Improvement in Memory With Plasticity-Based Adaptive Cognitive Training (IMPACT)

The computer-based training program is focused on speech reception to strengthen an
individual's memory for speech. This type of training program was chosen because speech
perception and memory are crucial elements of human communication and losses in this area
are often the first signal of overall cognitive decline.

Subjects meeting eligibility criteria and providing written, informed consent are randomized
to one of two 40-session, computerized training programs.

Inclusion Criteria:

- Age 65 or older at the time of consent.

- Mini-Mental State Examination (MMSE) score of 26 or higher.

- Fluent English speaker. For the purposes of this study, fluency will be defined as
living in an English speaking country and attending an English speaking school by the
age of six (participants will demonstrate fluency by reading aloud a selected
paragraph).

- Visual capacity adequate to read 14 point type (participants will demonstrate visual
capacity by reading aloud a selected sentence).

- Adequate hearing capacity. (Participants will demonstrate by repeating a series of
words spoken by the screening clinician; the words will be spoken while a view of the
clinician's mouth is obstructed to prevent lip-reading.)

- Willing and able to commit to the 6-month time requirement of the entire study period
with an emphasis on availability for the 8-10 week computer based training.

Exclusion Criteria:

- Mini-Mental State Examination (MMSE) score of 25 or lower.

- Self-report of current diagnosis or history of major neurological illness.
Specifically:

- Alzheimer's disease

- Parkinson's disease

- Multiple sclerosis

- Amyotrophic lateral sclerosis

- Self-report of current diagnosis or history of psychiatric illness. Specifically:

- Major depressive disorder

- Bipolar disorder

- Schizophrenia

- Post traumatic stress disorder

- Obsessive-compulsive disorder

- Self-reported history of psychiatric hospitalization.

- History of a stroke, transient ischemic attack (TIA), or traumatic brain injury
within the past year; or lifetime history of stroke, TIA, or traumatic brain injury
that has left residual expressive or receptive language problems. Traumatic brain
injuries include, but are not limited to: concussion with loss of consciousness; head
trauma with loss of consciousness; persistent migraines (persistent being defined as
a predictable pattern occurring more frequently than every other month); and history
of seizure disorder.

- Fibromyalgia or symptoms of tremor severe enough to prevent the use of a computer
mouse or other pointing device. Clinician to observe participant during signature of
consent form, during drawing portion of Repeatable Battery for the Assessment of
Neuropsychological Status (RBANS) assessment, and to directly ask participant as
instructed in the Body Image Ideals Questionnaire (BIQ) to make tremor assessment.

- Self-report of current substance abuse, including alcoholism.

- Current use, or use within the past 3 months, of medications with substantial central
nervous system (CNS) effects, including acetylcholinesterase inhibitors and
medications with either anticholinergic or antidepressant properties.

- Behaviors during screening or baseline visits that, in the judgment of the screening
clinician, are likely to present significant problems for the trainers in the in home
setting may be excluded at the discretion of the clinician. Such behaviors include
significant uncooperative behavior, significant rudeness or temper management
problems, or inappropriate physical conduct.

- Unable to perform neuropsychological evaluations.

- Participant is not capable of giving informed consent or is unable to comprehend
and/or follow instructions.

- Participant is enrolled in a concurrent clinical study that could affect the outcome
of this study.