Skip to main content
    • Aa
    • Aa

ACTIVE Cognitive Training and Rates of Incident Dementia

  • Frederick W. Unverzagt (a1), Lin T. Guey (a2), Richard N. Jones (a3), Michael Marsiske (a4), Jonathan W. King (a5), Virginia G. Wadley (a6), Michael Crowe (a7), George W. Rebok (a8) and Sharon L. Tennstedt (a2)...

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)

Corresponding author
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:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

A. Acevedo , D.A. Loewenstein (2007). Nonpharmacological cognitive interventions in aging and dementia. Journal of Geriatric Psychiatry and Neurology, 20(4), 239249.

Z. Arvanitakis , R.S. Wilson , J.L. Bienias , D.A. Evans , D.A. Bennett (2004). Diabetes mellitus and risk of Alzheimer disease and decline in cognitive function. Archives of Neurology, 61(5), 661666.

K. Ball , D.B. Berch , K.F. Helmers , J.B. Jobe , M.D. Leveck , M. Marsiske , 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.

J. Brandt (1991). The Hopkins Verbal Learning Test: Development of a new memory test with six equivalent forms. The Clinical Neuropsychologist, 5(2), 125142.

F. Caamano-Isorna , M. Corral , A. Montes-Martinez , B. Takkouche (2006). Education and dementia: A meta-analytic study. Neuroepidemiology, 26(4), 226232.

M.L. Daviglus , C.C. Bell , W. Berrettini , P.E. Bowen , E.S. Connolly , N.J. Cox , M. Trevisan (2010). National Institutes of Health State-of-the-Science Conference Statement: Preventing Alzheimer disease and cognitive decline. Annals of Internal Medicine, 153(3), 176181.

S.M. Euser , M.T. Schram , A. Hofman , R.G. Westendorp , M.M. Breteler (2008). Measuring cognitive function with age: The influence of selection by health and survival. Epidemiology, 19(3), 440447.

D.A. Evans , D.A. Bennett , R.S. Wilson , J.L. Bienias , M.C. Morris , P.A. Scherr , J. Schneider (2003). Incidence of Alzheimer disease in a biracial urban community: Relation to apolipoprotein E allele status. Archives of Neurology, 60(2), 185189.

M.F. Folstein , S.E. Folstein , P.R. McHugh (1975). Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.

R.P. Friedland (1993). Epidemiology, education, and the ecology of Alzheimer's disease. Neurology, 43, 246249.

M. Ganguli , H.H. Dodge , P. Chen , S. Belle , S.T. DeKosky (2000). Ten-year incidence of dementia in a rural elderly US community population: The MoVIES Project. Neurology, 54(5), 11091116.

S. Gao , H.C. Hendrie , K.S. Hall , S. Hui (1998). The relationships between age, sex, and the incidence of dementia and Alzheimer disease: A meta-analysis. Archives of General Psychiatry, 55, 809815.

H.C. Hendrie , A. Ogunniyi , K.S. Hall , O. Baiyewu , F.W. Unverzagt , O. Gureje , S.L. Hui (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.

L. Jean , M.E. Bergeron , S. Thivierge , M. Simard (2010). Cognitive intervention programs for individuals with mild cognitive impairment: Systematic review of the literature. American Journal of Geriatric Psychiatry, 18(4), 281296.

J.B. Jobe , D.M. Smith , K. Ball , S.L. Tennstedt , M. Marsiske , S.L. Willis , K. Kleinman (2001). ACTIVE: A cognitive intervention trial to promote independence in older adults. Controlled Clinical Trials, 22, 453479.

R. Katzman (1993). Education and the prevalence of dementia and Alzheimer's disease. Neurology, 43, 1320.

F. Landi , E. Tua , G. Onder , B. Carrara , A. Sgadari , C. Rinaldi , 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.

L.J. Launer , K. Andersen , M.E. Dewey , L. Letenneur , A. Ott , L.A. Amaducci , A. Hofman (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.

O. Lazarov , J. Robinson , Y.P. Tang , I.S. Hairston , Z. Korade-Mirnics , V.M. Lee , S.S. Sisodia (2005). Environmental enrichment reduces Abeta levels and amyloid deposition in transgenic mice. Cell, 120(5), 701713.

J. Lindsay , D. Laurin , R. Verreault , R. Hebert , B. Helliwell , G.B. Hill , I. McDowell (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.

A.J. Mitchell (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.

J.N. Morris , B.E. Fries , K. Steel , N. Ikegami , R. Bernabei , G.I. Carpenter , E. Topinkova (1997). Comprehensive clinical assessment in community setting: Applicability of the MDS-HC. Journal of the American Geriatrics Society, 45(8), 10171024.

T. Oksanen , M. Kivimaki , J. Pentti , M. Virtanen , T. Klaukka , J. Vahtera (2010). Self-Report as an indicator of incident disease. Annals of Epidemiology, 20(7), 547554.

Y. Okura , L.H. Urban , D.W. Mahoney , S.J. Jacobsen , R.J. Rodeheffer (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.

P.G. O'Mahony , R. Dobson , H. Rodgers , O.F. James , R.G. Thomson (1995). Validation of a population screening questionnaire to assess prevalence of stroke. Stroke, 26(8), 13341337.

C. Owsley , K. Ball , G. McGwin , M.E. Sloane , D.L. Roenker , M.F. White , E.T. Overley (1998). Visual processing impairment and risk of motor vehicle crash among older adults. Journal of the American Medical Association, 279(14), 10831088.

B.L. Plassman , K.M. Langa , G.G. Fisher , S.G. Heeringa , D.R. Weir , M.B. Ofstedal , R.B. Wallace (2007). Prevalence of dementia in the united states: The aging, demographics, and memory study. Neuroepidemiology, 29(1–2), 125132.

B.L. Plassman , K.M. Langa , R.J. McCammon , G.G. Fisher , G.G. Potter , J.R. Burke , R.B. Wallace (2011). Incidence of dementia and cognitive impairment not dementia in the United States. Annals of Neurology, 70(3), 418426.

L.S. Radloff (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measures, 1, 385401.

J.S. Saczynski , A. Beiser , S. Seshadri , S. Auerbach , P.A. Wolf , R. Au (2010). Depressive symptoms and risk of dementia: The Framingham Heart Study. Neurology, 75(1), 3541.

P. Satz (1993). Brain reserve capacity on symptom onset after brain injury: A formulation and review of evidence for threshold theory. Neuropsychology, 7, 273295.

N. Scarmeas , G. Levy , M.X. Tang , J. Manly , Y. Stern (2001). Influence of leisure activity on the incidence of Alzheimer's Disease. Neurology, 57(12), 22362242.

C.T. Siwak-Tapp , E. Head , B.A. Muggenburg , N.W. Milgram , C.W. Cotman (2008). Region specific neuron loss in the aged canine hippocampus is reduced by enrichment. Neurobiology of Aging, 29(1), 3950.

P.D. Sloane , S. Zimmerman , C. Suchindran , P. Reed , L. Wang , M. Boustani , S. Sudha (2002). The public health impact of Alzheimer's disease 2000-2050: Potential implication of treatment advances. Annual Review of Public Health, 23, 213231.

Y. Stern , B. Gurland , T.K. Tatemichi , M.X. Tang , D. Wilder , R. Mayeux (1994). Influence of education and occupation on the incidence of Alzheimer's disease. Journal of the American Medical Association, 271, 10041010.

M.X. Tang , P. Cross , H. Andrews , D.M. Jacobs , S. Small , K. Bell , R. Mayeux (2001). Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan. Neurology, 56(1), 4956.

J. Verghese , R.B. Lipton , M.J. Katz , C.B. Hall , C.A. Derby , G. Kuslansky , H. Buschke (2003). Leisure activities and the risk of dementia in the elderly. New England Journal of Medicine, 348(25), 25082516.

J.E. Ware , C.D. Sherbourne (1992). The MOS 36-Item Short-Form Health Survey (Sf-36) .1. Conceptual-framework and item selection. Medical Care, 30(6), 473483.

S.L. Willis , S.L. Tennstedt , M. Marsiske , K. Ball , J. Elias , K.M. Koepke , 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.

R.S. Wilson , L.L. Barnes , C.F. Mendes de Leon , N.T. Aggarwal , J.S. Schneider , J. Bach , D.A. Bennett (2002). Depressive symptoms, cognitive decline, and risk of AD in older persons. Neurology, 59(3), 364370.

R.S. Wilson , D.A. Bennett , J.L. Bienias , N.T. Aggarwal , C.F. Mendes De Leon , M.C. Morris , D.A. Evans (2002). Cognitive activity and incident AD in a population-based sample of older persons. Neurology, 59(12), 19101914.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of the International Neuropsychological Society
  • ISSN: 1355-6177
  • EISSN: 1469-7661
  • URL: /core/journals/journal-of-the-international-neuropsychological-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 27
Total number of PDF views: 99 *
Loading metrics...

Abstract views

Total abstract views: 308 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 24th May 2017. This data will be updated every 24 hours.