This application extends follow-up of old and very-old persons who have received cognitive interventions as part of ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly). Findings at five years indicate the effects of the interventions on cognitive abilities are durable and that these intervention effects have transferred to maintenance of IADL function as hypothesized.
The Specific Aims of this extended follow-up are: 1) To determine if the cognitive interventions continue to have protective effects up to 10 years after initial training on: a) basic cognitive abilities of memory, reasoning, and speed or processing;b) self- reported and performance-based instrumental activities of daily living;and c) health-related quality of life. 2) To determine if the cognitive interventions have beneficial effects on the distal outcomes of driving safety, personal care activities of daily living, health service utilization, and mortality. 3) To examine heath, genetic and cognitive moderators in individual response to training, including such factors as low cognitive function, cardiovascular status, engagement, and ApoE genotype. 4) To estimate and project the effects of ACTIVE training to the general population of older adults by linking the measures and outcomes of ACTIVE to the Health and Retirement Study. This application affords a unique opportunity to prospectively study lagged effects of three types of cognitive interventions on functional decline in this well-characterized cohort that, given its advancing age, is now at imminent risk for both IADL and ADL decline. We will be able to test the basic question in this study: For older adults exposed to these cognitive interventions, can disability in the performance of key everyday activities be delayed and independence maintained as subjects age into their 80s. We estimate power to detect effect sizes of 0.2 over 10 years for the cognitive abilities, everyday problem solving, and everyday speed and an effect size of 0.4 for everyday functioning. The ACTIVE study will determine if cognitive . training can help older adults to continue functioning and living independently for a longer period of time. This application is a renewal of the application titled """"""""Trial of a Cognitive Intervention for Older Adults."""""""" This application is for the Field Site at Johns Hopkins University. Phase I of ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly) was a randomized controlled trial of three cognitive intervention arms, addressing the question of whether improving basic cognition aided in maintaining functional independence in elders. As to be reported in JAMA (11112102), Phase I found strong, broad, and durable cognitive ability-specific training effects. The effect sizes were comparable to or greater than the amount of cognitive decline observed in other longitudinal studies, suggesting that the interventions have the potential to reverse age-related decline. There was minimal transfer of training effects to everyday activities (i.e., functional competence). However, it should be noted that through the two-year followup, there was no evidence of a significant decline in ADL and IADL status. Therefore, to adequately understand the cognitive transfer effects of the training interventions, a longer followup period is required, particularly to see whether there is a separation of the change trajectories for everyday activities of trained and untrained participants over time. Phase II of ACTIVE is proposed as a followup study focused on measuring the long-term impact of training effects on cognitive function and cognitively demanding everyday activities. The Phase II followup will consist of one assessment to include the Phase I post-test battery and a clinical assessment. The ACTIVE cohort (n = 2832) is a special sample, containing substantial oversampling of African American, socioeconomically poor, and very old adults.
The Specific Aims of Phase II of ACTIVE are: 1) to determine whether the cognitive interventions (as initial treatment or as a consequence of repeated boosters) have long-term protective effects on functional outcomes;2) to document any delayed transfer of the cognitive training to secondary outcomes;and 3) to identify individual factors that affect response to intervention. As in Phase I, the primary analytical approach to detecting treatment effects on both cognitive and functional abilities will be a repeated-measures, mixed-effects model incorporating all design features as fixed effects and individual-level variability as random effects. Other multivariate analyses including lagged and cross-lagged analyses of change using latent change analysis, structural equation modeling, and growth curve analyses will also be used as appropriate to characterize relationships between individual difference factors and change in functional competence. Retention is projected conservatively at 72% with 65% of the cohort providing full data and another 7% providing partial data at year 5. Power analysis shows that extending the study will make it possible to observe effect sizes on the order of 0.05-0.10 with excellent power, in the range of at least 80-90%.
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