Cognitive Training and Daily Functioning in Older Adults
Cognitive training in older adults modestly improves select cognitive abilities and may slow the decline in everyday functioning.
The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study group investigated the long-term effects of cognitive training on everyday functioning and on specific cognitive abilities in nondemented, community-dwelling elders (age 65 or older). The ACTIVE study was a multicenter study with 5-year follow-up. Of 2832 subjects enrolled, two thirds completed the study. Subjects were randomized to either no intervention (unblinded placebo group) or one of three interventions: training in memory, reasoning, or processing speed. Training occurred at baseline; a subset of each group received booster training at 1 and 3 years. Outcome measures included self-reported and performance-based measures of everyday functioning and both cognitive and functionally related measures of each of the three cognitive areas trained.
Only the reasoning-trained group reported a modest but significant improvement in overall daily functioning at the end of the 5 years. The only group whose performance improved on any functionally related tasks was the processing-speed group that received booster training; these participants improved on performance of everyday speed of processing. Each training group modestly improved on testing of its targeted cognitive ability. The authors conclude that reasoning training improves reported overall daily functioning and that training in specific cognitive areas improves the targeted cognitive ability.
Comment: This was the first large, well-designed, community-based, longitudinal study of the effects of cognitive training on cognitive ability and daily functioning in nondemented elders. Unfortunately, it failed to document an objective improvement in daily functioning due to cognitive training, but it did hint at the known association between reasoning and daily functioning (Appl Neuropsychol 2002; 9:187). As noted in an editorial, the generalizability of the findings is limited in that three fourths of the subjects were women, and the researchers did not account for levels of physical activity. In addition, a significant proportion of subjects likely had mild cognitive impairment. These issues should be addressed in future studies.
Gad A. Marshall, MD
Dr. Marshall is Instructor in Neurology, Harvard Medical School, and Associate Neurologist, Memory Disorders Unit, Brigham and Womens Hospital, Boston.
Published in Journal Watch Neurology March 13, 2007
Willis SL et al. for the ACTIVE Study Group. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA 2006 Dec 20; 296:2805-14.
- Medline abstract (Free)
Shumaker SA et al. Behavior-based interventions to enhance cognitive functioning and independence in older adults. JAMA 2006 Dec 20; 296:2852-4.
- Medline abstract (Free)
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