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A Randomized Controlled Trial

Karlene Ball, PhD; Daniel B. Berch, PhD; Karin F. Helmers, PhD; Jared B. Jobe, PhD; Mary D. Leveck, PhD; Michael Marsiske, PhD; John N. Morris, PhD; George W. Rebok, PhD; David M. Smith, MD; Sharon L. Tennstedt, PhD; Frederick W. Unverzagt, PhD; Sherry L. Willis, PhD; for the ACTIVE Study Group

JAMA. 2002;288:2271-2281.

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.

Author Affiliations: Department of Psychology, University of Alabama at Birmingham (Dr Ball); National Institute on Aging (Dr Berch), National Institute of Nursing Research (Drs Helmers and Leveck), and National Heart, Lung, and Blood Institute (Dr Jobe), National Institutes of Health, Bethesda, Md; Institute on Aging and Departments of Health Policy and Epidemiology and Clinical and Health Psychology, University of Florida, Gainesville (Dr Marsiske); Hebrew Rehabilitation Center for the Aged, Roslindale, Mass (Dr Morris); Department of Mental Hygiene, Johns Hopkins University, Baltimore, Md (Dr Rebok); Department of Medicine (Dr Smith) and Department of Psychiatry (Dr Unverzagt), Indiana University School of Medicine, Bloomington; New England Research Institutes, Watertown, Mass (Dr Tennstedt); and Department of Human Development and Family Studies, Pennsylvania State University, University Park (Dr Willis). Order of authorship on this article is alphabetical by author by vote of the ACTIVE Steering Committee.

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