A Randomized Controlled Trial of Cognitive Training Using a Visual Speed of Processing Intervention in Middle Aged and Older Adults

Dotson MM (2013) A Randomized Controlled Trial of Cognitive Training Using a Visual Speed of Processing Intervention in Middle Aged and Older Adults. PLoS ONE 8(5): e61624. doi:10.1371/journal.pone.0061624 A Randomized Controlled Trial of Cognitive Training Using a Visual Speed of Processing Intervention in Middle Aged and Older Adults Fredric D. Wolinsky 0 Mark W. Vander Weg 0 M. Bryant Howren 0 Michael P. Jones 0 Megan M. Dotson 0 Jerson Laks, Federal University of Rio de Janeiro, Brazil 0 1 Department of Health Management and Policy, University of Iowa , Iowa City , Iowa, United States of America, 2 Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System , Iowa City , Iowa, United States of America, 3 Department of Biostatistics, University of Iowa , Iowa City , Iowa, United States of America, 4 College of Nursing, University of Iowa , Iowa City, Iowa , United States of America Background: Age-related cognitive decline is common and may lead to substantial difficulties and disabilities in everyday life. We hypothesized that 10 hours of visual speed of processing training would prevent age-related declines and potentially improve cognitive processing speed. Methods: Within two age bands (50-64 and$65) 681 patients were randomized to (a) three computerized visual speed of processing training arms (10 hours on-site, 14 hours on-site, or 10 hours at-home) or (b) an on-site attention control group using computerized crossword puzzles for 10 hours. The primary outcome was the Useful Field of View (UFOV) test, and the secondary outcomes were the Trail Making (Trails) A and B Tests, Symbol Digit Modalities Test (SDMT), Stroop Color and Word Tests, Controlled Oral Word Association Test (COWAT), and the Digit Vigilance Test (DVT), which were assessed at baseline and at one year. 620 participants (91%) completed the study and were included in the analyses. Linear mixed models were used with Blom rank transformations within age bands. Results: All intervention groups had (p,0.05) small to medium standardized effect size improvements on UFOV (Cohen's d = 20.322 to 20.579, depending on intervention arm), Trails A (d = 20.204 to 20.265), Trails B (d = 20.225 to 20.320), SDMT (d = 0.263 to 0.351), and Stroop Word (d = 0.240 to 0.271). Converted to years of protection against age-related cognitive declines, these effects reflect 3.0 to 4.1 years on UFOV, 2.2 to 3.5 years on Trails A, 1.5 to 2.0 years on Trails B, 5.4 to 6.6 years on SDMT, and 2.3 to 2.7 years on Stroop Word. Conclusion: Visual speed of processing training delivered on-site or at-home to middle-aged or older adults using standard home computers resulted in stabilization or improvement in several cognitive function tests. Widespread implementation of this intervention is feasible. Trial Registration: ClinicalTrials.gov NCT-01165463 PLOS ONE | www.plosone.org - Funding: This study was supported by National Institutes of Health (NIH) grant RC1 AG-035546 to FDW. The visual speed of processing training video game used in IHAMS is commercially available from Posit Science Corporation (San Francisco, CA, USA). None of the members of the investigative team have any conflicts of interest or commitment involving Posit Science. Specifically, no one on the investigative team will financially profit in any way from the use of the visual speed of processing training. Posit Science acquired ownership in October 2007 of Ball and Roenkers original speed of processing intervention that was used in the multisite ACTIVE study on which FW was a co-investigator. In collaboration with Professors Ball and Roenker, Posit Science subsequently developed the current version of the VSP training video game used in IHAMS. From December 2007 to March 2009, FW had a part-time consulting arrangement (15 days total) with Posit Science to support additional analyses of the first five-years of the ACTIVE follow-up data that had not been identified in the original ACTIVE protocols nor funded by the various NIH grants supporting ACTIVE. That arrangement was approved in advance by the ACTIVE Executive Committee (which included the NIH project officers), and was approved by the Provost of the University of Iowa. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. Age-related cognitive decline is common and affects memory, orientation, attention, abstract thinking, and perception [14]. These cognitive declines may lead to substantial difficulties and disabilities in everyday life [58]. Because life expectancy is at an all-time high and improving [9], identifying interventions that can be widely and efficiently implemented and that may prevent or even reverse cognitive decline are clinical and public health priorities [1012]. This is especially important given evidence that cognitive declines are well-documented as early as age 30 in crosssequential data [1315] and as early as age 45 in longitudinal data [16]. Because part (but clearly not all) of these declines reflect negative brain plasticity, cognitive abilities may be strengthened somewhat by interventions that promote positive brain plasticity [7,10,17,18]. Among the most promising such interventions are complex video games that train strategic control in structured situations [7]. Ball and Roenker [1921] developed the precursor to such a video game intervention focusing on visual speed of processing. Their original training program was used as one of three interventions in the U.S. National Institutes of Health (NIH) funded, multi-site Advanced Cognitive Trial for Independent and Vital Elderly (ACTIVE), the largest cognitive training trial ever conducted [2224]. Results from ACTIVE demonstrated that each of the three cognitive training interventionsmemory, reasoning, and visual speed of processingaffected their targeted proximal and primary outcomes over both short- and long-term (15 year) follow-up periods [2224] and reflected the equivalent of 6, 4, and 8 years, respectively, of cognitive decline restoration [25]. However, only the visual speed of processing intervention had significant and substantial effects on a variety of health outcomes including health-related quality of life, depressive symptoms and the onset of suspected clinical depression, selfrated health, and internal locus of control that lasted up to five years [2632]. ACTIVE, however, had some limitations [33,34]. First, because ACTIVE used a no contact rather than an attention control group, placebo effects could not be ruled out except by direct comparison of one training intervention to another. Second, because ACTIVEs booster training was compliance-conditioned, treatment effects could not be separated from adherence effects. Third, because ACTIVE relied on only one speed of processing outcome (the Useful Field of View te (...truncated)