News & Events

Cognitive Training May Help Slow Decline of Daily Functioning continued

Older adults who received cognitive training reported improved cognitive function for up to 5 years afterwards and less decline in the ability to perform daily activities as compared to those who did not receive the training, according to a report of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study in the December 20 issue of JAMA.

Decline in cognitive abilities has been shown to lead to an increased risk of difficulty in performing instrumental activities of daily living (IADL).  However, whether interventions to maintain or enhance cognitive abilities in older adults will prevent or delay these functional difficulties has been unclear..

The ACTIVE study is the first multicenter, randomized controlled trial to examine the long-term outcomes of cognitive interventions on the daily functioning of older individuals living independently. NERI is the Data Coordinating Center, led by Sharon Tennstedt PhD and Anne Stoddard ScD. The study was conducted at six field centers, including Pennsylvania State University (Sherry Willis PhD), Wayne State University and the University of Florida (Michael Marsiske PhD), the University of Alabama at Birmingham (Karlene Ball PhD), Indiana University (Frederick Unverzagt PhD), Johns Hopkins University (George Rebok PhD), and Hebrew Senior Life (John Morris PhD). The study is funded by the National Institute on Aging and the National Institute of Nursing Research.

The study was conducted between April 1998 and December 2004. Participants in the study included 2,832 persons (average age 73.6 years; 26 percent black), living independently in 6 U.S. cities, who were recruited from senior housing, community centers, and hospitals and clinics. Five-year follow-up was completed in 67 percent of the sample.

The study interventions included ten-session training for memory (verbal episodic memory), reasoning (inductive reasoning), or speed of processing (visual search and identification); and 4-session booster training at 11 and 35 months after training in a random sample of those who completed training.

At year 5, participants in all 3 intervention groups reported less difficulty compared with the control group in performing IADLs. However, this effect was significant only for the reasoning group. Neither speed of processing training nor memory training had a significant effect on IADL. The booster training for the speed of processing group, but not for the other 2 groups, showed a significant effect on the performance-based functional measure of everyday speed of processing.

No booster effects were seen for any of the groups for everyday problem-solving or self-reported difficulty in IADL. Each intervention maintained effects on its specific targeted cognitive ability through 5 years. Booster training produced additional improvement with the reasoning intervention for reasoning performance and the speed of processing intervention for speed of processing performance.

"The ACTIVE study is the first large-scale, randomized trial to show that cognitive training improves cognitive function in well-functioning older adults and that this improvement lasts up to 5 years from the beginning of the intervention," the researchers write. 

"In conclusion, declines in cognitive abilities have been shown to lead to increased risk of functional disabilities that are primary risk factors for loss of independence. The 5-year results of the ACTIVE study provide limited evidence that cognitive interventions can reduce age-related decline in self-reported IADLs that are the precursors of dependence in basic ADLs associated with increased use of hospital, outpatient, home health, nursing home services, and health care expenditures. However, given the lag in the relationship between cognitive decline and functional deficits, the full extent of intervention effects on daily function would take longer than 5 years to observe in a population that was highly functioning at enrollment. We consider these results promising and support future research to examine if these and other cognitive interventions can prevent or delay functional disability in an aging population," the authors write.

Pubmed abstract: JAMA. 2006;296:2805-2814

For more information about the ACTIVE study, please contact Sharon Tennstedt.