Department of Mental Health, Johns Hopkins University, Baltimore, Maryland; Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.
J Am Geriatr Soc. 2014 Jan;62(1):16-24. doi: 10.1111/jgs.12607. Epub 2014 Jan 13.
OBJECTIVES: To determine the effects of cognitive training on cognitive abilities and everyday function over 10 years. DESIGN: Ten-year follow-up of a randomized, controlled single-blind trial (Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE)) with three intervention groups and a no-contact control group. SETTING: Six U.S. cities. PARTICIPANTS: A volunteer sample of 2,832 persons (mean baseline age 73.6; 26% African American) living independently. INTERVENTION: Ten training sessions for memory, reasoning, or speed of processing; four sessions of booster training 11 and 35 months after initial 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 (IADLs) (memory: effect size = 0.48, 99% confidence interval (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 a mean age of 82, approximately 60% of trained participants, versus 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 Memory training effects were no longer maintained for memory performance.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). CONCLUSION: Each Advanced Cognitive Training for Independent and Vital Elderly 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.
目的：确定认知训练对认知能力和 10 年内日常功能的影响。
设计：一项随机、对照、单盲试验（积极的独立和重要老年人的高级认知训练（ACTIVE））的 10 年随访，该试验有三个干预组和一个无接触对照组。
地点：美国六个城市。
参与者：一项独立生活的志愿者样本，共 2832 人（平均基线年龄 73.6；26%为非裔美国人）。
干预措施：记忆、推理或处理速度的 10 次训练课程；初始训练后 11 个月和 35 个月进行 4 次强化训练。
测量：客观测量认知能力以及自我报告和基于表现的日常功能测量。
结果：每个干预组的参与者都报告称，在工具性日常生活活动（IADLs）方面的困难程度较低（记忆：效应量=0.48，99%置信区间（CI）=0.12-0.84；推理：效应量=0.38，99%CI=0.02-0.74；处理速度：效应量=0.36，99%CI=0.01-0.72）。在平均年龄为 82 岁时，与对照组的 50%相比，接受训练的参与者中有大约 60%（P<0.05）的人在 10 年内的自我报告 IADL 功能水平上达到或高于基线水平。推理和处理速度干预在 10 年内维持了对其靶向认知能力的效果（推理：效应量=0.23，99%CI=0.09-0.38；处理速度：效应量=0.66，99%CI=0.43-0.88）。记忆训练对记忆表现的效果不再维持。强化训练为推理干预的推理表现（效应量=0.21，99%CI=0.01-0.41）和处理速度干预的处理速度表现（效应量=0.62，99%CI=0.31-0.93）带来了额外的和持久的改善。
结论：与对照组相比，每项独立和重要老年人的高级认知训练认知干预都导致自我报告的 IADL 下降较少。推理和速度，但不是记忆训练，导致 10 年内靶向认知能力得到改善。
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