Among older adults, maintaining independence often hinges on the ability to perform particular activities of daily living. A potentially ground-breaking study suggests cognitive training can improve mental function for up to 5 years and help individuals experience fewer declines in the ability to perform key activities.
A decline in cognitive function foreshadows a loss of independence measured by the inability to perform instrumental activities of daily living (IADL). IADLs include meal preparation, managing money, shopping for groceries or personal items, performing light or heavy housework, and using a telephone.
In the new research, Sherry L. Willis, Ph.D., of Pennsylvania State University, State College, Pa., and colleagues conducted the first multicenter, randomized controlled trial to examine the long-term outcomes of cognitive interventions on the daily functioning of older individuals living independently.
Cognitive or mental training included sessions for memory, reasoning, and speed of processing followed by booster sessions after one and three years.
The research, funded by the National Institutes of Health, appears in the Dec. 20, 2006 Journal of the American Medical Association.
In an accompanying editorial, experts posit the discovery could provide options to individuals who cannot tolerate existing pharmacological agents. Also, specific drills could be designed to counter specific risks an individual may carry. For example, specific memory training would be appropriate for individuals at risk for Alzheimer’s disease while reasoning and speed of processing drills may be best for those at risk for vascular impairment.
If the results are replicated in future trials, proactive “brain-training” could be developed for the mass market and be distributed through nonhealth care facilities (e.g., senior centers, churches, schools) and health care facilities.
“Importantly, cognitive training programs may give individuals a greater sense of control over the disturbing prospect of cognitive decline and have a beneficial effect on their quality of life,” say Sally A. Shumaker, Ph.D., and colleagues from Wake Forest University Health Sciences, Winston-Salem, N.C., in the editorial.
The research, called the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE), 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 IADL. 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.