Brain Training Produces Effects Even After 10 Years
By Jamie Santa Cruz
A recent study suggests that the benefits of cognitive training can extend for as long as 10 years.
It’s long been known that patients who stimulate their brains through formal training or structured cognitive activities tend to be better off cognitively during the aging process than those who don’t have mental stimulation. Now, however, a new report from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study group, published in the January issue of the Journal of the American Geriatrics Society, has demonstrated that the effects of cognitive training can last much longer than previously realized: up to 10 years or more.
“Nobody had been able to demonstrate decade-long effects like this,” says George Rebok, MA, PhD, a professor of mental health at Johns Hopkins University and the lead study author. The results “suggested that even modest amounts of training [can produce] effects [that are] very long lasting.”
The report also suggests that cognitive training may translate to benefits in the tasks of daily life necessary for independent living, such as balancing a checkbook or going grocery shopping.
Short Intervention, Long-Term Results
Though the benefits varied depending on the type of skill being tested, the effects of the initial training were surprisingly durable: Subjects who underwent training in reasoning and speed of processing continued to show effects in these areas a full 10 years later. The biggest gains appeared in the speed of processing group, where patients showed “very large effects” after 10 years, according to Rebok.
With reasoning skills, the results were less dramatic but still significant, with patients showing a small to moderate effect after 10 years. (The group that received memory training continued to show benefits after five years, but these had disappeared by the 10-year mark.)
“One of the big problems or questions around a cognitive training regimen was [the question of] how long would this last?” says Jonathan King, PhD, program director for cognitive aging in the division of behavioral and social research at the NIA and a study coauthor. “It was not clear to anybody that that kind of training would last so long in the absence of any sort of follow-up, and that’s impressive.”
Previous studies hadn’t examined what impact booster training sessions would have, but the ACTIVE study suggests such sessions can be valuable. About one-half of the subjects who received the initial intervention were randomly selected for supplementary training after one year and again after three years, and the patients in this group showed additional benefits after 10 years over those who had received only the initial intervention. “That’s not to say that people didn’t decline,” Rebok says. “People were declining, but the people in the training group [and especially those who received the booster sessions] declined at a less steep rate than the people in the control group.”
Although the gains in reasoning and speed of processing were noteworthy, of even greater interest was what effect the cognitive training would have on everyday functioning. “We didn’t think that cognitive training would, for example, help you with being able to rise from a chair or transfer from a bed, or things like that,” King says.
Yet the results provide some evidence that brain training actually could produce benefits in exactly those areas. When the researchers used objective measurements of time and efficiency to evaluate participants on a variety of daily activities, there was no difference in functional abilities between the trained groups vs. the control group. However, in subjective evaluations, patients in all three training groups living after 10 years consistently reported fewer difficulties than the control group with activities of daily living.
It’s unclear why there was a discrepancy between objective measures and self-reports, but according to Rebok, the subjective reports of better functionality in daily life are encouraging. “That was new,” he says. “Nobody had ever been able to show that kind of effect.”
The Memory Conundrum
But Rachelle Doody, MD, PhD, director of the Alzheimer's Disease and Memory Disorders Center at the Baylor College of Medicine in Houston, who wasn’t involved in the study, believes clinicians shouldn’t read too much into the lack of evidence in this particular study for long-term benefits from memory training. “Depending on what tests you choose to test a person, you can see lots of variation,” she says. “Let’s say you measured memory with another task, like facial recognition instead of recall—you might have found a difference.” The more significant point for her is that the study showed cognitive training provided definite benefit in some areas, even if not on a specific memory test.
Rebok likewise isn’t disheartened by the results. In this case, he notes, the intervention was quite limited, and effects were visible after five years, even if not after 10. “This suggests that a lot can be done, but maybe to find even stronger effects that might last up through 10 years, we just need a larger dose of training or maybe other training techniques,” he says. “We focused around a set of techniques that were targeted primarily for memory of lists of items, like lists of words, and memory for text materials ... but there are lots of different types of memory: memory for numbers, memory for names and faces.”
Starting training earlier also could make a difference, King says. In the ACTIVE study, patients were in their mid 70s when the training was conducted, but had the intervention targeted younger patients, it’s possible the benefits would be more substantial and longer lasting.
Implications for Patients
Rebok also cautions that it’s unclear how well the techniques in the ACTIVE study would work for a population with cognitive impairments. (The ACTIVE study subjects were all fairly healthy, and those with any significant cognitive impairments were screened out.) Because of the various questions that still remain, more research is needed before the authors can encourage senior centers and community-based programs to start conducting brain-training courses on a large scale.
Despite the unanswered questions, however, one clear takeaway is that physicians should emphasize to patients the value of remaining cognitively active. “Across the whole body of studies that vary a great deal in their populations and in their details,” Doody says, “the message we’re getting is that people who stimulate their brain in formal ways from the earliest times in life onward do better over time.” The key, she says, is that stimulation must be active rather than passive. It’s far more beneficial to play bridge or play an instrument, for example, than to do something passive, such as watching a sport.
Moreover, it’s important that older adults stimulate their brains in a variety of ways rather than focusing on a single type of mental exercise. For example, patients can do different types of cognitive puzzles, Rebok says, but they also should challenge themselves in tasks of everyday life such as by not reaching for a calculator to figure out a math problem or by pushing themselves to read a newspaper article and then summarize the contents for a friend.
But physicians should encourage patients not to focus exclusively on cognitive stimulation to the detriment of other healthful habits. It’s worrisome if an older adult devotes time to computerized brain training activities, for example, at the expense of other activities that are known to have tremendous benefit in the aging process, such as physical exercise or maintaining a healthful diet, King says. Older adults who want to maintain their cognitive abilities should be reminded that preserving the mind doesn’t depend on direct cognitive stimulation alone; it’s a matter of engaging in a full range of healthful habits.
— Jamie Santa Cruz is a freelance writer based in New York City.