Cognitive training shows staying power

Training to improve cognitive abilities in older people lasted to some degree 10 years after the training program was completed, according to results of a randomized clinical trial supported by the National Institutes of Health.

The findings showed training gains for aspects of cognition involved in the ability to think and learn, but researchers said memory training did not have an effect after 10 years.

The report, from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, appears in the January 2014 issue of the Journal of the American Geriatrics Society. The project was funded by the National Institute on Aging (NIA) and the National Institute of Nursing Research (NINR), components of the NIH.

“Previous data from this clinical trial demonstrated that the effects of the training lasted for five years,” said NIA Director Richard J. Hodes, M.D. “Now, these longer term results indicate that particular types of cognitive training can provide a lasting benefit a decade later. They suggest that we should continue to pursue cognitive training as an intervention that might help maintain the mental abilities of older people so that they may remain independent and in the community.”

“ACTIVE is an important example of intervention research aimed at enabling older people to maintain their cognitive abilities as they age,” said NINR Director Patricia Grady, Ph.D. “The average age of the individuals who have been followed over the last 10 years is now 82. Given our nation’s aging population, this type of research is an increasingly high priority.”

The original 2,832 volunteers for the ACTIVE study were divided into three training groups — memory, reasoning and speed-of-processing — and a control group. The training groups participated in 10 60- to 70-minute sessions over five to six weeks, with some randomly selected for later booster sessions. The study measured effects for each specific cognitive ability trained immediately following the sessions and at one, two, three, five and 10 years after the training.

The investigators were also interested in whether the training had an effect on the participants’ abilities to undertake some everyday and complex tasks of daily living. They assessed these using standardized measures of time and efficiency in performing daily activities, as well as asking the participants to report on their ability to carry out everyday tasks ranging from preparing meals, housework, finances, health care, using the telephone, shopping, travel and needing assistance in dressing, personal hygiene and bathing.

At the end of the trial, all groups showed declines from their baseline tests in memory, reasoning and speed of processing. However, the participants who had training in reasoning and speed of processing experienced less decline than those in the memory and control groups. Results of the cognitive tests after 10 years show that 73.6 percent of reasoning-trained participants were still performing reasoning tasks above their pre-trial baseline level compared to 61.7 percent of control participants, who received no training and were only benefiting from practice on the test. This same pattern was seen in speed training: 70.7 percent of speed-trained participants were performing at or above their baseline level compared to 48.8 percent of controls. There was no difference in memory performance between the memory group and the control group after 10 years.

Participants in all training groups said they had less difficulty performing the everyday tasks compared with those in the control group. However, standard tests of function conducted by the researchers showed no difference in functional abilities among the groups.

“The speed-of-processing results are very encouraging,” said Jonathan W. King, Ph.D., program director for cognitive aging in the Division of Behavioral and Social Research at NIA and co-author. “The self-reported improvements in daily function are interesting, but we do not yet know whether they would truly allow older people to live independently longer; if they did, even a small effect would be important, not only for the older adults, but also for family members and others providing care.”

The ACTIVE study followed healthy, community-dwelling older adults from six cities — Baltimore; Birmingham, Ala.; Boston; Detroit; State College, Pa.; and Indianapolis. The participants averaged 74 years of age at the beginning of the study and 14 years of education, 76 percent were female, 74 percent were white and 26 percent were African-American. The 10-year follow-up was conducted with 44 percent of the original sample between April 1998 and October 2010.