Long-term Effects of Cognitive Training on Everyday Functional Outcomes in Older Adults
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CONTEXT: Cognitive training has been shown to improve cognitive abilities in older adults but the effects of cognitive training on everyday function have not been demonstrated. OBJECTIVE: To determine the effects of cognitive training on daily function and durability of training on cognitive abilities. DESIGN, SETTING, AND PARTICIPANTS: Five-year follow-up of a randomized controlled single-blind trial with 4 treatment groups. A volunteer sample of 2832 persons (mean age, 73.6 years; 26% black), living independently in 6 US cities, was recruited from senior housing, community centers, and hospitals and clinics. The study was conducted between April 1998 and December 2004. Five-year follow-up was completed in 67% of the sample. INTERVENTIONS: Ten-session training for memory (verbal episodic memory), reasoning (inductive reasoning), or speed of processing (visual search and identification); 4-session booster training at 11 and 35 months after training in a random sample of those who completed training. MAIN OUTCOME MEASURES: Self-reported and performance-based measures of daily function and cognitive abilities. RESULTS: The reasoning group reported significantly less difficulty in the instrumental activities of daily living (IADL) than the control group (effect size, 0.29; 99% confidence interval [CI], 0.03-0.55). Neither speed of processing training (effect size, 0.26; 99% CI, -0.002 to 0.51) nor memory training (effect size, 0.20; 99% CI, -0.06 to 0.46) had a significant effect on IADL. The booster training for the speed of processing group, but not for the other 2 groups, showed a significant effect on the performance-based functional measure of everyday speed of processing (effect size, 0.30; 99% CI, 0.08-0.52). No booster effects were seen for any of the groups for everyday problem-solving or self-reported difficulty in IADL. Each intervention maintained effects on its specific targeted cognitive ability through 5 years (memory: effect size, 0.23 [99% CI, 0.11-0.35]; reasoning: effect size, 0.26 [99% CI, 0.17-0.35]; speed of processing: effect size, 0.76 [99% CI, 0.62-0.90]). Booster training produced additional improvement with the reasoning intervention for reasoning performance (effect size, 0.28; 99% CI, 0.12-0.43) and the speed of processing intervention for speed of processing performance (effect size, 0.85; 99% CI, 0.61-1.09). CONCLUSIONS: Reasoning training resulted in less functional decline in self-reported IADL. Compared with the control group, cognitive training resulted in improved cognitive abilities specific to the abilities trained that continued 5 years after the initiation of the intervention. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00298558.
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When individuals participate in a cognitive-training program, beneficial effects on cognitive performance tend to be relatively narrow, usually localized to the specific cognitive test trained.
“For instance, research suggests that when individuals participate in a cognitive-training program, the beneficial effects on cognitive performance tend to be relatively narrow in scope, usually localized to the specific cognitive test that was trained (e.g., Ball et al., 2002; Willis et al., 2006; but see Tranter & Koutstaal, 2008).”
From Enrichment Effects on Adult Cognitive Development: Can the Functional Capacity of Older Adults Be Preserved and Enhanced? (2008) · cites this paper as Willis et al., 2006
Training Effects on Cognitive Abilities (p. 6) reports lasting improvement in the cognitive ability each intervention targeted, supporting the claim that benefits were relatively narrow. But Outcome Measures (p. 4) assesses each ability with three tests, so the paper does not establish that benefits were usually confined to the specific test trained. The Comment (p. 8) also reports modest transfer to everyday function. (LLM, conf=0.86)
Experimental — accuracy not yet measuredNo transfer effects were observed on performance-based measures of everyday problem solving or everyday speed of processing.
“No transfer effects were observed on performance-based measures of everyday problem solving or everyday speed of processing.”
From Enrichment Effects on Adult Cognitive Development: Can the Functional Capacity of Older Adults Be Preserved and Enhanced? (2008) · cites this paper as Willis et al., 2006
The Performance-Based IADL Measures section (p. 7) reports no general training effect on either performance-based measure. But it also reports a significant improvement in everyday speed of processing among participants assigned to booster training, so the unqualified claim that no transfer effects were observed is too broad. (LLM, conf=0.90)
Experimental — accuracy not yet measuredFive-year retest data showed that training benefits were still observed after the longer retention interval.
“Willis et al. (2006) reported 5-year retest data on the sample, showing that training benefits were still observed after the longer retention interval.”
From Enrichment Effects on Adult Cognitive Development: Can the Functional Capacity of Older Adults Be Preserved and Enhanced? (2008) · cites this paper as Willis et al., 2006
All older adults showed some aggregate decline in IADL, but this decline was milder in the reasoning training group.
“All older adults showed some aggregate decline in IADL, but this decline was milder in the reasoning training group.”
From Enrichment Effects on Adult Cognitive Development: Can the Functional Capacity of Older Adults Be Preserved and Enhanced? (2008) · cites this paper as Willis et al., 2006
Reasoning training had 5-year lagged benefits on self-reported instrumental activities of daily living by older adults.
“For example, Willis et al. (2006) showed that reasoning training had 5-year lagged benefits on self-reported aspects of instrumental activities of daily living (IADL) by older adults (see also Wolinsky et al., 2006).”
From Enrichment Effects on Adult Cognitive Development: Can the Functional Capacity of Older Adults Be Preserved and Enhanced? (2008) · cites this paper as Willis et al., 2006
Memory training and speed-of-processing training did not show differential preservation relative to controls.
“The memory training and speedof-processing training did not show differential preservation, relative to controls.”
From Enrichment Effects on Adult Cognitive Development: Can the Functional Capacity of Older Adults Be Preserved and Enhanced? (2008) · cites this paper as Willis et al., 2006
Given some evidence that training programs may improve functional status, the potential for reducing morbidity and dependence in older populations through long-term cognitive enrichment programs is real.
“Given at least some evidence that training programs may be associated with improvements in functional status (e.g., Willis et al., 2006), it is certainly the case that the potential for reducing morbidity and dependence in older populations through long-term cognitive enrichment programs is real.”
From Enrichment Effects on Adult Cognitive Development: Can the Functional Capacity of Older Adults Be Preserved and Enhanced? (2008) · cites this paper as Willis et al., 2006
Some prior studies used an inoculation or vaccination model, giving a single intervention dose sometimes followed by a few refresher doses.
“Some previous studies have adopted what might be termed an inoculation or vaccination model. That is, a single ''dose'' of an intervention is provided, occasionally followed by a small number of refresher doses (e.g., Ball et al., 2002; Willis et al., 2006).”
From Enrichment Effects on Adult Cognitive Development: Can the Functional Capacity of Older Adults Be Preserved and Enhanced? (2008) · cites this paper as Willis et al., 2006
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“Most successful studies have involved training programs that ranged from 4 to 12 weeks or more, characterized by multiple hours (10-60) of distributed training.”
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Self-citation
- Authors
- 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., Wright, E., & ACTIVE Study Group, F. T.
- Affiliations
- Pennsylvania State University (US)
- New England Research Institutes (US)
- University of Florida (US)
- University of Alabama (US)
- National Institutes of Health (US)
- Hebrew SeniorLife (US)
- Johns Hopkins University (US)
- Indiana University Indianapolis (US)
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2006-12-20
- Volume
- 296
- Issue
- 23
- Pages
- 2805
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC2910591
- OpenAlex
- W2131162932
- Cited by
- 1,496
- References
- 56
- Citations by year
- 2026: 25 · 2025: 48 · 2024: 49 · 2023: 47 · 2022: 62 · 2021: 52 · 2020: 58 · 2019: 100 · 2018: 87 · 2017: 100 · 2016: 81 · 2015: 125 · 2014: 111 · 2013: 100 · 2012: 101
- FWCI
- 36.62
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Funders
- Johns Hopkins University (AG14282, AG14263, NR04507, AG14289, U01 AG14260, NR04508)
- New England Research Institutes (AG14282, U01 AG14282, NR04508, AG14263, NR04507, AG14289)
- School of Medicine, Indiana University ((U01 NR04508), NR04508)
- National Institute on Aging (U01 AG14282, U01AG014260, U01 AG 14263, R37AG024102, U01AG14260, U01-AG14289, U01AG014289, U01AG014263, U01AG014276, U01AG014282, U01 AG14276)
- National Institute of Nursing Research (U01NR004507, U01NR04507, U01NR004508, U01 NR04508)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
- Keywords
- cognitive training, older adults, daily functioning, instrumental activities of daily living, booster training, memory training, inductive reasoning, processing speed, visual search, problem solving, cognitive aging, independent living, senior housing, community-dwelling older adults, self-efficacy
- MeSH terms
- Activities of Daily Living, Aged, Aged, 80 and over, Aging, Cognition, Cognition Disorders, Female, Follow-Up Studies, Humans, Male, Memory, Mental Processes, Cognitive Behavioral Therapy, Single-Blind Method
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