Brain games: Can they improve memory and cognition? (Part 2)

How do brain games work?
Brain fitness programs generally are available either online or as computer software. Most target cognitively normal adults over age 50 who want to maintain memory, awareness, problem-solving ability, and related skills. These programs consist of games or exercises that should challenge the user in specific ways, maintains Andrew Carle, MHSA, assistant professor and director of the Program in Assisted Living/Senior Housing Administration at George Mason University in Fairfax, Virginia. Carle, who coined the phrase “Nana technology” to refer to technologies for older adults, is also a spokesperson for Nintendo’s Brain Age2 program. But he has played all the brain fitness programs, and is enthusiastic about them.

“What I like about all the programs is that they force you to challenge yourself in things you don’t normally do,” says Carle. “Doing crossword puzzles only reinforces a strength you already have—it doesn’t force you to stretch and it’s only about language skills. It’s the same as exercising just one part of your body and neglecting the rest.” To fully crosstrain the brain, you need to do activities that produce improvements in the following areas, Carle suggests:

  • Accuracy. This speaks to short-term memory, the ability to remember something from five minutes ago. “Exercises that do this effectively force you to concentrate and quickly repeat information you’ve been given previously,” Carle notes.
  • Speed of processing. “Many times if you ask an older person, ‘How are you,’ he or she responds by saying, ‘Huh?’ We often react by speaking more loudly, when in fact the ‘Huh?’ really represents a delay in the person’s processing,” advises Carle. “People say this before responding so they can process the question.” One exercise that aims to improve speed of processing is Serial Subtraction: You start at the number 99 and keep subtracting seven until you get to zero. “The faster and more accurately you can do that, the better your score,” he explains.
  • Audio skills. “We get lazy in our listening skills as we age,” says Carle. An exercise that “forces” you to listen is Piano Player, in which you have to identify and tap out notes to familiar tunes, and in the proper rhythm. Most versions allow you to do this without having to know how to read music.
  • Visual skills. “We also get lazy in our visual processing and reaction time— skills that are necessary for driving, among other things,” Carle says. Road Runner is an exercise in which you have to track a designated runner in a race who is passing, and being passed by, other runners. At the end, you have to quickly and correctly identify that runner’s finish position.

 

“At this point, anything that makes your brain do something that it hasn’t been doing regularly is good,” Carle affirms. “The difference with these technologies is that the developers are trying to give you what is essentially a Universal Gym for your brain with a single purchase.”

 

What’s the science behind the games?
Any program you consider purchasing should have some form of published research showing that it works, according to the University of Florida’s Robin West. “If you go to a website and don’t see any published research, that’s a danger sign,” comments West, “because most people subjectively feel that these programs work for them. There’s a very strong placebo effect,” she says.

A number of the commercial products on the market have been developed in consultation with scientists or are based on the work of neuroscientists. But thus far, only Posit Science has published data in a scientific peer-reviewed journal,5 and reported additional outcomes at the Gerontological Society of America’s annual meeting in November 2007. In the multicenter IMPACT (Improvement in Memory with Plasticity-based Adaptive Cognitive Training) study, scientists at Mayo Clinic and the University of Southern California randomly assigned 524 cognitively normal adults ages 65 and older to the Brain Fitness Program or an active learning program. Chosen to match the Brain Fitness Program for novelty and intensity, the active learning program was typical of what a doctor might suggest for “staying cognitively active.” Unlike the active control group, participants who used the Posit Science program ended the study with 131% faster processing speed, meaning that the brain was more than twice as fast at taking in and processing information (such as speech). The gains extended to multiple standard measures of memory, and were equivalent to approximately 10 years of improvement in memory, according to the researchers. In addition, participants reported positive changes in their quality of life.

 

“This is the first large-scale study to prove that the brain can be effectively rejuvenated by doing the right kind of brain exercises, and that simply using the brain for new learning does not have a similar effect,” says Merzenich. “This calls for a refinement of the general advice to ‘use it or lose it,’” he adds, “and shows that you actually need to challenge elemental brain systems in a very specialized way to drive significant improvement in cognitive function.”

 

Other developers are also trying to boost the scientific evidence for their programs. For example, the Israeli company CogniFit released results of an independent, double-blind study of its MindFit program at the Eighth International Conference on Alzheimer’s and Parkinson’s Disease in Salzburg, Austria, in March 2007. This study showed shortterm memory improvement of 18% among participants ages 50 and over, according to the company’s website. [Ed. CogniFit recently became a preferred vendor for the International Council on Active Aging® (ICAA), publishers of the Journal on Active Aging®. ICAA is an association that supports professionals who develop wellness and fitness facilities and services for adults over 50.]

 

Happy Neuron is a Web-based program developed by “a group of scientists from various fields, including neurology, neuropsychology, computer science, and medicine,” explains the company’s vice president, Franck Tarpin-Bernard, PhD. The developers are based in France and the United States, and maintain French, German, Japanese, and English websites.

 

Happy Neuron has about 60 game engines, representing about 3,000 hours of unique game-playing time, reveals Chief Operating Officer Laura A. Fay. Games run from two to six minutes each, depending on the level of training. The games are based on “protocols used in cognitive psychological research, adapted so that people can do the activities recreationally, and so that the level of difficulty of each game increases appropriately,” Tarpin-Bernard says.

 

The company’s brain fitness games have been tested in French nursing homes, where participants showed improvements in cognitive function after eight months, according to Tarpin-Bernard. Further, a study in individuals diagnosed with mild cognitive impairment showed changes in cognitive function at six months. “In addition to the positive effect of training, participants were also more confident and had a better quality of life, according to interviews with friends and family members,” says Tarpin-Bernard. “But since we were starting from a low level of cognition, it was easier to measure significant improvements. Documenting results in cognitively normal individuals is much more difficult,” he adds. “It’s hard to come up with a good study protocol, because you can’t control what people do outside the study.” For now, the team is looking internally at results from people who are doing the training online to assess improvement, in addition to partnering with health organizations in Europe and the United States to conduct specific studies.

 

Robin West cautions that “the big question for all these programs is generalizability. Most research shows that people gain benefits in what they work on, and there’s not very much transfer to other activities,” she says. “So if you work on crossword puzzles, you get better at crossword puzzles, but that doesn’t help you remember people’s names. If you work on a system for memorizing numbers, you won’t necessarily get better at remembering appointments.”

 

Posit Science’s recent research suggests that there is carryover from the company’s program to some aspects of daily life. But for the most part, advises West, “don’t accept the assumption that working on one or two tasks will give you an overall boost in performance.”

 

Which product is the right fit?

How do active aging professionals know which products are right for their facilities? After looking at the science, they should try a product to see if they enjoy
playing it.

 

“The challenge some of the more science-based products have is how to make their games fun,” says Ceridwyn. “Only a special person is so goal oriented that improving by doing something over and over again is enough to stay motivated. Most people want instant fun, and some of the programs are building on that
aspect.”

 

Professionals should also make sure the product addresses multiple skills, and that the skills are relevant to everyday life, states West. “We work on remembering names, written text, shopping lists, and numbers. Some tasks are more attention related; others are speed related—we tap into all the different kinds of skills you need to use regularly.”

 

Also, any game’s effectiveness will depend at least in part on how the user approaches and plays it, emphasizes Cindy Lustig, PhD, an assistant professor of psychology at the University of Michigan, located in Ann Arbor. Professionals should be aware of this fact.

 

In one study, Lustig and her colleagues found that people who remembered words best focused most of their energy on studying the words. They seemed to use their time to think about the words in meaningful ways, rather than simply repeating them over and over. “Successful people used unique strategies—for example, building a song or story around the word—that had one thing in common: They gave the word some kind of meaning that related back to their own life,” Lustig explains. “Those who just quickly rehearsed the words in their mind, and instead spent more time taking the test than thinking about the words, did not benefit from the program.”

 

In addition, the programs that seem to work take a graded approach, Lustig says. “They start people on a level that allows them to grasp the task and become familiar with it, then they gradually increase the difficulty, so that the users are constantly being pushed to the edge of their comfort zone as the learning experience varies more and more,” she observes. “Those programs show some transfer to other activities, whereas testing on the same thing over and over simply lets you get faster at the game.”

 

Today, “an overwhelming number of the new games are aimed at healthy older adults without neurodegenerative disorders,” comments Lustig. “Therefore, the people who likely need training the most—those 80 and older and people with lower initial ability—improve the least.” But she envisions a time when brain-training programs will be used late in life as an adjunct to medication in people with, or at risk for, neurodegenerative diseases, such as Alzheimer’s and Parkinson’s. “If we could tap into the right kind of training program, we might actually be able to potentiate [augment] how some of these medications work,” Lustig says. “This is clearly in the future, but I think eventually the sum [of the interventions] will be greater than the parts.”

 

Marilynn Larkin, MA, a fitness professional and award-winning medical writer and editor, is the creator of Posture-cize®, an exercise and motivational program to improve posture and self-esteem (see www.mlarkinfitness.com). She is also the ICAA’s Northeastern Regional Manager.

 

References

  1. American Society on Aging and MetLife Foundation. (2006). Attitudes and Awareness of Brain Health Poll. Retrieved from http://www.asaging.org/asav2/mindalert/pdfs/BH.pdf.
  2. American Society on Aging and MetLife Foundation. (2006). Attitudes and Awareness of Brain Health Poll. Retrieved from http://www.asaging.org/asav2/mindalert/pdfs/BH.pdf.
  3. Willis, S. L., Tennstedt, S. L., Marsiske, M., et al. (2006). Long-term Effects of Cognitive Training on Everyday Functional Outcomes in Older Adults. Journal of the American Medical Association, 296(23), 2805–2814. Retrieved from http://jama.ama-assn.org/cgi/content/full/296/23/2805.
  4. American Society on Aging and MetLife Foundation. (2006). Attitudes and Awareness of Brain Health Poll. Retrieved from http://www.asaging.org/asav2/mindalert/pdfs/BH.pdf.
  5. Mahncke, H. W., Connor, B. B., Appelman, J., et al. (2006). Memory enhancement in healthy older adults using a brain plasticity-based training program: A randomized, controlled study. Proceedings of the National Academy of Sciences, 103(33), 12523–12528. Open access article retrieved from http://www.pnas.org/cgi/content/full/103/33/12523.

 

This article is provided courtesy of the International Council on Active Aging www.icaa.cc

 

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