Jigsaw Puzzles As Cognitive Enrichment (PACE) - the effect of solving jigsaw puzzles on global visuospatial cognition in adults 50 years of age and older: study protocol for a randomized controlled trial

Patrick Fissler, Olivia C Küster, Laura S Loy, Daria Laptinskaya, Martin J Rosenfelder, Christine A F von Arnim, Iris-Tatjana Kolassa, Patrick Fissler, Olivia C Küster, Laura S Loy, Daria Laptinskaya, Martin J Rosenfelder, Christine A F von Arnim, Iris-Tatjana Kolassa

Abstract

Background: Neurocognitive disorders are an important societal challenge and the need for early prevention is increasingly recognized. Meta-analyses show beneficial effects of cognitive activities on cognition. However, high financial costs, low intrinsic motivation, logistic challenges of group-based activities, or the need to operate digital devices prevent their widespread application in clinical practice. Solving jigsaw puzzles is a cognitive activity without these hindering characteristics, but cognitive effects have not been investigated yet. With this study, we aim to evaluate the effect of solving jigsaw puzzles on visuospatial cognition, daily functioning, and psychological outcomes.

Methods: The pre-posttest, assessor-blinded study will include 100 cognitively healthy adults 50 years of age or older, who will be randomly assigned to a jigsaw puzzle group or a cognitive health counseling group. Within the 5-week intervention period, participants in the jigsaw puzzle group will engage in 30 days of solving jigsaw puzzles for at least 1 h per day and additionally receive cognitive health counseling. The cognitive health counseling group will receive the same counseling intervention but no jigsaw puzzles. The primary outcome, global visuospatial cognition, will depict the average of the z-standardized performance scores in visuospatial tests of perception, constructional praxis, mental rotation, processing speed, flexibility, working memory, reasoning, and episodic memory. As secondary outcomes, we will assess the eight cognitive abilities, objective and subjective visuospatial daily functioning, psychological well-being, general self-efficacy, and perceived stress. The primary data analysis will be based on mixed-effects models in an intention-to-treat approach.

Discussion: Solving jigsaw puzzles is a low-cost, intrinsically motivating, cognitive leisure activity, which can be executed alone or with others and without the need to operate a digital device. In the case of positive results, these characteristics allow an easy implementation of solving jigsaw puzzles in clinical practice as a way to improve visuospatial functioning. Whether cognitive impairment and loss of independence in everyday functioning might be prevented or delayed in the long run has to be examined in future studies.

Trial registration: ClinicalTrials.gov, NCT02667314 . Registered on 27 January 2016.

Keywords: Cognitive aging; Cognitive enrichment; Cognitive impairment; Cognitive intervention; Daily functioning; Dementia; Jigsaw puzzles; Visuospatial cognition.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Ethics Committee of Ulm University (401/15 – Zo/bal.). All participants will provide oral informed consent before the telephone-based pre-screening and written informed consent before the on-site screening (see “Procedures”).

Consent for publication

Not applicable.

Competing interests

PF, OCK, LSL, DL, and MJR are employed within the PACE project that is funded by Ravensburger Spieleverlag GmbH (RSV). RSV may gain or lose financially from the publication of this and following manuscripts about the PACE project. The authors declare that they are not influenced in any way by RSV with regard to study design, collection, management, analysis, and interpretation of data; writing of the manuscript, and the decision to submit the report for publication. Apart from providing the jigsaw puzzles, RSV has no role in the study.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
SPIRIT schedule of enrollment, interventions, and assessments. IADL instrumental activities of daily living
Fig. 2
Fig. 2
Flow chart of the study procedures. Expectations are the participants’ expectations about benefits in visuospatial cognitive performance. AE adverse event

References

    1. Hurd MD, Martorell P, Delavande A, Mullen KJ, Langa KM. Monetary costs of dementia in the United States. N Engl J Med. 2013;368(14):1326–34. doi: 10.1056/NEJMsa1204629.
    1. Valenzuela MJ, Sachdev P. Brain reserve and cognitive decline: a non-parametric systematic review. Psychol Med. 2006;36(08):1065–73. doi: 10.1017/S0033291706007744.
    1. Valenzuela MJ, Sachdev P. Brain reserve and dementia: a systematic review. Psychol Med. 2006;36(4):441–54. doi: 10.1017/S0033291705006264.
    1. Barnes DE, Yaffe K. The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol. 2011;10(9):819–28. doi: 10.1016/S1474-4422(11)70072-2.
    1. Lampit A, Hallock H, Valenzuela M. Computerized cognitive training in cognitively healthy older adults: a systematic review and meta-analysis of effect modifiers. PLoS Med. 2014;11(11):e1001756. doi: 10.1371/journal.pmed.1001756.
    1. Zelinski EM, Spina LM, Yaffe K, Ruff R, Kennison RF, Mahncke HW, Smith GE. Improvement in memory with plasticity based adaptive cognitive training: results of the 3 month follow up. J Am Geriatr Soc. 2011;59(2):258–65. doi: 10.1111/j.1532-5415.2010.03277.x.
    1. Karbach J, Verhaeghen P. Making working memory work: a meta-analysis of executive-control and working memory training in older adults. Psychol Sci. 2014;25(11):2027–37. doi: 10.1177/0956797614548725.
    1. Hardy JL, Nelson RA, Thomason ME, Sternberg DA, Katovich K, Farzin F, Scanlon M. Enhancing cognitive abilities with comprehensive training: a large, online, randomized, active-controlled trial. PLoS One. 2015;10(9):e0134467. doi: 10.1371/journal.pone.0134467.
    1. Spencer-Smith M, Klingberg T. Benefits of a working memory training program for inattention in daily life: a systematic review and meta-analysis. PLoS One. 2015;10(3):e0119522. doi: 10.1371/journal.pone.0119522.
    1. Toril P, Reales JM, Ballesteros S. Video game training enhances cognition of older adults: a meta-analytic study. Psychol Aging. 2014;29(3):706–16. doi: 10.1037/a0037507.
    1. Green CS, Bavelier D. Action video game modifies visual selective attention. Nature. 2003;423(6939):534–7. doi: 10.1038/nature01647.
    1. Shute VJ, Ventura M, Ke F. The power of play: the effects of Portal 2 and Lumosity on cognitive and noncognitive skills. Comput Educ. 2015;80:58–67. doi: 10.1016/j.compedu.2014.08.013.
    1. Basak C, Boot WR, Voss MW, Kramer AF. Can training in a real-time strategy video game attenuate cognitive decline in older adults? Psychol Aging. 2008;23(4):765–77. doi: 10.1037/a0013494.
    1. Fissler P, Küster O, Schlee W, Kolassa IT. Novelty interventions to enhance broad cognitive abilities and prevent dementia: synergistic approaches for the facilitation of positive plastic change. Prog Brain Res. 2013;207:403–34. doi: 10.1016/B978-0-444-63327-9.00017-5.
    1. Cheng ST, Chow PK, Song YQ, Yu EC, Chan AC, Lee TM, Lam JH. Mental and physical activities delay cognitive decline in older persons with dementia. Am J Geriatr Psychiatry. 2014;22(1):63–74. doi: 10.1016/j.jagp.2013.01.060.
    1. Klusmann V, Evers A, Schwarzer R, Schlattmann P, Reischies F, Heuser I, Dimeo F. Complex mental and physical activity in older women and cognitive performance: a 6-month randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2010;65(6):680–8. doi: 10.1093/gerona/glq053.
    1. Park DC, Lodi-Smith J, Drew L, Haber S, Hebrank A, Bischof GN, Aamodt W. The impact of sustained engagement on cognitive function in older adults: the Synapse Project. Psychol Sci. 2013;25(1):103–12. doi: 10.1177/0956797613499592.
    1. Noice H, Noice T. An arts intervention for older adults living in subsidized retirement homes. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2009;16(1):56–79. doi: 10.1080/13825580802233400.
    1. Dykens EM. Are jigsaw puzzle skills ‘spared’ in persons with Prader-Willi syndrome? J Child Psychol Psychiatry. 2002;43(3):343–52. doi: 10.1111/1469-7610.00025.
    1. Levine SC, Ratliff KR, Huttenlocher J, Cannon J. Early puzzle play: a predictor of preschoolers’ spatial transformation skill. Dev Psychol. 2012;48(2):530–42. doi: 10.1037/a0025913.
    1. Lindstrom HA, Fritsch T, Petot G, Smyth KA, Chen CH, Debanne SM, Lerner AJ, Friedland RP. The relationships between television viewing in midlife and the development of Alzheimer’s disease in a case-control study. Brain Cogn. 2005;58(2):157–65. doi: 10.1016/j.bandc.2004.09.020.
    1. Friedland RP, Fritsch T, Smyth KA, Koss E, Lerner AJ, Chen CH, Petot GJ, Debanne SM. Patients with Alzheimer’s disease have reduced activities in midlife compared with healthy control-group members. Proc Natl Acad Sci U S A. 2001;98(6):3440–5. doi: 10.1073/pnas.061002998.
    1. Possin KL. Visual Spatial Cognition in Neurodegenerative Disease. Neurocase. 2010;16(6):466–87. doi: 10.1080/13554791003730600.
    1. Kelly ME, Loughrey D, Lawlor BA, Robertson IH, Walsh C, Brennan S. The impact of cognitive training and mental stimulation on cognitive and everyday functioning of healthy older adults: a systematic review and meta-analysis. Ageing Res Rev. 2014;15(1):28–43. doi: 10.1016/j.arr.2014.02.004.
    1. Slegers K, van Boxtel MP, Jolles J. Effects of computer training and internet usage on the well-being and quality of life of older adults: a randomized, controlled study. J Gerontol B Psychol Sci Soc Sci. 2008;63(3):176–84. doi: 10.1093/geronb/63.3.P176.
    1. Borness C, Proudfoot J, Crawford J, Valenzuela M. Putting brain training to the test in the workplace: a randomized, blinded, multisite, active-controlled trial. PLoS One. 2013;8(3):e59982. doi: 10.1371/journal.pone.0059982.
    1. Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98. doi: 10.1016/0022-3956(75)90026-6.
    1. Feise R. Do multiple outcome measures require p-value adjustment? BMC Med Res Methodol. 2002;2(1):2–8. doi: 10.1186/1471-2288-2-8.
    1. Benton A, Sivan A, Hamsher K, Varney N, Spreen O. Contributions to neuropsychological assessment: a clinical manual. New York, USA: Oxford University Press; 1994.
    1. Osterrieth PA. Le test de copie d'une figure complexe; contribution à l'étude de la perception et de la mémoire [Test of copying a complex figure; contribution to the study of perception and memory] Arch Psychol. 1944;30:206–356.
    1. Taylor L. Localisation of cerebral lesions by psychological testing. Clin Neurosurg. 1969;16:269–87.
    1. Neuburger S, Jansen P, Heil M, Quaiser-Pohl C. Gender differences in pre-adolescents’ mental-rotation performance: do they depend on grade and stimulus type? Pers Individ Dif. 2011;50(8):1238–42. doi: 10.1016/j.paid.2011.02.017.
    1. Peters M, Laeng B, Latham K, Jackson M, Zaiyouna R, Richardson C. A redrawn Vandenberg and Kuse mental rotations test-different versions and factors that affect performance. Brain Cogn. 1995;28(1):39–58. doi: 10.1006/brcg.1995.1032.
    1. Welsh KA, Butters N, Mohs RC, Beekly D, Edland S, Fillenbaum G, Heyman A. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part V. A normative study of the neuropsychological battery. Neurology. 1994;44(4):609–14. doi: 10.1212/WNL.44.4.609.
    1. Reitan RM. Validity of the Trail Making Test as an indicator of organic brain damage. Percept Motor Skills. 1958;8(3):271–6. doi: 10.2466/pms.1958.8.3.271.
    1. Härting C, Markowitsch H, Neufeld H, Calabrese P, Deisinger K, Kessler J. Wechsler Gedächtnis Test – Revidierte Fassung [Wechsler Memory Scale – Revised] Bern: Huber; 2000.
    1. Von Aster M, Neubauer A, Horn R. Wechsler Intelligenztest für Erwachsene (WIE). Deutschsprachige Bearbeitung und Adaptation des WAIS-III von David Wechsler [Wechsler Intelligence Scale for adults. German adaptation of the WAIS-III by David Wechsler] Frankfurt/Main: Harcourt Test Services; 2006.
    1. Owsley C, McGwin G, Jr, Sloane ME, Stalvey BT, Wells J. Timed instrumental activities of daily living tasks: relationship to visual function in older adults. Optom Vis Sci. 2001;78(5):350–9. doi: 10.1097/00006324-200105000-00019.
    1. Tucker-Drob EM. Neurocognitive functions and everyday functions change together in old age. Neuropsychology. 2011;25(3):368–77. doi: 10.1037/a0022348.
    1. Klumb PL. Cognitive failures and performance differences: validation studies of a German version of the cognitive failures questionnaire. Ergonomics. 1995;38(7):1456–67. doi: 10.1080/00140139508925202.
    1. Scholz A. Konzentration im Alltag: Erleben und Leistung [Attention in everyday life: subjective and objective performance]. Doctoral dissertation. Dresden: TU Dresden; 2006.
    1. Brähler E, Mühlan H, Albani C, Schmidt S. Teststatistische Prüfung und Normierung der deutschen Versionen des EUROHIS-QOL Lebensqualität-Index und des WHO-5 Wohlbefindens-Index [Testing and standardization of the German version of the EUROHIS-QOL and WHO-5 quality-of life-indices] Diagnostica. 2007;53(2):83–96. doi: 10.1026/0012-1924.53.2.83.
    1. Schwarzer R, Jerusalem M. Generalized Self-Efficacy scale. In: Weinman J, Wright S, Johnston M, editors. Measures in health psychology: a user’s portfolio. Causal and control beliefs. Windsor, UK: NFER-NELSON; 1995. pp. 35–7.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96. doi: 10.2307/2136404.
    1. Blom G. Statistical estimates and transformed beta-variables. New York, NY: John Wiley & Sons; 1958.
    1. Stewart AL, Mills KM, King AC, Haskell WL, Gillis D, Ritter PL. CHAMPS physical activity questionnaire for older adults: outcomes for interventions. Med Sci Sports Exerc. 2001;33(7):1126–41. doi: 10.1097/00005768-200107000-00010.
    1. Martínez-González MA, García-Arellano A, Toledo E, Salas-Salvadó J, Buil-Cosiales P, Corella D, Covas MI, Schröder H, Arós F, Gómez-Gracia E, et al. A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One. 2012;7(8):e43134. doi: 10.1371/journal.pone.0043134.
    1. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81–95. doi: 10.1007/s12160-013-9486-6.
    1. Boot WR, Simons DJ, Stothart C, Stutts C. The pervasive problem with placebos in psychology why active control groups are not sufficient to rule out placebo effects. Perspect Psychol Sci. 2013;8(4):445–54. doi: 10.1177/1745691613491271.
    1. Willis SL. Methodological issues in behavioral intervention research with the elderly. In: Birren JE, Schaie KW, editors. Handbook of the psychology of aging. San Diego, CA, US: Academic Press; 2001. pp. 78–108.
    1. Altman DG. Missing outcomes in randomized trials: addressing the dilemma. Open Med. 2009;3(2):e51–3.
    1. Gupta SK. Intention-to-treat concept: a review. Perspect Clin Res. 2011;2(3):109–12. doi: 10.4103/2229-3485.83221.
    1. Pinheiro J, Bates D, DebRoy S, Sarkar D, R Development Core Team. nlme: linear and nonlinear mixed effects models. R package version 3.1-97. Vienna: R Foundation for Statistical Computing; 2011.
    1. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c869. doi: 10.1136/bmj.c869.
    1. Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–91. doi: 10.3758/BF03193146.
    1. Lindenberger U, Wenger E, Lovden M. Towards a stronger science of human plasticity. Nat Rev Neurosci. 2017;18(5):261–2. doi: 10.1038/nrn.2017.44.
    1. Lövdén M, Bäckman L, Lindenberger U, Schaefer S, Schmiedek F. A theoretical framework for the study of adult cognitive plasticity. Psychol Bull. 2010;136(4):659–76. doi: 10.1037/a0020080.
    1. Fissler P, Kolassa I-T, Schrader C. Educational games for brain health: revealing their unexplored potential through a neurocognitive approach. Front Psychol. 2015;6:1056. doi: 10.3389/fpsyg.2015.01056.
    1. Militello LG, Hutton RJ. Applied Cognitive Task Analysis (ACTA): A practitioner’s toolkit for understanding cognitive task demands. Ergonomics. 1998;41(11):1618–41. doi: 10.1080/001401398186108.
    1. Baniqued PL, Lee H, Voss MW, Basak C, Cosman JD, DeSouza S, Severson J, Salthouse TA, Kramer AF. Selling points: What cognitive abilities are tapped by casual video games? Acta Psychol (Amst) 2013;142(1):74–86. doi: 10.1016/j.actpsy.2012.11.009.
    1. Jaeggi SM, Studer-Luethi B, Buschkuehl M, Su YF, Jonides J, Perrig WJ. The relationship between n-back performance and matrix reasoning - implications for training and transfer. Intelligence. 2010;38(6):625–35. doi: 10.1016/j.intell.2010.09.001.

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