Abstract The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study is the largest randomized clinical trial (N = 2802) to examine whether cognitive training enhanced both cognitive abilities and everyday functioning in normal older adults. Subjects trained on memory, reasoning, or processing speed performed significantly above controls at 5- and 10-year follow-ups. In addition, trained subjects reported less difficulty in performing IADL tasks at 10-year follow-up. Speed and reasoning training was associated with reduction in auto crashes and in driving cessation. Recent preliminary, but promising findings suggest an effect of training on incidence of Alzheimer's and related dementias. While these findings provide strong support for the benefits of cognitive training, the results focus on only short-term outcomes. This proposed 20-year follow-up would allow us to address questions highly relevant to health care and public policy that can only be addressed when the majority of the sample is deceased: Is training-related enhancement of cognition and everyday functioning associated with a long-term reduction in disability, loss of independence, and incident dementia in advanced old age and a reduction in associated financial costs? We propose to employ a wide range of linked data including: Medicare and Medicaid Claims, National Death Index, driving records, and credit reports. This study will assess the long-term impact and sustainability of the ACTIVE interventions on critical real life outcomes and related costs in advanced old age, including 1) Maintenance of independent functioning; 2) Physical health, disability, frailty, and mortality; 3) Incidence and duration of Alzheimer's and related dementias and depression.