Summary: New long-term results from the ACTIVE study show that a targeted cognitive training—called speed of processing training—can lower the risk of developing dementia for up to 20 years. In a randomized clinical trial that followed nearly 3,000 older adults, those who completed the initial speed training plus later booster sessions were about 25% less likely to receive a dementia diagnosis compared with the control group. This protective effect was not observed for the memory or reasoning training arms.
The benefit was strongest among participants who received refresher or “booster” sessions after the initial five-week training. The trial suggests that brief, adaptive training that sharpens visual attention and reaction time can create durable neuroprotective effects, while traditional memory or reasoning exercises did not produce the same long-term reduction in dementia incidence.
Key Facts
- What the training does: Speed of processing training uses computer-based tasks to improve how quickly participants find and respond to visual information across an expanding field of view.
- Booster sessions matter: The 25% reduction in dementia risk was seen only in participants who completed the initial training and later booster sessions at roughly 11 and 35 months. Participants who received only the initial training without boosters showed no significant long-term benefit.
- Long-term durability: Researchers linked ACTIVE study participants to 20 years of Medicare claims to track dementia diagnoses, showing that under 24 total hours of training can have measurable benefits into participants’ 80s and 90s.
- Implicit versus explicit learning: Investigators suggest speed training strengthens implicit (automatic) learning pathways, making it more resilient to age-related decline than training focused on explicit strategies such as memorization or logical reasoning.
Source: Johns Hopkins Medicine
Overview: Adults aged 65 and older who completed five to six weeks of speed of processing training—exercises designed to help people quickly locate and respond to visual information on a screen—and who returned for follow-up booster sessions about one to three years later were less likely to be diagnosed with dementia, including Alzheimer’s disease, up to twenty years after the intervention. These findings were published in Alzheimer’s & Dementia: Translational Research and Clinical Interventions.
Funded by the National Institutes of Health, this analysis is the first randomized clinical trial to examine 20-year links between cognitive training and diagnosed dementia using the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study cohort. Investigators enrolled 2,802 adults in 1998–1999 to compare three types of cognitive training—memory, reasoning and speed of processing—against a no-training control group.
Each training arm provided up to 10 sessions of 60–75 minutes over five to six weeks. In addition, approximately half of participants were randomly assigned to receive up to four additional booster sessions scheduled at 11 and 35 months after the initial training. The current 20-year follow-up used Medicare claims data to determine long-term outcomes.
Among participants randomized to speed training who also completed at least one booster session, 105 of 264 (40%) were diagnosed with dementia during the 20-year follow-up. By comparison, 239 of 491 (49%) in the control group received a dementia diagnosis—a 25% lower incidence in the boosted speed-training group. No other training arm showed a statistically significant reduction compared with controls.
The analysis used Medicare data for 2,021 participants (72% of the original sample) from 1999 to 2019. The follow-up sample closely resembled the original cohort: about three-quarters were women, roughly 70% were white, and the average starting age was 74. Approximately three-quarters of participants died during follow-up, with an average age at death of 84.
Dementia describes declines in thinking and daily functioning that prevent independent living. It is a major public health challenge—affecting many older adults and costing hundreds of billions of dollars annually in the United States. Alzheimer’s disease is the most common form, responsible for about 60–80% of cases, while other forms include vascular dementia, Lewy body dementia and frontotemporal dementia.
“That boosted speed training was associated with lower dementia risk two decades later is remarkable,” says Marilyn Albert, Ph.D., corresponding author and director of the Alzheimer’s Disease Research Center at Johns Hopkins Medicine. “This suggests a modest, nonpharmacological intervention can have durable effects. Even small delays in dementia onset could produce substantial public health benefits and reduce costs.”
Investigators note that further research is needed to identify the neural mechanisms behind the observed protection and to explain why memory and reasoning interventions did not yield similar long-term associations.
Earlier ACTIVE trial findings already showed that cognitive training improved everyday function—thinking, remembering, reasoning and decision-making—for up to five years, and that all three training arms produced better daily functioning at 10 years. Prior analyses also found a lower incidence of dementia 10 years after speed training, with each booster session linked to additional risk reductions.
Speed training used an adaptive approach, adjusting task difficulty to each participant’s performance on a given day. Faster participants progressed to more challenging tasks, while others began at slower levels. In contrast, the memory and reasoning programs taught the same strategies to all participants without adaptation. Speed training also emphasizes implicit learning—skill-based, automatic processes—whereas memory and reasoning rely more on explicit strategies and facts. Differences in how these types of learning are encoded in the brain may help explain the divergent long-term outcomes.
“These results support further development of cognitive training programs for older adults that target visual processing and divided attention,” says George Rebok, Ph.D., site principal investigator and professor emeritus of mental health at the Johns Hopkins Bloomberg School of Public Health. He notes that combining this training with other lifestyle interventions—such as exercise and cardiovascular risk management—may offer synergistic benefits, but that this remains to be tested.
Lifestyle measures known to reduce the risk of cognitive decline include managing blood pressure, blood sugar, cholesterol and body weight, along with staying physically active. The authors emphasize that more research is needed to confirm how speed training interacts with these factors and to refine training approaches for widespread use.
Additional study authors include Norma B. Coe, Chuxuan Sun and Elizabeth Taggert (University of Pennsylvania); Katherine E. M. Miller and Alden L. Gross (Johns Hopkins Bloomberg School of Public Health); Richard N. Jones (Brown University); Cynthia Felix (University of Pittsburgh); Michael Marsiske (University of Florida); Karlene K. Ball (University of Alabama at Birmingham); and Sherry L. Willis (University of Washington).
Funding: This research was supported by NIH grants from the National Institute on Aging (R01AG056486). The original ACTIVE trial also received NIH support across multiple field sites and a coordinating center.
Key Questions Answered:
A: No. The study found that memory and reasoning exercises—activities like crosswords or Sudoku—did not lower dementia risk over 20 years. The observed benefit was specific to speed training, which targets rapid visual processing and divided attention.
A: Relatively little. Participants completed about 10 sessions (roughly 10–12 hours) initially, plus a few hours of booster sessions spread over one to three years. Total training time was under 24 hours across three years.
A: Yes. The specific speed of processing exercises used in the trial have been adapted into commercially available software and home programs designed to train visual processing speed.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- The full journal paper was reviewed.
- Additional context was added by staff.
About this cognitive training and Alzheimer’s disease research news
Author: Jessica Frost
Source: Johns Hopkins Medicine
Contact: Jessica Frost, Johns Hopkins Medicine
Image: The image is credited to Neuroscience News
Original Research: Open access. “Impact of cognitive training on claims-based diagnosed dementia over 20 years: evidence from the ACTIVE study” by Norma B. Coe, Katherine E. M. Miller, Chuxuan Sun, Elizabeth Taggert, Alden L. Gross, Richard N. Jones, Cynthia Felix, Marilyn S. Albert, George W. Rebok, Michael Marsiske, Karlene K. Ball, and Sherry L. Willis. DOI: 10.1002/trc2.70197
Abstract
Impact of cognitive training on claims-based diagnosed dementia over 20 years: evidence from the ACTIVE study
INTRODUCTION
The long-term effect of cognitive training on the risk of Alzheimer’s disease and related dementias (ADRD) remains poorly understood. This study examines whether targeted cognitive interventions can influence ADRD diagnoses over two decades.
METHODS
The analysis linked data from the ACTIVE randomized controlled trial to Medicare claims from 1999 to 2019. Inclusion required enrollment in traditional Medicare at baseline (n = 2,021). ADRD diagnoses were identified using the Chronic Conditions Warehouse algorithm.
RESULTS
Participants randomized to speed training who completed one or more booster sessions had a significantly lower risk of diagnosed ADRD (hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.59–0.95). Speed-trained participants who received no booster showed no reduction in risk (HR: 1.01, 95% CI: 0.81–1.27). There was no main effect of memory or reasoning training on ADRD risk.
CONCLUSIONS
Cognitive training that targets processing speed and visual attention—when reinforced with booster sessions—has the potential to delay clinically recognized ADRD diagnoses and merits further development and study.