Browsing by Author "Tennstedt, Sharon L."

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    The ACTIVE cognitive training trial and predicted medical expenditures
    (BioMed Central, 2009-06-29) Wolinsky, Fredric D.; Mahncke, Henry W.; Kosinski, Mark; Unverzagt, Frederick W.; Smith, David M.; Jones, Richard N.; Stoddard, Anne; Tennstedt, Sharon L.; Medicine, School of Medicine
    Background Health care expenditures for older adults are disproportionately high and increasing at both the individual and population levels. We evaluated the effects of the three cognitive training interventions (memory, reasoning, or speed of processing) in the ACTIVE study on changes in predicted medical care expenditures. Methods ACTIVE was a multisite randomized controlled trial of older adults (≥ 65). Five-year follow-up data were available for 1,804 of the 2,802 participants. Propensity score weighting was used to adjust for potential attrition bias. Changes in predicted annualmedical expenditures were calculated at the first and fifth annual follow-up assessments using a new method for translating functional status scores. Multiple linear regression methods were used in this cost-offset analysis. Results At one and five years post-training, annual predicted expenditures declinedby $223 (p = .024) and $128 (p = .309), respectively, in the speed of processing treatment group, but there were no statistically significant changes in the memory or reasoning treatment groups compared to the no-contact control group at either period. Statistical adjustment for age, race, education, MMSE scores, ADL and IADL performance scores, EPT scores, chronic condition counts, and the SF-36 PCS and MCS scores at baseline did not alter the one-year ($244; p = .012) or five-year ($143; p = .250) expenditure declines in the speed of processing treatment group. Conclusion The speed of processing intervention significantly reduced subsequent annual predicted medical care expenditures at the one-year post-baseline comparison, but annual savings were no longer statistically significant at the five-year post-baseline comparison.
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    Relationship of Demographic and Health Factors to Cognition in Older Adults in the ACTIVE Study
    (Sage, 2013) Rexroth, Daniel F.; Tennstedt, Sharon L.; Jones, Richard; Guey, Lin T.; Rebok, George W.; Marsiske, Michael; Xu, Yan; Unverzagt, Frederick W.; Psychiatry, School of Medicine
    Objective: Examine the relationship of demographics and health conditions, alone and in combination, on objective measures of cognitive function in a large sample of community-dwelling older adults. Method: Baseline data from 2,782 participants in the Advanced Cognitive Training in Independent and Vital Elderly (ACTIVE) study were used to examine relationships of demographics and health conditions with composite scores of memory, reasoning, and speed of processing. Results: Younger age, increased education, and White race were independently associated with better performance in each cognitive domain after adjusting for gender and health conditions. Male gender, diabetes, and suspected clinical depression were associated with poorer cognitive functioning; suspected clinical depression was associated with lower reasoning and diabetes and history of stroke with slower speed of processing. Discussion: Age, education, and race are consistently associated with cognitive performance in this sample of older community-dwelling adults. Diabetes, stroke, and suspected clinical depression had independent but weaker effects on cognition.
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    Ten-Year Effects of the ACTIVE Cognitive Training Trial on Cognition and Everyday Functioning in Older Adults
    (Wiley, 2014) Rebok, George W.; Ball, Karlene; Guey, Lin T.; Jones, Richard N.; Kim, Hae-Young; King, Jonathan W.; Marsiske, Michael; Morris, John N.; Tennstedt, Sharon L.; Unverzagt, Frederick W.; Willis, Sherry L.; ACTIVE Study Group; Psychiatry, School of Medicine
    Objectives: To determine the effects of cognitive training on cognitive abilities and everyday function over 10 years. Design: Ten-year follow-up of a randomized, controlled single-blind trial (Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE)) with three intervention groups and a no-contact control group. Setting: Six U.S. cities. Participants: A volunteer sample of 2,832 persons (mean baseline age 73.6; 26% African American) living independently. Intervention: Ten training sessions for memory, reasoning, or speed of processing; four sessions of booster training 11 and 35 months after initial training. Measurements: Objectively measured cognitive abilities and self-reported and performance-based measures of everyday function. Results: Participants in each intervention group reported less difficulty with instrumental activities of daily living (IADLs) (memory: effect size = 0.48, 99% confidence interval (CI) = 0.12-0.84; reasoning: effect size = 0.38, 99% CI = 0.02-0.74; speed of processing: effect size = 0.36, 99% CI = 0.01-0.72). At a mean age of 82, approximately 60% of trained participants, versus 50% of controls (P < .05), were at or above their baseline level of self-reported IADL function at 10 years. The reasoning and speed-of-processing interventions maintained their effects on their targeted cognitive abilities at 10 years (reasoning: effect size = 0.23, 99% CI = 0.09-0.38; speed of processing: effect size = 0.66, 99% CI = 0.43-0.88). Memory training effects were no longer maintained for memory performance. Booster training produced additional and durable improvement for the reasoning intervention for reasoning performance (effect size = 0.21, 99% CI = 0.01-0.41) and the speed-of-processing intervention for speed-of-processing performance (effect size = 0.62, 99% CI = 0.31-0.93). Conclusion: Each Advanced Cognitive Training for Independent and Vital Elderly cognitive intervention resulted in less decline in self-reported IADL compared with the control group. Reasoning and speed, but not memory, training resulted in improved targeted cognitive abilities for 10 years.
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    The ACTIVE Study: Study Overview and Major Findings
    (Sage, 2013) Tennstedt, Sharon L.; Unverzagt, Frederick W.; Psychiatry, School of Medicine