Brain-Training Keeps Age-Linked Mental Decline at Bay
'Cognitive intervention' helps healthy seniors stay sharp, study suggests
By Amanda Gardner
HealthDay Reporter
TUESDAY, Dec. 19 (HealthDay News) -- Healthy seniors who underwent "mental training" to boost memory, reasoning and mental processing were still reaping the rewards five years later.
In fact, these improvements in cognitive functioning more or less compensated for the amount of cognitive decline associated with normal aging, researchers say. It also helped preserve the participants' independence.
"It really shows that older adults, with these readily available cognitive training techniques, actually improve their perception of activities of daily living and improved on an objective measure as well," said Dr. Gary J. Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City. "It really does look like it helps older adults maintain independence."
The results were seen in healthy adults, so it remains to be seen if such interventions will have any effect on people who already have some type of cognitive impairment or even dementia.
"Prior research has said that some of our interventions don't work if a person already has the onset of dementia," said study co-author Michael Marsiske, associate professor and associate chair of clinical and health psychology at the University of Florida, Gainesville. "But perhaps this can serve as an impetus for the design of a next generation of interventions that could work in people with cognitive impairment. Rehabilitation for people with dementia is going to go a little bit more slowly, but there's a great deal of intent to let that be the next question," he added.
With some 24 million individuals worldwide suffering from dementia, not to mention cognitive losses from normal aging, such interventions will be sorely needed.
The decline in cognitive abilities which frequently accompanies aging can lead to more difficulty in performing instrumental activities of daily living, such as cooking, taking medication and managing finances. It's unclear if there is a way to ameliorate this.
Prior interventions have looked primarily at people who already had cognitive deficits or functional limitations, thus focusing on remediation rather than prevention.
The current trial is the first multicenter, randomized controlled trial to look at the long-term outcomes of cognitive interventions on the daily functioning of older adults still living independently.
The study, which appears in the Dec. 20 issue of the Journal of the American Medical Association, involved over 2,800 adults aged 65 to 96 who were living independently in six U.S. cities. More than one-quarter of the participants were African-American. Five-year follow-up data was available for two-thirds of the original sample.
Participants were divided into four groups: One received 10 sessions of training for memory, one an equal amount of training for reasoning; and the third training for speed of processing. They also got four-session booster training at 11 and 35 months.
A fourth group received no training and served as the control group.
When tested right after training, 87 percent of individuals in speed-training, 74 percent of those in reasoning-training and 26 percent of those in memory-training showed improvements.
After five years, individuals in all three intervention groups reported more ease in performing those instrumental activities of daily living than the control group, although the effect was only significant for the reasoning group.
The booster training had an effect on the speed-of-processing group but not on the other two groups.
The strength and durability of the results were surprising to the authors. "There's virtually nothing in the literature to give us grounds to expect this, except our own optimism," Marsiske said. "The durability of the effects really is unprecedented. There was also a much more diverse sample than any other cognitive research had allowed. We showed that the training worked well for a broad cross-section of people."
One of the take-away messages is that new learning is "very possible" in later life, he added.
"What would happen if we could incorporate this into people's lives more generally, so they could do it like physical exercise for longer periods of time?" Marsiske asked.
The interventions used in this study are already being developed so that they can be made more widely accessible, with the speed-of-processing intervention under development by a private company.
More information
For more on healthy aging, visit the U.S. National Institute on Aging.
SOURCES: Michael Marsiske, Ph.D., associate professor and associate chair, department of clinical and health psychology, University of Florida, Gainesville; Gary J. Kennedy, M.D., director, geriatric psychiatry, Montefiore Medical Center, New York City; Dec. 20, 2006, Journal of the American Medical Association
Copyright © 2006 ScoutNews, LLC. All rights reserved.
Cognitive training for older adults may help slow decline of daily functioning abilities
CHICAGO—Older adults who received cognitive training reported improved cognitive function for up to 5 years afterwards and less decline in the ability to perform daily activities as compared to those who did not receive the training, according to a study in the December 20 issue of JAMA.
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.
To contact co-author Michael Marsiske, Ph.D., call Jill Pease at 352-273-5816. To contact editorial co-author Sally A. Shumaker, Ph.D., call Mark Wright at 336-716-3382.
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.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations@jama-archives.org .