12 Jun 2014

Taking your brain to the gym has become more popular than ever. As evident from the NeuroGaming Conference and Expo held in San Francisco May 7-8, companies such as Lumosity claim that pushing your brain’s cognitive limits with computer games will boost its performance. However, carefully controlled studies are lacking, and evidence that brain-training skills transfer to other, more practical aspects of life has yet to materialize. While the jury is out on that, a new appreciation is emerging that the games might be useful to researchers in other ways. Some researchers hope to extract data from Lumosity’s gigantic, 60 million user-strong database to learn more about how cognition wanes with age and disease. Others predict the games may serve as sensitive, widely distributed tools to flag people in cognitive decline and guide them toward clinical trials, or to measure the effects of therapeutic interventions on the brain (see Part 2 of this two-part story). 

The potential benefits of cognitive training are based on the concept of neuroplasticity—the idea that the brain’s networks of cells, signals, and chemicals adapt when called into action. “That idea really drives this whole field,” said Adam Gazzaley of the University of California, San Francisco. “Games are a vehicle to deliver a targeted interaction that challenges the brain, and if that interaction is done is a way that is adaptive and facilitates learning, you’ll get benefits that go beyond performance on the game itself,” he said. Gazzaley has no relationship to Lumosity.

Brain Training or Just Plain Gaming? 
Neuroplasticity was certainly a buzzword at the NeuroGaming conference. Gaming companies and researchers who hope to use games to enhance mood, boost cognition, relieve the symptoms of PTSD, or just entertain, attended this second annual meeting. A key burden of proof that scientists demand from brain trainers is the demonstration that cognitive benefits transfer to realms beyond improving at the game itself. Pressed by an audience question about this transfer, Lumosity’s Joe Hardy acknowledged its importance during a panel discussion and said his company was working on creating reliable cognitive tests to measure it. “That’s what I’m spending most of my time thinking about these days,” he said. 

Lumosity was co-founded in 2005 by Michael Scanlon, who left his Ph.D. studies in neuroscience at Stanford behind to start the company. The website went online in 2007 and to date has been backed by $67.5 million in venture capital investment, according to the company. Lumosity charges users a subscription fee to gain access to its full suite of games and cognitive tracking services, but declined to disclose how many initial users become subscribers. Hardy is the company’s vice president of research and development.

In an interview with Alzforum, Hardy cited the Advanced Cognitive Training for Independent and Vital Elderly trial as one that convinced him that brain training held promise for seniors. ACTIVE measured the effects of computerized brain training (from the company Posit Science) on nearly 3,000 healthy older adults, who played games designed to strengthen either reasoning, processing speed, or memory. Over five to 10 years, participants who played the games were modestly protected from declines in reported performance on activities of everyday living, such as preparing meals, keeping up with finances, and doing housework (see Rebok et al., 2014, and Dec 2006 news story). A decade after playing the games, participants in the reasoning and processing speed groups, though not the memory group, continued to show benefits of training based on cognitive tests designed to measure these skills.

Hardy also pointed to the Human Cognition Project, an ongoing collaboration between Lumosity and scientists around the globe. Adding to the company’s in-house studies, researchers involved in the project either use Lumosity’s games in their own studies or tap into the company’s 1.5 billion recorded game sessions in search of patterns that could reveal factors affecting cognition. Many of the project’s investigations test whether Lumosity’s brain games improve cognitive function in vulnerable populations, including children with attention deficit hyperactivity disorder, cancer survivors suffering from aftereffects of chemotherapy, and people with psychiatric disorders such as depression or schizophrenia. Some investigations focus on older people who could be in the preclinical phase of neurodegenerative diseases such as Alzheimer’s. 

Of the 47 posters, presentations, and publications listed on Lumosity’s HCP website, 11 have been published in peer-reviewed journals, and three of these dealt with cognitive impairment in the aging population. A pilot study led by Skye McDonald at the University of New South Wales in Kensington, Australia, looked at whether Lumosity games would improve cognition in 16 people with mild cognitive impairment (MCI). Those who participated in daily Lumosity training improved their performance on the games. However, they improved on only one of six measures—visual attention—of the Cambridge Neuropsychological Test Automated Battery (CANTAB), and this effect was partly due to a decrease in performance within the control group, who did not play games or participate in cognitive activities of any kind (see Finn and McDonald, 2011). After 30 training sessions spanning nearly 12 weeks, none of the participants reported improvements in daily functioning or boosts in memory, first author Maurice Finn told Alzforum. “The results weren’t convincing enough for us to pursue the Lumosity software further,” he said.

Another small study tested whether playing Lumosity games would improve attention and alertness in healthy older adults (see Mayas et al., 2014). Fifteen seniors each logged 20 one-hour Lumosity game sessions over 10 to 12 weeks, while a control group of 12 people met three times to chat about aging issues over coffee. After the trial, all were tested on a separate measure of distractibility in which they had to distinguish between odd and even numbers from a list while being distracted by unfamiliar sounds. Before the intervention, these distracting sounds slowed down response times by about 40 milliseconds in both groups. Following the intervention, those who played Lumosity’s games lowered that distraction penalty by an average of 12 milliseconds, while those in the control group stayed the same. The study also reported a small but significant improvement in a measure of alertness in the experimental group. The study did not test whether the benefit endured or translated to everyday tasks. For context, a blink of the human eye is 100 to 300 milliseconds long; the average driver’s reaction time is around .75 seconds, according to the Delaware Department of Motor Vehicles.

Thomas Dannhauser of St. Margaret’s Hospital in Epping, England, tested whether Lumosity’s brain games, when administered along with stimulating activities and physical exercise, could boost cognition in people with mild cognitive impairment (see Dannhauser et al., 2014). The researchers measured cognition in 67 people who received three interventions: learning new group activities, such as tap dancing, pottery, and photography; physical exercise; and individual cognitive training on Lumosity’s games. After 12 weeks, the participants showed improvement in working memory, which was one of six cognitive tests they took. They also improved in measures of physical health and fitness. Dannhauser said he hopes to conduct larger trials to parse out which of the three interventions each participant received was responsible for the cognitive benefit. Physical exercise has been reported in randomized controlled clinical trials to improve cognition in people with mild cognitive impairment (see Sep 2008 news story and Suzuki et al., 2012). For future studies, Dannhauser plans to use the Einstein Brain Trainer, another cognitive training program, because it is less expensive than a Lumosity subscription, he said. Dannhauser thinks the act of learning and participating in novel activities, whether computer brain training games or a new craft, is what may ultimately boost cognition.

Denise Park of the University of Texas in Dallas agrees. Park studies aging, and she recently reported that learning quilting, digital photography, or both (as opposed to playing word games, reading informative magazines such as National Geographic, or socializing) over 14 weeks improved cognitive function in healthy seniors (see Park et al., 2014). “This study tells us that you can probably maintain function of your mind longer if you stay mentally engaged and consistently challenge yourself,” said Park. “I don’t think it’s important what the activity is, but more that it be novel and hard enough to require mental effort,” she said. As to whether brain-training games such as Lumosity’s fit the bill for such challenging activities, Park said she considers their effectiveness yet to be determined.

John Harrison of Metis Cognition in Warminster, England, told Alzforum that based on available evidence, he remains agnostic whether or not brain training works. Many people in the field do not share his doubt, Harrison said, noting, “Views on whether brain training works seem to be very visceral.” Harrison consults for pharmaceutical companies looking to design cognitive tests that measure the effect of drugs. He also consults for companies that make brain-training games, such as the London-based MyCognition, which designs games to improve productivity at school or work, and to stave off cognitive decline. At present, MyCognition is still validating whether players of its game, called Monster Valley, even improve at the game as they play, Harrison said. Next will come the more important and challenging task: showing that the game improves cognitive function on separate neuropsychological tests or in everyday life.

Even for studies that appear to indicate a cognitive boost from brain training, interpretation of the results can be clouded by caveats, according to Daniel Simons of the University of Illinois in Urbana-Champaign. One pitfall is the placebo effect. This manifests in the form of expectations of better cognitive performance in members of the experimental group, Simons told Alzforum. Therefore, especially with studies that rely on groups of controls who do nothing or participate in activities that would not be expected to confer a cognitive benefit, the results should be taken with dose of skepticism, he said.

Some studies do include relevant control groups. In a recent trial, Gazzaley included an active control group that played a version of the driving game his lab developed, called NeuroRacer, without distractions from road signs. The experimental group, on the other hand, drove the digital car while also responding to the signs, a task the researchers hoped would improve multitasking. The experimental group did show gains in measures of attention and working memory, as compared with the active control group. The gains lasted up to six months and correlated with changes in brain-wave patterns (see Sep 2013 news story).

However, Simons counters that even in NeuroRacer, participants may still have a keen sense of exactly which skills they are being trained in, voiding the placebo control. Simons co-authored a survey in which researchers polled volunteers about their expectations for cognitive improvement from playing Tetris or an action video game, and found that participants expected the action video game (but not Tetris) would help them improve on visual and attention tasks (see Boot et al., 2013). Simons thinks researchers would be well advised to at least poll participants about their expectations to aid in the interpretation of results as well the development of well-designed controls.

Gazzaley’s study was featured in the general media, including The New York Times. It came on the heels of reports that improvements on game performance failed to transfer to related skills or to tasks of everyday life (see Redick et al, 2013, and Owen et al., 2010).—Jessica Shugart

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References

News Citations

1. Brain Training Database: Treasure Trove for Preclinical Alzheimer’s Research? 13 Jun 2014
2. The ACTIVE Trial—Long-Term Effects of Cognitive Training 27 Dec 2006
3. Work Up a Sweat to Stay Sharp, Randomized Trial Suggests 5 Sep 2008
4. In Small Study, Brain Training Benefits Healthy Seniors 12 Sep 2013

Paper Citations

1. Rebok GW, Ball K, Guey LT, Jones RN, Kim HY, King JW, Marsiske M, Morris JN, Tennstedt SL, Unverzagt FW, Willis SL. Ten-Year Effects of the Advanced Cognitive Training for Independent and Vital Elderly Cognitive Training Trial on Cognition and Everyday Functioning in Older Adults. J Am Geriatr Soc. 2014 Jan 13; PubMed.
2. Finn M, McDonald S. Computerised Cognitive Training for Older Persons With Mild Cognitive Impairment: A Pilot Study Using a Randomised Controlled Trial Design. Brain Impair. 2011 Dec;12(3):187-99.
3. Mayas J, Parmentier FB, Andrés P, Ballesteros S. Plasticity of attentional functions in older adults after non-action video game training: a randomized controlled trial. PLoS One. 2014;9(3):e92269. Epub 2014 Mar 19 PubMed.
4. Dannhauser TM, Cleverley M, Whitfield TJ, Fletcher BC, Stevens T, Walker Z. A complex multimodal activity intervention to reduce the risk of dementia in mild cognitive impairment--ThinkingFit: pilot and feasibility study for a randomized controlled trial. BMC Psychiatry. 2014 May 5;14:129. PubMed.
5. Suzuki T, Shimada H, Makizako H, Doi T, Yoshida D, Tsutsumimoto K, Anan Y, Uemura K, Lee S, Park H. Effects of multicomponent exercise on cognitive function in older adults with amnestic mild cognitive impairment: a randomized controlled trial. BMC Neurol. 2012 Oct 31;12:128. PubMed.
6. Park DC, Lodi-Smith J, Drew L, Haber S, Hebrank A, Bischof GN, Aamodt W. The impact of sustained engagement on cognitive function in older adults: the Synapse Project. Psychol Sci. 2014 Jan;25(1):103-12. Epub 2013 Nov 8 PubMed.
7. Boot WR, Simons DJ, Stothart C, Stutts C. The Pervasive Problem With Placebos in Psychology: Why Active Control Groups Are Not Sufficient to Rule Out Placebo Effects. Perspect Psychol Sci. 2013 Jul;8(4):445-54. PubMed.
8. Redick TS, Shipstead Z, Harrison TL, Hicks KL, Fried DE, Hambrick DZ, Kane MJ, Engle RW. No evidence of intelligence improvement after working memory training: a randomized, placebo-controlled study. J Exp Psychol Gen. 2013 May;142(2):359-79. Epub 2012 Jun 18 PubMed.
9. Owen AM, Hampshire A, Grahn JA, Stenton R, Dajani S, Burns AS, Howard RJ, Ballard CG. Putting brain training to the test. Nature. 2010 Jun 10;465(7299):775-8. PubMed.

External Citations

1. Department of Motor Vehicles
2. The New York Times

Further Reading

News

1. Tech Revolution: Behavioral and Cognitive Interventions 27 Dec 2012