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Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults.

ABSTRACT: To determine the effects of cognitive training on cognitive abilities and everyday function over 10 years.Ten-year follow-up of a randomized, controlled single-blind trial (Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE)) with three intervention groups and a no-contact control group.Six U.S. cities.A volunteer sample of 2,832 persons (mean baseline age 73.6; 26% African American) living independently.Ten training sessions for memory, reasoning, or speed of processing; four sessions of booster training 11 and 35 months after initial training.Objectively measured cognitive abilities and self-reported and performance-based measures of everyday function.Participants in each intervention group reported less difficulty with instrumental activities of daily living (IADLs) (memory: effect size = 0.48, 99% confidence interval (CI) = 0.12-0.84; reasoning: effect size = 0.38, 99% CI = 0.02-0.74; speed of processing: effect size = 0.36, 99% CI = 0.01-0.72). At a mean age of 82, approximately 60% of trained participants, versus 50% of controls (P < .05), were at or above their baseline level of self-reported IADL function at 10 years. The reasoning and speed-of-processing interventions maintained their effects on their targeted cognitive abilities at 10 years (reasoning: effect size = 0.23, 99% CI = 0.09-0.38; speed of processing: effect size = 0.66, 99% CI = 0.43-0.88). Memory training effects were no longer maintained for memory performance. Booster training produced additional and durable improvement for the reasoning intervention for reasoning performance (effect size = 0.21, 99% CI = 0.01-0.41) and the speed-of-processing intervention for speed-of-processing performance (effect size = 0.62, 99% CI = 0.31-0.93).Each Advanced Cognitive Training for Independent and Vital Elderly cognitive intervention resulted in less decline in self-reported IADL compared with the control group. Reasoning and speed, but not memory, training resulted in improved targeted cognitive abilities for 10 years.

SUBMITTER: Rebok GW

PROVIDER: S-EPMC4055506 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

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Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults.

Rebok George W GW Ball Karlene K Guey Lin T LT Jones Richard N RN Kim Hae-Young HY King Jonathan W JW Marsiske Michael M Morris John N JN Tennstedt Sharon L SL Unverzagt Frederick W FW Willis Sherry L SL

Journal of the American Geriatrics Society 20140113 1

<h4>Objectives</h4>To determine the effects of cognitive training on cognitive abilities and everyday function over 10 years.<h4>Design</h4>Ten-year follow-up of a randomized, controlled single-blind trial (Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE)) with three intervention groups and a no-contact control group.<h4>Setting</h4>Six U.S. cities.<h4>Participants</h4>A volunteer sample of 2,832 persons (mean baseline age 73.6; 26% African American) living independently.<h ...[more]

PMID: 24417410

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Project description:ObjectiveMany people with epilepsy (PWE) suffer from reduced everyday functioning such as unemployment, relationship difficulties, or lifestyle limitations. To identify whether subjective cognitive impairment (SCI) is a potential source of these impairments, associations with restrictions of daily life (RDL) and reduced daily activities (DA) were examined.MethodsIn a prospective cross-sectional sample of 316 adult in-patients with epilepsy, multiple regression analyses were calculated predicting RDL and DA. The relationships between these two measures and SCI were controlled for age, sex, seizure frequency, presence of structural lesions, epilepsy duration, mono- vs polytherapy and adverse events of antiseizure medication (ASM), level of depressive and anxiety symptoms, education, and employment. We also checked for an interaction between depressive symptoms and SCI, to evaluate whether patients with more depressive symptoms are more vulnerable for unfavorable associations between SCI and RDL or DA, respectively. General dominance indices (GDIs) were calculated to compare predictors.ResultsSubstantial SCI was present in 46% of our sample. SCI was independently associated with RDL and DA. Comparison of relative predictor importance revealed that SCI accounted for 23% of the total variance of RDL (GDISCI = 0.12, RRDL2 = 50%) and 24% of the total variance of DA (GDISCI = 0.08, RDA2 = 32%). SCI was among the two most important predictors in both models. PWE with more depressive symptoms had stronger associations between SCI and RDL or DA, respectively.SignificanceSubjective cognitive impairment represents a frequent concern in PWE and may have detrimental consequences for their everyday life. PWE with depressive symptoms may be at greater risk of unfavorable relationships between SCI and everyday functioning. Exchange and collaboration between professionals offering psychotherapeutic, neuropsychological, and psychosocial interventions are crucial to address the patients' individual needs.

Project description:Introduction: Instrumental activities of daily living (IADLs) are complex daily tasks important for independent living. Many older adults experience difficulty with IADLs as their physical and/or cognitive function begins to decline. However, it is unknown in what order IADLs become difficult. Methods: Participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study who were free of IADL difficulty at baseline (N = 1,277) were followed up to 10 years until first reported IADL difficulty. A total of 19 IADL tasks were grouped into seven task categories. A discrete-time multiple-event process survival mixture model (MEPSUM) was used to generate hazard estimates of incident IADL difficulty in seven groups from ages 65 to 80. Hazard estimates were compared in the three intervention groups (memory, inductive reasoning, and speed of information processing) vs. the no-contact control group. Results: A total of 887 (69.5%) participants reported incident difficulty in at least one IADL task category. Compared to individuals who remained free of IADL difficulty, those who reported incident difficulty were more likely to be older, female, and have lower Short Form 36 general health scores. The IADL task categories to first become difficult were housework, managing health care, and phone use. There were no differences by intervention group in the hazard estimates of incident IADL difficulty. Conclusion: Managing health care and phone use are more cognitively demanding IADLs, and individuals who experience difficulty in these tasks first may be more likely to experience cognitive decline. Recognizing early difficulty in managing health care may allow for implementation of compensation strategies to minimize unintentional medication misuse, increased adverse medical events, and unnecessary hospitalization. Training of a specific cognitive domain may not influence ordering of IADL difficulty because IADL tasks require proficiency in, and integration of, multiple cognitive domains.

Dataset Information

Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults.

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Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults.

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