Speed of processing training results in lower risk of dementia 2017 United States, University of South Florida
Simple Summary
Speed of processing training resulted in reduced risk of dementia compared to control, but memory and reasoning training did not. Each additional speed of processing training session was associated with a 10% lower risk for dementia.
More Detail
Methods
Advanced Cognitive Training in Vital Elderly (ACTIVE), started in 1998 by recruiting healthy older adult participants for a study to look at the effectiveness of three cognitive training programs (memory, reasoning, and speed of processing) using a randomized controlled trial with four groups. The study eventually ended up with over 2,800 individuals in six different U.S. cities.
Note: You can download the raw data and analyze the information yourself. Who knows, you might find something worth publishing.
Participants completed baseline assessments of cognitive and functional abilities. The training sessions were given to small groups in each of the three areas of interest (memory, reasoning, speed of processing). Sessions were 60-75 minutes long and participants were asked to complete 10 sessions over 5 to 6 weeks. The fourth group was the control and received no training.
Memory training strengthens memory functions and would prepare the subject for a verbal episodic memory test. Reasoning training prepares the subject for problem solving and identifying serial patterns. Speed of processing training requires the subject to locate objects on the computer screen as quickly as they can, with the objects becoming increasingly harder to find.
A subset of participants completed at least 80% of the training sessions and was randomly selected to receive four additional training sessions 11 and 35 months later. Thus, the total for each type of training could range from 0–18 sessions. Follow-up assessments were conducted at 1, 2, 3, 5, and 10 years.
Results
There was no real difference for risk of dementia between the control group and those receiving memory and reasoning training. At first blush, it looked like a greater number of memory training sessions was associated with reduced dementia risk, but after adjusting for risk factors the perceived benefit evaporated.
When it came to improved cognitive performance and a positive effect for daily functioning, the reasoning and speed of processing groups did show positive results. Booster sessions for each group increased the benefits.
For dementia, the speed of processing group stands out in a big way. “Healthy older adults randomized to speed of processing cognitive training had a 29% reduction in their risk of dementia after 10 years of follow-up compared to the untreated control group.” The effects were EVEN GREATER for those who completed additional training, and that increase was measurable for EACH additional session completed. The effect of number of speed training sessions remained significant after controlling for age, sex, race, depressive symptoms, diabetes, and congestive heart failure.
As if that weren’t enough. Others have mined the ACTIVE data and published papers over the years that show that speed of processing training has the following benefits:
Older adults at higher risk for dementia due to older age, low education, or mild cognitive impairment are more likely to benefit from speed of processing training.
Dementia was defined using a combination of interview- and performance-based methods. Specifically, a dementia designation was assigned at the first occurrence of any of the following:
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Cognitive and functional impairment defined as follows: a) memory composite score at or below −1.5 SD of the baseline sample mean and reasoning composite, speed composite, or vocabulary score at or below −1.5 SD of the baseline mean , and b) MDS IADL total score at or below the 10th percentile of the baseline (self-reported)
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A score of <22 on the MMSE
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Self- or proxy-report of diagnosis of dementia or Alzheimer’s disease during the follow-up
Of the 2,802 participants in ACTIVE, a total of 260 developed dementia during the 10-year follow-up. Those who developed dementia during this period were “older, male, of nonwhite race, less educated, more likely nondrinkers, with more depressive symptoms, and more likely to have diabetes or Congestive Heart Failure.”
Memory testing included the:
- Hopkins Verbal Learning Test
- Rey Auditory-Verbal Learning Test
- Rivermead Behavioral Memory Test (immediate recall).
The reasoning tests included:
- Letter Series
- Letter Sets
- Word Series
Speed testing included:
- the four subtests of the Useful Field of View
At baseline, the overall sample was 73.6 years-old on average, and had an average MMSE score of 27.3 out of 30. The overall group was predominately white (73.3%) and female (76.2%).
Each training arm of the study was comparable for health conditions, total number of training sessions, demographics, and attrition. Heal conditions included diabetes, hypertension, myocardial infarction, stroke, and depressive symptoms. At the 10-year follow-up, 627 participants had died and 938 had dropped out. The 30.6% attrition rate due to death, withdrawal, and loss to follow-up “was in expected ranges given the age of the sample at baseline, and, importantly, did not differ by training arm.”
A total of 639 participants qualified for booster training. Each additional training session was associated with an 11% lower risk of dementia. Among participants who completed five or more booster training sessions, indicators of dementia were evident in 5.9% of participants from the speed arm and 9.7–10.1% among those completing the memory and reasoning booster training arms, respectively
