The effects of the ACTIVE cognitive training trial on clinically relevant declines in health-related quality of life.
OBJECTIVE
The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study used three cognitive interventions (memory, reasoning, or speed of processing) in order to improve cognitive abilities. In this article, we evaluate ACTIVE's ability to avoid extensive decline in health-related quality of life (HRQoL).


METHODS
ACTIVE enrolled 2,802 adults aged 65 or older and randomized them into one of three cognitive interventions or a no-contact control group. Researchers obtained data on 2,147 participants at the 24-month follow-up. We measured HRQoL by using the eight Short Form-36 scales, and we defined clinically relevant decline on each as a drop of 0.5 standard deviations from baseline. We defined extensive HRQoL decline as clinically relevant drops on four or more Short Form-36 scales, and we assessed this by using multiple logistic regression methods that adjusted for sociodemographic, cognitive, and health status covariates, and incorporated propensity score derived weights in order to adjust for potential attrition bias.


RESULTS
We found that 25.0% of ACTIVE participants had extensive HRQoL decline. Participants in the speed-of-processing intervention arm were less likely to have extensive HRQoL decline (adjusted odds ratio = 0.643; p =.004) compared with controls, and participants in the memory and reasoning arms were equivalent to controls (adjusted odds ratios = 1.149 and 1.014, respectively; ps =.322 and.919, respectively).


CONCLUSIONS
Although all three intervention arms improved cognitive ability, only the speed-of-processing arm protected against extensive clinically relevant decline in HRQoL.
Wolinsky
Fredric D
FD
Department of Health Management and Policy, College of Public Health, University of Iowa, 200 Hawkins Drive, E205 General Hospital, Iowa City, IA 52242, USA. fredric-wolinsky@uiowa.edu
Unverzagt
Frederick W
FW
Smith
David M
DM
Jones
Richard
R
Wright
Elizabeth
E
Tennstedt
Sharon L
SL
D000368:Aged; D001076:Aptitude; D003072:Cognition Disorders / Q000523:psychology / Q000534:rehabilitation*; D004493:Education; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008128:Logic; D008297:Male; D008569:Memory Disorders / Q000523:psychology / Q000534:rehabilitation; D011340:Problem Solving; D011788:Quality of Life / Q000523:psychology*; D011930:Reaction Time; D012803:Sick Role; D016037:Single-Blind Method; D014481:United States