ACTIVE Trial: Cognitive Training Outcomes in Older Adults

Study Overview and Design

The ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly) study was a randomized controlled, single-blind trial using a four-group design that included three treatment groups and one control group (Willis et al., 2006).

Participant Selection and Group Assignment

The researchers recruited 2,832 older adults who lived independently — not in nursing homes or similar facilities — with an average age of 73.6 years. Participants were identified through community centers, senior housing facilities, clinics, and hospitals in six American cities: Birmingham, Detroit, Indianapolis, State College (PA), Boston, and Baltimore. Original recruitment took place in April 1998, with a follow-up conducted in December 2004; 67% of the original sample participated in the 2004 follow-up.

Individuals were disqualified from the study if they were younger than 65, showed serious cognitive decline, had other substantial impairments, had been diagnosed with Alzheimer's disease, were near death or in serious decline, were nearly blind or deaf, had trouble communicating adequately, had recently undergone cognitive training, or would be unavailable for the full study period.

Among those who qualified, a computer algorithm randomly assigned participants to one of four groups: three intervention groups and one control group.

Treatment Interventions and Outcome Measures

Each of the three intervention groups received training narrowly targeted at a specific cognitive ability: memory, reasoning, or speed of processing. The memory training used mnemonic strategies, including techniques for organizing information, visualizing, making associations, and remembering word lists. The reasoning intervention taught strategies for identifying patterns in letter sequences and determining the next word or letter in a series. The speed-of-processing training presented images on a computer screen at increasingly brief exposures (Willis et al., 2806).

In addition to the initial training sessions, participants received "booster training" sessions at 11 and 35 months. Each booster session lasted 75 minutes and was designed to maintain the improvements in cognitive ability gained during initial training. Cognitive outcomes were assessed for each intervention: three measures of verbal ability were tested for the memory group, three reasoning abilities for the reasoning group, and three speed-of-processing outcomes for that group (Willis et al., 2808).

Research Questions and Key Findings

This was reportedly the first study of its kind to carefully examine the long-term outcomes of cognitive interventions on how older adults function while living independently. The central question was: when given interventions designed to improve cognitive skills, how effectively do those interventions achieve their goals, and how well do the gains hold up over five years?

Each of the three interventions produced immediate improvements in the targeted cognitive skills, and those gains were sustained across the five-year period. The booster training sessions produced significantly better performance on the expected outcomes (Willis et al., 2811). Notably, the measurement of instrumental activities of daily living (IADL) showed meaningful improvement only for the reasoning group; neither the speed-of-processing nor the memory training groups demonstrated significant improvements in daily living outcomes — which was the study's primary applied focus (Willis et al., 2811).

Works Cited

Willis, S. L., Tennstedt, S. L., Marsiske, M., Ball, K., Elias, J., Koepke, K. M., Morris, J. N., Rebok, G. W., Unverzagt, F. W., Stoddard, A. M., and Wright, E. (2006). Long-term effects of cognitive training on everyday functional outcomes in older adults. Journal of the American Medical Association, 296(23), 2805–2814.