Nearly half of community-dwelling persons aged 60 years and older express concern about declining mental abilities.¹ Although there is substantial evidence that many cognitive abilities and processes are related to measures of functional status, need for care, and quality of life, few studies have addressed whether improving cognitive functions might have short- or long-term effects on activities related to living independently. Interventions designed to delay or prevent the need for nursing homes, home care, and hospital stays can save health care costs, while also ensuring the independence and dignity of the aging population.

Cognitive training has been shown to improve cognitive abilities in older adults but the effects of cognitive training on everyday function have not been demonstrated. To determine the effects of cognitive training on daily function and durability of training on cognitive abilities. Five-year follow-up of a randomized controlled single-blind trial with 4 treatment groups. A volunteer sample of 2832 persons (mean age, 73.6 years; 26% black), living independently in 6 US cities, was recruited from senior housing, community centers, and hospitals and clinics. The study was conducted between April 1998 and December 2004. Five-year follow-up was completed in 67% of the sample. Ten-session training for memory (verbal episodic memory), reasoning (inductive reasoning), or speed of processing (visual search and identification); 4-session booster training at 11 and 35 months after training in a random sample of those who completed training. Self-reported and performance-based measures of daily function and cognitive abilities. The reasoning group reported significantly less difficulty in the instrumental activities of daily living (IADL) than the control group (effect size, 0.29; 99% confidence interval [CI], 0.03-0.55). Neither speed of processing training (effect size, 0.26; 99% CI, -0.002 to 0.51) nor memory training (effect size, 0.20; 99% CI, -0.06 to 0.46) had a significant effect on IADL. The booster training for the speed of processing group, but not for the other 2 groups, showed a significant effect on the performance-based functional measure of everyday speed of processing (effect size, 0.30; 99% CI, 0.08-0.52). No booster effects were seen for any of the groups for everyday problem-solving or self-reported difficulty in IADL. Each intervention maintained effects on its specific targeted cognitive ability through 5 years (memory: effect size, 0.23 [99% CI, 0.11-0.35]; reasoning: effect size, 0.26 [99% CI, 0.17-0.35]; speed of processing: effect size, 0.76 [99% CI, 0.62-0.90]). Booster training produced additional improvement with the reasoning intervention for reasoning performance (effect size, 0.28; 99% CI, 0.12-0.43) and the speed of processing intervention for speed of processing performance (effect size, 0.85; 99% CI, 0.61-1.09). Reasoning training resulted in less functional decline in self-reported IADL. Compared with the control group, cognitive training resulted in improved cognitive abilities specific to the abilities trained that continued 5 years after the initiation of the intervention. clinicaltrials.gov Identifier: NCT00298558.

Research from JAMA — Visual Processing Impairment and Risk of Motor Vehicle Crash Among Older Adults — Context.—Motor vehicle crash risk in older drivers has been associated with visual acuity loss, but only weakly so, suggesting other factors contribute. The useful field of view is a measure that reflects decline in visual sensory function, slowed visual processing speed, and impaired visual attention skills.Objective.—To identify whether measures of visual processing ability, including the useful field of view test, are associated with crash involvement by older drivers.Design.—Prospective cohort study with 3 years of follow-up, 1990-1993.Setting.—Ophthalmology clinic assessment of community-based sample.Patients.—A total of 294 drivers aged 55 to 87 years at enrollment.Main Outcome Measure.—Motor vehicle crash occurrence.Results.—Older drivers with a 40% or greater impairment in the useful field of view were 2.2 times (95% confidence interval, 1.2-4.1) more likely to incur a crash during 3 years of follow-up, after adjusting for age, sex, race, chronic medical conditions, mental status, and days driven per week. This association was primarily mediated by difficulty in dividing attention under brief target durations.Conclusion.—Reduction in the useful field of view increases crash risk in older drivers. Given the relatively high prevalence of visual processing impairment among the elderly, visual dysfunction and eye disease deserve further examination as causes of motor vehicle crashes and injury.

The useful field of view is defined as the visual area in which information can be acquired within one eye fixation. We studied visual search within this context and found a reduction in the size of the field as a function of age. This loss, however, was recovered partially with practice. Standard acuity and perimetric tests of visual field, although diagnostic of disease, underestimate the degree of difficulty experienced by visually healthy older adults in everyday activities requiring the use of peripheral vision. To aid in predicting such performance, a model incorporating the effects of distractors and secondary task demands was developed.