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Elder Care News
Elderly Can Be Trained to Improve Cognitive Ability,
Manage Daily Activities
Limited evidence that
cognitive interventions reduce age-related decline
 December
20, 2006 – You are never too old to learn, has been proven again. Older
people – the average age in this program was almost 74 - who received
specific cognitive training saw their cognitive function improve and
stay at this level for up to 5 years afterwards. More importantly, they
also had less of a decline in the ability to perform daily activities,
as compared to those who did not receive the training.
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 published today in JAMA.
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).
It also included 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.
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.
Editor's Note: The authors are supported by
contracts from the National Institutes of Health.
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