Can Cognitive Decline in the Elderly be Stalled

Declining cognitive abilities are of major concern in the geriatric population.

Can cognitive interventions improve mental abilities in the elderly, and can this improvement exert short- or long-term positive effects on activities related to living independently? In addition to improving the quality of life of the elderly, the delay or prevention of the need for nursing homes, home care and hospital stays present the possibility of decreasing the burden of health care costs. Much like exercise programs must be adhered to in order to maintain physical fitness and prevent muscular atrophy, many studies indicate that deliberate and sustained intellectual engagement is necessary to stave off mental decline.

The ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly) trial was conducted to examine the effect of three cognitive interventions on the improvement of mental abilities and cognitively-demanding daily activities in independent-living adults aged 65-94. Participants were randomized to a memory training group focused on verbal episodic memory, a reasoning training group centred around problem solving involving serial patterns, a speed-of-processing training group concerned with visual search capabilities or a no-contact control group. Over five to six weeks, 10 sessions were carried out, each 60-75 minutes.

The proximal outcome was the impact of the three interventions on their respective cognitive abilities, while the primary outcome was the effect of the training on functional abilities. Each of the three training programs exerted a directly positive effect on the corresponding cognitive function. This effect was most pronounced in the speed group (87% of trained participants showed cognitive improvement), fairly prominent in the reasoning group (74%) and less so in the memory group (26%). These effects continued, albeit at decreased levels, over the subsequent two-year follow-up period. The net impact of ACTIVE training on functional outcome, however, was modest.

These results can be viewed with cautious optimism. While a direct correlation can be drawn between training in a specific area and resultant cognitive improvement in that same area, the failure of this improvement to extend to general everyday performance deems the utility of such specialized training somewhat questionable. Perhaps alternate training groups could be developed in which participants are forced to use various cognitive abilities in conjunction, thus preparing them for the inherent complexities of independent living.

Source

1. Ball K, Berch DB, Helmers KF, et al. Effects of cognitive training interventions with older adults. JAMA 2002;288:2271-81.