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The Effects of the ACTIVE Cognitive Training Trial on Clinically Relevant Declines in Health-Related Quality of Life

¹ The University of Iowa and Iowa City Veterans Affairs Medical Center.
² Indiana University, Indianapolis.
³ Regenstrief Institute, Inc., Indianapolis, Indiana.
⁴ Hebrew Rehabilitation Center for the Aged, Boston, Massachusetts.
⁵ New England Research Institutes, Watertown, Massachusetts.

Address correspondence to Fredric D. Wolinsky, the John W. Colloton Chair, Department of Health Management and Policy, College of Public Health, University of Iowa, 200 Hawkins Drive, E205 General Hospital, Iowa City, IA 52242. E-Mail: fredric-wolinsky{at}uiowa.edu

Objectives. 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).

Discussion. Although all three intervention arms improved cognitive ability, only the speed-of-processing arm protected against extensive clinically relevant decline in HRQoL.