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A specific regimen of computer-based brain exercises focused on visual processing speed may lower the long-term risk of receiving a dementia diagnosis. A new analysis of data spanning two decades suggests that older adults who engaged in this adaptive training, provided they participated in follow-up sessions, were approximately 25 percent less likely to be diagnosed with dementia compared to a control group. These results were published in the journal Alzheimer’s & Dementia: Translational Research & Clinical Interventions.
The search for effective ways to prevent or delay Alzheimer’s disease and related dementias is a primary focus of modern medical research. While physical exercise and diet are frequently cited as potential protective factors, the role of specific cognitive training remains a subject of intense debate. Many commercial products promise to sharpen the mind, yet scientific evidence supporting their ability to prevent disease has been inconsistent. To address this uncertainty, researchers revisited data from a gold-standard clinical trial to see if specific interventions had lasting effects on brain health.
The research was led by Norma B. Coe, a professor at the Perelman School of Medicine at the University of Pennsylvania. Coe and her colleagues sought to understand if the benefits of cognitive training could be detected in medical records twenty years after the training took place. They focused on whether different types of mental exercises had varying impacts on the likelihood of a patient developing dementia as they aged into their eighties and nineties.
The team utilized data from the Advanced Cognitive Training for Independent and Vital Elderly study. Known as the ACTIVE study, this large-scale project began in the late 1990s. It was designed as a randomized controlled trial, which is widely considered the most rigorous method for determining cause and effect in science. The original trial enrolled nearly 3,000 healthy adults over the age of 65 living in the community.
Participants in the ACTIVE study were randomly assigned to one of four groups. The first group received memory training. This instruction focused on teaching strategies for remembering word lists and sequences of items. The second group received reasoning training. These sessions involved identifying patterns in number series and solving problems related to daily living. The third group received speed of processing training. The fourth group served as a control and received no training.
The speed of processing intervention was distinct from the other two. It involved a computer-based task designed to improve the user’s visual attention. Participants were asked to identify an object in the center of the screen while simultaneously locating a target in the periphery. As the user improved, the program became faster and the tasks became more difficult. This made the training “adaptive,” meaning it constantly pushed the participant to the limit of their ability.
The initial training period lasted for five to six weeks. Researchers offered a subset of participants “booster” sessions. These additional training blocks occurred one year and three years after the initial enrollment. The goal of these boosters was to reinforce the skills learned during the first phase.
To determine long-term outcomes, Coe and her team linked the original study data with Medicare claims records spanning from 1999 to 2019. This allowed the researchers to track the participants for up to 20 years. They looked for diagnostic codes indicating Alzheimer’s disease or other forms of dementia. By using insurance claims, the team could identify diagnoses made by doctors in real-world clinical settings, even for participants who had stopped communicating with the original study organizers.
The analysis included 2,021 of the original participants. The results revealed a specific and isolated benefit. Participants who underwent the speed of processing training and attended at least one booster session showed a reduced risk of diagnosed dementia. The hazard ratio was 0.75, indicating a 25 percent lower risk compared to the control group.
The study did not find similar benefits for the other groups. Participants who received memory training or reasoning training did not show a statistically distinct difference in dementia diagnosis rates compared to the control group. This was true even if they attended booster sessions. Additionally, individuals in the speed training group who did not attend the booster sessions showed no reduction in risk. The protective effect appeared to depend on the combination of the specific visual speed task and the reinforcement provided by the follow-up sessions.
The researchers propose several reasons why the speed training might have yielded different results than the memory or reasoning exercises. One hypothesis centers on the type of memory engaged. The memory and reasoning interventions relied on “declarative memory.” This involves learning explicit strategies and conscious techniques to solve problems. In contrast, the speed training engaged “procedural memory.” This type of learning becomes automatic and unconscious through repetition, similar to riding a bike.
Another key difference was the adaptive nature of the speed task. The computer program adjusted the difficulty in real-time. This ensured that participants were always challenged, potentially stimulating the brain more effectively than the static strategies taught in the other groups. The authors suggest that this intense, adaptive engagement of the brain’s processing systems might facilitate neuroplasticity, or the brain’s ability to rewire itself.
The findings align with previous, shorter-term analyses of the ACTIVE study, which had hinted at cognitive benefits for the speed training group. However, this is the first analysis to use Medicare claims to confirm a reduction in diagnosed disease over such a lengthened timeframe.
“This work conveys a clear message but also leads us to ask many new questions. We are keen to dig deeper to understand the underlying mechanisms at play here, but ultimately this is a great problem to have,” said Marilyn Albert, the corresponding study author and director of the Johns Hopkins Alzheimer’s Disease Research Center at the Johns Hopkins School of Medicine.
There are limitations to the study that provide context for the results. The analysis relied on administrative billing codes rather than direct neurological examinations of every participant. This means a diagnosis would only be recorded if a participant visited a doctor and the doctor coded the visit correctly. It is possible that some participants developed dementia but were never formally diagnosed.
The study also excluded participants who were enrolled in Medicare Advantage plans because complete claims data were not available for them. If the population in Medicare Advantage plans differs in health or socioeconomic status from those in traditional Medicare, it could influence the generalizability of the findings. Additionally, the researchers noted that individuals with higher education levels or better access to healthcare are often more likely to receive a dementia diagnosis, which could introduce bias into the claims data.
Despite these caveats, the results offer a potential avenue for preventative intervention. “The findings reported here suggest that moderate cognitive training could delay the onset of dementia over subsequent years,” said Richard Hodes, director of the National Institute on Aging, in a press release. “There is still more research to be done to determine about how this works, but this promising lead may move the field further into developing effective interventions to delay or prevent onset of dementia.”
Future research will likely focus on isolating the specific mechanisms that made the speed training effective. Scientists need to understand if the benefit comes from the visual aspect of the task, the speed component, or the adaptive difficulty. Understanding why the memory and reasoning strategies failed to prevent disease diagnosis is equally important for designing future public health programs.
The study also raises questions about the optimal “dose” of training. Since the benefit was only seen in those who received booster sessions, it suggests that brain training may be like physical exercise: it requires maintenance to remain effective.
“This study shows that simple brain training, done for just weeks, may help people stay mentally healthy for years longer,” said Jay Bhattacharya, a director at the National Institutes of Health. “That’s a powerful idea — that practical, affordable tools could help delay dementia and help older adults keep their independence and quality of life.”
The study, “Impact of cognitive training on claims-based diagnosed dementia over 20 years: evidence from the ACTIVE study,” was authored by Norma B. Coe, Katherine E. M. Miller, Chuxuan Sun, Elizabeth Taggert, Alden L. Gross, Richard N. Jones, Cynthia Felix, Marilyn S. Albert, George W. Rebok, Michael Marsiske, Karlene K. Ball, and Sherry L. Willis.
