Speed-Based Cognitive Training With Booster Sessions Linked to Lower Dementia Risk Over 20 Years

Cognitive training focused on speed of processing, when reinforced with booster sessions, was associated with a significantly lower risk of claims-based diagnosed Alzheimer disease and related dementias (ADRD) over 20 years, according to long-term follow-up data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. The findings were published in Alzheimer’s & Dementia: Translational Research & Clinical Interventions.¹

“Seeing that boosted speed training was linked to lower dementia risk two decades later is remarkable because it suggests that a fairly modest nonpharmacological intervention can have long-term effects,” Marilyn Albert, PhD, the corresponding study author and director of the Alzheimer’s Disease Research Center at Johns Hopkins Medicine, said in a press release.² “Even small delays in the onset of dementia may have a large impact on public health and help reduce rising health care costs.”

The analysis linked participants from the original ACTIVE randomized controlled trial to Medicare claims data spanning 1999 through 2019 to assess whether different cognitive training interventions were associated with long-term dementia outcomes. Among adults randomized to speed-of-processing training who also completed one or more booster sessions, the risk of diagnosed was significantly lower compared with controls (hazard ratio [HR], 0.75; 95% CI, 0.59–0.95). In contrast, speed-trained participants who did not receive booster sessions did not have a reduced risk (HR, 1.01; 95% CI, 0.81–1.27). Memory and reasoning training were not associated with a lower risk of diagnosed ADRD.¹

The ACTIVE study originally enrolled 2 802 community-dwelling adults aged 65 years and older between 1998 and 1999 across six US metropolitan areas. Participants were randomized to 1 of 4 arms: speed-of-processing training, memory training, reasoning training, or a no-contact control group. For the current analysis, investigators included 2 021 participants who were enrolled in traditional Medicare at baseline and could be reliably linked to claims data.¹

ADRD diagnoses were identified using the Medicare Chronic Conditions Warehouse algorithm, which relies on International Classification of Diseases codes and has demonstrated 85% to 90% sensitivity and specificity for dementia detection during the study period. Participants were followed for up to 20 years, with censoring at enrollment in Medicare Advantage, death, or the end of follow-up on December 31, 2019.¹

At baseline, the mean age of the analytic sample was 73.6 years (range, 65–94), 76% were women, and 70% were White. Common vascular risk factors included hypertension (66%), ischemia (40%), congestive heart failure (20%), diabetes (21%), and atrial fibrillation (8%). Over the 20-year follow-up, 77% of participants died, with a mean age at death of 83.9 years.¹

Overall, 239 of 491 participants (48.7%) in the control group were diagnosed with ADRD during follow-up. When each training arm was compared with controls without accounting for booster sessions, none of the interventions was associated with a statistically significant reduction in ADRD risk after adjustment for baseline demographics, health characteristics, and cognitive performance.

However, outcomes differed when booster sessions were considered. Among participants who completed at least 8 of the initial 10 training sessions and were eligible for boosters, those in the speed-training arm who received booster sessions at 11 and 35 months after baseline had a significantly lower hazard of diagnosed ADRD compared with controls (adjusted HR, 0.75; 95% CI, 0.59–0.95). These participants also had a lower risk compared with speed-trained participants who were eligible but not randomized to booster training (adjusted HR, 0.81; 95% CI, 0.66–1.00). No significant differences were observed for memory or reasoning training with or without boosters.¹

The investigators also examined whether age at baseline modified the effect of cognitive training on dementia risk. No statistically significant interactions were observed across age groups (65–69, 70–74, 75–79, or ≥80 years) for any of the training arms, although a nonsignificant trend toward lower ADRD risk was noted among younger participants in the memory-training group.¹

Speed-of-processing training in ACTIVE emphasized visual search, divided attention, and rapid information processing using adaptive, computer-based tasks that increased in difficulty as performance improved. In contrast, memory and reasoning interventions focused on explicit strategies to enhance verbal memory or pattern recognition. The authors noted that the adaptive and procedural nature of speed training, combined with repeated reinforcement through boosters, may have contributed to the observed long-term association with reduced dementia diagnoses.¹

The study has several limitations. Dementia outcomes were based on administrative claims rather than adjudicated clinical diagnoses, and participants enrolled in Medicare Advantage were excluded due to incomplete claims data, potentially biasing results toward the null. In addition, booster training was offered only to participants who completed the majority of initial sessions, raising the possibility of postrandomization selection effects.¹

Despite these limitations, the authors concluded that cognitive training involving speeded, adaptive tasks, reinforced over time, “has the potential to delay the diagnosis of ADRD.” They emphasized that future studies are needed to clarify which elements of cognitive training are most critical for long-term dementia risk reduction and how such interventions might be integrated with broader multidomain prevention strategies.¹

References:

1. Coe NB, Albert MS, Miller KEM, et al. Impact of cognitive training on claims-based diagnosed dementia over 20 years: evidence from the ACTIVE study. Alzheimers Dement (N Y). Published online February 9, 2026. doi:10.1002/trc2.70197
2. Cognitive Speed Training Linked to Lower Dementia Incidence Up To 20 Years Later. Johns Hopkins Medicine. News release. February 9, 2026. Accessed February 9, 2026. https://www.hopkinsmedicine.org/news/newsroom/news-releases/2026/02/cognitive-speed-training-linked-to-lower-dementia-incidence-up-to-20-years-later