Effects of cognitive training interventions with older adults: a randomized controlled trial.

CONTEXT Cognitive function in older adults is related to independent living and need for care. However, few studies have addressed whether improving cognitive functions might have short- or long-term effects on activities related to living independently. OBJECTIVE To evaluate whether 3 cognitive training interventions improve mental abilities and daily functioning in older, independent-living adults. DESIGN Randomized, controlled, single-blind trial with recruitment conducted from March 1998 to October 1999 and 2-year follow-up through December 2001. SETTING AND PARTICIPANTS Volunteer sample of 2832 persons aged 65 to 94 years recruited from senior housing, community centers, and hospital/clinics in 6 metropolitan areas in the United States. INTERVENTIONS Participants were randomly assigned to 1 of 4 groups: 10-session group training for memory (verbal episodic memory; n = 711), or reasoning (ability to solve problems that follow a serial pattern; n = 705), or speed of processing (visual search and identification; n = 712); or a no-contact control group (n = 704). For the 3 treatment groups, 4-session booster training was offered to a 60% random sample 11 months later. MAIN OUTCOME MEASURES Cognitive function and cognitively demanding everyday functioning. RESULTS Thirty participants were incorrectly randomized and were excluded from the analysis. Each intervention improved the targeted cognitive ability compared with baseline, durable to 2 years (P<.001 for all). Eighty-seven percent of speed-, 74% of reasoning-, and 26% of memory-trained participants demonstrated reliable cognitive improvement immediately after the intervention period. Booster training enhanced training gains in speed (P<.001) and reasoning (P<.001) interventions (speed booster, 92%; no booster, 68%; reasoning booster, 72%; no booster, 49%), which were maintained at 2-year follow-up (P<.001 for both). No training effects on everyday functioning were detected at 2 years. CONCLUSIONS Results support the effectiveness and durability of the cognitive training interventions in improving targeted cognitive abilities. Training effects were of a magnitude equivalent to the amount of decline expected in elderly persons without dementia over 7- to 14-year intervals. Because of minimal functional decline across all groups, longer follow-up is likely required to observe training effects on everyday function.

[1]  M. Sloane,et al.  Visual processing impairment and risk of motor vehicle crash among older adults. , 1998, JAMA.

[2]  K. Schaie,et al.  Everyday problem solving in older adults: observational assessment and cognitive correlates. , 1995, Psychology and aging.

[3]  J. Schneider,et al.  Participation in cognitively stimulating activities and risk of incident Alzheimer disease. , 2002, JAMA.

[4]  Reinhold Kliegl,et al.  On the locus and process of magnification of age differences during mnemonic training. , 1990 .

[5]  Beth T. Stalvey,et al.  Older drivers and cataract: driving habits and crash risk. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[6]  C. Owsley,et al.  The useful field of view test: a new technique for evaluating age-related declines in visual function. , 1993, Journal of the American Optometric Association.

[7]  Sandra M. Powers,et al.  MEMORY IMPROVEMENT AMONG ADULT LEARNERS , 1987 .

[8]  F. J. Dudek.  The Continuing Misinterpretation of the Standard Error of Measurement , 1979 .

[9]  David E. Booth,et al.  Analysis of Incomplete Multivariate Data , 2000, Technometrics.

[10]  Beth T. Stalvey,et al.  Driving avoidance and functional impairment in older drivers. , 1998, Accident; analysis and prevention.

[11]  J. Teresi.  Measurement in elderly chronic care populations , 1997 .

[12]  K. Hall,et al.  Relationship of age, education, and occupation with dementia among a community-based sample of African Americans. , 1996, Archives of neurology.

[13]  F. David,et al.  Statistical Estimates and Transformed Beta-Variables. , 1960 .

[14]  K. Ball,et al.  Vision impairment, eye disease, and injurious motor vehicle crashes in the elderly. , 1998, Ophthalmic epidemiology.

[15]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[16]  S. Willis,et al.  Cognitive Training and Everyday Competence , 1987, Annual Review of Gerontology and Geriatrics.

[17]  J. Yesavage.  Nonpharmacologic treatments for memory losses with normal aging. , 1985, The American journal of psychiatry.

[18]  J. Brandt.  The Hopkins Verbal Learning Test: Development of a new memory test with six equivalent forms. , 1991 .

[19]  K. Ball,et al.  Visual attention problems as a predictor of vehicle crashes in older drivers. , 1993, Investigative ophthalmology & visual science.

[20]  K. Schaie,et al.  Training the elderly on the ability factors of spatial orientation and inductive reasoning. , 1986, Psychology and aging.

[21]  Y. Stern,et al.  Influence of leisure activity on the incidence of Alzheimer’s Disease , 2001, Neurology.

[22]  P. Baltes,et al.  Fluid Intelligence Performance in the Elderly: Intraindividual Variability and Conditions of Assessment. , 1981 .

[23]  Karlene K. Ball,et al.  Transfer of a Speed of Processing Intervention to Near and Far Cognitive Functions , 2002, Gerontology.

[24]  Cynthia Owsley,et al.  Timed Instrumental Activities of Daily Living Tasks: Relationship to Cognitive Function and Everyday Performance Assessments in Older Adults , 2002, Gerontology.

[25]  H. Harman,et al.  Kit of factor-referenced cognitive tests , 1976 .

[26]  Paul B. Baltes,et al.  Plasticity and Enhancement of Intellectual Functioning in Old Age , 1982 .

[27]  Arthur F Kramer,et al.  Exercise, experience and the aging brain , 2002, Neurobiology of Aging.

[28]  S. Willis,et al.  Long-term effects of fluid ability training in old-old age , 1990 .

[29]  S. Willis,et al.  Life Span Perspective on Practical Intelligence , 1991 .

[30]  G. Rebok,et al.  Memory self-efficacy and performance differences in young and old adults: The effect of mnemonic training. , 1989 .

[31]  G. Jay,et al.  Longitudinal Change and Prediction of Everyday Task Competence in the Elderly , 1992, Research on aging.

[32]  M. Lachman,et al.  Improving memory and control beliefs through cognitive restructuring and self-generated strategies. , 1992, Journal of gerontology.

[33]  Paul B. Baltes,et al.  Intellectual Development in Adulthood: The Seattle Longitudinal Study , 1996 .

[34]  K. Ball,et al.  Visual/cognitive correlates of vehicle accidents in older drivers. , 1991, Psychology and aging.

[35]  D. Morrow,et al.  Elders' Nonadherence, Its Assessment, and Computer Assisted Instruction for Medication Recall Training , 1988, Journal of the American Geriatrics Society.

[36]  A. Rey.  Lexamen psychologique : Dans les cas d'encephalopathie traumatique (Les problemes) , 1941 .

[37]  P. Lachenbruch.  Statistical Power Analysis for the Behavioral Sciences (2nd ed.) , 1989 .

[38]  J. Brandt,et al.  Effects of Three Types of Memory Training in Normal Elderly , 1999 .

[39]  K. A. Ericsson,et al.  Maintaining excellence: deliberate practice and elite performance in young and older pianists. , 1996, Journal of experimental psychology. General.

[40]  N. Laird,et al.  Using the general linear mixed model to analyse unbalanced repeated measures and longitudinal data. , 1997, Statistics in medicine.

[41]  S. Levitus,et al.  US Government Printing Office , 1998 .

[42]  J N Morris,et al.  ACTIVE: a cognitive intervention trial to promote independence in older adults. , 2001, Controlled clinical trials.

[43]  N. Ikegami,et al.  Comprehensive Clinical Assessment in Community Setting: Applicability of the MDS‐HC , 1997, Journal of the American Geriatrics Society.

[44]  R. Suzman,et al.  Trends in the health of older Americans: United States, 1994. Analytic and epidemiologic studies no. 3. , 1995, Vital & health statistics. Series 3, Analytical and epidemiological studies.

[45]  M. Folstein,et al.  Population-based norms for the Mini-Mental State Examination by age and educational level. , 1993, JAMA.

[46]  E. Zelinski,et al.  Sixteen-year longitudinal and time lag changes in memory and cognition in older adults. , 1997, Psychology and aging.

[47]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[48]  M. Lowenthal,et al.  Aging and mental disorder in San Francisco : a social psychiatric study , 1967 .

[49]  C. McHorney,et al.  Comparisons of the Costs and Quality of Norms for the SF-36 Health Survey Collected by Mail Versus Telephone Interview: Results From a National Survey , 1994, Medical care.

[50]  D. Roenker,et al.  Age and visual search: expanding the useful field of view. , 1988, Journal of the Optical Society of America. A, Optics and image science.

[51]  Karlene K. Ball,et al.  INCREASING MOBILITY AND REDUCING ACCIDENTS OF OLDER DRIVERS. IN: MOBILITY AND TRANSPORTATION IN THE ELDERLY , 2000 .

[52]  R. Dixon,et al.  Longitudinal changes in quantitative and qualitative indicators of word and story recall in young-old and old-old adults. , 1999, The journals of gerontology. Series B, Psychological sciences and social sciences.