Dement Neuropsychol 2021 December;15(4):428-439 Original Article

https://doi.org/10.1590/1980-57642021dn15-040002

Cognitive interventions in mature and

older adults, benefits for psychological
well-being and quality of life:
a systematic review study
Thais Bento Lima da Silva1,2,3 , Gabriela dos Santos1,3 , Ana Paula Bagli Moreira3 ,
Graciela Akina Ishibashi1,3 , Cássia Elisa Rossetto Verga1,3 , Luiz Carlos de Moraes3,4 ,
Patrícia Prata Lessa3,4 , Neide Pereira Cardoso3,4 , Tiago Nascimento Ordonez3 , Sonia Maria Dozzi Brucki2,3,5

ABSTRACT. Few recently published studies investigating the benefits of educational and cognitive interventions on quality of
life (QoL), psychological well-being, and depressive symptoms are available. Objective: The aim of this study was to investigate
the effects of educational and cognitive interventions on psychological well-being, QoL, and mood in mature and older adults
without dementia and/or with mild cognitive impairment (MCI). Methods: The systematic review took place from September to
October 2020 and the following databases were used to select the studies: SciELO, LILACS, PubMed, and Medline. The search
terms used were idos* AND “treino cognitivo” AND “bem-estar psicológico” AND “qualidade de vida” and their corresponding
translations in English and Spanish. Results: Of the 241 articles retrieved, 26 primary studies were included in the review.
Of these, 18 showed improvement in QoL, psychological well-being, or cognition. Conclusions: The studies reported beneficial
effects of educational and cognitive interventions for QoL, psychological well-being, and depressive symptoms of mature and
older adults without dementia or depression.
Keywords: aging, educational activities, cognitive aging, social neuroscience, quality of life, depressive symptoms.

INTERVENÇÕES COGNITIVAS EM ADULTOS MADUROS E IDOSOS, BENEFÍCIOS AO BEM-ESTAR PSICOLÓGICO E À QUALIDADE DE

VIDA: UM ESTUDO DE REVISÃO SISTEMÁTICA
RESUMO. Nos últimos anos, foram encontrados poucos estudos relatando os benefícios das intervenções cognitivas e educativas
à qualidade de vida, ao bem-estar psicológico e contra os sintomas depressivos. Objetivo: Investigar os impactos de intervenções
educativas e cognitivas nas variáveis de bem-estar psicológico, qualidade de vida e humor de adultos maduros e idosos sem
demência e/ou com comprometimento cognitivo leve. Métodos: A pesquisa de revisão sistemática ocorreu entre setembro
e outubro de 2020 e, para a seleção dos estudos, foram utilizadas as bases de dados: Scientific Electronic Library Online
(SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), PubMed e Medical Literature Analysis and
Retrieval System Online (MEDLINE). Foram selecionados os seguintes termos para a busca: “idos*” AND “treino cognitivo” AND
“bem-estar psicológico” AND “qualidade de vida” e seus correspondentes em inglês e espanhol. Resultados: De 241 artigos
contendo as palavras-chave, 26 estudos primários foram selecionados para esta revisão. Deles, 18 demonstraram melhora
significativa na qualidade de vida, no bem-estar psicológico ou na cognição. Conclusões: Os estudos analisados evidenciaram
efeitos positivos das intervenções educacionais e cognitivas para a qualidade de vida, para o bem-estar psicológico e contra
os sintomas depressivos de idosos e adultos maduros sem demência e depressão.
Palavras-chave: envelhecimento, atividades educativas, envelhecimento cognitivo, neurociência social, qualidade de vida,
sintomas depressivos.

This study was conducted by the Group of Cognitive and Behavioral Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
1
Gerontology, School of Arts, Sciences, and Humanities, Universidade de São Paulo – São Paulo, SP, Brazil. 2Group of Cognitive and Behavioral Neurology, Hospital
das Clínicas, Faculdade de Medicina, Universidade de São Paulo – São Paulo, SP, Brazil. 3Cognitive Training Study Group, School of Arts, Science and Humanities,
Universidade de São Paulo – São Paulo, SP, Brazil. 4Instituto Supera de Educação – São José dos Campos, SP, Brazil. 5Department of Neurology, School of Medicine,
Universidade de São Paulo – São Paulo, SP, Brazil.
Thais Bento Lima da Silva. Gerontologia – Escola de Artes, Ciências e Humanidades da Universidade de São Paulo. Avenida Arlindo Béttio, 1000 – Ermelino
Matarazzo – 03828-000 São Paulo SP – Brazil – E-mail: [email protected]
Disclosure: The authors report no conflicts of interest.
Funding: none.
Received on February 25, 2021. Accepted in final on June 09, 2021.

428   Cognitive interventions and the benefits on psychological well-being and quality of lif   Silva et al.
 Dement Neuropsychol 2021 December;15(4):428-439

INTRODUCTION of self-acceptance, personal growth, and relationship

A ging is a process associated with a host of biolog-

ical, social, and psychological changes, including
those affecting the cognitive domains. One of the main
with the environment. The authors stated that one
reason that explains the effect of cognitive training on
improving psychological well-being is that cognitive
changes seen in cognitive ageing relates to executive functioning in older adults is also influenced by psycho-
functions, which support task planning and execution. logical well-being. These results may indicate a positive
Although there is a natural decline in these functions association between improvements in cognition and
with age, the extent of this impairment is influenced by psychological variables.
an individual’s extrinsic (environmental) and intrinsic The study by Seinfeld et al.11 found that other types
(physical and mental) situation. Physical and cognitive of intervention, such as piano practice and stimulation
abilities, that is, inherent characteristics, dictate func- for cognitive domains — motor skills, attention, and ex-
tional capacity, promoting autonomous and indepen- ecutive function — also had beneficial effects in reduc-
dent living. This capacity has a significant impact on ing depressive symptoms and improving mood in older
the quality of life (QoL) and well-being of older adults.1-3 adults. Thus, based on the results found, the authors
The decline in functional capacity negatively impacts suggested that playing piano at more advanced ages can
the QoL, defined as “an individual’s perception of his/ help increase cognitive reserve, improving or maintain-
her position in life in the context of the culture and value ing cognitive function in later life — consistent with
systems in which he/she lives, and about his/her goals, the findings of the cited studies. Therefore, although
expectations, standards, and concerns.”4 Effects on psy- the study did not involve cognitive training per se, the
chological and social variables can manifest in the form results of the investigations were significant, suggesting
of depressive symptoms, which are closely associated that different types of cognitive interventions can im-
with general, subjective, and psychological well-being prove the aspects of psychological well-being and QoL.
since depression undermines an individual’s sense of Among the actions used for health promotion, there
worth.5 The concept of subjective well-being encompass- are educational interventions, whose concept has not
es emotional factors, positive or negative, and cognitive been much explored in the literature. What comes
factors, more associated with personal satisfaction.6 closest is the characterization described in the study
Psychological well-being is related to six different by Carvalho et al.,12 who proposed that educational
factors: (1) autonomy: decision-making capacity; (2) interventions are actions that would facilitate the
purpose in life: having personal goals; (3) personal understanding of the subjects involved, promoting the
growth: developing new skills; (4) environmental mas- construction of new spaces of knowledge, through edu-
tery: management of situations according to context; cational and dialogical relationships. Given the various
(5) positive relations: maintaining ties with others; and intervention strategies presented, the integration of
(6) self-acceptance: having self-knowledge to accept nursing in behavioral science also serves as a guide to
oneself.5,7 One way of promoting maintenance of psy- explore the motivation or demotivation of the elderly, in
chological well-being is through cognitive intervention. addition to self-care in healthy aging, through the use of
Cognitive interventions can be divided into three educational sessions with playful strategies in Social —
types: (1) Cognitive Stimulation, in which standardized Poetry workshops. Lima-Silva et al.13 mentioned that
repeated activities are performed without structured cognitive interventions added to cognitive stimuli can
learning programs; (2) Cognitive Training, in which generate benefits for individuals’ self-efficacy, which is
standardized activities are established, targeting spe- related to psychological well-being.
cific cognitive functions, such as attention, planning, The absence of literature reviews on the effects of
reasoning, among others, while employing strategies cognitive and educational interventions on subjective
to improve intervention outcomes; and (3) Cognitive well-being, mood, and QoL of mature and elderly adults
Rehabilitation, aimed at recovery or compensatory limits the possibility of gathering evidence that con-
strategies for cognitive impairments.8,9 In this study, our firms or contradicts the results found in this study. How-
focus is on cognitive training and cognitive stimulation. ever, clinical studies of cognitive training and cognitive
Cognitive training can positively influence psycho- stimulation have directed their results toward gains in
logical well-being and QoL, as found in the study by terms of QoL and reduction of depressive symptoms,14-16
Irigaray et al.10 Their results showed that in addition to while studies of educational intervention have identified
improvements in cognitive functions such as memory, improvements in subjective well-being.17,18
language apraxias, there was a better perception of QoL In face of the explicit sociodemographic changes
and psychological well-being, with regard to the areas that take place in the course of the human existential

Silva et al.   Cognitive interventions and the benefits on psychological well-being and quality of life   429
 Dement Neuropsychol 2021 December;15(4):428-439

trajectory, there is an increase in diseases involving and cognitive intervention, including memory training
mental health, particularly in the elderly population.19 and cognitive stimulation. After this process, eligible
However, there is scant literature about cognitive train- descriptors were selected on the Descriptors in Health
ing in cognitively healthy older adults. There is a difficul- Sciences (DeCS) system to serve as keywords for the
ty in finding studies in the literature that directly focus search. The following search terms were employed: idos*
on the effects of cognitive training on QoL, psycholog- AND “treino cognitivo” AND “bem-estar psicológico” AND
ical well-being, and depressive symptoms. This study “qualidade de vida,” their corresponding translations in
did not identify other systematic reviews that aimed to English: elderly AND “cognitive training” AND “psycho-
ascertain the relationship between cognitive and educa- logical well-being” AND “quality of life” and Spanish: an-
tional interventions and psychological well-being, QoL, cianos y “entrenamiento cognitivo” y “bienestar psicológico”
and mood. The only reviews that aimed to investigate and “calidad de vida.”
the general gains of cognitive training were found. The following filters were used to search for articles
Most studies found in the literature sample elderly in the databases: “year 2010 to 2020,” “full text,” “ran-
people with preserved cognition, and associate cognitive domized controlled trial,” and language “Portuguese,”
training with improvements in memory, and also with “English,” and “Spanish.” Inclusion criteria were ap-
improvements in social and psychological variables. plied to articles published between 2010 and 2020.
However, there is a scarcity of comparative studies be- A process of inclusion and exclusion was carried out
tween the benefits of memory training for elderly people for the studies retrieved from each database congruent
with MCI and for elderly people without any cognitive with this review. Inclusion criteria were: randomized
impairment, which limits the finding of which of the clinically controlled trials, cohort studies, and studies
cognitive profiles benefit the most. involving older adults that were healthy, had MCI or
Therefore, considering the relevance of studies on comorbidities, and without neurodegenerative diseases.
cognitive and educational interventions and the gap In addition, the studies should have been published in
of systematic reviews on the theme, this systematic Portuguese, English, or Spanish. We included studies
literature review sought to address the importance of analyzing the effects on QoL or psychological well-being.
promoting and reporting the effectiveness of cognitive Exclusion criteria were secondary studies such as
interventions, such as cognitive training and cognitive systematic reviews, meta-analyses, and studies con-
stimulation and educational interventions for the elder- ducted before 2010 and those that included older adults
ly, along with the benefits they can bring. diagnosed with major neurocognitive disorders. Publi-
This study aimed to investigate the effects of edu- cations, which were case studies, master’s dissertations,
cational and cognitive interventions on psychological doctoral theses, and book chapters, were also excluded.
well-being, QoL, and mood in mature and older adults Other studies that failed to satisfy the predefined search
without dementia and/or with MCI. criteria were also not included.
First, the titles and abstracts were read. Sec-
ond, those who met the inclusion criteria, had their
METHODS objectives, methods, and results filled out in a spread-
In this study, a systematic review of the literature was sheet together with the name of the authors, the year of
conducted according to the guidelines set forth in the publication, and with the database website for a double
PRISMA (Preferred Reporting Items for Systematic check. The following data were observed: if the partici-
Reviews and Meta-Analyses) statement.20 The search pants were 50 years or older; the application and effec-
and review of studies, carried out from September to tiveness of the educational or cognitive intervention
October 2020, was performed on the SciELO, LILACS, and; the use of instruments to assess the variables of
PubMed, and Medline databases. subjective well-being and QoL in the pre- and posttest.
Using the PICo (Population, Interest and Context) Up to that stage, the research had been conducted by
framework, 20 the following research question was four reviewers. Finally, after methods, objectives, and
defined: Can educational and cognitive interventions results were checked, the selected articles were read
promote improvement in psychological well-being, completely by two researchers.
mood, and QoL of older adults with MCI and those
with depressive symptoms? The population refers to
the mature and older adults without dementia and/ RESULTS
or with MCI, the interest refers to the psychological The database searches led to the retrieval of 241 arti-
well-being and QoL, and context refers to educational cles (6 PubMed, 3 Lilacs, 199 Medline, and 33 SciELO).

430   Cognitive interventions and the benefits on psychological well-being and quality of lif   Silva et al.
 Dement Neuropsychol 2021 December;15(4):428-439

After initial filtering for the inclusion of studies pub- 3 (11.5%) investigated older people with and without
lished between 2010 and 2020 plus RCTs and exclusion MCI (11.5%), and 2 (7.7%) assessed groups with and
of duplicate studies, 81 articles remained, 4 of which without memory complaints. Published preliminary
were identified from paper references. Subsequent studies outlining methods only with no results were
reading of titles and abstracts of the pre-selected arti- also assessed (Table 1).
cles led to the exclusion of a further 46, giving a total Many studies have found an association between re-
of 35 publications for a full reading. Finally, 26 studies ducing depression symptoms or increasing the QoL or psy-
met all inclusion criteria and were included as a part of chological well-being of participants after the intervention.
this systematic review (Figure 1). Among the studies, those which offered only educational
Of the 26 studies reviewed, most were published intervention were the ones that identified an increase in
in 2018 (19.2%), 15 (57.7%) involved cognitive inter- psychosocial well-being. Regarding mood, those which
ventions, and the mean sample size was 212 partici- carried out cognitive intervention such as cognitive stim-
pants. Concerning participants’ cognitive status, 21 ulation, showed more results in reducing depressive symp-
(80.8%) studies involved cognitively healthy elderly, toms, compared to studies with other types of intervention.
Iden�fica�on

Records iden�fied through Addi�onal records iden�fied

database searching through other sources
(n=88) (n=04)

Records a�er duplicates removed

(n=11)
Screening

Records screened Records excluded

(n=81) (n=46)
Eligibility

Full-text ar�cles assessed Full-text ar�cles excluded

for eligibility (n=09)
(n=35)

Studies included in
Included

systema�c review
(n=26)

Figure 1. Flowchart of study search and review process.

Silva et al.   Cognitive interventions and the benefits on psychological well-being and quality of life   431
 Table 1. Summary of studies included.
Type of Sample Application
Author/year Objectives Sample Results
intervention characteristics effects
Quality of life
To investigate whether “olfactory training” Analyses showed significant improvement in olfactory function for the OT
Birte-Antina Cognitive Cognitively (QoL), mood,
(OT) had positive effects on subjective well- n=91 group participants and improved verbal function and subjective well-being.
et al. (2018)22 (training) healthy psychological
being and cognitive function. Also, results indicated a decrease in depressive symptoms.
well-being.

A 2×2 mixed-model ANOVA suggested the tablet intervention group (n=22)

To test the efficacy of a tablet computer
Vaportzis et al. Cognitive had more significant improvements in Processing Speed (η2=0.10) compared Cognitively
training intervention to improve cognitive n=48 QoL
(2017) 23 (stimulation) with controls (n=21), but no difference in Verbal Comprehension, Perceptual healthy
abilities of older adults.
Processing, or Working Memory (WM) (η2 range=0.03–0.04).

The piano training group (TG) on the Stroop test measured executive function,
inhibitory control, and divided attention in the piano TG. A tendency indicating
To study the specific effects of musical
Dement Neuropsychol 2021 December;15(4):428-439

enhancement of visual scanning and motor ability was also found (Trail-
training vs. effects of other leisure activities
Seinfeld et al. Cognitive (WM Making Test part A). Piano lessons decreased depression, induced positive Cognitively
in older adults. The impact of piano training n=29 Mood, QoL
(2013)11 training) mood states, and improved the psychological and physical QoL of the elderly. healthy
on cognitive functioning, mood, and QoL was
Results suggested that playing piano and learning to read music can help
evaluated in older adults.
older adults promote cognitive reserve (CR) and improve subjective well-
being.

The staff showed significant improvement in knowledge and attitude to pain

To examine the effects of an 8-week management, with the survey score increasing from 8.46±3.74 to 19.43±4.07
integrated pain management program (p<0.001). Among residents, 74% had experienced pain within the previous 6
(IPMP) on enhancing the knowledge and months, with a pain intensity of 4.10±2.20. Those in the experimental group
Tse et al. Cognitive Cognitively Psychological
attitude toward pain management among n=535 (EG) showed a more significant reduction in pain scores than the control
(2012)27 (stimulation) healthy well-being
staff; and improving pain, QoL, physical and group (CG), from 4.19±2.25 to 2.67±2.08 (p<0.001). Group differences were
psychosocial functions, and use of non-drug also found in psychological well-being, including happiness, loneliness, life

432   Cognitive interventions and the benefits on psychological well-being and quality of lif   Silva et al.
therapies for the elderly in nursing homes. satisfaction, and depression (p<0.05) and in the use of non-drug methods
(p<0.05).

To report the rationale and methodology

of the first trial to investigate isolated and
combined effects of cognitive training Required sample size 10% larger than expected effect size (ES) (n=132) was
(CT) and progressive resistance training originally estimated. The retention rate was >90%, confirming an appropriate
(PRT) on general cognitive functioning and recruitment target of 120/0.90=133. Thus, 80/133 were recruited, 60%
Cognitive
Gates et al. functional independence in older adults with of the planned cohort. Compliance with training sessions was high for all Cognitively
n=132 (computerized No results
(2011)24 early cognitive impairment in the Study of groups, with a median ranging from 78.44% for sham physical/CT to 100% healthy
CT)
Mental and Regular Training (SMART). The for PRT/CT. One adverse event was reported (rotator cuff injury managed
secondary aim was to quantify differential conservatively) in the PRT group, and no adverse events during assessments,
adaptations to these interventions in CT, or sham interventions.
terms of brain morphology and function,
cardiovascular and metabolic

Continue…
 Table 1. Continuation.
Type of Sample Application
Author/year Objectives Sample Results
intervention characteristics effects
function, exercise capacity, psychological
state, and body composition, to identify the
potential mechanisms of benefit and broader
health status effects.

To investigate a memory rehabilitation Cognitive performance pre- and post-intervention was compared using the
Cognitively
program’s therapeutic effect with Wilcoxon test. There was a reduction in memory complaints and depressive
Maria Netto Cognitive healthy (with
assessments pre- and post-intervention n=7 symptoms, increased attentional processing speed, and improved WM. The Mood
et al. (2012)14 (stimulation) memory
in a group of older adults with mnemonic authors suggested replicating the study in larger samples and groups with
complaints)
complaints and depressive symptoms. objective memory impairments and clinically diagnosed depression vs. CGs.

Cognitively
healthy (20
To determine the effects of a cognitive Results showed that training improved performance on the cognitive test by elderly people
Schultheisz Cognitive
stimulation program on self-esteem and n=38 older adults with and without cognitive impairment. This improvement had a without cognitive QoL
et al. (2018)29 (stimulation)
cognition of older persons. subsequent positive effect on self-esteem. complaints and
18 with cognitive
complaints)

To determine whether cognitive gains

promoted by two cognitive intervention
programs were associated with
Chariglione Cognitive Both groups showed a tendency for reduced depressive symptoms, increased Without and with
improvements in mood, QoL, physical fitness n=39 Mood
et al. (2020)15 (stimulation) fat mass, and decreased lean mass. cognitive decline
(maximum oxygen consumption, lean mass,
fat percentage, and handgrip strength) in
older adults.

To investigate the effects of an electronic TG’s cognitive performance improved significantly after the program,
Ordonez et al. Cognitive Cognitively
game program (Actively Station) on global n=124 particularly in language and memory domains, and there was a decrease in Mood
(2017)16 (stimulation) healthy
cognitive performance in adults >50 years. anxiety index and frequency of memory complaints compared to CG.

The TG showed significant improvements, particularly on verbal fluency test

To test the efficacy of a CT program based
Cognitive – animals category and on immediate recall of words list (sum of three trials)
Silva et al. on ecological tasks that simulated shopping Cognitively Psychological
n=12 (training – of CERAD battery. No significant difference was found for the CG in pre- and
(2011)28 tasks, involving memorizing grocery items and healthy well-being
categorization) post-test performance for variables assessed. Results suggested CT can increase
performing simple mathematical calculations.
performance in memorizing and calculation tasks among elderly adults.

To investigate the influence of different CT

Results showed the ARFC was influenced by training type and that free recall
Chariglione procedures in memory, neuropsychological
Cognitive of words improved after training only for literate individuals, regardless of Cognitively
and Janczura measures, and mood of institutionalized n=16 Mood
(training) training type. No positive effects were detected in picture recognition, whereas healthy
(2013)30 elderly and examine the relationship between
training sessions positively influenced GDS scores.
Dement Neuropsychol 2021 December;15(4):428-439

educational level and intervention results.

Silva et al.   Cognitive interventions and the benefits on psychological well-being and quality of life   433
Continue…
 Table 1. Continuation.
Type of Sample Application
Author/year Objectives Sample Results
intervention characteristics effects
The study also sought to provide health
professionals with a tool for aiding the
rehabilitation of institutionalized elderly.

Results showed significant group differences for the number of errors on the
Lopes and To characterize the elderly participants and Sternberg Paradigm and Completed Categories of the WCST and Symbol Search.
Cognitive Cognitively
Argimon measure the effects of CT, with emphasis on n=83 Intragroup comparisons showed EG had substantial improvement in scores Mood
(training) healthy
(2016)31 executive functions, vs. a CG. post-intervention on GDS, RAVLT, Rey Complex Figures – memory, Forward
Digit Span, and Total Digit Span Vocabulary tasks.

To compare the effectiveness of two types of

After training, group A had better QoL (p<0.001, ES=0.69) and attention (increased
CT in 60 older adults with MCI by assessing
Dement Neuropsychol 2021 December;15(4):428-439

loading score, p<0.05, ES=-0.23; errors, p<0.001, ES=-0.47); however, there QoL,
Hagovská et al. the impact on functional activities, QoL, and Cognitive
n=60 were no group differences in functional activity level. Group A demonstrated MCI psychological
(2017)25 various cognitive functions. The primary (training)
greater improvements in QoL and attention than group B (i.e., classical CT), but the well-being.
outcomes were functional activity level and
transfer to functional activities was same for both groups.
QoL.

Structural equation modeling (SEM) was

used to model hypothesized and novel
relationships between constructs using
available measures in ACTIVE based on
the ACTIVE conceptual framework (Jobe
Preconceived measurement models for memory, reasoning, processing
et al., 2001; Figure 1). Each construct
speed, everyday problem-solving, instrumental activities of daily living (IADL)
was first separately factor-analyzed in a
difficulty, everyday speed, driving difficulty, and health-related QoL each fit
measurement model to optimize fit to the
well to the data (RMSEA<0.05; CFI>0.95). Fit of full model was excellent

434   Cognitive interventions and the benefits on psychological well-being and quality of lif   Silva et al.
Gross et al. data. Measurement models were then Cognitive Cognitively
n=2802 (RMSEA=0.038; CFI=0.924). In contrast with previous ACTIVE findings QoL
(2018)32 combined for all constructs together in a (training) healthy
regarding who benefits from training, interaction testing revealed associations
single model to explore hypothesized and
between proximal abilities and primary outcomes were generally stronger
additional pathways. In an extension to
among individuals of non-white race, with worse health, older age, and less
the ACTIVE conceptual framework, effect
education (p<0.005).
modification by demographic and health
variables was tested. It was hypothesized
that the data would fit the framework
well, but a priori hypotheses about effect
modifiers were not specified.

To assess whether 12 weeks of cognitive Subjective cognitive failures and executive dysfunctioning improved four weeks
flexibility training leads to improvement in post-training in all groups, although ESs were small (ɳp2=0.058 and 0.079,
Buitenweg Cognitive Cognitively
subjective cognitive failures and executive n=158 respectively), and there were no differences between groups (all p’s>0.38). No QoL
et al. (2019)26 (training) healthy
dysfunctioning, everyday functioning, significant changes in subjective reports were seen directly after training, which
depressive symptoms, anxiety, and QoL. was the case in all groups.

Continue…
 Table 1. Continuation.
Type of Sample Application
Author/year Objectives Sample Results
intervention characteristics effects
Proxies reported no functional changes over time, yet their evaluations were
significantly more favorable than those of the participants, both pre-training
(p<0.0005) and post-training (p=0.004).

The “TRIPL-A” study (i.e., a TRIal to promote

Physical Activity among patients in the young-
old affected by T2D) aimed to assess whether
performing an innovative Exercise Referral Primary and secondary outcome results will evaluate the effectiveness
Lucertini et al. Scheme (ERS), based on close collaboration of an ERS, specifically designed for the management of T2D clinical Cognitively
n=300 Educational No results
(2019)33 among general practitioners, specialist conditions and supported by a WBA, in promoting physical activity within healthy
physicians, exercise specialists and patients, Italian primary care settings.
supported by a web-based application (WBA),
can effectively lead sedentary older T2D
patients to adopt an active lifestyle.

To study the efficacy of the CBCT protocol

in a breast cancer survivor sample on QoL, The Accrual of eligible participants was high (77%), and the drop-out rate was
Gonzalez- psychological well-being, fear of cancer 16%. Attendance of CBCT sessions was high, and practice outside sessions QoL, mood,
Cognitively
Hernandez et al. recurrence (FCR), self-compassion, and n=56 Educational exceeded expectations. CBCT effectively diminishes stress caused by FCR, psychological
healthy
(2018)34 compassion domains and mindfulness facets. fostering self-kindness and common humanity, and increasing overall self- well-being.
Enrolment, adherence, and satisfaction with compassion scores, mindful observation, and acting with awareness skillsets.
the intervention were also analyzed.

To evaluate the effectiveness of a six-session

Psychological Well-Being (PWB) intervention
Cantarella et al. to improve PWB and identify transfer effects Only the trained group reported more significant gains in PWB and WM Cognitively Psychological
n=32 Educational
(2017)17 on an aspect related to PWB, QoL. Transfer performance after training. healthy well-being.
effects on a high-level cognitive process, WM,
were also investigated.

Cognitively
Positive affect and wellness increased significantly in acute and elderly healthy (part of
and residential care though not psychiatric care, whereas negative affect the group had
Thomson and To determine whether therapeutic benefits Mood,
Educational decreased and happiness increased in all settings. Examination of audio anxiety and
Chatterjee could be measured objectively using clinical n=40 psychological
(ludic) recordings revealed enhanced confidence, social interaction, and learning. The depression,
(2014)36 scales. well-being
program allowed adults access to a museum activity that would not otherwise but the results
have engaged with museum objects by age and ill-health. were described
separately).

To evaluate the effectiveness of an exercise The BOOMER balance test was to be used as the primary outcome measure.
Sales et al. intervention using an exercise park Secondary outcome measures included handgrip strength, 2-minute walk test, Cognitively
n=120 Educational No results
(2015)35 specifically designed for older people in lower limb strength test, spatiotemporal walking parameters, health-related QoL, healthy
Dement Neuropsychol 2021 December;15(4):428-439

reducing the risk of falls. feasibility, adherence, safety, and several other psychosocial measures.

Silva et al.   Cognitive interventions and the benefits on psychological well-being and quality of life   435
Continue…
 Table 1. Continuation.
Type of Sample Application
Author/year Objectives Sample Results
intervention characteristics effects
Outcome assessments were to be conducted at baseline and 18 and 26 weeks after
intervention commencement. Participants would report falls and physical activity
history for 12 months via monthly calendars. Mixed linear modeling incorporating
intervention and CGs at baseline and two follow-ups (18 weeks and 26 weeks after
intervention commencement) would be used to assess outcomes.
Independent-group t tests showed that the CG, compared to the EG, at rest
and on the second measurement, had significantly higher levels of state
To examine the effect of Greek traditional anxiety, psychological distress, fatigue, and significantly lower levels of positive
Mavrovouniotis Educational Cognitively Psychological
dances on the improvement of older people’s n=111 well-being. After dancing, approximately 63% of the maximum heart rate
et al. (2010)18 (ludic) healthy well-being.
QoL. was achieved in the EG. At the same time, paired t tests revealed significant
decreases in state anxiety and psychological distress, as well as substantial
increases in positive well-being and fatigue.
Dement Neuropsychol 2021 December;15(4):428-439

To test the efficacy of a CT program based on

the creation of mental images and changes Cognitive The TG showed significant improvement between pre- and post-tests on
Lima-Silva et al. Cognitively
in specific aspects of meta-memory in n=32 (training) and delayed recall of 10 pictures and self-efficacy to memorize stories. These same Mood
(2010)13 healthy
individuals with 3–15 years of education Educational changes were not found in the CG.
(M=8.38, SD=4.24).
To investigate the effects of a CT program Cognitive Results showed that healthy elderly could benefit from this type of intervention, QoL,
Irigaray et al. Cognitively
on the QoL and psychological well-being of n=76 (training) and reducing conditions that lead to pathological cognitive aging and promoting QoL psychological
(2011)10 healthy
healthy elderly. Educational and psychological well-being in old age. well-being
Post-test, the EG had better performance on attention, WM, language
To investigate the effects of an attention, Cognitive (inferences and spontaneous writing), constructional praxis, problem-solving,
Irigaray et al. Cognitively
memory, and executive functions training n=76 (training) and and executive function tasks. The training produced significant results after a Mood
(2012)38 healthy
intervention on healthy older adults’ cognition. Educational 12-session intervention, indicating that healthy elderly individuals’ cognitive
functioning can be improved.

436   Cognitive interventions and the benefits on psychological well-being and quality of lif   Silva et al.
272 participants (mean [SD] age, 75 [8] years; 160 [58.8%] males and 112
[41.2%] females) were enrolled, with 56 randomized to no yoga group, 54
to no computerized CT, 52 to no wellness, 53 to no support, and 57 to no
To compare the cumulative effects of Cognitive memory support system. The most remarkable ES for QoL was between
Chandler et al. Cognitively Psychological
combinations of five behavioral interventions n=272 (stimulation) no computerized CT and no wellness education groups (ES 0.34, 95%CI
(2019)39 healthy and MCI well-being.
on significant outcomes in patients with MCI. and Educational 0.05–0.64). On secondary analyses, wellness education had a greater effect
than computerized CT on mood (ES 0.53; 95%CI 0.21–0.86), and yoga had a
more significant impact than support groups on memory-related activities of
daily living (ES 0.43; 95%CI 0.13–0.72).
To assess the effectiveness of memory Study results will be useful for social and public health policies related to older
training workshops for healthy older people Cognitive people. Given the increase in the prevalence of older people, many interventions
Pérez et al. Cognitively
in terms of short- and long-term impact on n=230 (training) and targeting memory loss are funded by public resources. To ensure transparency No results
(2015)40 healthy
cognitive function, health-related QoL, and Educational and effective prioritization, such research is needed to provide evidence of
functioning. these interventions’ effectiveness and usefulness.
ACTIVE: Advanced Cognitive Training for Independent and Vital Elderly, ANOVA: analysis of variance, ARFC: Brief Cognitive Function Assessment, BOOMER: Balance Outcome Measure for Elder Rehabilitation, CBCT: Cognitively Based Compassion Training,
CERAD: Consortium to Establish a Registry for Alzheimer’s Disease, CFI: Comparative Fit Index, GDS: Geriatric Depression Scale, MCI: mild cognitive impairment, RAVLT: Rey Auditory–Verbal Learning Test, RMSEA: Root Mean Square Error of Approximation,
T2D: type 2 diabetes, WCST: Wisconsin Card Sorting Test.
 Dement Neuropsychol 2021 December;15(4):428-439

DISCUSSION Other studies combined educational interventions

This systematic review study aimed to analyze edu- with cognitive interventions, incorporating discussions
cational and cognitive interventions and determine about memory, aging, and well-being in the cognitive
their effects on associated subjective variables, such as training programs.11,13,38-40 The study by Irigaray et al.,10
QoL, psychological well-being, and depressive symp- investigating the effects of cognitive training on QoL
toms in cognitively healthy mature and older adults, and psychological well-being, found significant results
subjects with MCI and no depression. The approach for both variables. The researchers’ first hypothesis to
entailed analysis of several instruments and aspects explain this outcome involves the relationship between
associated with definitions of QoL and psychological enhanced cognitive capacity and its benefits for QoL.
well-being.7,21 At the same time, the secondary idea suggests a broad-
Cognitive type interventions employ a range of ening of participants’ social circle.
different approaches: olfactory training,22 cognitive However, one of the studies analyzed psychologi-
training using electronic devices, such as computers cal well-being and depressive symptoms and failed to
or tablets,13,23-26 training using musical instruments,10 identify significant results.5 This outcome echoes Silva
training through manual interventions, 27 training et al.,28 who also found no improvements in depressive
using categorization strategies,28 and multifactorial symptoms in training or control groups after a cognitive
training,14,15,25,29-32 which proved the most predominant training intervention in mature and older adults.
approach (7/15 cognitive intervention studies). In summary, the studies reported positive effects of
The majority of the studies reviewed, which in- educational and cognitive interventions for QoL, psy-
volved cognitive nature activities, showed significant chological well-being, and depressive symptoms among
results for at least one of the variables assessed (QoL, mature and older adults without dementia or depres-
psychological well-being, depressive symptoms, or sion. These results suggest that different intervention
mood). The study by Birte-Antina,22 whose sample strategies can benefit mature and older individuals,
received olfactory training, found improvements for warranting further research on the topic.
cognition, psychological well-being, QoL, and depressive The results corroborate another systematic review,
symptoms. By contrast, three studies failed to achieve which investigated the benefits of cognitive training,
significant results for QoL or psychological well-being but without focusing on the three variables evaluated
post-intervention.15,16,26 Buitenweg et al.26 concluded in this study. Gomes et al.,41 in an integrative review
that a possible explanation for nonsignificant effects on the relationship between cognitive training and
in the sample investigated might lie in the fact that the functionality in elderly people without cognitive im-
elderly participants had high cognitive performance and pairment, found that 50% of the studies that were
low depression symptoms preintervention. analyzed indicated positive effects of cognitive training
Educational type interventions tend to be used for on psychological, social, and QoL variables.
promoting health, given that the individual is empow- Santos and Mendoza,8 however, in a systematic
ered to practice self-care and thus has greater adherence review of national studies that involved cognitive
to professional practices.12 Studies with an educational training, warn of the need for caution when relating
approach in the present literature review focused on the cognitive intervention to psychosocial gains. The au-
following areas: healthy lifestyle,33 personal growth,17,34 thors claim that because these are variables measured
falls prevention,35 and play-oriented activities involving through self-reporting, responses may be influenced
museum object handling36 or dance.18 by external factors, which compromises the validity
The study by Cantarella et al.,17 in which a group of of the information collected. In general, there is a lack
women participated in classes and discussions aimed of literature reviews on the theme brought up by this
at favoring personal growth, found significant results study, which prevents the comparison of the results
for participants’ psychological well-being following found and, consequently, the application of greater
the intervention. The results were consistent with the scientific basis.
findings of the studies by Cachioni et al.7 and Ordonez The main limitations of this review were a dearth of
et al.,37 assessing subjective and psychological well-be- methodological processes in studies involving cogni-
ing of elderly participants of an open Universidade tive and educational interventions among cognitively
da Terceira Idade, which identified positive effects of healthy mature and older adults or those with MCI,
education on general satisfaction with life, where stu- particularly regarding the application of assessment
dents engaged in the interventions for longer had more instruments pre- and posttest. In addition, there was a
significant results. lack of cognitive training interventions concomitantly

Silva et al.   Cognitive interventions and the benefits on psychological well-being and quality of life   437
 Dement Neuropsychol 2021 December;15(4):428-439

investigating effects on QoL, psychological well-being, variables. Therefore, these practices can be applied by
depressive symptoms, and mood among older adults. professionals who seek improvements beyond cognition
Another limitation was the absence of a calculation and learning. This possibility allows the adoption of
that could measure the effect size of the results found. complementary strategies to provide psychosocial gains
In addition, there was a lack of prior registration of the for mature and elderly adults.
review protocol in a database. It is suggested, for future research, that there is
Despite the limitations, the results found sugg‑est greater deepening in the comparison of the gains from
that there is a relationship between educational and educational interventions and the gains resulting from
cognitive interventions and psychological and QoL cognitive interventions.

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