The above findings confirmed that after attending the Active Mind cognitive-training program, the treatment group showed better improvement in cognitive function and QoL than the control group who only participated in the usual group activities. This study provides evidence supporting the effectiveness of cognitive-training program for community-dwelling Chinese elderly adults.
The subjects’ characteristics were consistent with those attending other DECCs for older adults in Hong Kong. In order to target for the population of general Chinese elderly adults without apparent cognitive impairment, those who were known to have dementia or diseases leading to cognitive impairment were excluded. The results are therefore applicable to general community-dwelling Chinese older adults of good cognitive status. In this study, subjects with lower education level were more likely to benefit from the Active Mind program. This could be due to the ceiling effect of the cognitive-training program and more challenging tasks should be given to subjects with higher education levels.
Many DECCs in Hong Kong are serving older adults with a similar profile. The Active Mind cognitive-training program is therefore suitable to be carried out at various DECCs in Hong Kong. Older adults can benefit from this program by visiting the DECCs in their neighborhood for an enjoyable social encounter with other elderly in their vicinity. As a nonpharmacological intervention for people with memory complaints, it might be economically efficient to scale up this cognitive-training intervention. As the Active Mind cognitive-training program has been shown to be effective in improving cognitive function and QoL for local Chinese older adults, this program should be further promoted so that more elderly can benefit.
This study was limited by the fact that aspects of age, educational level, and status of CSSA for the intervention and control groups were different at baseline. This was likely to be due to cluster randomization as the randomization was performed at center level instead of individually. Besides, despite the finding that significantly better improvement has been shown by the current study, the Active Mind program was rather short, with only eight 1-hour sessions performed once a week. The contrast for treatment and control groups will likely be increased if the cognitive-training program can be lengthened. Nevertheless, with the evidence of the current study, further studies of larger scale, longer studying period, and other potentially beneficial aspects of cognitive training are warranted. Mood and general affectivity may have an effect on cognitive improvement by the Active Mind program. It was also a limitation that these potential factors were not taken into account in evaluating our program.
In future, longitudinal studies with a longer follow-up period should be considered to determine whether cognitive-training programs could generate long-time effects on Chinese older adults and whether such programs could delay the progression of dementia or prevent cognitive loss. This should be considered because the long-term effect of cognitive training has been proven in a longitudinal study.23
In that study, for which more than 2800 participants were involved, they found that the improvements in the trained cognitive abilities could last for five years after the initiation of the intervention. Measurement at more frequent time intervals may also be useful to keep track of the changes of cognitive ability and mood.
In summary, the current study confirmed the effectiveness of the Active Mind cognitive-training program in improving cognitive function and QoL for community-dwelling Chinese older adults in Hong Kong. Subjects with lower education level or who were illiterate were found to benefit from the program. As such a characteristic is commonly found among clients of DECCs in Hong Kong, the current study provides justification for implementing extensive cognitive-training programs as a routine center activity.