Healthy AgingSTARTNCT03661190
Online Grammatical Reasoning Training for Older Adults
A study testing Grammatical Reasoning and Card Pairs in people with Healthy Aging, run by University of Exeter at 1 site in United Kingdom.
Trial summary
The START study will investigate the impact of playing a Grammatical Reasoning brain training task on overall brain function (cognition) and day-to-day function in people over 50. . Read more about this study
- Who is it for?
- Ages 50 to 100 yearsHealthy volunteers can take part
- Conditions the study is for
- Healthy Aging
- What is being tested?
- Grammatical Reasoning and Card Pairs
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 6,544 participants
- Where
- 1 siteUnited Kingdom
- Study dates
- 31 Mar 2017to 30 Nov 2018
- Phase
- Interventional
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 50 to 100 years
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Adults over 50
- Access to a computer with a keyboard and the internet
- Participant registered on the PROTECT study
Who cannot join
- Diagnosis of dementia
Trial locations and contacts
1 site in 1 country.
United Kingdom1 site
University of Exeter Medical School
Exeter, EX1 2LU
About this study
Official title: Impact of Short-term Intensive Online Grammatical Reasoning Training on Cognition and Function in Adults Over 50: An Online Randomised Controlled Trial
The START study will investigate the impact of playing a Grammatical Reasoning brain training task on overall brain function (cognition) and day-to-day function in people over 50.
.
Read the detailed description
The study builds on existing work that has shown very promising results with brain training approaches in older adults. There is good evidence that playing brain training games leads to improvements in brain functions including memory and reasoning. There is also a suggestion that regular involvement in brain training games might help reduce the risk of cognitive decline and dementia later in life. It appears that reasoning, or problem-solving, is particularly important as it is one of the first abilities to decline with age. This study will use this evidence to target reasoning in a specific brain training task. It will also explore the potential role of genetic factors in how people perform in the task.
The study will compare the impact of a Grammatical Reasoning Task (START) with a control task consisting of simple picture-matching. Over 7000 participants will be randomly allocated to either START or the control and will be asked to play the task as often as they wish for a period of six weeks. Both tasks will be delivered entirely online so people will access the study from home on their computers. This will be achieved through our dedicated online research platform, PROTECT, which hosts a cohort of over 20,000 older adults who have provided DNA samples as part of a longitudinal study.
This study will measure the impact of the training on cognition and Instrumental Activities of Daily Living. Assessments will be completed online at baseline, two/six weeks and six months. Overall, this study aims to generate exciting new data about how brain training could be included in guidance on healthy ageing
- Conditions
- Healthy Aging
- Being tested
- Grammatical Reasoning, Card Pairs
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Grammatical ReasoningOther
Also called START
START measures the ability to determine the relationships among different shape combinations which are assigned to grammatical statements about them which can be either correct or incorrect. It is a measure of attention, working memory and executive control.
Card PairsOther
A basic picture-matching task.
| Study group | Role | What they receive |
|---|---|---|
| Grammatical Reasoning | Other | This group will complete a short-term Intensive Grammatical Reasoning cognitive task delivered online by Wesnes Cognition Ltd (START). Participants will be encouraged to complete the START training once a day for six-weeks. Receives: Other: Grammatical Reasoning |
| Control - Card Pairs | Other | The control group will complete a basic picture-matching task that will provide the same level of engagement, but without the learning effects. Receives: Other: Card Pairs |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in Executive Function From Baseline
Measured by the validated task-switching test of Trailmaking B. This is a well established computerised test of executive function. On a computer screen participants are presented with 24 circles with either numbers (0-13) or letters (A-L). They must select the circles in the correct numerical and alphabetic order, alternating numbers and letters each time (e.g. 1, A, 2, B, 3, C etc). The test is completed when all the circles have been correctly selected. The test outputs a total score. A higher score indicates a better performance. A negative mean score indicates a decline in performance. The range of scoring for this test is 0 - 300,000.
Data reported here are for mean change per group form baseline to six weeks
Measured: Baseline to Six weeks
Secondary outcomes (5)
Change in Numerical Working Memory From Six Weeks
Digit Span test for numerical working memory. Partifcipants complete a computerised task. They must remember increasingly long strings of digits and repeat them back. Scores are based on correct responses. Higher score means better performance. Score range is 0 - 20
Measured: Baseline to six weeks
Change in Working Memory From Baseline
Measured through a computerised version of the Paired Associate Learning task in which participants must remember the location of a symbol behind a series of boxes on a screen, and accurately identify the correct location when prompted. Scores are based on accuracy. Higher score indicates better performance. Data reported here shows mean change from baseline. Range of scores is 0 - 16
Measured: Baseline to six weeks
Change in Reaction Time From Baseline
Measured through a Simple Reaction time test as part of the Wesnes Cognition Ltd CogTrackTM system. Participants are shown a target symbol on the screen and must react by pressing the keyboard / touching the screen (depending on the device being used) when the target appears. Output is measured in milliseconds as a reaction time variable. Lower scores are better; higher scores are worse. Range of scores is 100 - 30,000
Measured: Baseline to six weeks
Change in Episodic Memory From Baseline
Measured with the Delayed Picture Recognition task in which participants recall a series of images shown earlier in the cognitive test battery. The test outputs percentage of correct answers as the measure. A higher score shows a better outcome. Range output is 0 - 100
Measured: Baseline to six weeks
Change in Overall Composite Measure of Global Cognition
This is a composite measure of overall cognition that is created by normalising the outputs from all other cognitive tests to give a total score out of 100. The data shown here is the change in total score from baseline to six weeks. Range is 0 - 100. A higher score indicates a better outcome
Measured: Baseline to six weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted7 Sep 2018
- Study start31 Mar 2017
- Primary completion31 May 2018
- Study completion30 Nov 2018
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Other trials for Healthy AgingStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 6,544 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Exeter
- Sponsor type
- University, hospital or other
- Collaborators
- South London and Maudsley NHS Foundation Trust, King's College London, Wesnes Cognition Ltd
- Responsible party
- Sponsor
- Investigators
- Anne Corbett, BSc MRes PhD, Principal investigator, University of Exeter Medical School
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03661190
- Sponsor's protocol ID
- 216941
- Acronym
- START
- Status last verified
- Apr 2026
- First submitted
- 30 Jul 2018
- Last updated
- 4 May 2026
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: De-identified individual participant data (IPD) that underlie results in a publication or for secondary data analysis purposes.
Study at a glance
From the registry record, last updated by the sponsor on 4 May 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Impact of Short-term Intensive Online Grammatical Reasoning Training on Cognition and Function in Adults Over 50: An Online Randomised Controlled Trial
- ClinicalTrials.gov ID
- NCT03661190
- Acronym / sponsor ID
- START / 216941
- Conditions
- Healthy Aging
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 6,544 participants (actual)
- Lead sponsor
- University of ExeterUniversity, hospital or other
- Collaborators
- South London and Maudsley NHS Foundation Trust, King's College London, Wesnes Cognition Ltd
- Study start
- 31 Mar 2017 (actual)
- Primary completion
- 31 May 2018 (actual)
- Study completion
- 30 Nov 2018 (actual)
- First posted
- 7 Sep 2018 (actual)
- Results
- Posted 4 May 2026
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The START study will investigate the impact of playing a Grammatical Reasoning brain training task on overall brain function (cognition) and day-to-day function in people over 50.
.
Detailed description
The study builds on existing work that has shown very promising results with brain training approaches in older adults. There is good evidence that playing brain training games leads to improvements in brain functions including memory and reasoning. There is also a suggestion that regular involvement in brain training games might help reduce the risk of cognitive decline and dementia later in life. It appears that reasoning, or problem-solving, is particularly important as it is one of the first abilities to decline with age. This study will use this evidence to target reasoning in a specific brain training task. It will also explore the potential role of genetic factors in how people perform in the task.
The study will compare the impact of a Grammatical Reasoning Task (START) with a control task consisting of simple picture-matching. Over 7000 participants will be randomly allocated to either START or the control and will be asked to play the task as often as they wish for a period of six weeks. Both tasks will be delivered entirely online so people will access the study from home on their computers. This will be achieved through our dedicated online research platform, PROTECT, which hosts a cohort of over 20,000 older adults who have provided DNA samples as part of a longitudinal study.
This study will measure the impact of the training on cognition and Instrumental Activities of Daily Living. Assessments will be completed online at baseline, two/six weeks and six months. Overall, this study aims to generate exciting new data about how brain training could be included in guidance on healthy ageing
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Grammatical Reasoning | Other | Other: Grammatical ReasoningThis group will complete a short-term Intensive Grammatical Reasoning cognitive task delivered online by Wesnes Cognition Ltd (START). Participants will be encouraged to complete the START training once a day for six-weeks. |
| Control - Card Pairs | Other | Other: Card PairsThe control group will complete a basic picture-matching task that will provide the same level of engagement, but without the learning effects. |
Who may qualify
- Ages
- 50 to 100 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Adults over 50
- Access to a computer with a keyboard and the internet
- Participant registered on the PROTECT study
Key exclusion criteria (1 listed)
- Diagnosis of dementia
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Grammatical ReasoningAlso: STARTSTART measures the ability to determine the relationships among different shape combinations which are assigned to grammatical statements about them which can be either correct or incorrect. It is a measure of attention, working memory and executive control. | Other | Grammatical Reasoning |
| Card PairsA basic picture-matching task. | Other | Control - Card Pairs |
Primary outcome
Change in Executive Function From Baseline
Time frame: Baseline to Six weeks
Measured by the validated task-switching test of Trailmaking B. This is a well established computerised test of executive function. On a computer screen participants are presented with 24 circles with either numbers (0-13) or letters (A-L). They must select the circles in the correct numerical and alphabetic order, alternating numbers and letters each time (e.g. 1, A, 2, B, 3, C etc). The test is completed when all the circles have been correctly selected. The test outputs a total score. A higher score indicates a better performance. A negative mean score indicates a decline in performance. The range of scoring for this test is 0 - 300,000. Data reported here are for mean change per group form baseline to six weeks
5 secondary outcomes
Change in Numerical Working Memory From Six Weeks
Time frame: Baseline to six weeks
Change in Working Memory From Baseline
Time frame: Baseline to six weeks
Change in Reaction Time From Baseline
Time frame: Baseline to six weeks
Change in Episodic Memory From Baseline
Time frame: Baseline to six weeks
Change in Overall Composite Measure of Global Cognition
Time frame: Baseline to six weeks
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 May 2026.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Individual participant dataSharing planned: Yes. De-identified individual participant data (IPD) that underlie results in a publication or for secondary data analysis purposes.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Anne Corbett, BSc MRes PhD principal investigator
University of Exeter Medical School
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Grammatical Reasoning and Card Pairs in people with Healthy Aging, run by University of Exeter at 1 site in United Kingdom.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 4 May 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Yes. Results are posted in the registry (first posted 4 May 2026). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in Executive Function From Baseline (time frame: Baseline to Six weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 May 2026.