Decline in cognitive abilities has been shown to lead to an increased risk of difficulty in performing instrumental activities of daily living (IADL). However, whether interventions to maintain or enhance cognitive abilities in older adults will prevent or delay these functional difficulties has been unclear, according to background information in the article.
Sherry L. Willis, Ph.D., of Pennsylvania State University, State College, Pa., and colleagues conducted the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, the first multicenter, randomized controlled trial to examine the long-term outcomes of cognitive interventions on the daily functioning of older individuals living independently. The study 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.
(JAMA. 2006;296:2805-2814. Available pre-embargo to the media at www.jamamedia.org)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Behavior-Based Interventions to Enhance Cognitive Functioning and Independence in Older Adults
In an accompanying editorial, Sally A. Shumaker, Ph.D., and colleagues from Wake Forest University Health Sciences, Winston-Salem, N.C., discuss the findings concerning cognitive training and functional outcomes.
“Results from the ACTIVE study have several clinical implications. If the results that cognitive training can protect cognitive and possibly functional performance were to be extended to individuals with Alzheimer disease, individuals who cannot tolerate existing pharmacological agents (such as the cholinesterase inhibitors or N-methyl-D-aspartate receptor antagonists) would have additional treatment options. Matching cognitive training with an individual’s risk factor profile is an intriguing possibility. For example, vascular cognitive impairment reveals itself predominantly in frontal lobe–mediated cognitive functioning (executive functions) and may respond best to training that targets executive functions, whereas memory training may be better for individuals at greater risk for Alzheimer disease–related cognitive impairment.
“Cognitive training programs, once standardized and developed for mass market application, might be made available to seniors 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,” they write.
(JAMA. 2006;296:2852-2854. Available pre-embargo to the media at www.jamamedia.org)
Editor’s Note: The authors are supported by contracts from the National Institutes of Health. Financial disclosures: none reported.
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