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Hearing Journal:
doi: 10.1097/01.HJ.0000446436.57633.e4
Editorial

What the ACTIVE Trial Means for Audiology

Pichora-Fuller, M. Kathleen PhD

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Dr. Pichora-Fuller is a full professor of psychology at the University of Toronto in Mississauga, ON; guest professor at Linköping University in Linköping, Sweden; and adjunct scientist at the Toronto Rehabilitation Institute and at the Rotman Research Institute at Baycrest, both in Toronto. She combines experience in rehabilitative audiology for older adults with experimental research on auditory and cognitive aging.

Cognitive decline increases difficulties in everyday functioning, but can cognitive training delay the onset or slow progression of these problems? The results of a large-scale, multisite, longitudinal, randomized, controlled clinical trial provide evidence that it can ( J Am Geriatr Soc 2014;62[1]:16-24 http://onlinelibrary.wiley.com/doi/10.1111/jgs.12607/full).

Figure. M. Kathleen ...
Figure. M. Kathleen ...
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At 10-year follow-up of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial, older adults who participated in cognitive intervention had declined less in self-reported instrumental activities of daily living (IADLs) compared with a control group.

The initial study sample included 2,832 healthy volunteers from six cities whose mean age was 74 when the study began in 1998-99. They were randomly assigned to a no-contact control group or to one of three different intervention groups.

Each intervention group received ten weeks of training and booster sessions on one of the following targeted cognitive abilities: memory, reasoning, or speed of processing. Participants were assessed before and immediately after the intervention, and they were re-assessed one, two, three, five, and 10 years later.

At the 10-year follow-up, about 300 participants in each of the four groups were reassessed (44% retention of the baseline sample).

In addition to relative preservation of everyday function on instrumental activities of daily living, which was found for all three interventions at 10 years, performance on behavioral tests of the targeted cognitive abilities also was maintained for those who had received reasoning or speed-of-processing training, but not for those who had received memory training.

This study provides a good example of the kind of research needed to determine whether or not audiologic rehabilitation could be similarly beneficial to everyday functioning.

A question remains as to whether people who are hard of hearing would benefit from cognitive training to the same extent as people with normal hearing.

Like many studies concerning cognitive aging, people with “poor” hearing were excluded from the ACTIVE study, although the hearing criterion for inclusion is not described well. Visual acuity is included in some analyses, but hearing thresholds are not.

Interestingly, the two interventions that yielded long-term benefits on tests of targeted cognitive abilities—reasoning and speed of processing—both focused on visual tasks and were evaluated using visual measures.

In contrast, the memory intervention, which yielded short-term (up to five years post-intervention) but not longer-term targeted cognitive benefits, focused on improving verbal episodic memory, and memory was tested using verbal tests.

Could the greater deterioration in memory than in reasoning or speed of processing be related to greater auditory/verbal declines than visual/nonverbal declines over the 10 years following intervention?

It is also curious that all three cognitive interventions had a significant effect on self-reported instrumental activities of daily living but not on performance-based measures of everyday functioning.

The study adds an important piece to the puzzle, but many more pieces must be added to complete our understanding of the possible benefits of different types of training for older adults who are hard of hearing.

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