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Training
sessions for 2 hours a week for 5 weeks improved the memory, concentration
and problem solving skills of healthy independent adults 65 years
and older who participated in the nation's largest study of cognitive
training. The training not only improved participants' cognitive
abilities, but the improvement persisted for 2 years after the
training, according to initial findings from the multi-site trial
of Advanced Cognitive Training for Independent and Vital Elderly,
or ACTIVE.*
"The
trial was highly successful in showing that we can, at least in
the laboratory, improve certain thinking and reasoning abilities
in older people," says Richard M. Suzman, Ph.D., Associate Director
for the Behavioral and Social Research Program at the National
Institute on Aging (NIA). "The findings here were powerful and
very specific. Although they did not appear to make any real change
in the actual, daily activities of the participants, I think we
can build on these results to see how training ultimately might
be applied to tasks that older people do everyday, such as using
medication or handling finances. This intervention research, aimed
at helping healthy older people maintain cognitive status as they
age, is an increasingly high priority."
The
study, published in the November 13, 2002, issue of the Journal
of the American Medical Association, was funded by the NIA
and the National Institute of Nursing Research (NINR), two components
of the National Institutes of Health at the Department of Health and
Human Services.
According
to Dr. Patricia A. Grady, Director of the NINR, "The ACTIVE trial
provides encouraging preliminary findings that we may be able to conserve
or improve some cognitive abilities in older adults not currently
having problems in these areas. How this training may affect those
who later experience cognitive deficits is a tantalizing question
waiting to be answered."
The
study looked at several types of cognitive training and then assessed,
in the laboratory and in "real world" measures, whether the training
was effective. At the outset, certified trainers conducted 10 sessions
of 60 to 75 minutes over a 5- to 6-week period. The 2,802 participants
were divided into four groups -- three groups that received either
memory training, reasoning training, or speed of processing training,
and a fourth group that received no training. The three types of training
were chosen because they showed the most promise in small laboratory
studies and were related to tasks of daily living such as telephone
use, shopping, food preparation, housekeeping, laundry, transportation,
medication use, and personal finances. For all three groups, the training
focused on developing strategies as well as providing exercises using
these new strategies. All participants were assessed prior to training,
immediately after training, and again 1 and 2 years later.
Those
in the memory-training group were taught strategies for remembering
word lists and sequences of items, text material, and main ideas and
details of stories. Participants in the reasoning group were taught
how to solve problems that follow patterns. Such strategies can be
used in tasks such as reading a bus schedule or filling out an order
sheet. Speed of processing training focused on the ability to identify
and locate visual information quickly for use in tasks such as looking
up a phone number, finding information on medicine bottles, and responding
appropriately to traffic signs.
Immediately
following the 5-week training period, 87 percent of participants in
speed training, 74 percent of participants in reasoning training,
and 26 percent of participants in memory training demonstrated reliable
improvement on their respective cognitive ability. The training effects
continued through 24 months, particularly for the participants who
received "booster" training. "The improvements in memory, problem
solving, and concentration following training were sizeable," noted
Karlene Ball, Ph.D., of the University of Alabama at Birmingham, the
study's corresponding author. "These roughly counteract the degree
of cognitive decline that we would expect to see over a 7- to 14-year
period among older people without dementia."
The
analysis did not find, however, that participants' improvements in
thinking and reasoning also improved their ability to perform everyday
tasks like preparing food or handling medications. "Since all participants
were living independently, and most were functioning quite well at
the outset of the study, it will be interesting to see if those who
received training experience less decline in their daily living skills
over time," Ball said.
The
NIA leads the Federal effort supporting and conducting biomedical,
clinical, social, and behavioral research on aging. This effort includes
research into the causes and treatment of memory declines and other
cognitive problems associated with age. Press releases, fact sheets,
and other materials about aging and aging research can be viewed at
the NIA's general information Web site, www.nia.nih.gov.
*The
Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE),
a single-blind clinical trial, tested the effectiveness and durability
of three techniques to improve the ability of older people to think
and reason. ACTIVE investigators included Karlene Ball, Ph.D., Department
of Psychology, University of Alabama at Birmingham and Daniel B. Berch,
Ph.D., National Institute on Aging,** Karin F. Helmers, Ph.D., National
Institute of Nursing Research; Jared B. Jobe, Ph.D., National Heart,
Lung and Blood Institute; Mary D. Leveck, Ph.D., National Institute
of Nursing Research; Michael Marsiske, Ph.D., Institute on Aging and
Departments of Health Policy and Epidemiology and Clinical and Health
Psychology, University of Florida; John N. Morris, Ph.D., Hebrew Rehabilitation
Center for the Aged; George W. Rebok, Ph.D., Department of Mental
Hygiene, Johns Hopkins University; David M. Smith M.D., Department
of Medicine, Indiana University School of Medicine; Sharon L. Tennstedt,
Ph.D., New England Research Institutes; Frederick W. Unverzagt, Ph.D.
Department of Psychiatry, Indiana University School of Medicine; Sherry
L. Willis, Ph.D., Department of Human Development and Family Studies,
Pennsylvania State University; the ACTIVE Study Group.
*Current
address NICHD.
