Cognitive training has become increasingly popular for individuals looking to reduce cognitive decline in normal aging and to reduce their risk of dementia. But does it work? The most comprehensive and well-designed study of cognitive training has been the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Study. This study featured a randomized controlled design, three types of cognitive tasks to which participants could be assigned, and 2,832 participants with an average age of 73.6 when the study began. Five years after the study, researchers compared the participants who received training to a control group, and found that those individuals who received cognitive training had improved cognitive functions in the areas in which they received training, and that those individuals who received the cognitive training also showed less difficulty with instrumental activities of daily living (IADL).
Recently, the researchers published their findings on the effects of the ACTIVE Study’s cognitive training 10 years later.
The participants in the Active Study were community-dwelling adults over 65 without any major cognitive or physical impairments. Seventy-four percent of the participants were Caucasian, 26 percent were African American, and 76 percent were female. These participants were assigned to one of four conditions. First was cognitive training aimed at improving memory, and included memory strategies. Second was training aimed at improving reasoning, through training in problem solving. Third was cognitive training aimed at quicker speed of processing. The fourth group was a control group that received no cognitive training. For each training group, their training consisted of 10 60- to 75-minute sessions spread over five to six weeks. There were also booster sessions offered 11 and 35 months after the original training, which were offered to 39 percent of the participants in the original training. Following their training, all participants were tested on memory, reasoning, and speed of processing, regardless of which condition they were randomly assigned to. They were also asked about three measures of daily function: IADL, and tests of Everyday Problem Solving and Everyday Speed. The 10-year follow-up discussed below included 44 percent of the original participants.
Ten years after completing their training, the reasoning group and the speed of processing group still showed better performance than the control group on the type of task that they received training on. The long-term effect of the processing speed training was medium to large, while the reasoning intervention’s effect was smaller. The effect of the memory training was not significant 10 years later, although it was significant at the five-year follow-up. For the individuals in the reasoning and speed of processing groups who had booster sessions, the researchers reported that there was also an “additional and durable” benefit. Again, for the booster groups, the processing speed group showed a larger effect than the reasoning group, and the memory group again showed no significant effect of memory training. The researchers also looked at what percentage of each group showed maintenance of cognitive function 10 years later, remaining within a specified range of their baseline cognitive scores. Of the individuals in the reasoning group, 74 percent showed maintenance of cognitive function, compared to 62 percent of the control group. For speed training, 71 percent showed maintenance of cognitive function, compared to 49 percent of the control group. Again, there wasn’t a significant effect for the memory trained group. Importantly, the authors note, “A main lesson of the ACTIVE Study and other cognitive intervention trials is that the benefits of cognitive training are specific to the cognitive ability trained.” These observed benefits only applied to the types of tasks that reasoning and processing speed group members were trained in.
Although the memory trained group did not show any significant benefit over controls in cognitive tests 10 years later, all three training groups reported less difficulty performing IADLs compared to the control group. The speed and reasoning groups had similar rates of decline in IADLs, while the decline in the memory group was a bit larger but still less than the control group’s decline. After 10 years, 49 percent of controls reported the same or an improved level of IADL difficulty as baseline. In contrast, 62 percent of memory, 60 percent of reasoning, and 59 percent of speed training groups reported the same or improved levels of IADL difficulty. Booster training sessions showed no effect on maintaining or improving IADLs. No significant results were found for Everyday Problem Solving and Everyday Speed tests.
The ACTIVE Study continues to demonstrate benefits for cognition and everyday functioning even 10 years after the initial cognitive training of only 10 to 12 weeks. Since training on certain cognitive abilities leads only to improvements specific to that ability, the findings here suggest that interventions should be designed to target multiple cognitive abilities. These findings also suggest that booster sessions could play an important role in providing additional benefit. Although more research is required to determine why memory training did not have a significant impact on memory tests 10 years after the original training, its significant impact on memory five years after training and its impact on IADLs 10 years after the original training both suggest that it should not be eliminated from an intervention aimed at improving everyday functioning and cognitive performance.
Rebok GW, Ball K, Guey LT, et al. Ten-year effects of the Advanced Cognitive Training for Independent and Vital Elderly cognitive training trial on cognition and everyday functioning in older adults. Journal of the American Geriatrics Society (2014); Vol. 62(1): 16–24.