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Does cognitive training work? (For Whom? For What?)

The grow­ing field of cog­ni­tive train­ing (one of the tools for brain fit­ness) can appear very con­fus­ing as the media keeps report­ing con­tra­dic­to­ry claims. These claims are often based on press releas­es, with­out a deep­er eval­u­a­tion of the sci­en­tif­ic evi­dence.

Let’s take a cou­ple of recent exam­ples, in suc­ces­sive days:

It doesn’t work!” type of head­line:
Reuters (Feb. 10, 2009)  For­mal brain exer­cise won’t help healthy seniors: research
Healthy old­er peo­ple shouldn’t both­er spend­ing mon­ey on com­put­er games and web­sites promis­ing to ward off men­tal decline, the author of a review of sci­en­tif­ic evi­dence for the ben­e­fits of these “brain exer­cise” pro­grams says.

It works! type of head­line:
Sci­enceDai­ly (Feb. 11, 2009)  “Com­put­er Exer­cis­es Improve Mem­o­ry And Atten­tion, Study Sug­gests”
Accord­ing to the researchers, par­tic­i­pants who used the Brain Fit­ness Pro­gram also scored as well as those ten years younger, on aver­age, on mem­o­ry and atten­tion tests for which they did not train.

So, does struc­tured brain exer­cise / cog­ni­tive train­ing work or not?

The prob­lem may in fact reside in ask­ing this very ques­tion in the first place, as Alvaro point­ed out a while ago in his arti­cle Alzheimer’s Dis­ease: too seri­ous to play with head­lines.

We need a more nuanced set of ques­tions.

Why? Because:
1. Cog­ni­tion is made of sev­er­al dif­fer­ent abil­i­ties (work­ing mem­o­ry, atten­tion, exec­u­tive func­tions such as deci­sion-mak­ing, etc)
2. Avail­able train­ing pro­grams do not all train the same abil­i­ties
3. Users of train­ing pro­grams do not all have the same needs or goals
4. We need to dif­fer­en­ti­ate between enhanc­ing cog­ni­tive func­tions and delay­ing the onset of cog­ni­tive deficits such as Alzheimer’s.

Let’s illus­trate these points, by ana­lyz­ing briefly the very same study that allowed Reuters Health to claim that “For­mal “brain exer­cise” won’t help healthy seniors”:

1 + 2: Con­trary to what you may believe if you only read the Reuters head­line, the review study cit­ed did find 10 high-qual­i­ty stud­ies in which brain exer­cis­es suc­cess­ful­ly improved tar­get­ed func­tions in healthy old­er adults. Which sug­gests that brain exer­cis­es “work” when used to boost spe­cif­ic cog­ni­tive skills, and that effects last longer than the train­ing itself.

Train­ing pro­grams do not all train the same abil­i­ties. If I need to train my exec­u­tive func­tions and use a pro­gram that trains basic audi­to­ry skills, I may well con­clude that this pro­gram does not “work”. But this pro­gram may work for some­body who needs help in audi­to­ry pro­cess­ing areas.

3 + 4- Why a per­son uses a train­ing pro­gram makes a big dif­fer­ence in the assess­ment of whether this pro­gram works or not.

As men­tioned above, a per­son who reads the review ask­ing whether using a train­ing pro­gram may enhance some cog­ni­tive skills, will prob­a­bly con­clude that a good num­ber of pro­grams work — age itself is not an obsta­cle.

Fur­ther, the review shows that in the 4 stud­ies that tracked ben­e­fits a few months to a few years after the train­ing, ben­e­fits (or sig­nif­i­cant part of them) remained. So it is not that the report didn’t find any study that showed that the pro­grams work beyond the train­ing peri­od itself; what it not­ed, and jus­ti­fi­ably so, was the very small num­ber of long-term stud­ies to start with!
The authors of the review also acknowl­edge that evi­dence sup­ports the val­ue of cog­ni­tive train­ing with peo­ple who have mild cog­ni­tive impair­ment and even Alzheimer’s Dis­ease (before exclud­ing such evi­dence from their review in order to focus exclu­sive­ly on healthy adults).

Now, if some­one in Obama’s health­care team reads the review ask­ing, Is there enough evi­dence to invest $5 bil­lion today in buy­ing prod­ucts and dis­trib­ute them to the pub­lic at large in order to pre­vent the upcom­ing Alzheimer’s Dis­ease prob­lem?, it is much hard­er to decide that the pro­grams work for the good rea­son that sci­en­tists do not know yet whether this is an effi­cient and sus­tained way to do so. It would be arguably be pre­ma­ture to invest those $5 bil­lion in buy­ing prod­ucts today.

Let’s now con­trast in more depth those 2 recent stud­ies and try to under­stand what they mean and what they do not mean.

Papp, Walsh, & Sny­der (2009), report­ed in Reuters as “train­ing doesn’t work”, con­duct­ed a meta-analy­sis of the stud­ies pub­lished after 1992 that used cog­ni­tive train­ing with healthy old­er adults. They includ­ed only high-qual­i­ty well-con­duct­ed stud­ies (ran­dom­ized con­trolled tri­als pub­lished in peer-reviewed jour­nals), which left 10 stud­ies in the analy­sis.

The results con­sis­tent­ly sug­gest­ed that cog­ni­tive skills can be trained, no mat­ter the age group, on a short-term basis. How­ev­er it is not always the case that the train­ing ben­e­fits trans­fer to untrained tasks, even when these are cog­ni­tive­ly close to the trained tasks.

Only 4 stud­ies assessed long-term train­ing ben­e­fits. They showed that small ben­e­fits were main­tained over time after the train­ing (dur­ing a peri­od of sev­er­al months for 2 stud­ies and up to 5 years for one study).

The authors con­clud­ed that there was almost no evi­dence for long-term ben­e­fits BECAUSE most of the stud­ies do not assess long-term ben­e­fits.

What this study means:

  • Short-term improve­ments can be obtained for some spe­cif­ic cog­ni­tive skills when using a com­put­er­ized train­ing pro­gram. These improve­ments last longer than the train­ing itself.
  • Stud­ies that assess long-term ben­e­fits of cog­ni­tive train­ing (i.e., delay in onset of demen­tia) are rare; thus the evi­dence for long-term ben­e­fits is scant. We need more research.

What this study does not mean:

  • Cog­ni­tive train­ing CAN post­pone the emer­gence of Alzheimer’s.
  • Cog­ni­tive train­ing CANNOT post­pone the emer­gence of Alzheimer’s.
  • We sim­ply don’t know yet! We need more research track­ing the direct impact of cog­ni­tive train­ing over the long haul.

Now, let’s review the oth­er study, report­ed in Sci­ence Dai­ly.

Smith and col­leagues (2009), “train­ing works!”, report­ed the results of a large ran­dom­ized, con­trolled, dou­ble-blind study test­ing the short-term effects of a com­put­er­ized train­ing pro­gram (Posit Sci­ence clas­sic pro­gram). The IMPACT study involved 487 healthy adults, aged 65 and old­er, for an amount of 40h of train­ing (1h per day, 5 days per week for 8 weeks). Par­tic­i­pants either used a brain train­ing pro­gram or watch edu­ca­tion­al DVD fol­lowed by quizzes (con­trol group). The pro­gram includes 6 exer­cis­es designed to improve the speed and accu­ra­cy of audi­to­ry infor­ma­tion pro­cess­ing.

Par­tic­i­pants who used the train­ing pro­gram showed improve­ment in most of the tests used to assess their audi­to­ry mem­o­ry per­for­mance. Such improve­ment was not shown in the con­trol group.

What this study means:

  • Short-term improve­ments can be obtained for some spe­cif­ic cog­ni­tive skills by using a com­put­er­ized train­ing pro­gram.
  • These improve­ments can gen­er­al­ize from the trained tasks to untrained tasks that are cog­ni­tive­ly close.

What this study does not mean:

  • Com­put­er­ized train­ing pro­grams can post­pone the emer­gence of demen­tia.
  • Com­put­er­ized train­ing pro­grams can­not post­pone the emer­gence of demen­tia.
  • This train­ing gen­er­al­izes to every impor­tant cog­ni­tive skill one would like to main­tain as we age, or that one’s brain get’s 10 years younger.
  • All train­ing pro­grams will show ben­e­fits for every­body: Train­ing ben­e­fits do not seem to trans­fer to tasks that are not cog­ni­tive­ly close to the trained tasks. Thus one needs to under­stand what tool to use — which is why Sharp­Brains released this 10-Ques­tion Eval­u­a­tion Check­list to help con­sumers and pro­fes­sion­als make informed deci­sions.

CONCLUSIONS

What those 2 recent stud­ies say and imply

  • Cog­ni­tive train­ing can help healthy adults improve spe­cif­ic cog­ni­tive skills, and improve­ments seem to last longer than the train­ing itself (Willis et al., 2006; Smith et al., 2009).
  • Cog­ni­tive train­ing can help adults in the ear­ly stages of cog­ni­tive impair­ment and demen­tia improve some cog­ni­tive skills (Sitzer et al, 2006)
  • One needs to make informed deci­sions. Sharp­Brains’ Eval­u­a­tion Check­list may prove use­ful.

What nei­ther study says or implies

  • Whether cog­ni­tive train­ing can post­pone the emer­gence of demen­tia: More long-term stud­ies are need­ed. (We know that men­tal­ly stim­u­lat­ing activ­i­ties can help build a Cog­ni­tive Reserve and delay symp­toms of Alzheimer’s Dis­ease, but that evi­dence is not based on ran­dom­ized clin­i­cal tri­als like the ones dis­cussed above).

Ref­er­ences:

- Papp, Walsh, & Sny­der. (2009). Imme­di­ate and delayed effects of cog­ni­tive inter­ven­tions in healthy elder­ly: A review of cur­rent lit­er­a­ture and future direc­tions. Alzheimer’s & Demen­tia, 50–60.

- Sitzer, Twamley, & Jeste (2006). Cog­ni­tive train­ing in Alzheimer’s Dis­ease: A meta-analy­sis of the lit­er­a­ture. Acta Psy­chi­a­tr Scand, 114, 75–90.

- Smith et al. A Cog­ni­tive train­ing pro­gram designed based on prin­ci­ples of brain plas­tic­i­ty: Results from the Improve­ment in Mem­o­ry with Plas­tic­i­ty-based Adap­tive Cog­ni­tive Train­ing Study. Jour­nal of the Amer­i­can Geri­atrics Soci­ety, April 2009.

- Willis, S. L., Tennst­edt, S. L., Mar­siske, M., Ball, K., Elias, J., Koep­ke, K. M., Mor­ris, J. N., Rebok, G. W. Unverza­gt, F. W. Stod­dard, A. M., & Wright, E. (2006). Long-term effects of cog­ni­tive train­ing on every­day func­tion­al out­comes in old­er adults. Jour­nal of the Amer­i­can Med­ical Asso­ci­a­tion, 296(23), 2805–2814.

Pascale MichelonPas­cale Mich­e­lon, Ph. D., is Sharp­Brains’ Research Man­ag­er for Edu­ca­tion­al Projects. Dr. Mich­e­lon has a Ph.D. in Cog­ni­tive Psy­chol­o­gy and has worked as a Research Sci­en­tist at Wash­ing­ton Uni­ver­si­ty in Saint Louis, in the Psy­chol­o­gy Depart­ment. She con­duct­ed sev­er­al research projects to under­stand how the brain makes use of visu­al infor­ma­tion and mem­o­rizes facts. She is now an Adjunct Fac­ul­ty at Wash­ing­ton Uni­ver­si­ty.

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6 Responses

  1. Mike says:

    Thanks for pro­vid­ing this objec­tive view­point on the state of cog­ni­tive train­ing research. Edu­cat­ed and sober arti­cles are hard to find these days!

  2. abdo says:

    thanks soo much …

  3. Maria says:

    Thanks for your respon­si­ble insight. Every­one must research one-on-one brain train­ing. Human to human brain train­ing.

  4. Nick Almond says:

    This is a real­ly good arti­cle and it address­es two major issues in the research area. The ques­tion of who can ben­e­fit from cog­ni­tive train­ing is very impor­tant. It is also direct­ly linked to what cog­ni­tive func­tion­ing needs improv­ing. I am sur­prised that you did not men­tion metacog­ni­tion. Our research has demon­strat­ed that cog­ni­tive activ­i­ty can increase metacog­ni­tion in indi­vid­u­als who have a low num­ber of years in edu­ca­tion or who do not take part in as many cog­ni­tive activ­i­ties.

    I must add a note of cau­tion in the con­clu­sions. The major­i­ty of research has used a between-sub­jects design and our research has demon­strat­ed how small indi­vid­u­als dif­fer­ence can play a large role in the effec­tive­ness of a cog­ni­tive inter­ven­tion pro­gramme. You are defi­nate­ly right when you say that more research is need­ed, but these must use a dif­fer­ent exper­i­men­tal approach.

  5. Michael Patterson says:

    This arti­cle, and your web site, pro­vide a won­der­ful ser­vice in help­ing the gen­er­al pub­lic under­stand how to read beyond the head­lines and the mar­ket­ing hyper­bole. Keep up the good work.

  6. coolmathaz says:

    Although neur­al plas­tic­i­ty is rel­a­tive­ly new in terms of tar­get­ed treat­ment pro­grams the jury is in and it most cer­tain­ly does work. Neur­al train­ing pro­grams have doc­u­ment­ed suc­cess in ani­mals and humans, from all spec­trums old and young.

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As seen in The New York Times, The Wall Street Journal, BBC News, CNN, Reuters and more, SharpBrains is an independent market research firm tracking health and performance applications of brain science.

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