By Karla Gale

NEW YORK (Reuters Health) Nov 12, 2002- Cognitive training interventions with elderly individuals produced significant improvements in memory, reasoning ability and speed of processing that were durable for at least 2 years, according to a report in the November 13th issue of the Journal of the American Medical Association.

"This is the largest and best-designed and executed trial ever of cognitive interventions for healthy older adults, bringing together cognitive psychology and neuroscience," Dr. Richard M. Suzman, of the National Institute on Aging, told Reuters Health.

The study participants were 2802 healthy, independently living individuals between the ages 65 and 94 years. At enrollment, their Mini-Mental State examination (MMSE) scores were above 22. The findings were presented Tuesday morning at a JAMA press briefing in Washington, DC.

Dr. Karlene Ball, of the University of Alabama at Birmingham, and fellow members of the ACTIVE study group evaluated the results of the interventions, which included 10 group sessions lasting 60 to 75 minutes held over 5- to 6-week periods.

The sessions targeted verbal episodic memory (n = 711), inductive reasoning (n = 705), or speed of processing (n = 712). Strategies were introduced during the first five sessions, while practice exercises were provided during all 10 sessions. A no-contact control group included 704 individuals.

Reliable improvement (defined as improvement over baseline performance by at least one standard error of the mean) was documented post-test in 26% of the memory training group, 74% of the reasoning training group, and 87% of speed training group (p < 0.001 for each). This level of statistical significance was maintained at the 1- and 2-year follow-up.

"We were all very encouraged by results of the memory training program," Dr. Ball said in an interview with Reuters Health. "Previous literature hasn't shown [memory training] to be that durable. So the fact that it was is a highly significant finding."

Booster training offered 11 months after the initial sessions enhanced the training gains in speed and reasoning (p < 0.001). The booster was provided to 60% of the initial cohort, delivered in four sessions. By the end of the second year, 57% of those given additional training in reasoning versus 35% of their counterparts still maintained reliable improvement over baseline. For speed training, corresponding figures were 75% versus 37%.

"These effect sizes are comparable with or greater than the amount of longitudinal decline that has been reported in previous studies," Dr. Ball's group writes. In fact, they add, the effects approximated the amount of cognitive decline expected in this age cohort over 7 to 14 years, in the absence of dementia.

"Physicians should be aware that there are ways to maintain and improve cognitive skills, which has not been the mindset in the past," Dr. Ball added. "The tendency has been to accept that as people age, they have a poor memory and have slower reaction times. Now we know there are ways to prevent that."

Dr. Ball noted that she and her associates are continuing to develop these types of programs. "We hope to make them more accessible, for example, to the point where patients can undergo training at home."

The improvements noted in the study did not appear to affect cognitive aspects of everyday life (JAMA 2002;288:2271-2281).

Our Comment: The appropriate control group would be one which is not a "no-contact control group" but one given as much social contact and active non-targeted mental activities.