Can Brain Training Reduce Dementia Risk 20 Years Later?
A long-term study of older adults found that just 22 hours of speed-based cognitive training was linked to a lower risk of dementia two decades later.
Keeping the brain active may make it resilient to cognitive decline and Alzheimer’s. Several studies find that people who engage in reading, crossword puzzles and other games are less likely to be diagnosed with dementia.
Though this suggests a possible link, since the evidence is observational it isn’t clear if these activities are protective or if people who are cognitively healthy can stay more mentally active as they age. Some companies have also developed brain games, but for the most part, they’ve failed to test these games rigorously or show that they lead to meaningful improvements beyond the game.
More than 20 years ago, researchers recruited 2,832 healthy older adults to take part in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study to test whether specific types of brain training could lead to lasting improvements in everyday life.
A study published in the journal Translational Research & Clinical Interventions reviewed the Medicare claims data for the participants. “The original goal of the study was to see if this generalized everyday activities and at 10 years there was evidence that that was true,” Marilyn Albert, author of the study and a professor of neurology at Johns Hopkins University School of Medicine, told Being Patient.
The new analysis found that a subgroup of participants who received five weeks of speed training and at least one booster training session were less likely to be diagnosed with dementia 20 years later.
The ACTIVE brain training study
The researchers running the ACTIVE study randomized participants to a control group that received no training, or one of three groups focused on training speed, memory or reasoning. Each participant received 10 sessions of brain training over five weeks, consisting of two 60 to 75 minute sessions each week.
Researchers then assessed their cognitive health after training as well as one, two, three, five, and 10 years later. Those who completed at least eight of the initial sessions received booster training — an extra four hours at the end of the first year and an extra three hours at the end of the third year, or 22.5 hours of training in total.
The training improved the specific cognitive abilities targeted — reasoning, memory, or processing speed — and some of these domain-specific gains persisted for years.
After 20 years, participants who received the speed training along with a booster session were less likely to be diagnosed with dementia. Among 264 trained participants, only 105 developed dementia versus 239 out of 491 in the untrained group, translating to 47 fewer cases per 1,000 people or a 25 percent reduction in risk.
The speed training involved showing participants images on a screen, and having them make fast decisions about what to do, while also taking note of objects in the periphery. The games became more difficult as participants improved.
Why were these benefits only seen for speed training? “I wish we knew the answer to that question,” Albert said. The speed training was unique because unlike the memory and reasoning training, investigators didn’t give the participants tips on how to improve.
Since this form of training, called implicit learning, strengthens connections in the brain, it might explain how these benefits persisted. Still, the researchers didn’t have any imaging or biomarker data to confirm how the training impacted participants’ brains.
“At the time the study started, we didn’t actually have the kind of MRI sequences that we have now that would allow us to look at brain connectivity,” said Albert.
The speed training task is offered commercially by the company Posit Science as the Double Decision exercise, one of many brain games offered via its BrainHQ app. One of the study’s authors, Dr. Karlene Ball, helped develop the original training and now serves as a consultant for Posit Science, which owns it.
Some brain researchers caution benefits
While the study’s findings are impressive, some researchers remained cautious about the conclusions. Sarah Ackley, an epidemiologist at Brown University, who wasn’t involved in the study, raised concerns that the results might be false positives.
The researchers used more than 20 statistical tests to see if any aspect of the treatment was beneficial and only two of these tests suggested that the brain training was beneficial. “When you run that many tests, the chance of finding at least one statistically significant result just by chance increases substantially, even if none of the interventions truly work,” Ackley told Being Patient. “This is not an intervention I’d be willing to endorse.”
Baptiste Leurent, associate professor in medical statistics at University College London pointed to similar issues, writing to the Science Media Center that the booster group wasn’t comparable to the control group as they may be “possibly in poorer health than those who were able to complete the training.”
Even so, the ACTIVE study remains the largest randomized clinical trial of its kind. Albert finds the evidence persuasive. “If I were going to try anything,” she said, “this is the task I would try.”
