Can mindfulness-based interventions influence cognitive functioning in older adults? A review and considerations for future research

Figures & data

Figure 1. Schematic model for the effects of meditation on cognition. (Adapted from Marciniak et al. (2014).)

Figure 2. Flow diagram review.

Table 1. Characteristics of studies.

Author (year)	Design	ITT N (%male)	Completers N (%ITT)	Population	Mean age (SD)	Intervention	Cognitive tests findings	Other findings
Ernst et al. (2008)	Not Random Two groups; MBSR and CON Two time points: Pre- and post-intervention measurements	EXP: 15 (20) CON: 7 (43)	EXP: 9 (60) CON:7 (100)	Nursing home residents	EXP: 80 CON: 89	MBSR Adjustments: –No retreat, –90-minute sessions –Physical exercises simplified –No obligatory time for homework set –Possibility of practice in group twice a week CON: No intervention	No sign. differences between groups: –MMSE	Sig. greater improvement in physical health (SF-12), depression (GDS-12R), and severity of major complaints
Lenze et al. (2014)	Two EXP groups: 8 and 12 weeks (only 8-week results reported here) Two time points: Pre- and post-intervention measurements Pre, midway, post, 3 month and 6 month FU for clinical	EXP(8 weeks): 16 (31) EXP(12 weeks): 18 (22)	EXP(tot): 32 (94)	65+ with worry symptoms and subjective cognitive dysfunction	EXP(8 weeks): 70.9(4.5) EXP(12 weeks): 70.7(4.9)	MBSR (8 and 12 weeks) –Half-day retreat –Reducing intensity of yoga CON: No Control group	No sign. differences pre- and post-intervention: –List learning –Digit span test *Sign. improvement post-intervention: –List delayed recall –Paragraph immediate recall –Paragraph delayed recall –Verbal fluency –Color–word interference **half of participants completed these tests	Worry reduction (PSWQ-A), Increased mindfulness (measured by CAMS-R, but not MAAS), Feasibility (attendance, satisfaction rating)
Mallya and Fiocco (2015)	RCT Two groups: MBSR and CON Pre- and post-intervention measurements	EXP: 57 (23) CON: 40 (30)	EXP: 53 (91) CON: 33 (70)	65+ healthy	EXP: 68.8(4.6) CON: 69.7(4.9)	MBSR Adjustments: –Half-day retreat –30 minutes instead of 40 minutes daily homework CON: Active control (reading and relaxation)	No sign. differences pre/post between groups: –MMSE –CVLT-LDFR –TMT A –TMT B –COWAT-FAS –COWAT-Animal	MAAS (CON>EXP) PSS (ns) Depression GDS (ns) QoL (EXP>CON) RSES (ns)
Moynihan et al. (2013)	RCT Two groups: MBSR and CON Four time points: Pre- and post-intervention, 3 weeks later, 21 weeks later	EXP: 108 (38) CON:111 (38)	EXP: 105 (97) CON:103 (93)	Older adults	EXP: 73.3(6.7) CON: 73.6(6.7)	MBSR Adjustments: –120-minute sessions –Adjusted yoga CON: Waiting List	–Trail B/A Ratio: EXP sign. better than CON at post-intervention but not at FU1 or FU2	CES-D-R (ns) PSS (ns) MAAS (EXP>CON) Greater alpha asymmetry EXP Antibody response (EXP higher at FU1, but lower at FU2)
O'Connor et al. (2014)	Not randomized Two groups: MBCT and waitlist control Three time points: Pre- and post-intervention, and 5 month FU	EXP: 18 (28) CON: 18 (33)	EXP: 12 (67) CON: 18 (100)	Elderly bereaved people with loss-related distress	EXP: 76.7(4.5) CON: 77.0(4.1)	MBCT Adjustments: –120-minute sessions –Psychoeduction on general negative affect instead of depressive symptoms –Booster session at 3 and 6 months -post-intervention CON: Waiting List	Letter number sequencing (trend EXP improved)	BDI (EXP improved compared to CON) HTQ (ns) ICG-R (ns)
Smart et al. (2016)^a	RCT Two Groups: MBSR and psychoeducation CON	SCD: 23 (61) CON: 15 (27)	SCD: 22 (96) CON: 15 (93)	Older adults with and without SCD	SCD: 70.0 (3.45) CON: 69.60 (3.58)	MBSR Adjustments: 120-minute sessions CON: Psychoeducationon cognitive aging	No sign. differences between groups: –Go/Nogo RT –Go/Nogo accuracy –EXP but not CON reduced: –Go/Nogo RT IIV	P3 ERP (EXP>CON) CCI (ns) FFMQ-A (ns) GDS (ns) Memory self-efficacyPVBC (EXP>CON)

BDI: Beck Depression Inventory; CAMS-R: Cognitive Affective Mindfulness Scale-Revised; CCI: Cognitive Complaints Index comprised of complaints items from the GDS, Memory Complaints Questionnaire and Metamemory in Adulthood Questionnaire; CON: Control Group; COWAT: Controlled Oral Word Association Task; CVLT-LDFR: California Verbal Learning Test- Long Delay Free Recall; EXP: Experimental Group; FFMQ-A: Mindful Attention composite from Five Facet Mindfulness Questionnaire subscales Observe, Describe, and Act with Awareness; FU: Follow-up; GDS: Geriatric Depression Scale; GDS-12R: Geriatric Depression Scale Residential; HTQ: Harvard Trauma Questionnaire; ICG: Inventory of Complicated Grief –Revised; ITT: Intention to treat; MAAS: Mindful Attention Awareness Scale; MBCT: Mindfulness-Based Cognitive Therapy; MBSR: Mindfulness-Based Stress Reduction; MCI: Mild Cognitive Impairment; MMSE: Mini-Mental State Examination; ns: no significant difference between groups; PSWQ-A: Penn State Worry Questionnaire-Abbreviated; PVBC: Percent Brain Volume Change; QOLS: Quality of Life Scale; RCT: randomized controlled trial; RSES: Rosenberg Self-Esteem Scale; SCD: Subjective Cognitive Decline; SF-12: Short-Form General Health Survey; TMT: Trail Making Test.

^a This study compared healthy controls and SCD in both MBSR and CON. This table shows results are for comparison MBSR with CON only.

Table 2. Risk of bias summary.

	Selection bias	Performance bias	Detection bias	Attrition bias	Reporting bias
Author (year)	Random sequence generation	Allocation concealment	Blinding of participants and personnel	Treatment fidelity	Blinding of outcome assessment	Incomplete outcome data	Selective reporting
Ernst et al. (2008)	N/A	N/A	^?	^?	^?	^−	^?
Lenze et al. (2014)	N/A	N/A	^−	^+	^?	^+	^−
Mallya and Fiocco (2015)	^+	^+	^+	^+	^+	^+	^?
Moynihan et al. (2013)	^+	^?	^?	^+	^?	^+	^−
O'Connor et al. (2014)	^−	^−	^−	^?	^?	^+	^?
Smart et al. (2016)	^?	^+	^+	^?	^?	^+	^?

Note: ^?Unknown risk; ⁺Low risk; ⁻High risk.

Marciniak, R., Sheardova, K., Cermáková, P., Hudeček, D., Sumec, R., & Hort, J. (2014). Effect of meditation on cognitive functions in context of aging and neurodegenerative diseases. Frontiers in Behavioral Neuroscience, 8, 17. http://doi.org/10.3389/fnbeh.2014.00017

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Mallya, S., & Fiocco, A.J. (2015). Effects of mindfulness training on cognition and well-being in healthy older adults. Mindfulness, 7(2), 453–465. http://doi.org/10.1007/s12671-015-0468-6

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O'Connor, M., Piet, J., & Hougaard, E. (2014). The effects of mindfulness-based cognitive therapy on depressive symptoms in elderly bereaved people with loss-related distress: A controlled pilot study. Mindfulness, 5, 400–409. http://doi.org/10.1007/s12671-013-0194-x

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Smart, C.M., Segalowitz, S.J., Mulligan, B.P., Koudys, J., & Gawryluk, J.R. (2016). Mindfulness training for older adults with subjective cognitive decline: Results from a pilot randomized controlled trial. Journal of Alzheimer's Disease, 52(2), 757–774. http://doi.org/10.3233/JAD-150992

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