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

Abstract

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.

Figure 1. Flow of Participants Through the Trial

“Withdrew” indicates subjects withdrew for reasons including scheduling conflicts, poor health, and lack of interest in continuing; “site decision,” that subjects were withdrawn by study sites because they repeatedly missed appointments or were uncooperative or disruptive during testing sessions.

Figure 2. Cognitive Outcomes: Mean Scores Across Time by Group

Data are Blom-transformed and also adjusted for time, booster, field site, and replicate. Error bars indicate SE.