Cognitive Speed Training Linked to 20-Year Reduction in Dementia Risk

A recent 20-year follow-up study of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial indicates that older adults who received cognitive speed training, particularly with booster sessions, demonstrated a reduced likelihood of a dementia diagnosis, including Alzheimer's disease, over two decades. The findings, published in Alzheimer's & Dementia: Translational Research and Clinical Interventions, suggest a statistically significant 25% lower incidence of dementia in this specific intervention group compared to a control group.

Older adults who received cognitive speed training with booster sessions demonstrated a statistically significant 25% lower incidence of dementia, including Alzheimer's disease, over two decades.

Study Overview: The ACTIVE Trial

The National Institutes of Health (NIH)-funded ACTIVE study, initiated in 1998–99, originally enrolled 2,802 adults aged 65 and older. Participants were randomized into four distinct groups: three types of cognitive training (memory, reasoning, or speed of processing) or a control group that received no training.

Participants assigned to the training groups completed up to 10 sessions, each lasting 60–75 minutes, over a period of five to six weeks. A crucial element of the study was that half of these participants also received up to four additional "booster" training sessions 11 and 35 months after their initial training concluded.

For the 20-year follow-up, investigators meticulously reviewed Medicare data for 2,021 participants from 1999 to 2019 to identify dementia diagnoses. The characteristics of these participants were largely consistent with the original trial cohort, comprising approximately three-fourths women, 70% white individuals, and an average age of 74 at the study's commencement.

Key Findings from the 20-Year Follow-up

The extended 20-year follow-up of the ACTIVE trial provided compelling and specific results:

• Among the 264 participants in the speed-training group who received booster sessions, 105 (40%) were diagnosed with dementia.
• This represents a 25% reduction in dementia incidence compared to the control group, where 239 out of 491 participants (49%) received a dementia diagnosis.
• Significantly, this reduction in dementia incidence was statistically significant solely for the speed-training group that included booster sessions.

Previous follow-ups of the ACTIVE trial had already indicated positive outcomes. Cognitive training was shown to improve everyday tasks for up to five years, and all three training arms improved everyday function after 10 years. Notably, speed training was previously associated with a 29% lower incidence of dementia at the 10-year mark.

Expert Perspectives and Proposed Mechanisms

Marilyn Albert, Ph.D., corresponding study author and director of the Alzheimer's Disease Research Center at Johns Hopkins Medicine, commented on the profound implications of these findings. She highlighted that the link between boosted speed training and lower dementia risk two decades later suggests that a nonpharmacological intervention can have significant, long-term effects. Dr. Albert emphasized that even slight delays in dementia onset could substantially impact public health and healthcare costs. She also indicated that further studies are needed to understand the underlying mechanisms and why memory and reasoning interventions did not show similar long-term associations.

George Rebok, Ph.D., a site principal investigator, offered insights into why speed training might be particularly effective, suggesting its success may stem from its adaptive nature. He explained that the program adjusted its challenge level based on each participant's individual performance, allowing for personalized progression. This differs notably from the standardized strategies typically used in memory and reasoning programs. Dr. Rebok added that speed training promotes implicit learning, which involves distinct brain processes compared to explicit learning.

Michael Marsiske, another principal investigator, noted that the training benefits did not substantially decrease with age, suggesting that individuals can begin cognitive training at any time.

Understanding Dementia

Dementia is characterized by a decline in cognitive abilities that affects an individual's capacity to live independently. It is estimated to impact 42% of adults over age 55 at some point in their lives, incurring over $600 billion annually in U.S. costs. Alzheimer's disease accounts for 60%–80% of all dementia cases.

Future Research and Accessibility

The study authors propose that combining cognitive training with lifestyle interventions may further delay dementia onset. They suggest that speed training could complement other lifestyle interventions that strengthen neural connections, such as maintaining cardiovascular health, engaging in regular physical activity, managing nutrition, and controlling hypertension. Further research is necessary to explore these interactions and potential synergistic effects.

The specific speed training utilized in the study is commercially available via BrainHQ. The study received funding from NIH grants, including R01AG056486 from the National Institute on Aging, with the original ACTIVE trial supported by NIH grants to its field sites and coordinating center. Additional study authors include researchers from multiple institutions across the U.S., including the University of Pennsylvania, Johns Hopkins Bloomberg School of Public Health, Brown University, University of Pittsburgh, University of Florida, University of Alabama at Birmingham, and University of Washington.