Vision and Hearing Difficulty as a Modifier of the Effects of Cognitive Training Over 5 and 10 Years in Older Adults

Abstract

AbstractBackgroundCognitive training interventions are delivered visually and/or aurally. Whether sensory loss modifies its effect in older adults is unknown. We assessed differences in the effect of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Study, a randomized cognitive training intervention trial, by self‐reported vision and hearing difficulty.MethodsParticipants (65 years and older, cognitively/functionally healthy) were randomized to cognitive training in memory, reasoning, or speed of processing or a no‐contact control. Composite scores were created using multiple cognitive assessments in memory, reasoning, and speed of processing. Self‐reported near vision difficulty was defined as reading ordinary print in the newspaper (no difficulty/a little or some difficulty), and hearing loss was self‐reported (yes/no). Differences in the 10‐year effect of cognitive training on change in trained cognitive ability were assessed using linear mixed effect models adjusted for demographic and study design characteristics.ResultsAmong 2,788 participants, 22% reported vision difficulty and 43% reported hearing loss. Participants with sensory loss benefited from all cognitive training interventions (Figure 1); however, the magnitude of benefit of reasoning training was smaller among participants with vs. without vision difficulty (10‐year difference in reasoning ability [intervention vs. control]: vision difficulty: ‐0.25, 95% CI: [‐0.88, 0.39], no vison difficulty: 0.58, 95% CI: [0.28, 0.89]). Magnitude of benefit of memory training was greater for participants with vs. without hearing loss (10‐year difference in memory ability [intervention vs. control]: hearing difficulty: 0.17, 95% CI: [‐0.37, 0.72], no hearing difficulty: ‐0.20, 95% CI: [‐0.65,0.24]). Beneficial effect of speed of processing training was similar by sensory status.ConclusionParticipants with vision difficulty did not benefit as much from reasoning training, likely because training required more visually complex exercises (e.g., deciphering patterns across similar symbols). Memory training was more efficacious for participants with hearing loss, perhaps because training provided compensation strategies for overcoming cognitive load (increased effort for processing degraded auditory signals). Cognitive training interventions should consider sensory function in design and administration. Individuals with sensory loss have increased risk for cognitive decline and should not be excluded from cognitive training interventions as magnitude of benefit may be greater for these individuals.