Speed-Focused Cognitive Training With Booster Sessions Linked to Lower Dementia Diagnoses Over 20 Years
Long-term follow-up data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study indicate that a specific form of cognitive training—speed of processing training combined with booster sessions—was associated with a lower risk of claims-based diagnoses of Alzheimer’s disease and related dementias (ADRD) over two decades, while memory and reasoning training showed no statistically significant effect.
The findings were published in Alzheimer’s & Dementia: Translational Research & Clinical Interventions and are based on linkage of ACTIVE trial data with Medicare claims spanning 1999 to 2019 . ACTIVE was a large, multisite, randomized controlled trial that enrolled 2,802 community-dwelling adults aged 65 years and older between 1998 and 1999. The present analysis included 2,021 participants who were enrolled in traditional Medicare at baseline and free of diagnosed dementia at study entry.
Participants in ACTIVE were randomized to one of four arms: speed of processing training, memory training, reasoning training, or a no-contact control group. Each intervention consisted of up to ten training sessions over several weeks. Individuals who completed at least eight sessions were subsequently eligible for randomization to booster training at 11 and 35 months after baseline. The primary outcome for the current analysis was a diagnosis of ADRD identified through Medicare claims using the Chronic Conditions Warehouse algorithm.
Over 20 years of follow-up, 48.7 percent of participants in the control group received a diagnosis of ADRD. When comparing each intervention arm with the control group, none of the three cognitive training programs demonstrated a statistically significant reduction in dementia risk in the absence of booster sessions. Hazard ratios for memory, reasoning, and speed training without boosters were close to 1.0 after adjustment for demographic, clinical, and baseline cognitive factors.
A different pattern emerged among participants in the speed-training arm who received booster sessions. In this subgroup, the adjusted hazard ratio for diagnosed ADRD was 0.75 compared with controls, corresponding to a 25 percent lower relative risk. Speed-trained participants who did not receive booster sessions showed no reduction in ADRD risk, with an adjusted hazard ratio of 1.01. Direct comparisons within the speed-training arm indicated a lower hazard of ADRD among those randomized to boosters than among booster-eligible participants who did not receive them.
Memory and reasoning training did not demonstrate statistically significant associations with ADRD risk, either with or without booster sessions. Although participants in the reasoning-plus-booster group showed a lower unadjusted risk of dementia, this association did not remain statistically significant after covariate adjustment.
The analysis also examined whether age at the time of training modified the effect of the interventions. No statistically significant interactions were observed between age group and any training arm, indicating that the association between speed training with boosters and reduced ADRD diagnoses was consistent across baseline age categories.
The speed-of-processing intervention in ACTIVE focused on visual attention and rapid information processing using adaptive, computer-based tasks that increased in difficulty as performance improved. In contrast, memory and reasoning interventions emphasized strategy-based approaches. The authors note that the adaptive and procedural nature of speed training, combined with reinforcement through booster sessions, may account for the observed differences in long-term outcomes, though causal mechanisms were not directly assessed.
Several limitations were acknowledged. Dementia diagnoses were identified through administrative claims rather than clinical adjudication, and participants enrolled in Medicare Advantage plans were excluded because of incomplete claims data. In addition, booster training was offered only to a subset of participants who completed initial training, introducing potential selection effects despite randomization within the booster-eligible group.
Despite these limitations, the study represents one of the longest follow-ups of a randomized cognitive training trial with a real-world clinical outcome. The results indicate that speed-focused cognitive training, when reinforced with booster sessions, was associated with a lower likelihood of diagnosed ADRD over 20 years, whereas other cognitive training approaches were not associated with reduced dementia diagnoses.