Long-term effects of cognitive training on everyday functional outcomes in older adults
Long-term effects of cognitive training on everyday functional outcomes in older adults
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DOI：
10.1001/jama.296.23.2805
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发表时间：
2006-12-20
影响因子：
120.7
通讯作者：
Wright, Elizabeth
中科院分区：
文献类型：
--
作者：
Willis, Sherry L.;Tennstedt, Sharon L.;Wright, Elizabeth
背景：认知训练已被证明可提高老年人的认知能力，但认知训练对日常功能的影响尚未得到证实。
目的：确定认知训练对日常功能的影响以及训练对认知能力的持久性。
设计、地点和参与者：对4个治疗组进行的一项随机对照单盲试验的5年随访。从美国6个城市独立生活的老年人住房、社区中心以及医院和诊所招募了2832名志愿者（平均年龄73.6岁；26%为黑人）。该研究于1998年4月至2004年12月进行。67%的样本完成了5年随访。
干预措施：针对记忆（言语情景记忆）、推理（归纳推理）或加工速度（视觉搜索和识别）进行10次训练课程；在完成训练的人员中随机抽取样本，在训练后11个月和35个月进行4次强化训练。
主要观察指标：日常功能和认知能力的自我报告及基于表现的测量指标。
结果：推理组报告在日常生活工具性活动（IADL）中的困难明显少于对照组（效应量为0.29；99%置信区间[CI]为0.03 - 0.55）。加工速度训练（效应量为0.26；99%CI为 - 0.002至0.51）和记忆训练（效应量为0.20；99%CI为 - 0.06至0.46）对IADL均无显著影响。加工速度组的强化训练，但其他2个组没有，对基于表现的日常加工速度功能测量指标有显著影响（效应量为0.30；99%CI为0.08 - 0.52）。在日常问题解决或自我报告的IADL困难方面，任何组都未观察到强化效果。每种干预措施在5年内都对其特定的目标认知能力保持影响（记忆：效应量为0.23[99%CI为0.11 - 0.35]；推理：效应量为0.26[99%CI为0.17 - 0.35]；加工速度：效应量为0.76[99%CI为0.62 - 0.90]）。强化训练对推理干预的推理表现（效应量为0.28；99%CI为0.12 - 0.43）和加工速度干预的加工速度表现（效应量为0.85；99%CI为0.61 - 1.09）有额外的改善作用。
结论：推理训练导致自我报告的IADL功能下降较少。与对照组相比，认知训练导致针对所训练能力的认知能力提高，这种提高在干预开始后持续了5年。
Context Cognitive training has been shown to improve cognitive abilities in older adults but the effects of cognitive training on everyday function have not been demonstrated.Objective To determine the effects of cognitive training on daily function and durability of training on cognitive abilities.Design, Setting, and Participants Five-year follow-up of a randomized controlled single-blind trial with 4 treatment groups. A volunteer sample of 2832 persons ( mean age, 73.6 years; 26% black), living independently in 6 US cities, was recruited from senior housing, community centers, and hospitals and clinics. The study was conducted between April 1998 and December 2004. Five-year follow-up was completed in 67% of the sample.Interventions Ten-session training for memory ( verbal episodic memory), reasoning ( inductive reasoning), or speed of processing ( visual search and identification); 4-session booster training at 11 and 35 months after training in a random sample of those who completed training.Main Outcome Measures Self-reported and performance-based measures of daily function and cognitive abilities.Results The reasoning group reported significantly less difficulty in the instrumental activities of daily living ( IADL) than the control group ( effect size, 0.29; 99% confidence interval [CI], 0.03- 0.55). Neither speed of processing training ( effect size, 0.26; 99% CI, - 0.002 to 0.51) nor memory training ( effect size, 0.20; 99% CI, - 0.06 to 0.46) had a significant effect on IADL. The booster training for the speed of processing group, but not for the other 2 groups, showed a significant effect on the performance-based functional measure of everyday speed of processing ( effect size, 0.30; 99% CI, 0.08-0.52). No booster effects were seen for any of the groups for everyday problem-solving or self-reported difficulty in IADL. Each intervention maintained effects on its specific targeted cognitive ability through 5 years ( memory: effect size, 0.23 [ 99% CI, 0.11-0.35]; reasoning: effect size, 0.26 [ 99% CI, 0.17-0.35]; speed of processing: effect size, 0.76 [ 99% CI, 0.62-0.90]). Booster training produced additional improvement with the reasoning intervention for reasoning performance ( effect size, 0.28; 99% CI, 0.12-0.43) and the speed of processing intervention for speed of processing performance ( effect size, 0.85; 99% CI, 0.61-1.09).Conclusions Reasoning training resulted in less functional decline in self-reported IADL. Compared with the control group, cognitive training resulted in improved cognitive abilities specific to the abilities trained that continued 5 years after the initiation of the intervention.