To determine if something works we first need to define what we mean by “work”. A machine to train abdominal muscles probably won’t “work” if what we measure is blood pressure. In the same way, a program training auditory processing speed may not work if visual functions are measured (see Chapter 1 for a better understanding of cognitive abilities).Â This is why to determine whether a brain training software “works” it is crucial to (a) understand the claims made by the developer as to what abilities are trained, (b) find well conducted studies showing that these abilities are indeed trained by the program and (c) decide whether that training is relevant to one’s needs and objectives.
Another important aspect when evaluating whether a brain training program “works” is to look at the extend to which the training effects transfer to untrained tasks. It is well established that practice usually triggers improvement in the practiced tasks. So the first requirement for a well working brain training program is to show that people who use the program get better at the tasks trained. The second and more important requirement is to show that this improvement transfers to other, untrained, tasks, mostly tasks performed during everyday life. This would show that the cognitive abilities targeted by the program were indeed trained. If I use a training program to train my ability to concentrate (attention skills) I will probably get better at the tasks included in the program if I practice long enough, but will I see any benefits when I do other tasks, at work for instance?
Teams of neuroscientists and psychologists from around the world have partnered with software and game developers to bring targeted brain fitness products to market with more solid clinical validation. These teams have published results using the gold standard of randomized controlled trials, supported by neuroimaging. As a result, they have been able to claim quantifiable short-term and long-term improvements to specific cognitive skills if used according to a specific regimen over a specified length of time.
Much of the hope and media coverage of the brain fitness market in 2007 can be traced to the publication of the results of the five years ACTIVE study conducted by Willis and her colleagues (2001, 2006). This study was one of the first randomized controlled, scientifically sound studies ever published in the area of brain training. Participants in this groundbreaking study were 73.6 years old on average. They were exposed to different forms of mental training: reasoning, memory and speed training. Strategies and practice were provided during training. The training of processing speed was computer-based. Participants showed an improvement in the skills trained and retained a significant percentage of this improvement when tested five years later. Interestingly, the group who received the training in processing speed showed the most pronounced short-term and long-term improvements.
Since the publication of the ACTIVE study, a growing number of randomized controlled studies are showing how well directed training software may produce cognitive and other improvements to daily life.
For instance, in 1994, Dr. Daniel Gopher and his colleagues used Space Fortress, a complex computer game precursor to IntelliGym, to train flight cadets. Participants received 10h of training. Results showed that compared to a no-training group, flight cadets who were trained showed a 30% improvement in their flight performance. This supports the idea that the benefit gained through practicing a computer game can transfer to a task involving similar cognitive abilities (flight performance here).
Cogmed is a computerized program aimed at improving working memory (WM). WM is the memory system that allows one to hold information briefly in mind for the purpose of the task at hand. In 2005, Dr. Torkel Klingberg and his colleagues conducted a randomized, controlled, study to test whether the use of Cogmed could help improve the WM performance of children with attention-deficit/hyperactivity disorder (ADHD). The training period was at least 20 days. Results showed that training WM using Cogmed increased the performance of the children in untrained tasks measuring WM as well as in tasks measuring response inhibition and complex reasoning. The benefits were still present when the children were tested again 3 month after the training.
Dr. Arthur Kramer, whose interview you can find at the end of Chapter 2, just published the results of a study testing the benefits induced by playing a strategy-based videogame (Rise of Nations Gold Edition). Results of this study showed that trained participants (age 69 on average) not only got better at playing the game but also showed transfer of benefits to untrained tasks that engaged the same abilities (working memory, task switching, etc.) as the game.
In 2003, Dr. John Gabrieli and his colleagues used Fast Forword, a computerized program designed to train auditory processing with 20 children with dyslexia. Functional Magnetic Resonance Imaging (fMRI) was performed on the children during phonological processing before and after the training. Behaviorally, the training improved oral language and reading performance. Physiologically, children with dyslexia showed increased activity in multiple brain areas correlated with improvement in oral language ability. These results suggest that the training improved the targeted brain functions. Although the number of participants in this study was small, the results were replicated in a further study published in 2007.
Posit Science Classic is another computerized program, designed to train auditory processing. One controlled, randomized, study published in 2006 by Dr. Michael Merzenich and his colleagues showed that adults age 60 and over trained using Posit Science program improved in auditory tasks. More importantly the improvement generalized to an untrained memory task. The memory benefits were still present 3 months after the training. The same computerized program is ongoing further testing in the IMPACT study conducted by Dr. Elizabeth Zelinski (see her interview at the end of Chapter 2). The initial results of this study were presented at the Gerontology Society of America in 2007. They showed significant gains in auditory processing and auditory memory “equivalent to ten years of aging for that skill” in over 500 adults with a median age of seventy-five.
In sum, these studies show quantifiable improvements to specific cognitive skills if the tested brain training software is used according to a specific regimen over a specified length of time. In some studies, transfer of benefit to untrained tasks has also been observed.
However, it is still too early to tell whether or not these products will result in measurable long-term health benefits, such as better overall brain health, or lower incidence of Alzheimer’s symptoms. One of the reasons for this, to be fair, is the fact that most of the commercially available products have not been on the market long enough to examine any longer term effects.
Note that not all companies are running randomized, controlled, studies to show that their product has a specific impact on brain functions. These companies, such as Nintendo, base their more limited claims on general research that shows how mental stimulation can lower the probability of developing Alzheimer’s and other dementias’ symptoms, via the cognitive reserve theory. We can view these untested programs as a new, high-tech, generation of crossword puzzles, that may be useful but that cannot make specific brain benefit claims beyond the general “use it or lose it.”
This new online resource is based on the content from the book The SharpBrains Guide to Brain Fitness (May 2009, $19.95), by Alvaro Fernandez and Dr. Elkhonon Goldberg.