CATEGORY: HEALTHY AGING & LONGEVITY
Speed-of-processing brain training went with fewer dementia diagnoses over the following 20 years, but only among people who came back for at least one refresher round. Their diagnosis rate ran 25% lower. In that boosted group, 40% had a dementia diagnosis by 2019, which was 105 of 264 people. Among those given no training the figure was 49%, or 239 of 491. The numbers come from a new analysis of the landmark ACTIVE trial, published in Alzheimer’s & Dementia: Translational Research & Clinical Interventions.1 Speed training without the refreshers showed no effect at all, and neither did two other kinds of training.
An Arcade Game With a Road Sign at the Edge of Vision
The training itself looks almost like a video game. In speed-of-processing training, also called Useful field of view training, a participant watches a screen and identifies an object flashed at the center of gaze, a car or a truck. At the same moment a road sign flashes somewhere out toward the edge of vision, and that has to be caught too. Get it right and the next round comes faster, with more distractions. The program tunes its difficulty to each player, every session. The initial course ran ten sessions of 60 to 75 minutes over five to six weeks. Random subsets of participants were later offered booster rounds of up to four extra sessions, at about one year in and again at three.
Randomized in 1998, Answered by Medicare in 2019
ACTIVE enrolled 2,802 healthy adults aged 65 and older at six U.S. sites in 1998 and 1999. A random draw sorted them into memory training, reasoning training, speed-of-processing training or no training. Neither the participants nor their doctors had any say in it, which leaves the groups alike in everything but the training. The new analysis linked the 2,021 participants enrolled in traditional Medicare to their claims records from 1999 through 2019, flagging dementia with a standard federal claims algorithm. That is what makes a 20-year answer possible. It also draws the boundary. Only dementia that was actually diagnosed and billed for gets counted, nobody was examined in person, and a case that never reached a medical record would be missed.
One Arm of Three, and Only With Refreshers
Participants who completed speed training plus at least one booster had a hazard ratio of 0.75. That works out to a 25% lower risk of a dementia diagnosis across the follow-up, with a confidence range running from 5% to 41%. Those who took the initial speed course and no boosters did no better than the untrained, at a hazard ratio of 1.01. Memory and reasoning training, strategy-based programs teaching mnemonics and problem-solving patterns, showed nothing in any form. Speed training differs in kind from those two, the researchers point out. It builds an automatic skill through fast repetition, the way one learns to ride a bicycle, rather than teaching a strategy that has to be remembered and then applied. An earlier look at the same people pointed the same way. A 2017 analysis of the trial’s first decade used in-study assessments instead of Medicare claims. It found a 29% lower dementia risk with speed training, and roughly 10% lower risk for each additional session completed.2 Both analyses draw on the same 2,802 people, and no other randomized trial has tested this kind of training against dementia over decades. The benefit appeared only among those who took refreshers, so the result reads as much like a dose effect as a verdict on the five-week course.
Key Takeaways
- In the randomized ACTIVE trial, older adults given speed-of-processing training plus booster sessions were diagnosed with dementia at a 25% lower rate over 20 years, 40% against 49% among the untrained.
- The initial course alone was not enough. Without refresher sessions, dementia rates matched the no-training group, and memory and reasoning training showed no effect either way.
- Dementia was identified through Medicare billing records rather than in-person exams, so the finding is best read as a delay in diagnosed dementia. A 2017 analysis of the trial’s first decade found the same pattern.
References
- Coe NB, Miller KEM, Sun C, et al. Impact of cognitive training on claims-based diagnosed dementia over 20 years: evidence from the ACTIVE study. Alzheimer’s & Dementia: Translational Research & Clinical Interventions. 2026;12(1):e70197. link
- Edwards JD, Xu H, Clark DO, et al. Speed of processing training results in lower risk of dementia. Alzheimer’s & Dementia: Translational Research & Clinical Interventions. 2017;3(4):603–611. link