Feb 4, 2008
By: Alvaro Fernandez
Today we are fortunate to interview Dr. Jerri Edwards, an Associate Professor at University of South Florida’s School of Aging Studies and Co-Investigator of the influencial ACTIVE study. Dr. Edwards was trained by Dr. Karlene K. Ball, and her research is aimed toward discovering how cognitive abilities can be maintained and even enhanced with advancing age.
Main focus of research
Alvaro Fernandez: Please explain to our readers your main research areas
Jerri Edwards: I am particularly interested in how cognitive interventions may help older adults to avoid or at least delay functional difficulties and thereby maintain their independence longer. Much of my work has focused on the functional ability of driving including assessing driving fitness among older adults and remediation of cognitive decline that results in driving difficulties.
Some research questions that interest me include, how can we maintain healthier lives longer? How can training improve cognitive abilities, both to improve those abilities and also to slow-down, or delay, cognitive decline? The specific cognitive ability that I have studied the most is processing speed, which is one of the cognitive skills that decline early on as we age.
Can you explain what cognitive processing speed is, and why it is relevant to our daily lives?
Processing speed is mental quickness. Just like a computer with a 486 processor can do a lot of the same things as a computer with a Pentium 4 processor, but it takes much longer, our minds tend to slow down with age as compared to when we were younger. We can do the same tasks, but it takes more time. Quick speed of processing is important for quick decision making in our daily lives. When you are driving, if something unexpected happens, how quickly can you notice the situation and decide how to react?
Please describe how the ACTIVE trial used the cognitive training program, and what the results were found to be when they were published in the Journal of the American Medical Association in December 2006?
I was a co-investigator of the ACTIVE study, a multi-site, controlled study, with thousands of adults over sixty-five, to evaluate the effectiveness of three different cognitive training methods with three different groups:
– The first group used a memory training program including a variety of traditional memory techniques such as mnemonics and the method of loci.
– The second group was trained in learn inductive reasoning skills.
– The third group was exposed to computer-based programs to train processing speed.
All 3 groups spent the same amount of time in their respective training programs, around 2 hours a week for 5 weeks, going through exercises of increasing difficulty. The ACTIVE study was designed to track participants’ performance over a number of years, so, after this initial 5-week intervention, some groups received training booster sessions, after 1 year and again after 3 years.
Willis and colleagues published the 5-year results in JAMA last December and the results were very positive. All 3 types of cognitive programs were shown to have an effect immediately after the program, after 3 years, and after 5. But, the results of the group that used a computer-based program to train processing speed showed clear short-term and long-term results. Individuals who experienced improved speed of processing also showed better performance on tasks of instrumental activities of daily living such as quickly finding an item on a crowded pantry shelf and reading medication bottles. They also reacted to road signs more quickly. We found this transfer of training in our prior studies using the training protocol as well.
In short, significant percentages of the participants improved their memory, reasoning and information-processing speed across all three methods. The most impressive result was that, when tested five years later, the participants in the computer-based program had less of a decline in the skill they were trained in than did a control group that received no cognitive training.
The results of the ACTIVE study were quite impressive and contributed in large part to the amount of media coverage about brain fitness last year. However, as you have probably seen, there is a good deal of confusion about brain fitness among the media and the public at large. Can you help our readers understand two common questions: 1) Why are new programs better than, say, doing crosswords puzzles?, and 2) Can one really say that these programs can reverse age-related decline?
To answer the first question, I would say that a crossword puzzle is not a form of cognitive training. It can be stimulating, but it is not a form of structured mental exercise that has been shown to improve specific cognitive skills – other than the skill of doing crossword puzzles, of course.
In terms of the second question, it is too early to say whether we can really reverse decline in a permanent way. There are many skills involved and the studies are not long enough to really compare different trajectories. What we can say is that by doing some exercises, one can improve cognitive speed of processing by 146-250%, and that a significant portion of that improvement stays even after 5 years. We cannot say more definitively.
But I think it is noteworthy to be able to say that, in all of the programs tested, the payoff from cognitive training, or what we can call “mental exercise”, seemed far greater than we are accustomed to getting from physical exercise. Just imagine if you could say that 10 hours of workouts at the gym every day this month was enough to help keep you fit five years from now.
Now, the program used is not fully automated, correct? It required the intervention of a trained person to calibrate the program at the right level of difficulty.
That is correct.
Another fascinating study that you published as a co-author in Human Factors (2003), applied the same computer-based program to improving the driving-related mental skills of older adults. Can you explain that study?
Sure. Our goal was to train what is called the “useful field of view.” The useful field of view is a measure of processing speed and visual attention that is critical for driving performance, and one of the areas that declines with age. It has previously been shown that this skill can be improved with training, so we wanted to see what effect it would have on the driving performance of older adults, and whether the training would be more or less effective than a traditional driving simulation course.
For the study, we divided forty-eight adults over fifty-five years old into two intervention groups of twenty-four people each. Each group received twenty hours of training. One group was exposed to a traditional driving simulator, where they learned specific driving behaviours. The other one went through the cognitive training program.
Both groups’ driving performance improved right after their respective programs, but most benefits of the driving simulator disappeared by month eighteen.
The speed-of-processing intervention helped participants not only improve “useful field of view,” the skill that was directly trained, but it also transferred into real-life driving, and the results were sustained after 18 months. And, by the way, the evaluation was as real as one can imagine: a 14-mile open road evaluation.
Faster speed-of-processing seemed to enable adults to react better to unexpected events that require a fast response and to reduce by 40% the number of dangerous manoeuvres on real roads (defined as those that required the training instructor to intervene during the evaluation).
Research like this seems to present major opportunities for society. For example, wouldn’t insurance companies, or the AARP, want to sponsor more research and evaluate whether to offer this type of training to their members? Won’t major employers see opportunities to improve the performance of older employees by identifying the cognitive skills that may need the most improvement and offering tailored training? We could speculate that a person with faster processing abilities will also be able to make faster decisions and learn faster…
That makes sense, based on what we know. Cognitive abilities evolve in different ways as we age, and some typically start to decline in our thirties. Cognitive interventions may help train and improve those abilities, and there is already research that strongly indicates where and how training can be useful. More research is still required to deliver more precise and tailored interventions in a variety of environments. I suspect we will see the field grow significantly – and not just for aging-related priorities. Cognitive training may become useful for a variety of health conditions, such as Parkinson’s and Alzheimer’s patients, for example. More research will help researchers refine assessments and training programs.
– Edwards, J.D., Ross, L.A., Clay, O.C., Wadley, V.G., Crowe, M., Roenker, D.L. & Ball, K.K. (2006). The Useful Field of View test: Normative data. Archives of Clinical Neuropsychology, 21: 275-286
– Ball, K.K., Roenker, D., Wadley, V.G., Edwards, J.D., Roth, D.L., McGwin, G. M., Raleigh, R., Joyce, J., & Cissell, G.M. & Dube, T. (2006). Can high-risk older drivers be identified through performance-based measures in a department of motor vehicles setting? Journal of the American Geriatrics Society, 54: 77-84.
– Roenker, D., Cissell, G., Ball, K., Wadley, V., & Edwards, J. (2003). Speed of processing and driving simulator training result in improved driving performance. Human Factors, 45: 218-233.
– Jobe, J.B., Smith, D.M., Ball, K., Tennstedt, S. L., Marsiske, M., Willis, S.L., Rebok, G.W., Morris, J.N., Helmers, K.F., Leveck, M.D., Kleinman, K. ACTIVE: A cognitive intervention trail to promote independence in older adults. Control Clinical Trials, 2001, 22(4): 453-479.
– Edwards, J., Wadley, V., Myers, R., Ball, K., Roenker, D., & Cissell, G. (2002). Transfer of a speed of processing intervention to near and far cognitive functions. Gerontology, 48: 329-340.
– Edwards, J.D., Wadley, V.G., Vance, D.E., Wood, K.M., Roenker, D.L., & Ball, K.K. (2005). The impact of speed of processing training on cognitive and everyday performance. Aging & Mental Health, 9: 262-271.
Credit for pic: Dennis Keim dk-studio