Certain mental exercises can offset some of the expected decline in older adults' thinking skills and show promise for maintaining cognitive abilities needed to do everyday tasks such as shopping, making meals and handling finances, according to a new study. The research, funded by the National Institutes of Health (NIH) and published in the Dec. 20, 2006, Journal of the American Medical Association, showed that some of the benefits of short-term cognitive training persisted for as long as five years.
The Advanced Cognitive Training for Independent and Vital Elderly, or ACTIVE, Study is the first randomized, controlled trial to demonstrate long-lasting, positive effects of brief cognitive training in older adults. However, testing indicated that the training did not improve the participants' ability to tackle everyday tasks, and more research is needed to translate the findings from the laboratory into interventions that prove effective at home.
The ACTIVE trial was funded by the National Institute on Aging (NIA) and the National Institute of Nursing Research (NINR), both components of NIH. Sherry L. Willis, Ph.D., of Pennsylvania State University in State College, Pa., and co-authors report the findings on behalf of ACTIVE investigators at the study's six sites: Hebrew SeniorLife, Boston; Indiana University School of Medicine, Indianapolis; Johns Hopkins University, Baltimore; Pennsylvania State University; University of Alabama at Birmingham; and University of Florida, Gainesville (in collaboration with Wayne State University, Detroit), and the data coordinating center at the New England Research Institutes, Watertown, Mass.
"This large trial found that community-dwelling seniors who received cognitive training had less of a decline in certain thinking skills than their peers who did not have training. The study addresses a very important hypothesis--that interventions can be designed to maintain cognitive function," says NIA Director Richard J. Hodes, M.D. "The challenge now is to further examine these interventions and others to see how they can be employed in real-world settings."
"Cognitive decline is known to precede loss of functional ability in older adults. It affects everyday activities such as driving or following instructions on a medicine bottle," says NINR Director Patricia A. Grady, Ph.D., R.N. "Research to identify effective ways of delaying this decline is important because it may help individuals, and our aging citizenry, maintain greater independence as they grow older."
The ACTIVE Study included 2,802 adults aged 65 and older who were living independently and had normal cognitive and functional status at the beginning of the study. Participants were randomly assigned to four groups. Three groups took part in training that targeted a specific cognitive ability--memory, reasoning or speed of processing. The fourth group received no cognitive training.
People in the three intervention groups attended up to 10 training sessions lasting 60 to 75 minutes each, over a five- to six-week time period. The memory group learned strategies for remembering word lists and sequences of items, text, and story ideas and details. The reasoning group learned strategies for finding the pattern in a letter or word series and identifying the next item in a series. The speed-of-processing group learned ways to identify an object on a computer screen at increasingly brief exposures, while quickly noting where another object was located on the screen.
After the initial training, 60 percent of those who completed the initial training took part in 75-minute "booster" sessions designed to maintain improvements gained from the initial sessions.
The investigators tested the participants at baseline, after the intervention and annually over five years. They found:
- Immediately after the initial training, 87 percent of the speed-training group, 74 percent of the reasoning group and 26 percent of the memory group showed improvement in the skills taught.
- After five years, people in each group performed better on tests in their respective areas of training than did people in the control group. The reasoning-training and speed-training groups who received booster training had the greatest benefit.
"The improvements seen after the training roughly counteract the degree of decline in cognitive performance that we would expect to see over a seven- to 14-year period among older people without dementia," says Dr. Willis.
The researchers also looked at the training's effects on participants' everyday lives. After five years, all three intervention groups reported less difficulty than the control group in tasks such as preparing meals, managing money and doing housework. Only the effect of reasoning training on self-reported performance of daily tasks was statistically significant. Those who received speed-of-processing training and follow-up booster training scored better on how quickly and accurately they could find items on a pantry shelf, make change, read medicine dosing instructions, place telephone calls and react to road traffic signs.
"Beyond middle age, people worry about their mental sharpness getting 'rusty.' This study offers hope that cognitive training may be useful," notes Richard Suzman, Ph.D., director of the NIA's Behavioral and Social Research Program, which sponsored the work. "ACTIVE has shown that relatively brief targeted cognitive exercises can produce durable changes in the skills taught. I would now like to see studies aimed at producing more generalized changes, perhaps through more intensive and broader interventions."
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