- There are several known risk factors for dementia.
- Some of these, we cannot change, such as age and genetics, but some can be modified, such as lifestyle changes and keeping the brain active as we age.
- A new study has found that older adults who participate in computer-based “cognitive speed training” may reduce their dementia risk for up to 20 years.
According to Alzheimer’s Disease International, more than 55 million people around the world were living with dementia in 2020, and that number is expected to hit 78 million by 2030.
According to Marilyn Albert, PhD, director of the Johns Hopkins Alzheimer’s Disease Research Center at the Johns Hopkins School of Medicine and corresponding author of this study, the ACTIVE study initially enrolled about 2,800 participants across the U.S., with an average age of 74, between March 1998 and October 1999.
Participants were randomly assigned to one of three cognitive training groups, Albert said, which are referred to in the study as “speed,” “memory,” or “reasoning” training, or to a control group.
“In speed training, participants performed computerized training that was designed to improve the speed and accuracy of
“The training was adaptive and personalized, starting each participant at a task difficulty appropriate for their abilities, and getting more challenging as a participant succeeded at the task, and getting easier when a participant struggled with the task,” she continued.
“In memory training, participants were taught mnemonic strategies for remembering word lists and sequences of items, text material, and main ideas and details of stories,” Albert further explained. “For example, participants were instructed how to organize word lists into meaningful categories and to form visual images and mental associations to recall words and texts.”
“In reasoning training, participants focused on the ability to solve problems that follow a serial pattern, like identifying the pattern in a letter or number series or understanding the pattern in an everyday activity such as prescription drug dosing or travel schedules,” Albert added.
Study participants assigned to a cognitive training program were asked to complete 10 training sessions — twice a week for 60-75 minutes per session, over five weeks.
About half of the study’s participant pool, who completed at least eight of the 10 sessions, were then asked to participate in “booster” training for four additional sessions at the end of their first year, as well as four additional sessions at the end of their third year.
At the study’s conclusion, researchers found that participants who underwent cognitive speed training with follow-up “boosted” sessions were less likely to be diagnosed with dementia, including Alzheimer’s disease, during a 20-year follow-up.
“The participants who were randomly assigned to the speed training group and then randomly assigned to the booster sub-group showed a statistically significant 25% reduction in the risk of diagnosis with dementia in Medicare records over the course of the 20-year follow-up period compared to participants in the control group.”
— Marilyn Albert, PhD
“Participants randomly assigned to the speed group but not to the booster group, and participants in the other two cognitive training programs showed no significant benefit,” Albert pointed out.
“As further confirmation that the booster training was important, the participants who were randomly assigned to the speed booster group showed a significant 19% risk reduction when compared to participants who were eligible for booster training but were randomly assigned to the non-booster group,” she added.
MNT spoke with Vernon Williams, MD, a sports neurologist and founding director of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Orthopaedics in Los Angeles and B-ASE Performance, Inc., about this study.
As a doctor who treats both older adults concerned with high risk for dementia, as well as middle-aged and maturing adults aiming to reduce their risk and optimize their brain health and performance, Williams commented that his first reaction to the research results was cautious optimism.
“What stood out is that this wasn’t just about better test scores. One specific form of cognitive training (speed-of-processing training), when combined with reinforcement, was associated with a lower rate of real-world dementia diagnoses over nearly two decades. That’s unusual and important. It suggests that how we train the brain matters. It suggests that targeted, reinforced brain training may influence long-term dementia risk (not just short-term cognition).”
— Vernon Williams, MD
“Dementia risk really seems to boil down to poly pathology (many factors contributing), rather than being driven by one single factor,” Williams continued. “Realistically, many older adults can’t fully engage in exercise programs or may not tolerate or benefit from certain medications. But they can engage in brain-based interventions.”
“Even modest delays in dementia onset can mean years of preserved independence, lower caregiver burden, and better quality of life,” he added. “That’s why expanding the menu of evidence-based prevention tools is so critical. Dementia prevention isn’t about one silver bullet solution. In reality, it’s many cumulative gains and benefits from multiple protective factors. Cognitive training may be one of the most accessible.
MNT also spoke with Jill Del Pozzo, PhD, a clinical neuropsychologist at Hackensack Meridian Neuroscience Institute at Jersey Shore University Medical Center and Ocean University Medical Center, and assistant professor in the Department of Neurology at Hackensack Meridian School of Medicine in New Jersey, about this research.
Del Pozzo commented that what stands out most is not only that the speed of processing training was associated with a lower long-term risk of Alzheimer’s disease and related dementias, but that this benefit was specific to individuals who completed the training and received booster sessions over time.
“This mirrors what we see routinely in neurorehabilitation: repetition, adequate dose, and progression of difficulty matter,” she explained. “This study underscores that cognitive training is not a passive exposure but an active, behaviorally dependent intervention.”
“While this study does not suggest that cognitive training prevents dementia, it provides compelling evidence that targeted interventions may meaningfully delay onset — an outcome that is so important for patients, families, and health systems.”
— Jill Del Pozzo, PhD
As for next steps in this research, Del Pozzo said she would like to see future research focus on several areas.
“First, studies should examine how timing, dosage, boosters, and personalization of these interventions influence outcomes in higher-risk and more clinically/medically complex populations, not just cognitively healthy older adults,” she detailed.
“Second, there is a clear need to investigate mechanisms — specifically how adaptive, speeded, dual-attention training may promote neuroplasticity, strengthen neural connectivity, or interact with vascular and attentional systems over time. Third, research should move toward integrated, multi-domain intervention models, including physical activity, cardiovascular risk management, sleep optimization, and psychosocial engagement,” she continued.
“Lastly, ensuring greater representation of diverse populations and examining real-world functional outcomes — such as independence, driving safety, and healthcare utilization — will be essential for translating these findings into real-world clinical care,” Del Pozzo added.