Journal of the International Neuropsychological Society


Cognitive rehabilitation in the elderly: Effects on strategic behavior in relation to goal management

BRIAN  LEVINE  a1 a2 a3 c1 , DONALD T.  STUSS  a1 a2 a3 a4 , GORDON  WINOCUR  a1 a2 a5 a6 , MALCOLM A.  BINNS  a1 , LOUISE  FAHY  a1 , MARINA  MANDIC  a1 , KRISTEN  BRIDGES  a1 and IAN H.  ROBERTSON  a1 a7
a1 Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
a2 Department of Psychology, University of Toronto, Ontario, Canada
a3 Department of Medicine (Neurology), University of Toronto, Ontario, Canada
a4 Department of Medicine (Rehabilitation Sciences), University of Toronto, Ontario, Canada
a5 Department of Medicine (Psychiatry), University of Toronto, Ontario, Canada
a6 Department of Psychology, Trent University, Peterborough, Canada
a7 Department of Psychology and Institute of Neuroscience, Trinity College, Dublin, Ireland

Article author query
levine b   [PubMed][Google Scholar] 
stuss dt   [PubMed][Google Scholar] 
winocur g   [PubMed][Google Scholar] 
binns ma   [PubMed][Google Scholar] 
fahy l   [PubMed][Google Scholar] 
mandic m   [PubMed][Google Scholar] 
bridges k   [PubMed][Google Scholar] 
robertson ih   [PubMed][Google Scholar] 


Executive functions are highly sensitive to the effects of aging and other conditions affecting frontal lobe function. Yet there are few validated interventions specifically designed to address executive functions, and, to our knowledge, none validated in a healthy aging sample. As part of a large-scale cognitive rehabilitation randomized trial in 49 healthy older adults, a modified Goal Management Training program was included to address the real-life deficits caused by executive dysfunction. This program emphasized periodic suspension of ongoing activity to establish goal hierarchies and monitor behavioral output. Tabletop simulated real-life tasks (SRLTs) were developed to measure the processes targeted by this intervention. Participants were randomized to two groups, one of which received the intervention immediately and the other of which was wait-listed prior to rehabilitation. Results indicated improvements in SRLT performance and self-rated executive deficits coinciding with the training in both groups. These gains were maintained at long-term follow-up. Future research will assess the specificity of these effects in patient groups (JINS, 2007, 13, 143–152.)

(Received November 11 2005)
(Revised August 4 2006)
(Accepted August 8 2006)

Key Words: Neuropsychology; Geriatric assessment; Aging; Frontal lobe; Short-term memory; Intention.

c1 Correspondence and reprint requests to: Brian Levine, Ph.D., Rotman Research Institute, Baycrest, 3560 Bathurst St., Toronto, ON M6A 2E1, Canada. E-mail: