Advanced Cognitive Training For Independent And Vital Elderly Research Articles

Does Consumer Credit Precede or Follow Health Among Older Adults? An Investigation in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Trial.

Consumer credit has shown increasing relevance to the health of older adults; however, studies have not been able to assess the extent to which creditworthiness influences future health or health influences future creditworthiness. We assessed the relationships between 4-year pre and postmorbid consumer credit history and self-rated physical and mental health outcomes among older adults. Generalized estimating equations models assessed pre and postmorbid credit history (credit scores, derogatory accounts, and unpaid accounts in collections) and the onset of poor self-rated health (SF-36 score <50) among 1,740 participants aged 65+ in the Advanced Cognitive Training for Independent and Vital Elderly study from 2001 to 2017, linked to TransUnion consumer credit data. In any given year, up to 1/4 of participants had a major derogatory, unpaid, or collections account, and up to 13% of the sample had poor health. Each 50-point increase in credit score trended toward a 5% lower odds of poor health in the next 1 year, a 6% lower odds in the next 2 years, and a statistically significant finding of 13% lower odds by 3 years. A drop in credit score was associated with a 10% greater odds of poor health in the next year, and having a major derogatory account was associated with an 86% greater odds of poor health in the next 3 years. After poor health onset, credit scores continued to see significant losses up to the 3 years, with larger decrements over time. Having a major derogatory account or a sudden loss in credit may be a time to monitor older adults for changes in health. After a downturn in health, supporting older adults to manage their debt may help stabilize their credit.

PREDICTORS OF EVERYDAY FUNCTIONING, ADLS/IADLS AMONG OLDER ADULTS USING THE ACTIVE STUDY

Abstract The increase in life expectancy over the years has triggered both researchers and the aging population to focus more on achieving an active engagement with life. This ability to perform daily living activities (functionality) is a key component in healthy aging which aids older adults live independently with or without disease and disability. Gaining insight into the key elements that enhance physical functioning is necessary as the issue of limited physical functioning affects not only older adults but also, middle aged adults. This study examines the predictors of everyday functioning, Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) among 1920 older adults using data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. ADLs and IADLs were self-reported. Results of the hierarchical linear regression at baseline indicate that, being female and being African American significantly predict lower performance on everyday functioning, after adjusting for age and years of education. Fewer falls in the past 2 months, better cognition and normal weight significantly predict high performance on everyday functioning (all p &amp;lt; .05). For ADLs, being African American and female gender significantly predict higher scores on ADLs while female gender predicted lower scores on IADLs. There were no differences on living arrangements and access to healthcare on everyday functioning, ADLs and IADLs. 43.1% of variability in IADLs were explained by the predictors. Findings from this study identify target populations for interventions to promote active engagement with life.

THE RELATIONSHIP BETWEEN 10-YEAR CHANGES IN COGNITIVE ABILITY AND SUBSEQUENT MORTALITY: FINDINGS FROM THE ACTIVE

Abstract Cognitive ability and cognitive decline have been linked with mortality in older adults. However, little was understood about the role of cognitive interventions on mortality outcomes in this population. Using twenty-year follow-up data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial, we examined the association between cognitive change and mortality risk, and the effect of ACTIVE cognitive training (memory, reasoning, and speed of processing) on mortality risk. Mortality was ascertained through linkage to the National Death Index database. To model time to death as a function of cognitive change and training effect, we used shared growth-survival models with simultaneously estimated latent intercepts and slopes as predictors. Among the 2802 participants, 2021 died on or before the year 2019 (72.1%). Both higher baseline level and slower decline in global cognition were associated with lower hazards of all-cause mortality after adjusting for covariates (HR = 0.68, 95% CI 0.58, 0.79; HR = 0.42, 95% CI 0.40, 0.44, respectively). We did not observe any significant effects of ACTIVE cognitive training in memory, reasoning, or speed of processing on all-cause mortality. Our findings demonstrated the association between the trajectory of cognitive change and mortality among older adults, independent of cognitive training interventions. More work is needed to identify relevant timing as well as modalities of non-pharmaceutical interventions that can promote healthy longevity.

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

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.

77 Feasibility and Effectiveness of a Telehealth-Delivered Inductive Reasoning Training Program for Older Adults

Objective:Inductive reasoning training has been found to be particularly effective at improving inductive reasoning, with some evidence of improved everyday functioning and driving. Telehealth may be useful for increasing access to, reducing time and travel burdens of, and reducing the need for physical spaces for cognitive training. On the other hand, telehealth increases technology burden. The present study investigated the feasibility and effectiveness of implementing an inductive reasoning training program, designed to mimic the inductive reasoning arm used in a large multi-site clinical trial (Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE)), via telehealth (using Zoom and Canvas as delivery platforms).Participants and Methods:31 older adult participants (mean age = 71.2, range = 65-85; mean education = 15.5, range = 13-18; 64.5% female; 87.1% white) received 10-sessions of telehealth-delivered inductive reasoning training over 5 weeks. Comparison groups (inductive reasoning trained and no-contact controls) were culled from the in-person ACTIVE trial via propensity matching. All participants completed three pretest and posttest inductive reasoning measures (Word Series, Letter Series, Letter Sets), as well as a posttest measure assessing participant perceptions of the telehealth intervention. In addition, at the end of each of the ten training sessions, participants received a final inductive reasoning assessment.Results:Telehealth participants provided high levels of endorsement suggesting that the telehealth training program was useful, reliable, easy to use and interact on, and employed a useable interface. Participants were generally satisfied with the training program. With regard to performance, telehealth participants demonstrated greater gains than untrained controls on Letter Series [F(1, 116) = 9.81, p = 0.002, partial eta-squared = 0.084] and Letter Sets [F(1, 116) = 8.69, p = 0.004, partial eta-squared = 0.074], but did not differ in improvement on Word Series [F(1, 116) = 1.145, p = 0.287, partial eta-squared = 0.010]. Furthermore, telehealth participants evinced similar inductive reasoning gains as matched inperson inductive reasoning trained participants on Letter Series [F(1, 116) = 1.24, p = 0.226, partial eta-squared = 0.01] and Letter Sets [F(1, 116) = 1.29, p = 0.259, partial eta-squared = 0.01], but demonstrated fewer gains in Word Series performance [F(1, 116) = 25.681, p = &lt; 0.001, partial eta-squared = 0.181]. On the end-of-session reasoning tests, telehealth-trained participants showed a similar general pattern of improvement across the ten training sessions and did not differ significantly from in-person trained comparison participants.Conclusions:Cognitive training via telehealth evinced similar gains across nearly all measures as its in-person counterpart. However, telehealth also led to substantial challenges regarding the telehealth training platform. Despite these challenges, participants reported perceiving increased competence with computer use, peripherals (mice, trackpad), and videoconferencing. These may be ancillary benefits of such training and may be maximized if more age-friendly learning management systems are investigated. Overall, this study suggests that telehealth delivery may be a viable form of cognitive training in inductive reasoning, and future studies could increase performance gains by optimizing the online training platform for older adults.

1 Associations of Locus of Control and Memory Self-Awareness in Older Adults with and without MCI

Objective:While loss of insight into one’s cognitive impairment (anosognosia) is a feature in Alzheimer’s disease dementia, less is known about memory self-awareness in cognitively unimpaired (CU) older adults or mild cognitive impairment (MCI) or factors that may impact self-awareness. Locus of control, specifically external locus of control, has been linked to worse cognitive/health outcomes, though little work has examined locus of control as it relates to self-awareness of memory functioning or across cognitive impairment status. Therefore, we examined associations between locus of control and memory self-awareness and whether MCI status impacted these associations.Participants and Methods:Participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (mean age=73.51; 76% women; 26% Black/African American) were classified as CU (n=2177) or MCI (amnestic n=313; non-amnestic n=170) using Neuropsychological Criteria. A memory composite score measured objective memory performance and the Memory Functioning Questionnaire measured subjective memory. Memory self-awareness was defined as objective memory minus subjective memory, with positive values indicating overreporting of memory difficulties relative to actual performance (hypernosognosia) and negative values indicating underreporting (hyponosognosia). Internal (i.e., personal skills/attributes dictate life events) and external (i.e., environment/others dictate life events) locus of control scores came from the Personality in Intellectual Aging Contexts Inventory. General linear models, adjusting for age, education, sex/gender, depressive symptoms, general health, and vocabulary examined the effects of internal and external locus of control on memory self-awareness and whether MCI status moderated these associations.Results:Amnestic and non-amnestic MCI participants reported lower internal and higher external locus of control than CU participants. There was a main effect of MCI status on memory self-awareness such that amnestic MCI participants showed the greatest degree of hyponosognosia/underreporting, followed by non-amnestic MCI, and CU participants slightly overreported their memory difficulties. While, on average, participants were fairly accurate at reporting their degree of memory difficulty, internal locus of control was negatively associated with self-awareness such that higher internal locus of control was associated with greater underreporting (ß=-.127, 95% CI [-.164, -.089], p&lt;.001). MCI status did not moderate this association. External locus of control was positively associated with self-awareness such that higher external locus of control was associated with greater hypernosonosia/overreporting (ß=.259, 95% CI [.218, .300], p&lt;.001). Relative to CU, amnestic, but not non-amnestic, MCI showed a stronger association between external locus of control and memory self-awareness. Specifically, higher external locus of control was associated with less underreporting of cognitive difficulties in amnestic MCI (ß=.107, 95% CI [.006, .208], p=.038).Conclusions:In CU participants, higher external locus of control was associated with greater hypernosognosia/overreporting. In amnestic MCI, the lower external locus of control associations with greater underreporting of objective cognitive difficulties suggests that perhaps reduced insight in some people with MCI may result in not realizing the need for external supports, and therefore not asking for help from others. Alternatively, in amnestic participants with greater external locus of control, perhaps the environmental cues/feedback translate to greater accuracy in their memory self-perceptions. Longitudinal analyses are needed to determine how memory self-awareness is related to future cognitive declines.

Does Consumer Credit Precede or Follow Changes in Cognitive Impairment Among Older Adults? An Investigation in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Trial.

We assessed the relationships between pre- and post-morbid consumer credit history (credit scores, debts unpaid, or in collections) and classification of mild (or greater) cognitive impairment (MCI). Generalized Estimating Equation models assessed pre-and post-morbid credit history and MCI risk among 1740 participants aged 65+ in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, linked to TransUnion consumer credit data. Each 50-point increase in credit score was associated with up to 8% lower odds of MCI in the next 3years. In contrast, new unpaid collections over doubled the odds of having MCI in the next 3years. MCI was associated with subsequent credit score declines and a 47%-71% greater risk of having a new unpaid collection in the next 4years. Credit declines may signal risk for future MCI. MCI may lead to financial challenges that warrant credit monitoring interventions for older adults.

Does the association between objective and subjective memory vary by age among healthy older adults?

ABSTRACT Subjective memory is commonly used as an indicator of older adults’ objective memory in clinical screening; however, the correspondence between subjective and objective memory across different ages is unclear. The current study examined age-varying associations between subjective and objective memory in a cross-sectional sample of healthy older adults from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (N = 2,496). Time varying effects modeling (TVEM) models the association between variables as a function of time-varying metrics including age without imposing linear assumptions. TVEM was used to examine relationship magnitude fluctuations between subjective and objective memory across ages 65 to 85. Better subjective memory was weakly associated with better objective memory, even after controlling for gender, depressive symptoms, and education. The association was stable across all ages. There is a stable weak correspondence between subjective and objective memory in older adulthood across age, supporting the use of linear age as an appropriate time metric for examinations of objective and subjective memory among healthy older adults. Future work should examine the correspondence between subjective and objective memory in a larger age range. Longitudinal designs can also provide insights on whether the accuracy of subjective memory ratings change within a person over time.

Longitudinal associations of pain and cognitive decline in community-dwelling older adults.

Pain is inversely associated with cognitive function in older adults, but the effects of pain on cognitive decline are not fully clear. This study examined the associations of baseline pain, pain persistence, and incident pain with changes in cognition across 10 years in a sample of healthy community-dwelling older adults (n = 688; Mage = 74, SD = 6.05) from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. While ACTIVE was a four-arm single-blind cognitive training randomized controlled trial, the present study includes only participants from the no-contact control group. Pain was examined using the Medical Outcomes Survey SF-36-Item (MOS SF-36) and cognitive tests examined simple processing speed, complex processing speed, divided and selective attention, memory, reasoning, and cognitive status. Multilevel models tested the associations of baseline pain, incident pain, and pain persistence on cognitive function and cognitive decline, adjusted for baseline age, time (years after follow-up), race, gender, education, marital status, and depressive symptoms at baseline and over time. Thirty-one percent reported pain at baseline which was related to worse baseline memory and accelerated decline in processing speed. Forty-two percent of older adults reported incident pain had accelerated decline in complex processing speed, divided attention, memory, reasoning, and cognitive status. On average, older adults reported a mean of two waves of pain persistence related to accelerated decline in memory. In sum, pain is common in community-dwelling older adults and is related to accelerated cognitive decline, especially when the incident. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Long-Term Effects of Cognitive Training on All-Cause Mortality in US Older Adults.

Objectives: Cognitive abilities have been implicated as predictors of mortality in older adults. This study examines the effects of cognitive training on mortality 20 years post-intervention. Methods: Data come from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized control trial (N = 2802). Participants were cognitively and physically healthy, community-dwelling adults aged 65 and older. Cox proportional hazard models were used to investigate (1) the association between baseline cognition and mortality risk and (2) the effect of ACTIVE cognitive training (memory, reasoning, and speed of processing) on mortality risk 20 years post-intervention. Results: Higher baseline cognition predicted lower mortality risk 20 years post-intervention. No significant effects of ACTIVE cognitive training in memory, reasoning, or speed of processing on mortality risk were observed. Discussion: More work is needed to identify cognitive training interventions that may lead to lower mortality risks in later adulthood.

Predicting Verbal Learning and Memory Assessments of Older Adults Using Bayesian Hierarchical Models.

Verbal learning and memory summaries of older adults have usually been used to describe neuropsychiatric complaints. Bayesian hierarchical models are modern and appropriate approaches for predicting repeated measures data where information exchangeability is considered and a violation of the independence assumption in classical statistics. Such models are complex models for clustered data that account for distributions of hyper-parameters for fixed-term parameters in Bayesian computations. Repeated measures are inherently clustered and typically occur in clinical trials, education, cognitive psychology, and treatment follow-up. The Hopkins Verbal Learning Test (HVLT) is a general verbal knowledge and memory assessment administered repeatedly as part of a neurophysiological experiment to examine an individual’s performance outcomes at different time points. Multiple trial-based scores of verbal learning and memory tests were considered as an outcome measurement. In this article, we attempted to evaluate the predicting effect of individual characteristics in considering within and between-group variations by fitting various Bayesian hierarchical models via the hybrid Hamiltonian Monte Carlo (HMC) under the Bayesian Regression Models using ‘Stan’ (BRMS) package of R. Comparisons of the fitted models were done using leave-one-out information criteria (LOO-CV), Widely applicable information criterion (WAIC), and K-fold cross-validation methods. The full hierarchical model with varying intercepts and slopes had the best predictive performance for verbal learning tests [from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study dataset] using the hybrid Hamiltonian-Markov Chain Monte Carlo approach.

Older Men's Participation in Cognitive Training: A Review.

Background: Cognitive training for healthy older adults living in a community is an essential resource that allows them to live at home for as long as possible. Objective: The purpose of the review is to examine the degree of participation of males and females in longitudinal studies of cognitive training. Moreover, we want to identify if these studies include the gender variable in their analyzes or reflect on its importance. Method: This review considered longitudinal cognitive training studies were published in English and Spanish and conducted with healthy older adults living in a community. Results: The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (in English) and the Memoria Mejor (MM) Longitudinal Study (in Spanish), both illustrate the trend of sex/gender treatment of the studies reviewed: a) high participation of older people seventy and more years b) recruiting stratified by age and sex; c) males are disproportionately underrepresented in cognitive training studies [24% - 14%]; d) the evaluation measures (baseline, follow-up, and final) and dropout data are provided but not stratified by age and sex/gender. Conclusions: Researchers demonstrate awareness about the impact of sex/gender differences but do not focus on it. Understanding sex/gender differences are necessary for understanding not only that these differences occur, but also why they occur; this will allow policies or intervention programs with approaches that are more equitable for both sexes/genders to be formulated.

How Selection Over Time Contributes to the Inconsistency of the Association Between Sex/Gender and Cognitive Decline Across Cognitive Aging Cohorts

The association between sex/gender and aging-related cognitive decline remains poorly understood because of inconsistencies in findings. Such heterogeneity could be attributable to the cognitive functions studied and study population characteristics, but also to differential selection by dropout and death between men and women. We aimed to evaluate the impact of selection by dropout and death on the association between sex/gender and cognitive decline. We first compared the statistical methods most frequently used for longitudinal data, targeting either population estimands (marginal models fitted by generalized estimating equations) or subject-specific estimands (mixed/joint models fitted by likelihood maximization) in 8 studies of aging: 6 population-based studies (the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Study (1996-2009), Personnes Âgées QUID (PAQUID; 1988-2014), the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study (2003-2016), the Three-City Study (Bordeaux only; 1999-2016), the Washington Heights-Inwood Community Aging Project (WHICAP; 1992-2017), and the Whitehall II Study (2007-2016)) and 2 clinic-based studies (the Alzheimer's Disease Neuroimaging Initiative (ADNI; 2004-2017) and a nationwide French cohort study, MEMENTO (2011-2016)). We illustrate differences in the estimands of the association between sex/gender and cognitive decline in selected examples and highlight the critical role of differential selection by dropout and death. Using the same estimand, we then contrast the sex/gender-cognitive decline associations across cohorts and cognitive measures suggesting a residual differential sex/gender association depending on the targeted cognitive measure (memory or animal fluency) and the initial cohort selection. We recommend focusing on subject-specific estimands in the living population for assessing sex/gender differences while handling differential selection over time.

A-14 Factors Impacting Long-Term Proactive and Reactive Healthcare Utilization in Cognitively Healthy Older Adults

Abstract Objective Ongoing preventive healthcare is critical to support physical and cognitive health with aging. Several demographic factors have been identified as impacting older adult’s healthcare utilization (HCU), and cognitive training (CT) may prime for proactive (regular doctor’s visits) versus reactive (emergency department [ED] visits) HCU. This study sought to explore older adults’ HCU patterns, including predictors of CT and demographic factors, in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) data set. Method The full ACTIVE study included 2802 community-dwelling adults age 65+ without cognitive impairment. Available data were comprised of N&amp;#3f909 across six US sites at baseline and five-year follow up. Multiple linear regression was used to predict five-year doctor’s visits and ED visits from age, race, gender, education, MMSE score, community type, and cognitive training group. Results The model significantly predicted doctor’s visits but accounted for a low amount of the total variance [R2 = 0.025, F(7,885) = 3.21, p = 0.002]. Rural setting (β = 0.090, p = 0.012), female gender (β = 0.086, p = 0.012), higher MMSE (β = 0.079, p = 0.031), and higher education (β = 0.076, p = 0.041) predicted more doctor’s visits. Similarly, the overall model accounted for limited variance in ED visits [R2 = 0.016, F(7,888) = 3.21, p = 0.044], and older age was the only significant predictor (β = 0.089, p = 0.009). Conclusions CT did not significantly predict HCU at five-year follow up. Those living in a rural setting, of female gender, and with higher MMSE score and education level had higher proactive HCU at five years, whereas only older age predicted higher ED visits. Additional exploration of factors impacting long-term HCU within a diverse sample of healthy older adults is needed.

Application of neuropsychological criteria to classify mild cognitive impairment in the active study.

Objective: Comprehensive neuropsychological criteria (NP criteria) for mild cognitive impairment (MCI) has reduced diagnostic errors and better predicted progression to dementia than conventional MCI criteria that rely on a single impaired score and/or subjective report. This study aimed to implement an actuarial approach to classifying MCI in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. Method: ACTIVE study participants (N = 2,755) were classified as cognitively normal (CN) or as having MCI using NP criteria. Estimated proportion of MCI participants and reversion rates were examined as well as baseline characteristics by MCI subtype. Mixed effect models examined associations of MCI subtype with 10-year trajectories of self-reported independence and difficulty performing instrumental activities of daily living (IADLs). Results: The proportion of MCI participants was estimated to be 18.8%. Of those with MCI at baseline, 19.2% reverted to CN status for all subsequent visits. At baseline, the multidomain-amnestic MCI group generally had the greatest breadth and depth of cognitive impairment and reported the most IADL difficulty. Longitudinally, MCI participants showed faster IADL decline than CN participants (multidomain-amnestic MCI > single domain-amnestic MCI > nonamnestic MCI). Conclusion: NP criteria identified a proportion of MCI and reversion rate within ACTIVE that is consistent with prior studies involving community-dwelling samples. The pattern of everyday functioning change suggests that being classified as MCI, particularly amnestic MCI, is predictive of future loss of independence. Future work will apply these classifications in ACTIVE to better understand the relationships between MCI and health, social, and cognitive intervention-related factors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Incident Instrumental Activities of Daily Living Difficulty in Older Adults: Which Comes First? Findings From the Advanced Cognitive Training for Independent and Vital Elderly Study.

Introduction: Instrumental activities of daily living (IADLs) are complex daily tasks important for independent living. Many older adults experience difficulty with IADLs as their physical and/or cognitive function begins to decline. However, it is unknown in what order IADLs become difficult.Methods: Participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study who were free of IADL difficulty at baseline (N = 1,277) were followed up to 10 years until first reported IADL difficulty. A total of 19 IADL tasks were grouped into seven task categories. A discrete-time multiple-event process survival mixture model (MEPSUM) was used to generate hazard estimates of incident IADL difficulty in seven groups from ages 65 to 80. Hazard estimates were compared in the three intervention groups (memory, inductive reasoning, and speed of information processing) vs. the no-contact control group.Results: A total of 887 (69.5%) participants reported incident difficulty in at least one IADL task category. Compared to individuals who remained free of IADL difficulty, those who reported incident difficulty were more likely to be older, female, and have lower Short Form 36 general health scores. The IADL task categories to first become difficult were housework, managing health care, and phone use. There were no differences by intervention group in the hazard estimates of incident IADL difficulty.Conclusion: Managing health care and phone use are more cognitively demanding IADLs, and individuals who experience difficulty in these tasks first may be more likely to experience cognitive decline. Recognizing early difficulty in managing health care may allow for implementation of compensation strategies to minimize unintentional medication misuse, increased adverse medical events, and unnecessary hospitalization. Training of a specific cognitive domain may not influence ordering of IADL difficulty because IADL tasks require proficiency in, and integration of, multiple cognitive domains.

Cognitive Training Attenuates Decline in Physical Function Across 10 Years.

Poor physical function is associated with negative health and cognitive outcomes. Although nine studies demonstrated that cognitive training reduces age-related declines in physical function, only one study has examined the effects beyond immediate posttest changes. The first aim of this study was to assess the impact of three cognitive training programs on physical function measures across 10 years and the second aim was to examine whether baseline cognitive self-efficacy or depressive symptoms moderated training effects. Using data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized controlled trial, older adults in a no-contact control condition (n = 698) were compared to those receiving processing speed (n = 702), memory (n = 703), or reasoning (n = 694) training. Intention-to-treat (ITT) and dosage analyses were conducted for grip strength and Turn 360. Participants were followed up to 10 years posttest. There were no significant ITT effects of processing speed, memory, or reasoning training assignment to any physical function outcome (p > .05). Dosage models indicated that there were small age-related attenuation effects in Turn 360 decline with more processing speed training (b = -.011, p < .001), memory training (b = -.011, p < .001), and reasoning training (b = -.012, p < .001). There was no significant transfer to grip strength. These training gains were greater for those with more baseline depressive symptoms who received more processing speed training (b = -.001, p < .001). This is the first study to demonstrate the effects of cognitive training to complex physical function across 10 years.

NOVEL FINDINGS TWO DECADES FOLLOWING COGNITIVE TRAINING: FINDINGS FROM THE ACTIVE TRIAL

Although the only demonstrated panacea against cognitive decline, behavioral cognitive training usually fails to demonstrate transfer either to untrained cognitive abilities or to distal outcomes like everyday functioning. No such trials, however, have leveraged more than a decade of follow-up to adapt life-course perspectives. The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study remains the largest NIA-funded clinical trial of cognitively normal older adults. Efforts to re-invigorate the cohort after 20 years with external data linkages have coalesced around renewed interests in how training-related cognitive improvements affect long-term dementia risk, health care utilization and costs, credit scores, and active years in later life. The first presentation by Rebok overviews ACTIVE and its 20-year follow-up plans. Next, Gross and colleagues tested whether cognitive training attenuates the relationship between IADL difficulty and mortality; negative findings suggest proposed relationships between cognition and IADL difficulty are correlational, not causal, which has implications for transfer and trial outcomes. Third, Thomas tests a novel algorithm for classifying MCI, ushering opportunities to examine training effects on incidence of MCI after up to 20 years post-training. Marsiske then evaluates temporal transfer of training in reasoning ability, concluding that reasoning training and age, but not other baseline demographics, predict maintained alterations in reasoning abilities. Finally, Felix evaluates the stifling role of depressive symptoms on ability to benefit from training. Dr. Wally Boot, a recognized thought leader in transfer of cognitive training, will provide an illuminating discussion of promises and pitfalls of these lines of research.

INCIDENT DIFFICULTY IN INSTRUMENTAL ACTIVITIES OF DAILY LIVING: WHICH COMES FIRST?

Background: Instrumental activities of daily living (IADLs) are necessary for successful independent living. Older adults may develop difficulty completing IADLs as they become physically and/or cognitively frail. The relative ordering in which IADLs deteriorate, and the importance of this ordering, is not well understood. Methods: Participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study who reported no difficulty with IADLs at baseline were included. Individuals were followed up to 10 years for incidence of self-reported difficulty in 19 specific IADLs. The outcome of interest was time to any incident difficulty. We used Cox proportional hazards regression to estimate the hazard ratio (HR) of incident IADL difficulty for each IADL. Results: Of N=1,273 participants who contributed 6,144 person-years to the analysis, 887 developed difficulty with at least 1 IADL during the study period. The tasks in which participants reported difficulty earliest included giving self-injections (HR=5.69, [4.77, 6.79]), balancing checkbooks (HR=5.56, [4.32-7.16]), remembering often called numbers without having to look them up (HR=5.47, [4.55-6.59]), and household chores (HR=4.18, [3.43-5.11]). The last tasks to become difficult included keeping household expenses balanced (HR=0.07, [0.04-0.14]) and hanging up at the end of a phone call (HR=0.23, [0.09-0.56]). Conclusion: Independent older adults reported earlier difficulty with balancing checkbooks, remembering often called phone numbers, and doing household cleaning. Recognizing these early difficult tasks may facilitate early planning for family members and adoption of compensatory strategies.

COGNITIVE TRAINING ATTENUATES AGE-RELATED DECLINE IN PHYSICAL FUNCTION ACROSS 10 YEARS

Poor physical function is associated with negative health and cognitive outcomes. Although nine studies demonstrate that cognitive training reduces age-related declines in physical function, only one has examined effects beyond immediate posttest changes. The current study assessed the impact of three cognitive training programs on physical function measures across 10 years. Using data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial, older adults randomized to a no-contact control condition (n = 698) were compared to those randomized to processing speed (n = 702), memory (n = 703), or reasoning (n = 694) training. Intention-to-treat and treatment-received analyses were conducted for grip strength, Digit Symbol Copy, and Turn 360. There were no significant effects of being assigned to processing speed, memory, or reasoning training to any physical function outcome (p > .05). Treatment-received models indicated that processing speed training attenuated age-related declines in Digit Symbol Copy (b = -.005, p < .01) and Turn 360 (b = -.011, p < .001), memory training attenuated age-related declines in Digit Symbol Copy (b = -.009, p < .001) and Turn 360 (b = -.011, p < .001), and reasoning training attenuated age-related declines in Digit Symbol Copy (b = -.012, p < .001) and Turn 360 (b = -.012, p < .001). There was no significant transfer to grip strength. This is the first study to demonstrate beneficial effects of cognitive training to some physical functions across 10 years. Future work should examine moderators and mediators of transfer effects.