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| 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.
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