints leads to global cognitive improvements, as well as improvements in specific language proficiency and verbal fluency.
Finally, future studies should explore complaints in other domains such as language and the effects that this program produces on functional and psychological variables.

5. Conclusions

This study has shown that comprehensive cognitive stimulation in older people with SMC, with a work methodology by cognitive levels, and which takes into account previous work aspects, improves overall cognitive performance, in addition to improving language proficiency and verbal fluency.
In addition, aspects such as educational level, verbal fluency, and mental occupation are positively related as predictors of linguistic competence, which should be taken into account to treat the most vulnerable older people.

Author Contributions

Conceptualization, E.C., A.B.S.-V., Y.M.-R., C.S., E.A.-G., B.R.-R. and I.G.-S.; Methodology, E.C., A.B.S.-V., Y.M.-R., C.S., E.A.-G., B.R.-R. and I.G.-S.; Validation, E.C., A.B.S.-V., Y.M.-R., C.S., E.A.-G., B.R.-R. and I.G.-S.; Formal analysis, E.C., A.B.S.-V., Y.M.-R., C.S., E.A.-G., B.R.-R. and I.G.-S.; Investigation, E.C., A.B.S.-V., Y.M.-R., C.S., E.A-G, B.R.-R. and I.G.-S.; Resources, E.C., A.B.S.-V., Y.M.-R., C.S., E.A.-G., B.R.-R. and I.G.-S.; Data curation, E.C., A.B.S.-V., Y.M.-R., C.S., E.A.-G., B.R.-R. and I.G.-S.; Writing—original draft, E.C., A.B.S.-V., Y.M.-R., C.S., E.A.-G., B.R.-R. and I.G.-S.; Writing—review & editing, E.C., A.B.S.-V., Y.M.-R., C.S., E.A.-G., B.R.-R. and I.G.-S.; Supervision, E.C., A.B.S.-V., Y.M.-R., C.S., E.A.-G. and B.R.-R.; Project administration, I.G.-S. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki [75] and approved by the Research Ethics Committee of the Spanish Autonomous Community of Aragón, protocol number CEICA PI11/90 and registered on ClinicalTrials.gov (identifier NCT03831061 and NCT04648670).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Acknowledgments

The authors would like to thank the healthcare center and its professionals for their collaboration and for having provided us the physical space in which to conduct the evaluations. They also would like to thank all the participants and occupational therapy professionals who collaborated in this research study.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. United Nations, Department of Economic and Social Affairs, Population Division. World Population Ageing 2019 (ST/ESA/SER.A/390); United Nations: New York, NY, USA, 2020. [Google Scholar]
  2. Cosco, T.D.; Howse, K.; Brayne, C. Healthy ageing, resilience and wellbeing. Epidemiol. Psychiatry Sci. 2017, 26, 579–583. [Google Scholar] [CrossRef] [PubMed]
  3. Iasiello, M.; Bartholomaeus, J.; Jarden, A.; van Agteren, J. Maximising the Opportunity for Healthy Ageing: Online Mental Health Measurement and Targeted Interventions. Stud. Health Technol. Inform. 2018, 246, 111–123. [Google Scholar] [CrossRef] [PubMed]
  4. Zheng, F.; Liu, Y.; Yuan, Z.; Gao, X.; He, Y.; Liu, X.; Cui, D.; Qi, R.; Chen, T.; Qiu, J. Age-related changes in cortical and subcortical structures of healthy adult brains: A surface-based morphometry study. J. Magn. Reson. Imaging 2019, 49, 152–163. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  5. Statsenko, Y.; Habuza, T.; Gorkom, K.N.; Zaki, N.; Almansoori, T.M.; Al Zahmi, F.; Ljubisavljevic, M.R.; Belghali, M. Proportional Changes in Cognitive Subdomains During Normal Brain Aging. Front. Aging Neurosci. 2021, 13, 673469. [Google Scholar] [CrossRef] [PubMed]
  6. Salthouse, T.A. Trajectories of normal cognitive aging. Psychol. Aging 2019, 34, 17–24. [Google Scholar] [CrossRef]
  7. Bidet-Ildei, C.; Beauprez, S.A.; Boucard, G. The link between language and action in aging. Arch. Gerontol. Geriatr. 2020, 90, 104099. [Google Scholar] [CrossRef]
  8. Taler, V.; Jarema, G. Lexical access in younger and older adults: The case of the mass/count distinction. Can. J. Exp. Psychol. 2007, 61, 21–34. [Google Scholar] [CrossRef]
  9. Potkins, D.; Myint, P.; Bannister, C.; Tadros, G.; Chithramohan, R.; Swann, A.; O’Brien, J.; Fossey, J.; George, E.; Ballard, C.; et al. Language impairment in dementia: Impact on symptoms and care needs in residential homes. Int. J. Geriatr. Psychiatry 2003, 18, 1002–1006. [Google Scholar] [CrossRef]
  10. Soltani, M.; Moradi, N.; Rezaei, H.; Hosseini, M.; Jasemi, E. Comparison of verbal fluency in monolingual and bilingual elderly in Iran. Appl. Neuropsychol. Adult 2021, 28, 80–87. [Google Scholar] [CrossRef]
  11. Alenius, M.; Koskinen, S.; Hallikainen, I.; Ngandu, T.; Lipsanen, J.; Sainio, P.; Tuulio-Henriksson, A.; Hänninen, T. Cognitive Performance among Cognitively Healthy Adults Aged 30–100 Years. Dement. Geriatr. Cogn. Dis. Extra. 2019, 9, 11–23. [Google Scholar] [CrossRef]
  12. Taler, V.; Johns, B.T.; Jones, M.N. A Large-Scale Semantic Analysis of Verbal Fluency Across the Aging Spectrum: Data From the Canadian Longitudinal Study on Aging. J. Gerontol. B Psychol. Sci. Soc. Sci. 2020, 75, e221–e230. [Google Scholar] [CrossRef] [Green Version]
  13. Farina, M.; Breno Costa, D.; Webber de Oliveira, J.A.; Polidoro Lima, M.; Machado, W.L.; Moret-Tatay, C.; Fernandes, R.M.; Iracema, I.; Quarti, T. Cognitive function of Brazilian elderly persons: Longitudinal study with non-clinical community sample. Aging Ment. Health 2020, 24, 1807–1814. [Google Scholar] [CrossRef]
  14. Sahraoui, S.; Lefebvre, L. Étude des niveaux de traitement de l’information langagière chez les sujets Alzheimer bilingues, du stade débutant à modéré [Study of the levels of processing in language production in bilingual patients with Alzheimer’s disease from early to medium stage]. Geriatr. Psychol Neuropsychiatr. Vieil. 2019, 17, 221–228. [Google Scholar] [CrossRef]
  15. Clark, D.G.; Wadley, V.G.; Kapur, P.; DeRamus, T.P.; Singletary, B.; Nicholas, A.P.; Blanton, P.D.; Lokken, K.; Deshpande, H.; Marson, D.; et al. Lexical factors and cerebral regions influencing verbal fluency performance in MCI. Neuropsychologia 2014, 54, 98–111. [Google Scholar] [CrossRef]
  16. Chen, L.; Asgari, M.; Gale, R.; Wild, K.; Dodge, H.; Kaye, J. Improving the Assessment of Mild Cognitive Impairment in Advanced Age With a Novel Multi-Feature Automated Speech and Language Analysis of Verbal Fluency. Front. Psychol. 2020, 11, 535. [Google Scholar] [CrossRef]
  17. van Harten, A.C.; Mielke, M.M.; Swenson-Dravis, D.M.; Hagen, C.E.; Edwards, K.K.; Roberts, R.O.; Geda, Y.E.; Knopman, D.S.; Petersen, R.C. Subjective cognitive decline and risk of MCI: The Mayo Clinic Study of Aging. Neurology 2018, 91, e300–e312. [Google Scholar] [CrossRef]
  18. da Cunha, R.D.B.; Pacheco, T.F.; Barreto, S.D.S. Effects of language stimulation on cognition of institutionalized aged people: A preliminary case series study. Dement. Neuropsychol. 2021, 15, 136–144. [Google Scholar] [CrossRef]
  19. Phillips, C. Lifestyle Modulators of Neuroplasticity: How Physical Activity, Mental Engagement, and Diet Promote Cognitive Health during Aging. Neural. Plast. 2017, 2017, 3589271. [Google Scholar] [CrossRef]
  20. Cobos-Carbó, A.; Augustovski, F. Declaración CONSORT 2010: Actualización de la lista de comprobación para informar ensayos clínicos aleatorizados de grupos paralelos. Med. Clin. Barc 2011, 137, 213–215. [Google Scholar] [CrossRef] [Green Version]
  21. Lobo, A.; Saz, P.; Marcos, G.; Día, J.L.; de la Cámara, C.; Ventura, T.; Morales, F.; Pascual, L.F.; Montanes, J.A.; Aznar, S. Revalidación y normalización del Mini-Examen Cognoscitivo (primera versión en castellano del Mini-Mental Status Examination) en la población general geriátrica. Med. Clin. Barc 1999, 112, 767–774. [Google Scholar]
  22. Feeney, J.; Savva, G.M.; O’Regan, C.; King-Kallimanis, B.; Cronin, H.; Kenny, R.A. Measurement Error, Reliability, and Minimum Detectable Change in the Mini-Mental State Examination, Montreal Cognitive Assessment, and Color Trails Test among Community Living Middle-Aged and Older Adults. J. Alzheimers Dis. 2016, 53, 1107–1114. [Google Scholar] [CrossRef]
  23. Friedman, T.W.; Yelland, G.W.; Robinson, S.R. Subtle cognitive impairment in elders with Mini-Mental State Examination scores within the ‘normal’ range. Int. J. Geriatr. Psychiatry 2012, 27, 463–471. [Google Scholar] [CrossRef]
  24. Vinyoles, E.; Vila, J.; Argimon, J.M.; Boquet, J.E.; Pueyo, T.A.; Ramıírez, E.L. Concordance among Mini-Examen Cognoscitivo and Mini-Mental State Examination in cognitive impairment screening. Aten. Primaria. 2002, 30, 5–13. [Google Scholar] [CrossRef] [Green Version]
  25. Calero-García, M.D.; Navarro-González, E. Eficacia de un programa de entrenamiento en memoria en el mantenimiento de ancianos con y sin deterioro cognitivo. Clin. Salud. 2006, 17, 187–202. [Google Scholar]
  26. Pascual, L.F.; Martínez, J.V.; Modrego, P.; Mostacero, M.; López, J.; Morales, F. El Set-test en el diagnóstico de la demencia. Neurología 1990, 5, 82–85. [Google Scholar]
  27. Grotz, C.; Meillon, C.; Amieva, H.; Andel, R.; Dartigues, J.F.; Adam, S.; Letenneur, L. Occupational social and mental stimulation and cognitive decline with advancing age. Age. Ageing 2017, 47, 101–106. [Google Scholar] [CrossRef] [Green Version]
  28. Folstein, M.; Folstein, S.E.; McHugh, P.R. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J. Psychiatry Res. 1975, 12, 189–198. [Google Scholar] [CrossRef]
  29. Calero, M.D.; Navarro, E.; Robles, P.; Navarro, E. Estudio de validez; del Mini-Examen Cognoscitivo de Lobo et al. para la detección del deterioro cognitivo asociado a demencias. Neurología 2000, 15, 337–342. [Google Scholar]
  30. Gagnon, M.; Dartigues, J.F.; Mazaux, J.M.; Dequae, L.; Giroire, J.M.; Barberger-Gateau, P. Self-Reported Memory Complaints and Memory Performance in Elderly French Community Residents: Results of the PAQUID Research Program. Neuroepidemiology 1994, 13, 145–154. [Google Scholar] [CrossRef]
  31. Van Oijen, M.; De Jong, F.J.; Hofman, A.; Koudstaal, P.J.; Breteler, M.M.B. Subjective memory complaints, education, and risk of Alzheimer’s disease. Alzheimer’s Dement 2007, 3, 92–97. [Google Scholar] [CrossRef]
  32. Giuli, C.; Fattoretti, P.; Gagliardi, C.; Mocchegiani, E.; Venarucci, D.; Balietti, M.; Casoli, T.; Costarelli, L.; Giacconi, R.; Malavolta, M.; et al. My Mind Project: The effects of cognitive training for elderly-the study protocol of a prospective randomized intervention study. Aging Clin. Exp. Res. 2017, 29, 353–360. [Google Scholar] [CrossRef] [Green Version]
  33. Arilla, S.; Calatayud, E.; Gómez, I. Cuadernos de Activación Mental; Serie 1; Comuniter: Zaragoza, Spain, 2012. [Google Scholar]
  34. Félix, S.B.; Ribeiro, O.; Maia, H. Personalized cognitive stimulation through personhood: A case report on dementia diagnosis acceptance and therapeutic engagement. Clin. Gerontol. 2020, 43, 233–239. [Google Scholar] [CrossRef]
  35. Matías-Guiu, J.A.; Pérez-Martínez, D.A.; Matías-Guiu, J. A pilot study of a new method of cognitive stimulation using abacus arithmetic in healthy and cognitively impaired elderly subjects. Neurologia 2016, 31, 326–331. [Google Scholar] [CrossRef]
  36. Polito, L.; Abbondanza, S.; Vaccaro, R.; Valle, E.; Davin, A.; Degrate, A.; Villani, S.; Guaita, A. Cognitive stimulation in cognitively impaired individuals and cognitively healthy individuals with a family history of dementia: Short-term results from the "Allena-Mente" randomized controlled trial. Int. J. Geriatr. Psychiatry 2015, 30, 631–638. [Google Scholar] [CrossRef]
  37. Barban, F.; Annicchiarico, R.; Pantelopoulos, S.; Federici, A.; Perri, R.; Fadda, L.; Carlesimo, G.A.; Ricci, C.; Giuli, S.; Scalici, F.; et al. Protecting cognition from aging and Alzheimer’s disease: A computerized cognitive training combined with reminiscence therapy. Int. J. Geriatr. Psychiatry 2016, 31, 340–348. [Google Scholar] [CrossRef]
  38. Jung, A.R.; Kim, D.; Park, E.A. Cognitive Intervention Using Information and Communication Technology for Older Adults with Mild Cognitive Impairment: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2021, 18, 11535. [Google Scholar] [CrossRef]
  39. Assed, M.M.; Rocca, C.C.A.; Garcia, Y.M.; Khafif, T.C.; Belizario, G.O.; Toschi-Dias, E.; de Pádua, A. Memory training combined with 3D visuospatial stimulus improves cognitive performance in the elderly: Pilot study. Dement Neuropsychol. 2020, 14, 290–299. [Google Scholar] [CrossRef]
  40. Park, J.M.; Kim, M.W.; Shim, H.Y. Effects of a Multicomponent Cognitive Stimulation Program on Cognitive Function Improvement Among Elderly Women. Asian Nurs. Res. (Korean Soc. Nurs. Sci.) 2019, 13, 306–312. [Google Scholar] [CrossRef] [Green Version]
  41. Gamito, P.; Oliveira, J.; Alves, C.; Santos, N.; Coelho, C.; Brito, R. Virtual Reality-Based Cognitive Stimulation to Improve Cognitive Functioning in Community Elderly: A Controlled Study. Cyberpsychol. Behav. Soc. Netw. 2020, 23, 150–156. [Google Scholar] [CrossRef]
  42. Fernández-Prado, S.; Conlon, S.; Mayán-Santos, J.M.; Gandoy-Crego, M. The influence of a cognitive stimulation program on the quality of life perception among the elderly. Arch. Gerontol. Geriatr. 2012, 54, 181–184. [Google Scholar] [CrossRef]
  43. Carballo-García, V.; Arroyo-Arroyo, M.R.; Portero-Díaz, M.; Ruiz-Sánchez de León, J.M. Effects of non-pharmacological therapy on normal ageing and on cognitive decline: Reflections on treatment objectives. Neurologia 2013, 28, 160–168. [Google Scholar] [CrossRef] [PubMed]
  44. Hong, X.; Chen, Y.; Wang, J.; Shen, Y.; Li, Q.; Zhao, B.; Guo, X.; Feng, W.; Wu, W.; Li, C. Effects of multi-domain cognitive training on working memory retrieval in older adults: Behavioral and ERP evidence from a Chinese community study. Sci. Rep. 2021, 11, 1207. [Google Scholar] [CrossRef]
  45. Schultheisz, T.S.V.; de Aquino, R.R.; Alves, A.B.F.; Radl, A.L.M.; Serafim, A.P. Effect of cognitive stimulation workshops on the self-esteem and cognition of the elderly A pilot project. Dement Neuropsychol. 2018, 12, 421–426. [Google Scholar] [CrossRef] [PubMed]
  46. Woods, B.; Aguirre, E.; Spector, A.E.; Orrell, M. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst. Rev. 2012, CD005562. [Google Scholar] [CrossRef]
  47. Yuill, N.; Hollis, V. A systematic review of cognitive stimulation therapy for older adults with mild to moderate dementia: An occupational therapy perspective. Occup. Ther. Int. 2011, 18, 163–186. [Google Scholar] [CrossRef]
  48. Park, D.C.; Bischof, G.N. The aging mind: Neuroplasticity in response to cognitive training. Dialogues Clin. Neurosci. 2013, 15, 109–119. [Google Scholar] [CrossRef]
  49. Navarro, E.; Calero, M.D.; Calero-García, M.J. Differences Between Elderly Women and Men in Cognitive Functioning and Quality of Life. Eur. J. Investig. Health Psychol. 2014, 4, 267–277. [Google Scholar] [CrossRef]
  50. Lorente, T.; Olivera, F.J.; Benabarre, S.; Rodríguez, M.; Solans, B.; Giménez, A.C. Rendimiento diagnóstico de los test cognitivos aplicados desde atención primaria. Concordancia y validez de los test de cribado [Diagnostic yield of cognitive tests applied in primary care. Consistency and validity of screening tests]. Aten. Primaria. 2010, 42, 226–232. [Google Scholar] [CrossRef] [Green Version]
  51. Giuli, C.; Papa, R.; Lattanzio, F.; Postacchini, D. The Effects of Cognitive Training for Elderly: Results from My Mind Project. Rejuvenation Res. 2016, 19, 485–494. [Google Scholar] [CrossRef] [Green Version]
  52. Su, H.; Wang, H.; Meng, L. The effects of Baduanjin exercise on the subjective memory complaint of older adults: A randomized controlled trial. Medicine 2021, 100, e25442. [Google Scholar] [CrossRef]
  53. Thana-Udom, K.; Siddarth, P.; Miller, K.J.; Dunkin, J.J.; Small, G.W.; Ercoli, L.M. The Effect of Memory Training on Memory Control Beliefs in Older Adults with Subjective Memory Complaints. Exp. Aging Res. 2021, 47, 131–144. [Google Scholar] [CrossRef] [PubMed]
  54. Jean, K.R.; Lindbergh, C.A.; Mewborn, C.M.; Robinson, T.L.; Gogniat, M.A.; Miller, L.S. Education Differentially Buffers Cognitive Performance in Black and White Older Adults. J. Gerontol. B Psychol. Sci. Soc. Sci. 2019, 74, 1366–1375. [Google Scholar] [CrossRef]
  55. Jackson, J.D.; Rentz, D.M.; Aghjayan, S.L.; Buckley, R.F.; Meneide, T.F.; Sperling, R.A.; Amariglio, R. Subjective cognitive concerns are associated with objective memory performance in Caucasian but not African-American persons. Age Ageing 2017, 46, 988–993. [Google Scholar] [CrossRef] [Green Version]
  56. Rodríguez, D.; Ayers, E.; Weiss, E.F.; Verghese, J. Cross-Cultural Comparisons of Subjective Cognitive Complaints in a Diverse Primary Care Population. J. Alzheimers Dis. 2021, 81, 545–555. [Google Scholar] [CrossRef] [PubMed]
  57. Bernardes, F.R.; Machado, C.K.; Souza, M.C.; Machado, M.J.; Belaunde, A.M.A. Subjective memory complaints and their relation with verbal fluency in active older people. Codas 2017, 29, e20160109. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  58. Bjelajac, A.K.; Bobić, J.; Kovačić, J.; Varnai, V.M.; Macan, J.; Smolić, Š. Employment status and other predictors of mental health and cognitive functions in older Croatian workers. Arh. Hig. Rada. Toksikol. 2019, 70, 109–117. [Google Scholar] [CrossRef] [Green Version]
  59. Koehler, M.; Kliegel, M.; Wiese, B.; Bickel, H.; Kaduszkiewicz, H.; van den Bussche, H.; Eifflaender-Gorfer, S.; Eisele, M.; Fuchs, A.; Koenig, H.H.; et al. Malperformance in verbal fluency and delayed recall as cognitive risk factors for impairment in instrumental activities of daily living. Dement Geriatr. Cogn. Disord. 2011, 31, 81–88. [Google Scholar] [CrossRef] [Green Version]
  60. Overdorp, E.J.; Kessels, R.P.; Claassen, J.A.; Oosterman, J.M. The Combined Effect of Neuropsychological and Neuropathological Deficits on Instrumental Activities of Daily Living in Older Adults: A Systematic Review. Neuropsychol. Rev. 2016, 26, 92–106. [Google Scholar] [CrossRef] [Green Version]
  61. Zhang, X.; Shu, B.; Zhang, D.; Huang, L.; Fu, Q.; Du, G. The Efficacy and Safety of Pharmacological Treatments for Post-stroke Aphasia. CNS Neurol. Disord Drug. Targets 2018, 17, 509–521. [Google Scholar] [CrossRef]
  62. Alhurani, R.E.; Vassilaki, M.; Aakre, J.A.; Mielke, M.M.; Kremers, W.K.; Machulda, M.M.; Geda, Y.E.; Knopman, D.S.; Petersen, R.C.; Roberts, R.O. Decline in Weight and Incident Mild Cognitive Impairment: Mayo Clinic Study of Aging. JAMA Neurol. 2016, 73, 439–446, Erratum in: JAMA Neurol. 2017, 74, 364. [Google Scholar] [CrossRef]
  63. Mitchell, A.J.; Beaumont, H.; Ferguson, D.; Yadegarfar, M.; Stubbs, B. Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: Meta-analysis. Acta Psychiatry Scand. 2014, 130, 439–451. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  64. Farias, S.T.; Lau, K.; Harvey, D.; Denny, K.G.; Barba, C.; Mefford, A.N. Early Functional Limitations in Cognitively Normal Older Adults Predict Diagnostic Conversion to Mild Cognitive Impairment. J. Am. Geriatr. Soc. 2017, 65, 1152–1158. [Google Scholar] [CrossRef] [PubMed]
  65. Luck, T.; Luppa, M.; Matschinger, H.; Jessen, F.; Angermeyer, M.C.; Riedel-Heller, S.G. Incident subjective memory complaints and the risk of subsequent dementia. Acta. Psychiatry Scand. 2015, 131, 290–296. [Google Scholar] [CrossRef] [PubMed]
  66. Dickinson, C.; Gibson, G.; Gotts, Z.; Stobbart, L.; Robinson, L. Cognitive stimulation therapy in dementia care: Exploring the views and experiences of service providers on the barriers and facilitators to implementation in practice using Normalization Process Theory. Int. Psychogeriatr. 2017, 29, 1869–1878. [Google Scholar] [CrossRef] [PubMed]
  67. Montejo, P.; Montenegro, M.; Fernandez, M.A.; Maestu, F. Subjective memory complaints in the elderly: Prevalence and influence of temporal orientation, depression and quality of life in a population-based study in the city of Madrid. Aging Ment Health 2011, 15, 85–96. [Google Scholar] [CrossRef] [PubMed]
  68. Gates, N.J.; Rutjes, A.W.; Di Nisio, M.; Karim, S.; Chong, L.Y.; March, E.; Vernooij, R.W.M. Computerised cognitive training for 12 or more weeks for maintaining cognitive function in cognitively healthy people in late life. Cochrane Database Syst. Rev. 2020, 2, CD012277. [Google Scholar] [CrossRef]
  69. Marioni, R.E.; Proust-Lima, C.; Amieva, H.; Brayne, C.; Matthews, F.E.; Dartigues, J.F.; Jacqmin-Gadda, H. Cognitive lifestyle jointly predicts longitudinal cognitive decline and mortality risk. Eur. J. Epidemiol. 2014, 29, 211–219. [Google Scholar] [CrossRef] [Green Version]
  70. Rey Cao, A.; Canales Lacruz, I.; Táboas Pais, M.I. Calidad de vida percibida por las personas mayores. Consecuencias de un programa de estimulación cognitiva a través de la motricidad «Memoria en movimiento» [Quality of life perceived by the elderly. Results of the “Memory in movement” program which provide cognitive stimulation using motricity]. Rev. Esp. Geriatr. Gerontol. 2011, 46, 74–80. (In Spanish) [Google Scholar] [CrossRef]
  71. Kurz, A.F.; Leucht, S.; Lautenschlager, N.T. The clinical significance of cognition-focused interventions for cognitively impaired older adults: A systematic review of randomized controlled trials. Int. Psychogeriatr. 2011, 23, 1364–1375. [Google Scholar] [CrossRef] [Green Version]
  72. Wang, X.; Covey, T.J. Neurophysiological indices of the transfer of cognitive training gains to untrained tasks. Neurobiol. Learn Mem. 2020, 171, 107205. [Google Scholar] [CrossRef]
  73. Zimmermann, N.; Netto, T.M.; Amodeo, M.T.; Ska, B.; Fonseca, R.P. Working memory training and poetry-based stimulation programs: Are there differences in cognitive outcome in healthy older adults? NeuroRehabilitation 2014, 35, 159–170. [Google Scholar] [CrossRef] [PubMed]
  74. Marioni, R.E.; Valenzuela, M.J.; van den Hout, A.; Brayne, C.; Matthews, F.E.; MRC Cognitive Function and Ageing Study. Active cognitive lifestyle is associated with positive cognitive health transitions and compression of morbidity from age sixty-five. PLoS ONE 2012, 7, e50940. [Google Scholar] [CrossRef] [PubMed]
  75. World Medical Association. Declaration of Helsinki of the World Medical Association-Ethical Principles for Human Medical Research 2013. 2013. Available online: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-laamm-principios-eticos-para-las-investigaciones-medicasen-seres-humanos/ (accessed on 23 January 2018).
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Figure 1. Flow Diagram CONSORT 2010.
Figure 1. Flow Diagram CONSORT 2010.
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Figure 2. Cognitive stimulation program exercises.
Figure 2. Cognitive stimulation program exercises.
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Table
Table 1. Study participants’ sociodemographic and clinic characteristics.
Table 1. Study participants’ sociodemographic and clinic characteristics.
Mean ± SD/%
Total (n = 308)		Mean ± SD/%
GC (n = 177)		Mean ± SD/%
GI (n = 131)		p-Value
Age (years)73.66 ± 5.8874.57 ± 6.1672.85 ± 5.6080.009
Gender
 Man108 (35.1%)73 (4.2%)35 (26.7%)0.008
 Woman200 (64.9%)104 (58.8%)96 (73.3%)
Level of education
 Primary235 (76.3%)131 (74.0%)104 (79.4%)0.273
 Higher73 (23.7%)46 (26.0%)27 (20.6%)
Civil status
 Single16 (5.2%)10 (5.6%)6 (4.6%)
 Married207 (67.2%)120 (67.8%)87 (66.4%)0.929
 Widowed75 (24.4%)41 (23.2%)34 (26.0%)
 Separated10 (3.2%)6 (3.4%)4 (3.1%)
Physical occupational
 Low64 (20.8%)37 (20.9%)27 (20.6%)
 Medium123 (39.9%)71 (40.1%)52 (39.7%)0.992
 High121(39.3%)69 (39.0%)52 (39.7%)
Mental occupational
 Low178 (57.8%)106 (59.9%)72 (55.0%)
 Medium113 (36.7%)59 (33.3%)54 (41.2%)0.248
 High17 (5.5%)12 (6.8%)5 (3.8%)
HBP
 Yes151 (49.0%)84 (47.5%)67 (51.1%)0.522
 No157 (51.0%)93 (52.5%)64 (48.9%)
Diabetes
 Yes42 (13.6%)27 (15.3%)15 (11.5%)0.336
 No266 (86.4%)150 (84.7%)116 (88.5%)
Hypercholesterolemia
 Yes121 (39.3%)74 (41.8%)47 (35.9%)0.292
 No187 (60.7%)103 (58.2%)84 (64.1%)
Obesity
 Yes41 (13.3%)23 (13.0%)18 (13.7%)0.849
 No267 (86.7%)154 (87.0%)113 (86.3%)
CVA
 Yes20 (6.5%)11 (6.2%)9 (6.9%)0.817
 No288 (93.5%)166 (93.8%)122 (93.1%)
Table
Table 2. Mean and standard deviation in the main outcome variables in the control and intervention group at the four time points.
Table 2. Mean and standard deviation in the main outcome variables in the control and intervention group at the four time points.
Control Group (n = 177)Intervention Group (n = 131)
Basal10 Weeks Post-Intervention26 Weeks
(Follow-Up I)
6 Months		52 Weeks (Follow-Up II)
12 Months		Basal10 Weeks Post-Intervention26 Weeks
(Follow-Up I)
6 Months		52 Weeks (Follow-up II)
12 Months
MEC-3529.92 ± 2.63930.085 ± 3.16730.36 ± 3.28130.48 ± 2.78029.82 ± 2.62431.634 ± 2.39532.07 ± 2.51132.27 ± 2.402
Language and Praxis9.81 ± 1.1019.72 ± 1.1059.94 ± 1.1019.97 ± 0.9609.81 ± 0.92110.41 ± 0.78010.16 ± 1.01010.52 ± 0.707
Language5.36 ± 0.8015.43 ± 0.7805.58 ± 0.7465.50 ± 0.7075.34 ± 0.7215.75 ± 0.5585.65 ± 0.6855.83 ± 0.514
Set Test37.32 ± 3.75937.74 ± 4.01637.94 ± 3.88338.67 ± 2.86338.22 ± 2.63838.81 ± 2.11839.13 ± 1.76539.21 ± 2.072
MEC-35: Mini cognitive exam-35 points (Spanish version of MMSE). Data expressed with mean ± standard deviation.
Table
Table 3. Differences between groups at 10 weeks (Post), at 6 months (Follow-up I), and at 12 months (Follow-up II) with respect to the baseline evaluation in the main outcome variables.
Table 3. Differences between groups at 10 weeks (Post), at 6 months (Follow-up I), and at 12 months (Follow-up II) with respect to the baseline evaluation in the main outcome variables.
Differences between Groups Basal-10 Weeks Post-InterventionGroupTime Interaction
p-Value		Differences between Groups Basal-26 Weeks (Follow-Up I)
6 Months		GroupTime Interaction
p-Value		Differences between Groups Basal-52 Weeks
(Follow-Up II)
12 Months		GroupTime Interaction
p-Value
MEC-35−5.482 (−0.868, −6.819)0.000−5.321 (−1.215, −5.961)0.000−5.307 (−1.278, −5.728)0.000
Language and Praxis3.266 (1.285, 5.281)0.001−1.828 (−0.544, −2.199)0.068−3.706 (−0.839, −4.518)0.000
Language−4.557 (−0.964, −5.277)0.000−3.354 (−1.900, −2.946)0.001−3.928 (−1.355, −4.382)0.000
Set Test−2.860 (−1.488, −2.661)0.004−2.669 (−1.484, −2.340)0.008−4.403 (−3.100, −3.142)0.000
MEC-35: Mini cognitive exam-35 points (Spanish version of MMSE). p-value: Wicolson’s nonparametric test; IC95%: confidence interval at 95%.
Table
Table 4. Multiple regressions for the dependent variable language and Set- test in the post-intervention evaluation and one year after the intervention.
Table 4. Multiple regressions for the dependent variable language and Set- test in the post-intervention evaluation and one year after the intervention.
Language 2 (Post)Language 4 (year after the intervention)
BB standardizede.t.R2tSig.Anova
F		Sig. BB standardizede.t.R2tSig.Anova
F Sig
Group0.2730.1980.6490.1303.1370.0028.4780.000Group0.2670.2090.5940.1712.5380.0136.436, 0.000
Study0.2750.169 2.6970.008 Age−0.234−0.180 −2.1780.031
Set Test0.0320.151 2.4040.017 Mental occupation0.2320.180 2.1950.030
Depression−0.034−0.139 −2.2080.028 Depression−0.242−0.158 −1.8950.060
Set Test 2 (Post)Set Test 4 (year after the intervention)
BB standardizede.t.R2tSig.Anova
F		Sig. BB standardizede.t.R2tSig.Anova
F Sig
Age−1.207−0.1843.0500.134−2.8910.00411.7390.000Age−0.986−0.1922.2970.196−2.2160.0297.633, 0.000
CVA1.5990.117 1.8830.061 Mental occupation0.9760.192 2.2790.024
Lawton0.6320.268 4.1790.000 Study0.503−0.218 −2.5020.014
Lawton0.1770.277 3.2660.001
e.t.: standard error of the estimate; R2: R square (coefficient of determination); CVA: Cerebrovascular accident; B: Beta.
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Calatayud, E.; Subiron-Valera, A.B.; Marcén-Román, Y.; Salavera, C.; Andrade-Gómez, E.; Rodríguez-Roca, B.; Gómez-Soria, I. Effects on Language and Verbal Fluency of a Cognitive Stimulation Program in Older Adults: Randomized Controlled Trial. Sustainability 2023, 15, 2533. https://doi.org/10.3390/su15032533

AMA Style

Calatayud E, Subiron-Valera AB, Marcén-Román Y, Salavera C, Andrade-Gómez E, Rodríguez-Roca B, Gómez-Soria I. Effects on Language and Verbal Fluency of a Cognitive Stimulation Program in Older Adults: Randomized Controlled Trial. Sustainability. 2023; 15(3):2533. https://doi.org/10.3390/su15032533

Chicago/Turabian Style

Calatayud, Estela, Ana Belen Subiron-Valera, Yolanda Marcén-Román, Carlos Salavera, Elena Andrade-Gómez, Beatriz Rodríguez-Roca, and Isabel Gómez-Soria. 2023. "Effects on Language and Verbal Fluency of a Cognitive Stimulation Program in Older Adults: Randomized Controlled Trial" Sustainability 15, no. 3: 2533. https://doi.org/10.3390/su15032533

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