The Effectiveness of Cognitive-Based Rehabilitation on Attention, Working Memory, Cognitive Flexibility, Inhibitory Control, and Visual Memory in Older Adults

Abstract
Background: Aging is a process accompanied by numerous and diverse cognitive changes. Evidently, impairments or declines in this domain can disrupt daily functioning and lead to irreversible physical, psychological, and economic consequences for older adults.
Method: This study aimed to evaluate the effectiveness of cognitive-based rehabilitation (CBR) on cognitive functions in older adults. This was a quasi-experimental study using a pretest-posttest design with a control group. The statistical population included all older residents of District 11 in Tehran. Thirty participants (10 women and 5 men in each group) were selected through convenience sampling and based on inclusion criteria, and randomly assigned to experimental and control groups, each consisting of 15 individuals. The experimental group received Paul’s cognitive training package in eight weekly 45-minute sessions. Research instruments included the computerized Addenbrooke’s Cognitive Examination, computerized Wisconsin Card Sorting Test, computerized Stroop Test, and the paper-based Benton Visual Retention Test. Data were analyzed using ANCOVA in SPSS version 24.
Results: Findings revealed significant differences between the two groups in attention, working memory, cognitive flexibility, inhibitory control, and visual memory. The results indicate that CBR training enhances cognitive functions in older adults.
Conclusion: Therefore, CBR can be considered an effective intervention for promoting cognitive performance in this population.
EXTENDED ABSTRACT
 Introduction
Aging is often accompanied by an increase in diseases and disabilities, which can lead to a decline in quality of life. Although individuals in later adulthood generally retain their ability to comprehend situations and acquire new experiences and information, they may struggle with tasks that require rapid and precise responses. Early detection of cognitive decline can enable timely interventions to prevent further deterioration and facilitate rehabilitation, thereby avoiding irreversible stages of cognitive impairment. Therefore, this study aimed to examine the effectiveness of Paul’s cognitive-based rehabilitation (CBR) program on several cognitive functions, including attention, working memory, cognitive flexibility, inhibitory control, and visual memory, in healthy older adults in 2024. While this training method has previously been applied to individuals with cognitive impairments, brain injuries, and dementia, it has not yet been tested on cognitively healthy older adults without psychological, neurological, or physical disorders. This gap highlights the necessity of the present research, which seeks to contribute to the field of cognitive health prevention and enhancement before irreversible damage occurs. Accordingly, the objective of this study was to assess the effectiveness of CBR on attention, working memory, cognitive flexibility, inhibitory control, and visual memory in older adults.
Method
This was a quasi-experimental study using a pretest-posttest design with a control group. The statistical population consisted of all older adults residing in District 11 of Tehran, Iran. A sample of 30 participants (15 women and 15 men) was selected using a convenience sampling method. Inclusion criteria were (1) scoring above 85 on the Addenbrooke’s Cognitive Examination, (2) age between 65 and 80 years, and (3) basic literacy without university education. Exclusion criteria included (1) diagnosed cognitive disorders, (2) use of sedatives or psychoactive substances, (3) history of diabetes, hypertension, or chronic illness, and (4) history of accidents, chemotherapy, cardiac or cerebral stroke. The assessment tools included the Addenbrooke’s Cognitive Examination, Stroop Test, Wisconsin Card Sorting Test, and Benton Visual Retention Test. All participants completed the pre-test assessments and were randomly assigned to either the experimental or control group. The experimental group participated in eight weekly 45-minute sessions of CBR training, while the control group received no intervention. Post-test assessments were then conducted, and the data were analyzed using descriptive statistics and ANCOVA in SPSS version 24.
Results
To ensure the validity of statistical assumptions required for ANCOVA, several preliminary tests were conducted. Levene’s test was used to assess the homogeneity of variances between the experimental and control groups at post-test phase. The results showed no statistically significant differences for attention (F_(1,13)=1.65, p=.22), working memory (F_(1,13)=0.113, p=.74), cognitive flexibility (F_(1,13)=0.05, p=.82), inhibitory control (F_(1,13)=0.182, p=.67), and visual memory (F_(1,13)=2.05, p=.18), supporting  the assumption of equal variances. Additionally, the interaction effect between group and pre-test scores was non-significant (F=3.868, p=.14), validating the homogeneity of regression slopes. Box’s M test also supported the homogeneity of covariance matrices (F=0.938, p=.521). The Shapiro-Wilk test confirmed that all dependent variables were normally distributed in both groups (p>.05).
After verifying these assumptions, ANCOVA was performed to evaluate the effectiveness of the CBR intervention. The results indicated significant improvements across all assessed cognitive domains in the experimental group compared to the control group. These findings confirm the efficacy of CBR in enhancing cognitive functions.
Conclusion
Aging represents a critical stage in the human lifespan, and addressing the challenges and needs of this period is an important public health concern. It marks a phase of human development characterized by a decline in physical capabilities, cognitive skills, and the experience of loss. Aging is a multidimensional process involving profound transformations across physiological, psychological, and sociological domains. Cognitive impairments are among the most prevalent issues during this stage. From later adulthood onward, a gradual decline in certain cognitive abilities is often observed. Although individuals in later adulthood generally retain their ability to comprehend situations and acquire new experiences and information, they may encounter difficulties with tasks requiring rapid and precise responses. Numerous studies have shown that cognitive abilities naturally diminish with age. Nevertheless, healthy aging is a fundamental right for all individuals, underscoring the importance of proactive measures to prevent age-related challenges. These findings highlight the necessity of early identification and timely intervention in cognitive decline during aging. In recent years, CBR methods have gained widespread use in supporting individuals with cognitive impairments. CBR refers to a structured set of interventions designed to restore cognitive functioning by developing and applying cognitive and behavioral strategies aimed at enhancing brain performance and improving quality of life. The effectiveness of CBR programs in improving cognitive functions among older adults is supported by scientific evidence on neuroplasticity and cognitive reserve, suggesting that the brain remains capable of adaptive change even in advanced age. Given the growing aging population, the need for non-pharmacological interventions to promote cognitive health has become increasingly important. Such approaches can serve as effective strategies in senior care facilities and psychological clinics.
Ethical Consideration
Ethical Code
IR.ALZAHRA.REC.1403.037
Financial Support
This study did not receive financial support.
Authors’ Contributions
N.Y: Data Curation, Software, Formal analysis, Writing - Original Draft; Z.H: Methodology, Validation, Writing - Review & Editing, Supervision; H.Z: Writing - Review & Editing, Supervision
Conflict of Interest
The authors declared no conflicts of interest.
Acknowledgments
The authors sincerely thank all the older adult participants who took part in this study. Special appreciation is extended to the esteemed Research Deputy of Alzahra University for their collaboration in facilitating this research.
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