Advanced Cognitive Training for Independent and Vital Elders
Eligibility and demographic data (age, gender, race, education, and marital status) were gathered in a telephone screening. Health history (self-report of diabetes, myocardial infarction, angina, heart failure, stroke, hypertension, high cholesterol, and current alcohol use), physical status (MOS Short-form 36), functional status (MDS, see below), mental status (MMSE) and cognitive and function measures (see below) were gathered via in-person examinations in individual and small-group formats at baseline. Eligible participants were randomly assigned to one of three intervention arms or the no-contact control group. Screening and baseline assessment took place before randomization. Due to logistical considerations related to testing and training a large sample, recruitment and all subsequent field work were conducted in six replicates of approximately eight weeks duration. Outcome assessments were conducted immediately following and 1, 2, 3, and 5 and 10 years after the intervention.
Site staff who conducted the training interventions (trainers) and completed assessments (assessors) were trained centrally, followed by performance-based certification. Trainers for an intervention were not allowed to be cross-trained in the other interventions. Assessors were masked to participant assignments. Annual recertification was required. Annual monitoring visits were conducted by the Data Coordinating Center which included data audits and observations of trainers and assessors to check for drift.
Study procedures were approved by the institutional review boards at the collaborating institutions, and all subjects gave informed consent to participate.
Interventions were conducted in small groups in ten 60–75 minute sessions over 5 to 6 weeks. Memory training focused on improving verbal episodic memory through instruction and practice in strategy use. Reasoning training focused on improving the ability to solve problems that contained a serial pattern. Speed training focused on visual search and the ability to process increasingly more information presented in successively shorter inspection times. In all three interventions, sessions 1–5 focused on strategy instruction and exercises to practice the strategy while sessions 6–10 provided additional practice exercises. Content for each of the 10 sessions was scripted in a trainer’s manual. Booster training (four 75-minute sessions) was provided at 11 and 35 months after training to a randomly selected subset of participants in each intervention arm who completed initial training (defined as 8 of 10 sessions).