Maintaining Brain Function: What The ACTIVE Study Tells Us

The subject of brain health, along with preventing memory loss and dementia is frequently in the news these days. We think it is important to have an understanding of the limits to, and parameters of, brain health training in order to effectively choose a programme, try to develop your own course, or even do your own health planning for aging. For that reason, this month, Elder Voice reports on a major research project on maintaining and improving cognitive skills, called the ACTIVE Study.

The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study was started in 1996 and funded by the National Institutes of Health and of Nursing Research in the U.S. Over 2800 subjects were enrolled and have been followed for over ten years. At the beginning of the study they received either brain training in memory, reasoning, or speed of processing (the rate of ability to process sensory input) or were in a control group. A subset of those received additional (“booster”) training at 11 and 35 months. The goal was to see if brain training could help improve cognitive functioning which hopefully in turn would translate into maintaining independence.

The study produced some interesting results:

1. Participants in all areas had improvements, but only in their area of training. For instance, memory training did not improve speed of processing.
2. Many training gains were maintained after five years. Those having the additional training did the best. Even those with a diagnosis of MCI (Mild Cognitive Impairment) two years into the study were able to maintain some improvement in reasoning and speed of processing after five years.
3. After five years there was some transfer of the learned skills to daily functioning. In other words, training resulted in practical value on a daily basis.
4. The speed of processing and reasoning groups with the supplemental training did best in transferring function to everyday life. BUT: only in the areas for which they had the training.
5. Of the participants who were still driving, those who had undergone cognitive speed of processing training were 40% less likely to cease driving over the subsequent three years. Speed-of-processing and reasoning training also resulted in a 50% lower rate of at-fault car accidents over six years. There was no significant difference observed for the group focused on memory training.
6. At 10 years, all groups showed some decline. However, 73.6% of reasoning-trained participants continued to perform reasoning tasks above baseline, whereas only 61.7% of control group did so. Over 70% of speed-trained participants performed at or above baseline level compared to 48.8% of the control group. There was no difference in memory performance between the memory group and the control group after 10 years.
7. Most notably, after ten years, those who had speed of processing training had a 33 percent reduction in risk of developing dementia over the time of the study.

These results highlight some key information to consider:

1. Cognitive function is more than memory. It takes many brain skills to get us through our daily life. For example, try to write down exactly all the steps you took preparing your dinner last night or the last time you drove to your local grocery store. (That in itself is a cognitive skill!) You might be surprised at how many steps these activities require. And many of them call on different functions in different parts of the brain.
2. This suggests that if you are going to do “brain health training” you will need to focus on several areas of function to get the most impact. If you participate in such a programme, find out what types of functions they target, and what they do not.
3. Speed of processing is a key skill, but not the only one. Seek out training that incorporates several if not all of the areas referenced above.
4. If the program you are considering includes supplemental training, appreciate that the best results will be in whichever area you had initial training. In other words, supplemental training that attempts to fill in gaps from the initial training will not be as effective.
5. The best training is that which will transfer to practical daily use. After all, the purpose is to help to keep an individual as independent as possible, for as long as possible.

Finally, keep in mind that research is ongoing and the various programmes of brain training are relatively young. In addition, be aware that there are many factors which are important to maintaining cognitive functions. These include age at the start of training, general health, stress, nutrition, exercise levels, mood, genetics, and social interaction. One or some of those may be as effective as specific skill training in guarding against cognitive decline. We need pay attention to all aspects of our lifestyle when trying to maximize our our cognitive abilities.