The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study is the largest randomized clinical trial (N = 2802) of the efficacy of cognitive training in improving cognitive and everyday functioning in normal older adults. To our knowledge, the 26% African American (AA) ACTIVE sample is the largest study of minority older adults regarding the effectiveness of cognitive training. A 20-year ACTIVE follow-up (AG056486) is in progress, linking Medicare/Medicaid Claims, National Death Index, driving records, and credit reports, to examine the association of training effectiveness with long-term reduction in disability, loss of independence, and incident dementia in advanced old age. This 20-year follow-up involves no funding or aims directed toward examination of long-term training effects for the AA sample. The proposed supplement would provide funding for an in-depth examination of the association between race and social determinants of health (SDoH) in regard to long-term training effectiveness for AA on cognitive abilities, everyday functioning, and incidence of dementia. Supplement findings will fill a critical knowledge gap regarding the role of SDoH in understanding racial disparities in the efficacy of cognitive training, thereby informing future generations of cognitive intervention research and the role of intervention in regard to the significantly higher incidence of dementias in AA older adults. Moreover, the supplement would involve multiple AA and minority co- investigators through the support and collaboration of RCMAR and AD-RCMAR centers at JHU, UAB, and UF. ACTIVE participants trained on memory, reasoning, or processing speed performed significantly above controls at 5- and 10-year follow-ups on cognitive tasks in their respective domain of training. In addition, trained participants in all training arms reported less difficulty in performing IADL tasks at 10-year follow-up. Speed and reasoning training were associated with a reduced incidence of auto crashes as well as reduction in the number of participants who ceased driving relative to controls. At 10-year follow-up, promising findings suggested an effect of training on incidence of Alzheimer's disease (AD) and related dementias. The proposed supplement will enable us to examine how race and SDoH affect cognitive training and the long-term outcomes of training. If the training programs evaluated are shown to be protective against long-term outcomes, this would suggest that early intervention may help to reduce health disparities in AD and related disorders and provide benefit to all older adults.
The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized clinical trial (N =2802), which involved 26% African American participants, found that cognitive training enhanced both cognitive abilities, everyday functioning, and independent living at 5- and 10-year follow-ups. The Supplement would examine the association of race and social determinants of health in regard to cognition, cognitive training effects and everyday functioning. Given African Americans suffer lifelong disadvantages and receive earlier and more frequent diagnoses of cognitive impairment or dementia, findings regarding the relationship between race and social determinants in relation to cognitive training and dementia can have significant public health benefits in planning future intervention efforts and in improving the lives of future cohorts of African American elders.
