Long-term Effects of Cognitive Training on Everyday Functional Outcomes in Older Adults

Willis, Sherry L.; Tennstedt, Sharon L.; Marsiske, Michael; Ball, Karlene; Elias, Jeffrey W.; Koepke, Kathy Mann; Morris, John N.; Rebok, George W.; Unverzagt, Frederick W.; Stoddard, Anne M.; Wright, Elizabeth C.; for the ACTIVE Study Group · 2006 · OpenAlex-citations

DOI: 10.1001/jama.296.23.2805

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Summary

This study addresses the gap in evidence regarding whether cognitive training in older adults translates to improved everyday functional outcomes. While prior research demonstrated that cognitive interventions could enhance specific mental abilities, it remained unclear if these improvements prevented or delayed difficulties in instrumental activities of daily living (IADL). The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study was designed to determine the long-term effects of cognitive training on daily function and the durability of cognitive gains. The researchers conducted a five-year follow-up of a randomized, single-blind controlled trial involving 2,832 community-dwelling older adults (mean age 73.6 years) recruited from six U.S. cities. Participants were randomized into four groups: three treatment groups receiving ten sessions of training targeting memory, reasoning, or speed of processing, and a control group with no contact. A random subsample of those who completed initial training received four-session booster training at 11 and 35 months. Assessments were conducted at baseline and annually through year five, utilizing self-reported IADL difficulty and performance-based measures of everyday problem-solving and speed of processing. Statistical analysis employed repeated-measures mixed-effects models to evaluate net effects at the five-year mark, adjusting for multiple comparisons. The results indicated that cognitive training effects were specific to the trained ability and durable over five years. Memory, reasoning, and speed of processing groups maintained significant improvements in their respective targeted cognitive domains compared to the control group. Regarding functional outcomes, only the reasoning training group reported significantly less difficulty in IADL than the control group (effect size 0.29). Although memory and speed of processing groups showed similar trends, their effects did not reach statistical significance. Booster training yielded additional benefits for cognitive performance in reasoning and speed of processing groups. Furthermore, booster training for the speed of processing group significantly improved performance on everyday speed of processing tasks, though no booster effects were observed for everyday problem-solving or self-reported IADL difficulty. The study concludes that cognitive training can sustain improvements in specific cognitive abilities for at least five years. Crucially, it provides the first evidence from a large-scale randomized trial that such training can mitigate functional decline, specifically showing that reasoning training reduces self-reported difficulty in IADL. These findings suggest that cognitive interventions may help older adults maintain independence longer, although the transfer of training effects to functional outcomes appears limited and domain-specific.

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