The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized trial enrolled 2,802 adults in 1998–1999 and compared three cognitive interventions—memory, reasoning, and speed of processing—with a no-training control. Each training arm offered up to ten sessions of 60–75 minutes over five to six weeks, and half of participants were assigned to receive up to four booster sessions at 11 and 35 months after initial training.
For the 20-year analysis, investigators reviewed Medicare records for 2,021 participants (72% of the original cohort) from 1999 to 2019. The group had an average starting age of 74, about three-fourths women, and 70% white; roughly three-fourths died during follow-up at an average age of 84. The only intervention with a statistically significant difference versus control was speed training with boosters: 105 of 264 participants (40%) in that arm were diagnosed with dementia compared with 239 of 491 (49%) in the control arm, a 25% reduced incidence.
Previous ACTIVE reports showed cognitive training improved everyday function for up to five years and that all three training arms improved function ten years later. The authors propose that speed training may work because it adapts to each person’s performance and promotes implicit learning, unlike the memory and reasoning programs. Marilyn Albert, corresponding author, noted the long-term link and the public health importance of even small delays in dementia onset, and George Rebok highlighted the value of interventions targeting visual processing and divided attention. The study appears in Alzheimer’s & Dementia: Translational Research and Clinical Interventions and was funded by NIH grants from the National Institute on Aging.
- Johns Hopkins Medicine
- University of Pennsylvania
- Brown University
- University of Pittsburgh
- University of Florida
Difficult words
- intervention — planned program intended to change health or functioninterventions
- randomize — to assign people to groups by chancerandomized
- cohort — group of people studied over a period
- booster — additional sessions given after initial trainingbooster sessions, boosters
- incidence — number of new cases in a population
- implicit — learned or occurring without conscious awareness
- adapt — change to fit new conditions or abilityadapts
- divided attention — ability to focus on more than one task
Tip: hover, focus or tap highlighted words in the article to see quick definitions while you read or listen.
Discussion questions
- What public health effects might result from delaying dementia onset by a few years? Give reasons.
- How could booster sessions change the long-term impact of a cognitive training program? Provide examples.
- Why might targeting visual processing and divided attention help older adults in daily life?
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