January 2, 2007
Healthy, older men and women who received training to boost thinking, memory, and cognitive skills reported doing better on everyday tasks like shopping, preparing meals, and balancing the checkbook, researchers report. The benefits were evident up to five years after the initial training sessions. These findings suggest that regular challenges to boost memory and reasoning may help to keep seniors mentally vital and allow them to continue to live independently.
Such benefits, though modest, could have a huge impact on an aging population as seniors face the challenges of growing old and living on their own amid declining cognitive health and fading memory. There are an estimated 24 million people with Alzheimer's and other forms of dementia in the world, and 4.6 million new cases are diagnosed each year, the researchers report. By 2040, the number of people with age-related Alzheimer's and cognitive decline is expected to balloon to 84 million unless successful treatments are developed. Today, some 4.5 million Americans suffer from Alzheimer's, with the number expected to increase to 13 million by 2050.
Earlier research suggests that memory training and cognitive challenges, such as doing crossword puzzles, learning to play a musical instrument, or other mentally demanding tasks, can help to keep the mind sharp as we age. Regular exercise and eating heart-healthy foods is also thought to boost brain health. Decline in cognitive abilities has also been shown to lead to an increased risk of difficulty in performing daily activities of living. However, whether interventions to maintain or enhance cognitive abilities in older adults will prevent or delay these functional difficulties has been unclear.
This current study, known as the Advanced Cognitive Training for Independent and Vital Elderly, or 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 five years from the beginning of the intervention," the researchers write. The findings appeared in the Journal of the American Medical Association, a highly respected journal for physicians.
In the study, researchers from Pennsylvania State University and other institutions studied more than 2,800 seniors, aged 65 and up, living in six U.S. cities. Participants could all function independently and showed no major memory loss or other symptoms of Alzheimer's disease. None had serious illnesses or vision or hearing problems that would impair their ability to perform everyday chores.
They were divided into four groups, then given 10 training sessions targeted at various aspects of cognition:
- Memory: Mnemonic strategies, including organization, visualization, and word association tools, for remembering word lists and texts.
- Reasoning skills: Teaching strategies for finding the pattern in a series of letters or words, and identifying the next item in a series.
- Speed of processing: Identifying objects on a computer screen at increasingly short exposures, and dividing attention between two search tasks.
- Control group: This group received no special training and served as a comparison group for the other three.
Training sessions lasted for up to 75 minutes. Some participants received additional follow-up booster training one and three years after the initial training series.
After five years, participants were surveyed about their ability to perform everyday tasks, such as preparing meals, doing housework, paying bills, balancing the checkbook, personal hygiene and health maintenance, using the telephone, and shopping. They were also tested on such skills as reading medication labels, using the yellow pages to look up phone numbers, or responding to road signs.
Participants in all three treatment groups showed improvements in cognitive functioning compared with the control group that did not receive special training. Overall, those who received reasoning training performed the best. Booster training produced additional improvement for some.
"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 authors write. "The five-year results of the ACTIVE study provide limited evidence that cognitive interventions can reduce age-related decline in self-reported IADLs [Instrumental Activities of Daily Living] 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."
The authors go on to note that there is a long lag time in the relationship between cognitive decline and problems in carrying out everyday tasks. Therefore, the full extent of cognitive training on daily function would take longer than five 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," they write.
In an editorial accompanying the study, doctors speculate that cognitive training may be especially beneficial for those at risk for Alzheimer's disease. Such training, they say, might one day be offered in senior centers, churches, schools, and clinics. "Importantly," they write, "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."
This study did not examine people with Alzheimer's disease; further research is needed to determine the effects of cognitive training in this group of people. For more on Alzheimer's treatment and the effects of drug and lifestyle interventions, visit www.ALZinfo.org.
Sherry L. Willis, Ph.D., Sharon L. Tennstedt, Ph.D., Michael Marsiske, Ph.D., et al: "Long-Term Effects of Cognitive Training on Everyday Functional Outcomes in Older Adults." Journal of the American Medical Association, December 20, 2006, Volume 296, Number 23, pages 2805-2814.
Sally A. Shumaker, Ph.D., Claudine Legault, Ph.D., and Laura H. Coker, Ph.D: "Behavior-Based Interventions to Enhance Cognitive Functioning and Independence in Older Adults" (editorial). Journal of the American Medical Association, December 20, 2006, Volume 296, Number 23, pages 2852-2854.