Merits of Late Life Cognitive Training: Findings, Controversies, and a Way Forward

Research seeks to preserve and improve brain function through cognitive training. Photo Credit:  PBS.org

                                                                        

The Lefeber Winter Series on Aging welcomed Dr. Michael Marsiske to speak on research challenging the notion of irreversible declines that occur with aging. Recent research hopes to bolster the well being of the older adult population through cognitive training (CT). While vocabulary and knowledge increase with age, older adults show decreases in processing and memory. Decreases can continue until an older adult’s functional threshold is reached. Concern with preventing functional impairment has spurred the development of several commercial products and “brain games,” though many are not rooted in evidence. Most CT interventions have been done using healthy adult participants with the goal of preventing cognitive/functional decline rather than rehabilitating older adults who present with cognitive impairments. The question of whether or not age-related decline can be improved with CT is being answered with an encouraging “yes” through studies. A more challenging question posed is whether or not CT can actually improve everyday functioning. Training transfer is the term for how well tasks of CT in particular areas can be beneficial for improving separate yet similar activities. Research has found that the effects of training tend to be narrow and specific to the practiced task rather than generally applicable to all skills and abilities.

            The ACTIVE trial, a study initiated in 1996, differed from previous CT studies in that it was a multistate, randomized-controlled, and ethnically inclusive trial. Around 3,000 older adults (76% of which were female) were included in the study, excluding those showing signs of dementia or moderate functional impairment. Participants were randomized into four groups that focused on different types of training:  reasoning, memory, attention (called speed of processing), and no training. The groups were followed for 10 years after a minimum total training time of 10 hours and a maximum total training time of 18 hours. Disclosed critiques of the trial were under-representing the “old” old while over-representing the “young” old and the fact that many participants didn’t survive the extent of the follow-up period. Self-reporting and games/tests were used as well as the driving records of participants to measure functional ability. In all three areas of CT trained individuals on average experienced substantial improvement in mental functioning over those who were untrained. In the reasoning and attention groups, functional benefits were maintained above the untrained group and at/above baseline for 10 years. The memory group on average maintained a level of functioning superior to the untrained group throughout follow-up, but a decline below baseline began after 5 years. Greater functioning was measured in those trained for more hours.

            Future research will focus on using available technology measuring brain activity to personalize training to unique functional needs. It is disputed whether focusing more time on specific activities will be too narrow. There is a need to prove that greater amounts of CT benefit older adults. Combination studies with CT and exercise/mindfulness to compare singular and compounded benefits are also warranted.