Hostname: page-component-5db6c4db9b-bhjbq Total loading time: 0 Render date: 2023-03-25T09:00:06.675Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

ACTIVE Cognitive Training and Rates of Incident Dementia

Published online by Cambridge University Press:  09 March 2012

Frederick W. Unverzagt*
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
Lin T. Guey
New England Research Institutes, Watertown, Massachusetts
Richard N. Jones
Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts
Michael Marsiske
Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
Jonathan W. King
Division of Behavioral and Social Research, National Institute on Aging, Bethesda, Maryland
Virginia G. Wadley
Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Michael Crowe
Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
George W. Rebok
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Sharon L. Tennstedt
New England Research Institutes, Watertown, Massachusetts
Correspondence and reprint requests to: Frederick W. Unverzagt, Department of Psychiatry, Indiana University School of Medicine, 1111 W. 10th Street, Suite PB 218A, Indianapolis, IN 46202. E-mail:


Systematic cognitive training produces long-term improvement in cognitive function and less difficulty in performing activities of daily living. We examined whether cognitive training was associated with reduced rate of incident dementia. Participants were from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (n = 2,802). Incident dementia was defined using a combination of interview- and performance-based methods. Survival analysis was used to determine if ACTIVE treatment affected the rate of incident dementia during 5 years of follow-up. A total of 189 participants met criteria for incident dementia. Baseline factors predictive of incident dementia were older age, male gender, African American race, fewer years of education, relationship other than married, no alcohol use, worse MMSE, worse SF-36 physical functioning, higher depressive symptomatology, diabetes, and stroke (all p < .05). A multivariable model with significant predictors of incident dementia and training group revealed that cognitive training was not associated with a lower rate of incident dementia. Cognitive training did not affect rates of incident dementia after 5 years of follow-up. Longer follow-up or enhanced training may be needed to fully explore the preventive capacity of cognitive training in forestalling onset of dementia. (JINS, 2012, 18, 1–9)

Research Articles
Copyright © The International Neuropsychological Society 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)



Acevedo, A., Loewenstein, D.A. (2007). Nonpharmacological cognitive interventions in aging and dementia. Journal of Geriatric Psychiatry and Neurology, 20(4), 239249.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (1994). DSM-IV: Diagnostic and Statistical Manual of Mental Disorders (Vol. 4). Washington, DC: American Psychiatric Association.Google Scholar
Arvanitakis, Z., Wilson, R.S., Bienias, J.L., Evans, D.A., Bennett, D.A. (2004). Diabetes mellitus and risk of Alzheimer disease and decline in cognitive function. Archives of Neurology, 61(5), 661666.CrossRefGoogle ScholarPubMed
Ball, K., Berch, D.B., Helmers, K.F., Jobe, J.B., Leveck, M.D., Marsiske, M., ACTIVE Study Group. (2002). Effects of cognitive training interventions with older adults: A randomized controlled trial. Journal of the American Medical Association, 288(18), 22712281.CrossRefGoogle ScholarPubMed
Brandt, J. (1991). The Hopkins Verbal Learning Test: Development of a new memory test with six equivalent forms. The Clinical Neuropsychologist, 5(2), 125142.CrossRefGoogle Scholar
Caamano-Isorna, F., Corral, M., Montes-Martinez, A., Takkouche, B. (2006). Education and dementia: A meta-analytic study. Neuroepidemiology, 26(4), 226232.CrossRefGoogle ScholarPubMed
Colditz, G.A., Martin, P., Stampfer, M.J., Willett, W.C., Sampson, L., Rosner, B., Speizer, F.E. (1986). Validation of questionnaire information on risk factors and disease outcomes in a prospective Cohort Study of women. American Journal of Epidemiology, 123(5), 894900.CrossRefGoogle Scholar
Daviglus, M.L., Bell, C.C., Berrettini, W., Bowen, P.E., Connolly, E.S., Cox, N.J., Trevisan, M. (2010). National Institutes of Health State-of-the-Science Conference Statement: Preventing Alzheimer disease and cognitive decline. Annals of Internal Medicine, 153(3), 176181.CrossRefGoogle ScholarPubMed
Ekstrom, R.B., French, J.W., Harman, H., Derman, D. (1976). Kit of factor referenced cognitive tests (Vol. Revised). Princeton, NJ: Educational Testing Service.Google Scholar
Euser, S.M., Schram, M.T., Hofman, A., Westendorp, R.G., Breteler, M.M. (2008). Measuring cognitive function with age: The influence of selection by health and survival. Epidemiology, 19(3), 440447.CrossRefGoogle Scholar
Evans, D.A., Bennett, D.A., Wilson, R.S., Bienias, J.L., Morris, M.C., Scherr, P.A., Schneider, J. (2003). Incidence of Alzheimer disease in a biracial urban community: Relation to apolipoprotein E allele status. Archives of Neurology, 60(2), 185189.CrossRefGoogle Scholar
Folstein, M.F., Folstein, S.E., McHugh, P.R. (1975). Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle ScholarPubMed
Friedland, R.P. (1993). Epidemiology, education, and the ecology of Alzheimer's disease. Neurology, 43, 246249.CrossRefGoogle ScholarPubMed
Ganguli, M., Dodge, H.H., Chen, P., Belle, S., DeKosky, S.T. (2000). Ten-year incidence of dementia in a rural elderly US community population: The MoVIES Project. Neurology, 54(5), 11091116.CrossRefGoogle Scholar
Gao, S., Hendrie, H.C., Hall, K.S., Hui, S. (1998). The relationships between age, sex, and the incidence of dementia and Alzheimer disease: A meta-analysis. Archives of General Psychiatry, 55, 809815.CrossRefGoogle ScholarPubMed
Gonda, J., Schaie, K. (1985). Schaie-Thurstone Mental Abilities Test: Word Series Test. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Hendrie, H.C., Ogunniyi, A., Hall, K.S., Baiyewu, O., Unverzagt, F.W., Gureje, O., Hui, S.L. (2001). Incidence of dementia and Alzheimer disease in 2 communities: Yoruba residing in Ibadan, Nigeria, and African Americans residing in Indianapolis, Indiana. Journal of the American Medical Association, 285, 739747.CrossRefGoogle ScholarPubMed
Jean, L., Bergeron, M.E., Thivierge, S., Simard, M. (2010). Cognitive intervention programs for individuals with mild cognitive impairment: Systematic review of the literature. American Journal of Geriatric Psychiatry, 18(4), 281296.CrossRefGoogle ScholarPubMed
Jobe, J.B., Smith, D.M., Ball, K., Tennstedt, S.L., Marsiske, M., Willis, S.L., Kleinman, K. (2001). ACTIVE: A cognitive intervention trial to promote independence in older adults. Controlled Clinical Trials, 22, 453479.CrossRefGoogle ScholarPubMed
Katzman, R. (1993). Education and the prevalence of dementia and Alzheimer's disease. Neurology, 43, 1320.CrossRefGoogle ScholarPubMed
Landi, F., Tua, E., Onder, G., Carrara, B., Sgadari, A., Rinaldi, C., SILVERNET-HC Study Group of Bergamo. (2000). Minimum data set for home care: A valid instrument to assess frail older people living in the community. Medical Care, 38(12), 11841190.CrossRefGoogle ScholarPubMed
Launer, L.J., Andersen, K., Dewey, M.E., Letenneur, L., Ott, A., Amaducci, L.A., Hofman, A. (1999). Rates and risk factors for dementia and Alzheimer's disease: Results from EURODEM pooled analyses. EURODEM Incidence Research Group and Work Groups. European Studies of Dementia. Neurology, 52(1), 7884.CrossRefGoogle Scholar
Lazarov, O., Robinson, J., Tang, Y.P., Hairston, I.S., Korade-Mirnics, Z., Lee, V.M., Sisodia, S.S. (2005). Environmental enrichment reduces Abeta levels and amyloid deposition in transgenic mice. Cell, 120(5), 701713.CrossRefGoogle ScholarPubMed
Lindsay, J., Laurin, D., Verreault, R., Hebert, R., Helliwell, B., Hill, G.B., McDowell, I. (2002). Risk factors for Alzheimer's disease: A prospective analysis from the Canadian Study of Health and Aging. American Journal of Epidemiology, 156(5), 445453.CrossRefGoogle ScholarPubMed
McCallum, J., Simons, L.A., Simons, J., Friedlander, Y. (2007). Delaying dementia and nursing home placement: The Dubbo study of elderly Australians over a 14-year follow-up. Healthy Aging and Longevity, 1114, 121129.Google Scholar
Mitchell, A.J. (2009). A meta-analysis of the accuracy of the mini-mental state examination in the detection of dementia and mild cognitive impairment. Journal of Psychiatric Research, 43(4), 411431.CrossRefGoogle ScholarPubMed
Morris, J.N., Fries, B.E., Steel, K., Ikegami, N., Bernabei, R., Carpenter, G.I., Topinkova, E. (1997). Comprehensive clinical assessment in community setting: Applicability of the MDS-HC. Journal of the American Geriatrics Society, 45(8), 10171024.CrossRefGoogle ScholarPubMed
Oksanen, T., Kivimaki, M., Pentti, J., Virtanen, M., Klaukka, T., Vahtera, J. (2010). Self-Report as an indicator of incident disease. Annals of Epidemiology, 20(7), 547554.CrossRefGoogle ScholarPubMed
Okura, Y., Urban, L.H., Mahoney, D.W., Jacobsen, S.J., Rodeheffer, R.J. (2004). Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. Journal of Clinical Epidemiology, 57(10), 10961103.CrossRefGoogle Scholar
O'Mahony, P.G., Dobson, R., Rodgers, H., James, O.F., Thomson, R.G. (1995). Validation of a population screening questionnaire to assess prevalence of stroke. Stroke, 26(8), 13341337.CrossRefGoogle ScholarPubMed
Owsley, C., Ball, K., McGwin, G., Sloane, M.E., Roenker, D.L., White, M.F., Overley, E.T. (1998). Visual processing impairment and risk of motor vehicle crash among older adults. Journal of the American Medical Association, 279(14), 10831088.CrossRefGoogle ScholarPubMed
Petersen, R.C., Thomas, R.G., Grundman, M., Bennett, D., Doody, R., Ferris, S., Group, T.A.s.D.C.S. (2005). Vitamin E and Donepezil for the treatment of mild cognitive impairment. The New England Journal of Medicine, 353(9), 951952.Google Scholar
Plassman, B.L., Langa, K.M., Fisher, G.G., Heeringa, S.G., Weir, D.R., Ofstedal, M.B., Wallace, R.B. (2007). Prevalence of dementia in the united states: The aging, demographics, and memory study. Neuroepidemiology, 29(1–2), 125132.CrossRefGoogle ScholarPubMed
Plassman, B.L., Langa, K.M., McCammon, R.J., Fisher, G.G., Potter, G.G., Burke, J.R., Wallace, R.B. (2011). Incidence of dementia and cognitive impairment not dementia in the United States. Annals of Neurology, 70(3), 418426.CrossRefGoogle Scholar
R Foundation for Statistical Computing. (2010). A language and environment for statistical computing. (Version 2.12.0). Vienna, Austria: R Foundation for Statistical Computing. Retrieved from Scholar
Radloff, L.S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measures, 1, 385401.CrossRefGoogle Scholar
Rey, A. (1941). L'examen psychologique dans les cas d'encephalopathie traumatique. Archives de Psychologie, 28, 286340.Google Scholar
Saczynski, J.S., Beiser, A., Seshadri, S., Auerbach, S., Wolf, P.A., Au, R. (2010). Depressive symptoms and risk of dementia: The Framingham Heart Study. Neurology, 75(1), 3541.CrossRefGoogle ScholarPubMed
Satz, P. (1993). Brain reserve capacity on symptom onset after brain injury: A formulation and review of evidence for threshold theory. Neuropsychology, 7, 273295.CrossRefGoogle Scholar
Scarmeas, N., Levy, G., Tang, M.X., Manly, J., Stern, Y. (2001). Influence of leisure activity on the incidence of Alzheimer's Disease. Neurology, 57(12), 22362242.CrossRefGoogle ScholarPubMed
Siwak-Tapp, C.T., Head, E., Muggenburg, B.A., Milgram, N.W., Cotman, C.W. (2008). Region specific neuron loss in the aged canine hippocampus is reduced by enrichment. Neurobiology of Aging, 29(1), 3950.CrossRefGoogle ScholarPubMed
Sloane, P.D., Zimmerman, S., Suchindran, C., Reed, P., Wang, L., Boustani, M., Sudha, S. (2002). The public health impact of Alzheimer's disease 2000-2050: Potential implication of treatment advances. Annual Review of Public Health, 23, 213231.CrossRefGoogle ScholarPubMed
Stern, Y., Gurland, B., Tatemichi, T.K., Tang, M.X., Wilder, D., Mayeux, R. (1994). Influence of education and occupation on the incidence of Alzheimer's disease. Journal of the American Medical Association, 271, 10041010.CrossRefGoogle ScholarPubMed
Tang, M.X., Cross, P., Andrews, H., Jacobs, D.M., Small, S., Bell, K., Mayeux, R. (2001). Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan. Neurology, 56(1), 4956.CrossRefGoogle ScholarPubMed
Thurstone, L., Thurstone, T. (1949). Examiner Manual for the SRA Primary Mental Abilities Test (Form 10-14). Chicago, IL: Science Research Associates.Google Scholar
Verghese, J., Lipton, R.B., Katz, M.J., Hall, C.B., Derby, C.A., Kuslansky, G., Buschke, H. (2003). Leisure activities and the risk of dementia in the elderly. New England Journal of Medicine, 348(25), 25082516.CrossRefGoogle ScholarPubMed
Ware, J.E., Sherbourne, C.D. (1992). The MOS 36-Item Short-Form Health Survey (Sf-36) .1. Conceptual-framework and item selection. Medical Care, 30(6), 473483.CrossRefGoogle ScholarPubMed
Willis, S.L., Tennstedt, S.L., Marsiske, M., Ball, K., Elias, J., Koepke, K.M., ACTIVE Study Group. (2006). Long-term effects of cognitive training on everyday functional outcomes in older adults. Journal of the American Medical Association, 296(23), 28052814.CrossRefGoogle ScholarPubMed
Wilson, B., Cockburn, J., Baddeley, A. (1985). The Rivermead Behavioral Memory Test. Reading, England: Thames Valley Test Co.Google Scholar
Wilson, R.S., Barnes, L.L., Mendes de Leon, C.F., Aggarwal, N.T., Schneider, J.S., Bach, J., Bennett, D.A. (2002). Depressive symptoms, cognitive decline, and risk of AD in older persons. Neurology, 59(3), 364370.CrossRefGoogle ScholarPubMed
Wilson, R.S., Bennett, D.A., Bienias, J.L., Aggarwal, N.T., Mendes De Leon, C.F., Morris, M.C., Evans, D.A. (2002). Cognitive activity and incident AD in a population-based sample of older persons. Neurology, 59(12), 19101914.CrossRefGoogle Scholar