Results support the effectiveness and durability of the cognitive training interventions in improving targeted cognitive abilities. Training effects were of a magnitude equivalent to the amount of decline expected in elderly persons without dementia over 7- to 14-year intervals. Because of minimal functional decline across all groups, longer follow-up is likely required to observe training effects on everyday function.

clinicaltrials.gov Identifier: NCT00298558.

Objective To determine the effects of cognitive training on cognitive abilities and everyday function over 10 years. Design, Setting, and Participants Ten-year follow-up of a randomized, controlled single-blind trial with 3 intervention groups and a no-contact control group. A volunteer sample of 2832 persons (mean baseline age, 73.6 years; 26% African American) living independently in 6 US cities. Interventions Ten-session training for memory, reasoning, or speed-of-processing.; 4-session booster training at 11 and at 35 months after training. Measurements Objectively measured cognitive abilities and self-reported and performance-based measures of everyday function. Results Participants in each intervention group reported less difficulty with instrumental activities of daily living (IADL) (memory: effect size, 0.48 [99% CI, 0.12-0.84]; reasoning: effect size, 0.38 [99% CI, 0.02-0.74]; speed-of-processing: effect size, 0.36 [99% CI, 0.01-0.72]). At mean age of 82 years, about 60% of trained participants compared to 50% of controls (p<.05) were at or above their baseline level of self-reported IADL function at 10 years. The reasoning and speed-of-processing interventions maintained their effects on their targeted cognitive abilities at 10 years (reasoning: effect size, 0.23 [99% CI, 0.09-0.38]; speed-of-processing: effect size, 0.66 [99% CI, 0.43-0.88]). Memory training effects were no longer maintained for memory performance. Booster training produced additional and durable improvement for the reasoning intervention for reasoning performance (effect size, 0.21 [99% CI, 0.01-0.41]) and the speed-of-processing intervention for speed-of-processing performance (effect size, 0.62 [99% CI, 0.31-0.93]). Conclusions Each ACTIVE cognitive intervention resulted in less decline in self-reported IADL compared with the control group. Reasoning and speed, but not memory, training resulted in improved targeted cognitive abilities for 10 years.

The dual task of memorizing word lists while walking was predicted to become more difficult with age because balance and gait are in greater need of "attentional resources." Forty-seven young (ages 20-30 years), 45 middle-aged (40-50), and 48 old (60-70) adults were trained to criterion in a mnemonic technique and instructed to walk quickly and accurately on 2 narrow tracks of different path complexity.Then, participants encoded the word lists while sitting, standing, or walking on either track; likewise, speed and accuracy of walking performance were assessed with and without concurrent memory encoding. Dual-task costs increased with age in both domains; relative to young adults, the effect size of the overall increase was 0.98 standard deviation units for middle-aged and 1.47 standard deviation units for old adults. It is argued that sensory and motor aspects of behavior are increasingly in need of cognitive control with advancing age.The main purpose of this study was to test the prediction that the simultaneous execution of a challenging locomotion task-walking on a narrow track-and a memory task-memorizing a list of words-becomes increasingly difficult with advancing age. This prediction was motivated by the hypothesis that sensorimotor performance is increasingly in need of "attentional resources" (Craik & Byrd, 1982) with advancing age (Brown & Woollacott, 1998;Teasdale, Lajoie, Bard, Fleury, & Courtemanche, 1993; cf. Welford, 1958, pp. 186-187). As an illustration, imagine 20-yearold and 70-year-old pedestrians crossing a lively street corner. Because of losses in motor and sensory functioning, 70-year-old individuals will need, on average, to exert more attention to successfully perform this task than will 20-year-old individuals. As a consequence, one may hypothesize that they will be more likely than young adults to interrupt a conversation with another person while crossing the street.

The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial is a randomized, controlled, single-masked trial designed to determine whether cognitive training interventions (memory, reasoning, and speed of information processing), which have previously been found to be successful at improving mental abilities under laboratory or small-scale field conditions, can affect cognitively based measures of daily functioning. Enrollment began during 1998; 2-year follow-up will be completed by January 2002. Primary outcomes focus on measures of cognitively demanding everyday functioning, including financial management, food preparation, medication use, and driving. Secondary outcomes include health-related quality of life, mobility, and health-service utilization. Trial participants (n = 2832) are aged 65 and over, and at entry into the trial, did not have significant cognitive, physical, or functional decline. Because of its size and the carefully developed rigor, ACTIVE may serve as a guide for future behavioral medicine trials of this nature.