Small Steps, Big Trial: What 11,500 Older Adults Tell Us About Keeping the Mind Active

When you notice that names slip away more easily or that a crossword takes longer than it used to, it is natural to wonder whether anything you do can make a difference. A large new trial from the United Kingdom offers a hopeful answer, along with some useful reasons to read the headlines carefully.

What the researchers did

The Active Brains trial was led by Paul Little and Lucy Yardley of the Universities of Southampton and Bristol, and was published at the end of September in The Lancet Primary Care. It was funded by the National Institute for Health and Care Research.

Between October 2020 and October 2023, more than 11,500 people aged 60 to 85 took part, recruited through 670 GP practices across the country. All of them had internet access, and all had scored below the usual range on a verbal reasoning test, a short timed puzzle that checks how quickly people can make sense of simple sentences.

Everyone was randomly placed in one of three groups. The first group, which served as the comparison, took the test, answered questions about their daily activities and received brief advice on looking after their thinking through physical activity, a healthy diet and activities that stimulate the mind, such as puzzles, reading, music, learning something new or simply spending time with other people. The second group also got access to the Active Brains website, which offered brain exercises and support for staying active and eating well. The third group had the website plus a few short phone calls or emails, usually from a nurse.

What they found

After a year, average scores had gone up in all three groups. In the comparison group, about 28 percent of people with a follow-up result no longer scored in the low range. In the two website groups the figure was close to a third.

The website groups did slightly better than the comparison group on the main test. The difference was about half a point for the website alone and about one point for the website with support, on a test where the group averages rose from around 15 to between 18 and 19. After a year, 44 percent of the group with extra support scored in the range the researchers class as mild impairment, compared with 48 percent of the comparison group. People who actually used the programme regularly saw somewhat larger effects.

Paul Little described the result in the comparison group as a big surprise. His team had expected brief advice alone to do very little.

What this does and does not show

The improvement in the comparison group is encouraging, but it needs careful reading. There was no group that received nothing at all, so the trial cannot show how much of that improvement came from the advice itself. Taking the same test twice, joining a study called Active Brains and being asked about your habits can all nudge people to change, and scores that start low often drift upwards on a second try. The authors discuss that last point and think it is unlikely to explain most of the change, but it cannot be ruled out.

The university's press release spoke of proof that puzzles can reverse cognitive impairment. That goes further than the trial itself. The groups were defined by a single reasoning test, not by a medical diagnosis, and the paper describes people as no longer meeting the cognitive criteria rather than as cured.

The honest limits

Participants and researchers both knew who was in which group. About a third of people in the website groups did not complete the follow-up test, compared with about a fifth in the comparison group, and those with lower scores were more likely to drop out. The volunteers were mostly white, already fairly active and all online, so they may not represent everyone. The study was not designed to tell the two website groups apart, and whether any of this lowers the risk of dementia is still unknown. Five-year follow-up is under way.

Why this is still good news

Even with those caveats, the message is a hopeful one. In a large group of older adults with low scores, thinking abilities tended to improve over a year rather than decline, and simple, low-cost support added a little on top. As Paul Little put it, the brain remains able to learn well into older age.

None of the activities involved is exotic. Moving more, eating well, keeping up hobbies that make you think and spending time with people you enjoy are all things most of us can build into an ordinary week.

A small, steady habit

That is also the thinking behind Treeny. The daily exercises are short and meant to be enjoyed, and Flo, the coach inside the app, adjusts them to how you are doing each day. It is one gentle way to keep your mind busy alongside everything else that matters. The trial described here did not test Treeny, and Treeny does not treat or prevent any condition.

A note on how to read this

This article describes research and is not medical advice. The trial shows changes in test scores over one year and cannot show that these activities prevent dementia or reverse any medical condition. If you are worried about your memory or thinking, speak to your doctor, who knows your situation in a way no article can.