Cognitive Aging & Dementia

For well over ten years, I was involved in clinical work and subsequently research related to the topic of geriatric neuropsychology. Eight of those years was spent conducting research on subjective cognitive decline, or SCD. This term refers to a syndrome of older adulthood whereby people report significant concern about changes in their thinking abilities, more than just normal aging, yet who score within normal limits on standardized clinical-neuropsychological tests. Not all, but a significant proportion of these older adults will in fact decline to mild cognitive impairment and Alzheimer’s dementia (AD).

We were interested to identify cognitive processes that separate those with SCD from healthy controls before the emergence of clinical impairment. Findings from our research demonstrated the role of attention capacity  (Smart et al., 2014a), updating/working memory (Smart & Krawitz, 2015), and reaction time intra-individual variability (Mulligan et al., 2016) in discriminating persons with SCD from healthy controls. A prime reason to study SCD is to investigate early interventions that could slow or even prevent non-normal cognitive decline. To that end, we completed a randomized controlled trial of tailored mindfulness training for older adults with SCD, finding improvements in both neural, behavioral, and self-report measures (Smart et al., 2016; Smart & Segalowitz, 2017). This is currently being developed into a clinician manual by Oxford University Press’ Treatments That Work Series, with an anticipated publication date of mid-to-late 2020. Finally, we also completed a systematic review and meta-analysis of non-pharmacologic interventions for SCD (Smart et al., 2017), demonstrating that cognitive interventions have a small but clinically significant effect on cognitive function in persons with SCD.

The pinnacle of my aging work was co-authoring a book on geriatric neuropsychology, entitled the Neuropsychology of Cognitive Decline: An Applied Developmental Approach (Tuokko & Smart, 2018; Guilford Press).  After much success in the field of aging, for personal and professional reasons, I have decided to wind down this stream of research to focus on my other work on self-regulation. I am grateful for my experiences and knowledge gained in this field, but I know that there are many skilled and passionate researchers at UVic who will be ‘carrying the torch’ of geriatric psychology and gerontology after my departure.

Selected Publications of Interest

Ali, J. I., Smart, C. M., & Gawryluk, J. R. (2018). Subjective cognitive decline and APOE ε4: A systematic review. Journal of Alzheimer’s Disease, 65, 303-320.

cvMolinuevo, J. L., Rabin, L. A., Amariglio, R., Buckley, R., Dubois, B., Ellis, K. A., Ewers, M., Hampel, H., Kloppel, S., Rami, L., Reisberg, B., Saykin, A. J., Sikkes, S., Smart, C. M., Snitz, B. E., Sperling, R., van der Flier, W., Wagner, M., & Jessen, F. for the Subjective Cognitive Decline Initiative (SCD-I) Working Group. (2017). Implementation of Subjective Cognitive Decline criteria in research studies. Alzheimer’s & Dementia, 13, 296-311.

Mulligan, B. P., Ali, J., & Smart, C. M. (2016). Relationship between subjective and objective performance indicators in subjective cognitive decline. Psychology and Neuroscience, 9, 362-378

Mulligan, B. P., Smart, C. M., Segalowitz, S. J., & MacDonald, S. W. S. (2018). Characteristics of healthy older adults that influence self-rated cognitive function. Journal of the International Neuropsychological Society, 24, 57-66.

Rabin, L. A., Smart, C. M., & Amariglio, R. E. (2017). Subjective cognitive decline in preclinical Alzheimer’s disease. Annual Review of Clinical Psychology, ​DOI: 10.1146/annurev-clinpsy-032816-045136

Rabin, L. A., Smart, C. M., Crane, P. K., Amariglio, R. E., Berman, L. M., Boada, M., …and the Subjective Cognitive Decline Initiative (SCD-I) Working Group. (2015). Subjective cognitive decline in older adults: An overview of self-report measures used across 19 international research studies. Journal of Alzheimer’s Disease, 48 (Suppl. 1), S63-86.

Smart, C. M., Karr, J. E., Areshenkoff, C. N., Rabin, L. A., Hudon, C., Gates, N., … and the Subjective Cognitive Decline Initiative (SCD-I) Working Group. (2017). Non-pharmacologic interventions for older adults with subjective cognitive decline: Systematic review, meta-analysis, and preliminary recommendations. Neuropsychology Review, DOI: 10.1007/s11065-017-9342-8

Smart, C. M., & Krawitz, A. (2015). The impact of subjective cognitive decline on Iowa gambling task performance. Neuropsychology29, 971-87.

Smart, C. M., Koudys, J., & Mulligan, B. P. (2015). Examining conscientiousness in older adults with subjective cognitive decline: Are we really measuring personality? Alzheimer’s & Dementia, 11 Suppl. 7, 583.

Smart, C. M., & Segalowitz, S. J. (2017). Respond, don’t react: The influence of mindfulness training on performance monitoring in older adults. Cognitive, Affective, and Behavioral Neuroscience, 17, 1151-1163.

Smart, C. M., Segalowitz, S. J., Mulligan, B. P., & MacDonald, S. W. S., & (2014a). Attention capacity and self-report of subjective cognitive decline: A P300 ERP study. Biological Psychology, 103, 144-151.

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, 757-774.

Smart, C. M., Spulber, G., & Garcia-Barrera, M. (2014b). Structural brain changes in default mode network areas in older adults with subjective cognitive decline compared to healthy controls. Alzheimer’s & Dementia, 10 Suppl. 4, 608.

Tuokko, H. A., & Smart, C. M. (2014). Functional sequelae of cognitive decline in later life. In N. A. Pachana & K. Laidlaw (Eds.), Oxford Handbook of Clinical Geropsychology, DOI: 10.1093/oxfordhb/9780199663170.013.043

Tuokko, H. A., & Smart, C. M. (2018). Neuropsychological evaluation of cognition. In J. P. Michel, B. L. Beattie, F. C. Martin, & J. D. Walston (Eds.), Oxford Textbook of Geriatric Medicine, 3rd Ed (pp. 963-970). New York: Oxford.

Tuokko, H. A., & Smart, C. M. (2018). The Neuropsychology of Cognitive Decline: A Developmental Approach to Assessment and Intervention. New York, NY: Guilford Press.