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Improving Driving Skills and Brain Functioning– Interview with ACTIVE’s Jerri Edwards

Jerri Edwards- Active trialToday 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.

ACTIVE results

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.

Clar­i­fy­ing confusion

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.

Driving-related per­for­mance

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).

The Future

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.

Ref­er­ences

- 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

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