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Inclusion in the analyses required being enrolled in traditional Medicare at baseline (\n                      <jats:italic>n<\/jats:italic>\n                      = 2021). ADRD was measured with the Chronic Conditions Warehouse algorithm.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Participants randomized to the speed\u2010training arm who completed one or more booster sessions had a significantly lower risk of diagnosed ADRD (hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.59, 0.95), while speed\u2010trained participants with no booster training did not have a lower risk of diagnosed ADRD (HR: 1.01, 95% CI: 0.81, 1.27). There was no main effect of memory or reasoning training on risk of ADRD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Cognitive training involving speed of cognitive processing has the potential to delay the diagnosis of ADRD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>The ACTIVE study (a four\u2010arm randomized controlled trial of cognitive training in a large, representative sample) reports that the speed intervention arm of the study showed a reduced likelihood of being diagnosed with ADRD over a 20\u2010year follow\u2010up period.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>No prior cognitive training intervention has been shown to reduce risk of ADRD over a 20\u2010year period.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Cognitive training involving speeded, dual attention, adaptive tasks has the potential to delay the diagnosis of ADRD.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/trc2.70197","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T12:00:26Z","timestamp":1770638426000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Impact of cognitive training on claims\u2010based diagnosed dementia over 20 years: evidence from the ACTIVE study"],"prefix":"10.1002","volume":"12","author":[{"given":"Norma B.","family":"Coe","sequence":"first","affiliation":[{"name":"Department of Medical Ethics and Health Policy Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"National Bureau of Economic Research (NBER)  Cambridge Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine E. M.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuxuan","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Medical Ethics and Health Policy Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Taggert","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alden L.","family":"Gross","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard N.","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Psychiatry &amp; Human Behavior Warren Alpert Medical School Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Felix","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Pittsburgh Graduate School of Public Health  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilyn S.","family":"Albert","sequence":"additional","affiliation":[{"name":"Department of Neurology Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George W.","family":"Rebok","sequence":"additional","affiliation":[{"name":"Department of Mental Health Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Marsiske","sequence":"additional","affiliation":[{"name":"Department of Clinical and Health Psychology College of Public Health and Health Professions University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karlene K.","family":"Ball","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Alabama at Birmingham 1720 University Blvd  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherry L.","family":"Willis","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.17226\/24782"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0197-2456(01)00139-8"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.18.2271"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.296.23.2805"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12607"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trci.2017.09.002"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2014.02.004"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1745-6916.2006.00005.x"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/1529100616661983"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3956(75)90026-6"},{"key":"e_1_2_11_12_1","volume-title":"Measurement in Elderly Chronic Care Populations","author":"Morris J","year":"1997"},{"key":"e_1_2_11_13_1","volume-title":"Description of Matching Methods for Linking Data in LINKAGE","author":"MaCurdy TE"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1037\/0012-1649.26.6.894"},{"key":"e_1_2_11_15_1","first-page":"266","volume-title":"Handbook of the Psychology of Aging","author":"Schaie KW","year":"1996"},{"key":"e_1_2_11_16_1","unstructured":"Office of Inspector General Issue Brief.US Department of Health & Human Services. 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