Clinical trial NCT00298558: ACTIVE: Advanced Cognitive Training for Independent and Vital Elderly
Official title: Trial of a Cognitive Intervention for Older Adults
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
PHASE3
Conditions: Aging
Healthy
Keywords: cognition disorder
cognitive behavior therapy
functional ability
Lead sponsor: Carelon Research
Sponsor class: OTHER
Collaborators: name: National Institute on Aging (NIA)
name: National Institute of Nursing Research (NINR)
First posted: 2006-03-02
Enrollment: 2832
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: The purpose of the ACTIVE study was to test if cognitive training interventions could maintain functional independence in elders by improving basic mental abilities, with follow-up assessments through five years.

Detailed description: ACTIVE was a 4-arm, single-blind, randomized controlled trial. The primary objective of ACTIVE was to test the effectiveness and durability of three distinct cognitive interventions in improving elders' performance on basic measures of cognition and measures of cognitively demanding daily activities (e.g., food preparation, driving, medication use, financial management). These interventions previously had been found successful in improving cognitive abilities under laboratory or small-scale field conditions.

The three interventions shared common design features: 1) equivalent intensity and duration; 2) small group settings in ten 60-75 minute sessions; 3) focus on strategies for solving problems, remembering, or responding quickly to information; 4) modeling and demonstration of strategy usage; 5) practice on exemplar problems; 6) individual and group exercises; 7) feedback on performance; 8) fostering of self-efficacy regarding performance; 9) applying strategies to real-world tasks; 10) individualized training experiences, and 11) social interaction activities. In all three interventions, Sessions 1-5 focused on strategy instruction and exercises to practice the strategy. Sessions 6-10 provided additional practice exercises, but no new strategies were introduced. Content for each of the 10 sessions was scripted in a trainer's manual.

Interventions:

1. Reasoning training focused on inductive reasoning, the ability to solve problems that follow a serial pattern and manifest in executive functioning. Participants were taught strategies to identify the pattern or sequence required to solve a problem. Training exercises involved identifying patterns in both laboratory-type reasoning tasks and in everyday activities, e.g., understanding the pattern in a bus schedule.
2. Memory training focused on verbal episodic memory, which deals with acquisition and retrieval of information acquired in a particular place at a particular time. Participants were taught mnemonic strategies for remembering lists and sequences of items, text material, and main ideas and details of stories and other text-based information. Training exercises involved recalling laboratory-like episodic memory tasks as well as tasks related to everyday activities such as recalling a shopping list.
3. Speed training focused on visual search and the ability to identify and locate visual information quickly in a divided attention format, with and without distractors. Participants practiced speeded tasks on a computer, and were allowed to proceed to more complex tasks, and faster and faster presentation speeds at their own pace.
4. A control group received no training.

In addition, booster training was provided to help participants maintain gains made from initial training and to further improve cognitive skills. Booster training was provided to a random sample of approximately 50% of training participants at 11 and 35-36 months after primary training.

Participant involvement included assessments conducted at baseline, immediately post-intervention, and at 12, 24, 36 and 60 months. Assessments were conducted in individual and group sessions. For participants randomized to intervention groups, the interventions were conducted in small group settings in ten 60-75 minute sessions over a 5-6 week period. These were behavioral interventions with no pharmacologic component. Eleven months after the initial training was provided, booster training was offered, in all three intervention arms, to a randomly selected 60% of initially trained subjects. Booster training was delivered in four 75-minute sessions over a 2-3 week period.

The primary study hypotheses were:

* Each training group will perform better than the other training and control groups on their respective primary and proximal outcomes
* Those groups that received booster training will perform better than those that did not receive booster training on their respective primary and proximal outcomes.

Eligibility criteria: Inclusion Criteria:

* Age 65 or older
* Mini-Mental State Examination (MMSE) score 23 or greater
* Vision scored greater than 20/50
* Minimal dependence in hygiene, bathing, and dressing

Exclusion Criteria:

* Significant decline in cognitive skills, physical abilities, or functional independence
* Inability to complete study activities as evidenced by MMSE and vision scores lower than Inclusion Criteria requirement
* Diagnosis of Alzheimer's disease
* Stroke in previous 12 months
* Cancer with limited life expectance
* Current chemotherapy or radiation treatment
* Communication problems
* Planned move from study area
* Scheduling conflicts that would preclude participation in study activities
* Prior involvement in similar cognitive training studies

Primary outcomes:
measure: Changes in Cognitive Abilities of Memory From Baseline to Year 10
timeFrame: Up to 10 years
measure: Changes in Cognitive Abilities of Reasoning From Baseline to Year 10
timeFrame: Up to 10 years
measure: Changes in Cognitive Abilities of Speed of Processing From Baseline to Year 10
timeFrame: Up to 10 years
measure: Changes in Instrumental Activities of Daily Living (IADL) Difficulty From Baseline to Year 10
timeFrame: Up to 10 years
measure: Changes in Everyday Problem Solving From Baseline to Year 10
timeFrame: Up to 10 years
measure: Changes in Everyday Speed of Processing From Baseline to Year 10
timeFrame: Up to 10 years
Secondary outcomes:
measure: Changes in Health-related Quality of Life (HRQol), Driving Function, Health Service Use
timeFrame: 10th Year
measure: Examine Health, Genetic and Cognitive Moderators
timeFrame: 10th Year
measure: Estimate the Effects of ACTIVE Training to General Population
timeFrame: 10th Year
Other outcomes:
Locations:
city: Birmingham
country: United States
facility: University of Alabama at Birmingham
state: Alabama
city: Indianapolis
country: United States
facility: Indiana University
state: Indiana
city: Baltimore
country: United States
facility: Johns Hopkins University
state: Maryland
city: Cumberland
country: United States
facility: Johns Hopkins University
state: Maryland
city: Boston
country: United States
facility: Hebrew Rehabilitation Center for the Aged
state: Massachusetts
city: Detroit
country: United States
facility: Wayne State University
state: Michigan
city: University Park
country: United States
facility: Pennsylvania State University
state: Pennsylvania
Study officials:
affiliation: University of Alabama at Birmingham
name: Karlene Ball, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Indiana University
name: Frederick Unverzagt, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Johns Hopkins University
name: George Rebok, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Hebrew Senior Life
name: John Morris, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Carelon Research
name: Sharon L. Tennstedt, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Wayne State University
name: Michael Marsiske, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Penn State University
name: Sherry Willis, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Jobe JB, Smith DM, Ball K, Tennstedt SL, Marsiske M, Willis SL, Rebok GW, Morris JN, Helmers KF, Leveck MD, Kleinman K. ACTIVE: a cognitive intervention trial to promote independence in older adults. Control Clin Trials. 2001 Aug;22(4):453-79. doi: 10.1016/s0197-2456(01)00139-8.
citation: Jones RN, Rosenberg AL, Morris JN, Allaire JC, McCoy KJ, Marsiske M, Kleinman KP, Rebok GW, Malloy PF. A growth curve model of learning acquisition among cognitively normal older adults. Exp Aging Res. 2005 Jul-Sep;31(3):291-312. doi: 10.1080/03610730590948195.
citation: Kuo HK, Jones RN, Milberg WP, Tennstedt S, Talbot L, Morris JN, Lipsitz LA. Cognitive function in normal-weight, overweight, and obese older adults: an analysis of the Advanced Cognitive Training for Independent and Vital Elderly cohort. J Am Geriatr Soc. 2006 Jan;54(1):97-103. doi: 10.1111/j.1532-5415.2005.00522.x.
citation: Diehl M, Marsiske M, Horgas AL, Rosenberg A, Saczynski JS, Willis SL. The Revised Observed Tasks of Daily Living: A Performance-Based Assessment of Everyday Problem Solving in Older Adults. J Appl Gerontol. 2005;24(3):211-230. doi: 10.1177/0733464804273772.
citation: Wadley VG, Crowe M, Marsiske M, Cook SE, Unverzagt FW, Rosenberg AL, Rexroth D. Changes in everyday function in individuals with psychometrically defined mild cognitive impairment in the Advanced Cognitive Training for Independent and Vital Elderly Study. J Am Geriatr Soc. 2007 Aug;55(8):1192-8. doi: 10.1111/j.1532-5415.2007.01245.x.
citation: Cook SE, Marsiske M, Thomas KR, Unverzagt FW, Wadley VG, Langbaum JB, Crowe M. Identification of mild cognitive impairment in ACTIVE: algorithmic classification and stability. J Int Neuropsychol Soc. 2013 Jan;19(1):73-87. doi: 10.1017/S1355617712000938. Epub 2012 Oct 25.
citation: Owsley C, Sloane M, McGwin G Jr, Ball K. Timed instrumental activities of daily living tasks: relationship to cognitive function and everyday performance assessments in older adults. Gerontology. 2002 Jul-Aug;48(4):254-65. doi: 10.1159/000058360.
citation: Gallo JJ, Rebok GW, Tennsted S, Wadley VG, Horgas A; Advanced Cognitive Training for Independent and Vital Elderly (Active) Study Investigators. Linking depressive symptoms and functional disability in late life. Aging Ment Health. 2003 Nov;7(6):469-80. doi: 10.1080/13607860310001594736.
citation: Caskie GI, Willis SL. Congruence of self-reported medications with pharmacy prescription records in low-income older adults. Gerontologist. 2004 Apr;44(2):176-85. doi: 10.1093/geront/44.2.176.
citation: Edwards JD, Ross LA, Wadley VG, Clay OJ, Crowe M, Roenker DL, Ball KK. The useful field of view test: normative data for older adults. Arch Clin Neuropsychol. 2006 May;21(4):275-86. doi: 10.1016/j.acn.2006.03.001. Epub 2006 May 15.
citation: Wolinsky FD, Unverzagt FW, Smith DM, Jones R, Wright E, Tennstedt SL. The effects of the ACTIVE cognitive training trial on clinically relevant declines in health-related quality of life. J Gerontol B Psychol Sci Soc Sci. 2006 Sep;61(5):S281-7. doi: 10.1093/geronb/61.5.s281.
citation: Crowe M, Andel R, Wadley V, Cook S, Unverzagt F, Marsiske M, Ball K. Subjective cognitive function and decline among older adults with psychometrically defined amnestic MCI. Int J Geriatr Psychiatry. 2006 Dec;21(12):1187-92. doi: 10.1002/gps.1639.
citation: Kuo HK, Jones RN, Milberg WP, Tennstedt S, Talbot L, Morris JN, Lipsitz LA. Effect of blood pressure and diabetes mellitus on cognitive and physical functions in older adults: a longitudinal analysis of the advanced cognitive training for independent and vital elderly cohort. J Am Geriatr Soc. 2005 Jul;53(7):1154-61. doi: 10.1111/j.1532-5415.2005.53368.x.
citation: Wolinsky FD, Unverzagt FW, Smith DM, Jones R, Stoddard A, Tennstedt SL. The ACTIVE cognitive training trial and health-related quality of life: protection that lasts for 5 years. J Gerontol A Biol Sci Med Sci. 2006 Dec;61(12):1324-9. doi: 10.1093/gerona/61.12.1324.
citation: Ball K, Edwards JD, Ross LA. The impact of speed of processing training on cognitive and everyday functions. J Gerontol B Psychol Sci Soc Sci. 2007 Jun;62 Spec No 1:19-31. doi: 10.1093/geronb/62.special_issue_1.19.
citation: Rebok GW, Carlson MC, Langbaum JB. Training and maintaining memory abilities in healthy older adults: traditional and novel approaches. J Gerontol B Psychol Sci Soc Sci. 2007 Jun;62 Spec No 1:53-61. doi: 10.1093/geronb/62.special_issue_1.53.
citation: Unverzagt FW, Kasten L, Johnson KE, Rebok GW, Marsiske M, Koepke KM, Elias JW, Morris JN, Willis SL, Ball K, Rexroth DF, Smith DM, Wolinsky FD, Tennstedt SL. Effect of memory impairment on training outcomes in ACTIVE. J Int Neuropsychol Soc. 2007 Nov;13(6):953-60. doi: 10.1017/S1355617707071512.
citation: Edwards JD, Ross LA, Ackerman ML, Small BJ, Ball KK, Bradley S, Dodson JE. Longitudinal predictors of driving cessation among older adults from the ACTIVE clinical trial. J Gerontol B Psychol Sci Soc Sci. 2008 Jan;63(1):P6-12. doi: 10.1093/geronb/63.1.p6.
citation: Morgan AA, Marsiske M, Whitfield KE. Characterizing and explaining differences in cognitive test performance between african american and European American older adults. Exp Aging Res. 2008 Jan-Mar;34(1):80-100. doi: 10.1080/03610730701776427.
citation: Vance DE, Ross LA, Crowe MG, Wadley VG, Edwards JD, Ball KK. THE RELATIONSHIP OF MEMORY, REASONING, AND SPEED OF PROCESSING ON FALLING AMONG OLDER ADULTS. Phys Occup Ther Geriatr. 2008;27(3):212-228. doi: 10.1080/02703180802377123.
citation: Ackerman ML, Edwards JD, Ross LA, Ball KK, Lunsman M. Examination of cognitive and instrumental functional performance as indicators for driving cessation risk across 3 years. Gerontologist. 2008 Dec;48(6):802-10. doi: 10.1093/geront/48.6.802.
citation: Langbaum JB, Rebok GW, Bandeen-Roche K, Carlson MC. Predicting memory training response patterns: results from ACTIVE. J Gerontol B Psychol Sci Soc Sci. 2009 Jan;64(1):14-23. doi: 10.1093/geronb/gbn026. Epub 2009 Feb 4.
citation: Tucker-Drob EM, Johnson KE, Jones RN. The cognitive reserve hypothesis: a longitudinal examination of age-associated declines in reasoning and processing speed. Dev Psychol. 2009 Mar;45(2):431-46. doi: 10.1037/a0014012.
citation: Ross LA, Clay OJ, Edwards JD, Ball KK, Wadley VG, Vance DE, Cissell GM, Roenker DL, Joyce JJ. Do older drivers at-risk for crashes modify their driving over time? J Gerontol B Psychol Sci Soc Sci. 2009 Mar;64(2):163-70. doi: 10.1093/geronb/gbn034. Epub 2009 Feb 4.
citation: Wolinsky FD, Vander Weg MW, Martin R, Unverzagt FW, Ball KK, Jones RN, Tennstedt SL. The effect of speed-of-processing training on depressive symptoms in ACTIVE. J Gerontol A Biol Sci Med Sci. 2009 Apr;64(4):468-72. doi: 10.1093/gerona/gln044. Epub 2009 Jan 30.
citation: Wolinsky FD, Mahncke HW, Kosinski M, Unverzagt FW, Smith DM, Jones RN, Stoddard A, Tennstedt SL. The ACTIVE cognitive training trial and predicted medical expenditures. BMC Health Serv Res. 2009 Jun 29;9:109. doi: 10.1186/1472-6963-9-109.
citation: Unverzagt FW, Smith DM, Rebok GW, Marsiske M, Morris JN, Jones R, Willis SL, Ball K, King JW, Koepke KM, Stoddard A, Tennstedt SL. The Indiana Alzheimer Disease Center's Symposium on Mild Cognitive Impairment. Cognitive training in older adults: lessons from the ACTIVE Study. Curr Alzheimer Res. 2009 Aug;6(4):375-83. doi: 10.2174/156720509788929345.
citation: Wolinsky FD, Mahncke HW, Weg MW, Martin R, Unverzagt FW, Ball KK, Jones RN, Tennstedt SL. The ACTIVE cognitive training interventions and the onset of and recovery from suspected clinical depression. J Gerontol B Psychol Sci Soc Sci. 2009 Sep;64(5):577-85. doi: 10.1093/geronb/gbp061. Epub 2009 Jul 17.
citation: Edwards JD, Lunsman M, Perkins M, Rebok GW, Roth DL. Driving cessation and health trajectories in older adults. J Gerontol A Biol Sci Med Sci. 2009 Dec;64(12):1290-5. doi: 10.1093/gerona/glp114. Epub 2009 Aug 12.
citation: Edwards JD, Delahunt PB, Mahncke HW. Cognitive speed of processing training delays driving cessation. J Gerontol A Biol Sci Med Sci. 2009 Dec;64(12):1262-7. doi: 10.1093/gerona/glp131. Epub 2009 Sep 2.
citation: Kvale EA, Clay OJ, Ross-Meadows LA, McGee JS, Edwards JD, Unverzagt FW, Ritchie CS, Ball KK. Cognitive speed of processing and functional declines in older cancer survivors: an analysis of data from the ACTIVE trial. Eur J Cancer Care (Engl). 2010 Jan 1;19(1):110-7. doi: 10.1111/j.1365-2354.2008.01018.x. Epub 2009 Aug 26.
citation: Wolinsky FD, Mahncke H, Vander Weg MW, Martin R, Unverzagt FW, Ball KK, Jones RN, Tennstedt SL. Speed of processing training protects self-rated health in older adults: enduring effects observed in the multi-site ACTIVE randomized controlled trial. Int Psychogeriatr. 2010 May;22(3):470-8. doi: 10.1017/S1041610209991281. Epub 2009 Dec 15.
citation: O'Connor ML, Edwards JD, Wadley VG, Crowe M. Changes in mobility among older adults with psychometrically defined mild cognitive impairment. J Gerontol B Psychol Sci Soc Sci. 2010 May;65B(3):306-16. doi: 10.1093/geronb/gbq003. Epub 2010 Feb 10.
citation: Yen YC, Rebok GW, Gallo JJ, Jones RN, Tennstedt SL. Depressive symptoms impair everyday problem-solving ability through cognitive abilities in late life. Am J Geriatr Psychiatry. 2011 Feb;19(2):142-50. doi: 10.1097/JGP.0b013e3181e89894.
citation: Wolinsky FD, Vander Weg MW, Martin R, Unverzagt FW, Willis SL, Marsiske M, Rebok GW, Morris JN, Ball KK, Tennstedt SL. Does cognitive training improve internal locus of control among older adults? J Gerontol B Psychol Sci Soc Sci. 2010 Sep;65(5):591-8. doi: 10.1093/geronb/gbp117. Epub 2009 Dec 11.
citation: Aiken Morgan AT, Marsiske M, Dzierzewski JM, Jones RN, Whitfield KE, Johnson KE, Cresci MK. Race-related cognitive test bias in the active study: a mimic model approach. Exp Aging Res. 2010 Oct;36(4):426-52. doi: 10.1080/0361073X.2010.507427.
citation: Gross AL, Rebok GW, Unverzagt FW, Willis SL, Brandt J. Word list memory predicts everyday function and problem-solving in the elderly: results from the ACTIVE cognitive intervention trial. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2011 Mar;18(2):129-46. doi: 10.1080/13825585.2010.516814. Epub 2010 Nov 10.
citation: Ball K, Edwards JD, Ross LA, McGwin G Jr. Cognitive training decreases motor vehicle collision involvement of older drivers. J Am Geriatr Soc. 2010 Nov;58(11):2107-13. doi: 10.1111/j.1532-5415.2010.03138.x.
citation: Parisi JM, Gross AL, Rebok GW, Saczynski JS, Crowe M, Cook SE, Langbaum JB, Sartori A, Unverzagt FW. Modeling change in memory performance and memory perceptions: findings from the ACTIVE study. Psychol Aging. 2011 Sep;26(3):518-24. doi: 10.1037/a0022458.
citation: O'Connor ML, Edwards JD, Small BJ, Andel R. Patterns of level and change in self-reported driving behaviors among older adults: who self-regulates? J Gerontol B Psychol Sci Soc Sci. 2012 Jul;67(4):437-46. doi: 10.1093/geronb/gbr122. Epub 2011 Dec 1.
citation: Gross AL, Rebok GW. Memory training and strategy use in older adults: results from the ACTIVE study. Psychol Aging. 2011 Sep;26(3):503-17. doi: 10.1037/a0022687.
citation: Gross AL, Rebok GW, Unverzagt FW, Willis SL, Brandt J. Cognitive predictors of everyday functioning in older adults: results from the ACTIVE Cognitive Intervention Trial. J Gerontol B Psychol Sci Soc Sci. 2011 Sep;66(5):557-66. doi: 10.1093/geronb/gbr033. Epub 2011 May 9.
citation: Unverzagt FW, Guey LT, Jones RN, Marsiske M, King JW, Wadley VG, Crowe M, Rebok GW, Tennstedt SL. ACTIVE cognitive training and rates of incident dementia. J Int Neuropsychol Soc. 2012 Jul;18(4):669-77. doi: 10.1017/S1355617711001470. Epub 2012 Mar 9.
citation: Sisco SM, Marsiske M. Neighborhood Influences on Late Life Cognition in the ACTIVE Study. J Aging Res. 2012;2012:435826. doi: 10.1155/2012/435826. Epub 2012 Aug 26.
citation: Gross AL, Inouye SK, Rebok GW, Brandt J, Crane PK, Parisi JM, Tommet D, Bandeen-Roche K, Carlson MC, Jones RN. Parallel but not equivalent: challenges and solutions for repeated assessment of cognition over time. J Clin Exp Neuropsychol. 2012;34(7):758-72. doi: 10.1080/13803395.2012.681628. Epub 2012 Apr 30.
citation: Gross AL, Rebok GW, Brandt J, Tommet D, Marsiske M, Jones RN. Modeling learning and memory using verbal learning tests: results from ACTIVE. J Gerontol B Psychol Sci Soc Sci. 2013 Mar;68(2):153-67. doi: 10.1093/geronb/gbs053. Epub 2012 Aug 28.
citation: Sartori AC, Wadley VG, Clay OJ, Parisi JM, Rebok GW, Crowe M. The relationship between cognitive function and life space: the potential role of personal control beliefs. Psychol Aging. 2012 Jun;27(2):364-74. doi: 10.1037/a0025212. Epub 2011 Aug 29.
citation: Lin F, Chen DG, Vance DE, Ball KK, Mapstone M. Longitudinal relationships between subjective fatigue, cognitive function, and everyday functioning in old age. Int Psychogeriatr. 2013 Feb;25(2):275-85. doi: 10.1017/S1041610212001718. Epub 2012 Oct 19.
citation: Ball K, Berch DB, Helmers KF, Jobe JB, Leveck MD, Marsiske M, Morris JN, Rebok GW, Smith DM, Tennstedt SL, Unverzagt FW, Willis SL; Advanced Cognitive Training for Independent and Vital Elderly Study Group. Effects of cognitive training interventions with older adults: a randomized controlled trial. JAMA. 2002 Nov 13;288(18):2271-81. doi: 10.1001/jama.288.18.2271.
citation: Willis SL, Tennstedt SL, Marsiske M, Ball K, Elias J, Koepke KM, Morris JN, Rebok GW, Unverzagt FW, Stoddard AM, Wright E; ACTIVE Study Group. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA. 2006 Dec 20;296(23):2805-14. doi: 10.1001/jama.296.23.2805.
citation: Bell TR, Sprague BN, Ross LA. Longitudinal associations of pain and cognitive decline in community-dwelling older adults. Psychol Aging. 2022 Sep;37(6):715-730. doi: 10.1037/pag0000699. Epub 2022 Jul 28.
citation: Chamberlain JD, Sprague BN, Ross LA. Age- and Time-Varying Associations Between Subjective Health and Episodic Memory in Older Adults. J Gerontol B Psychol Sci Soc Sci. 2022 Apr 1;77(4):673-682. doi: 10.1093/geronb/gbab142.
citation: Clark DO, Xu H, Callahan CM, Unverzagt FW. Does Body Mass Index Modify Memory, Reasoning, and Speed of Processing Training Effects in Older Adults. Obesity (Silver Spring). 2016 Nov;24(11):2319-2326. doi: 10.1002/oby.21631.