April 28, 2009
Scientific American
P. Murali Doraiswamy and Marc E. Agronin

Do you misplace your keys or regularly miss appointments? Do you often forget the names of people you know well? Do you feel like your memory is slowly getting worse? If so, then you may find yourself considering those brain games advertised everywhere. Sales pitches such as “where the sweat is figurative, but results are real” and “your brain will thank you” are amusingly alluring. But you may find yourself wondering whether they are really worth the time and expense. You shell out the money, play a few rounds and your brain will start spitting out names, dates and pin numbers like you’re 18 again-right?

Yes, those computerized brain-training games seem like a cool idea. They are based in large part on clear evidence that living in an enriched environment with lots of mental stimulation produces positive brain changes. And we agree there’s huge potential for tapping into your own neuroplasticity (that is, the brain’s ability to change itself by remodeling nerve cell connections after experience) to enhance mental fitness and prevent age-related memory decline. The well-established benefits of early life education on reducing later risk for dementia has also given much credence to the theory that building a greater cognitive reserve capacity can help the brain compensate for injury-analagous to the concept that more cell phone towers equals fewer dropped calls. Furthermore, several brilliant neuroscientists have, in recent years, served as the designers of the best brain games on the market.

But there’s a crucial catch: most of these early studies were done on rodents. So lost in the brain game buzz is the obvious question: Are these claims true when it comes to human brain performance and aging? Can they really make your brain faster and stronger? Are there really better than the tried-and-true approach: remaining healthy, active, and engaged in the world around you? In other words, are they worth the money?

To date, more than 50 studies have examined the benefits of brain training in humans but only a handful have tested whether or not the benefits persist and transfer over to real life. Results from one of the best studies, published earlier this year in the Journal of the American Geriatrics Society, is certainly encouraging, however. As Glenn Smith of Mayo Clinic and her colleagues report, cognitively normal older adults who trained their brain were able to improve their auditory information processing speed by about 58 percent (versus 7 percent in controls). In their multi-center IMPACT trial, 487 adults ages 67 to 93 years worked for eight weeks at Posit Science’s Brain Fitness Program, which seeks to improve brain function by stimulating the auditory system. The Posit Science program is premised on the idea that as we get older our brains become less efficient at processing information from the senses (not because of specific hearing or vision loss but because of degenerative changes in the brain’s associative cortex), which then leads to a decline in memory. The control group did a more conventional cognitive learning program that entailed viewing educational videos on art and history. At the end of the study the brain training group also demonstrated more gains on measures of overall cognition and memory than the control group, but the differences were less impressive (4 percent versus 2 percent improvement). Forty-eight percent of people in the active training group (versus 40 percent of controls) also reported positive changes in their daily life such as greater self-confidence, better recall of shopping lists and attending to conversations in noisy settings.

So what do these findings tell us? Clearly IMPACT demonstrated that both trained and some untrained cognitive abilities can improve after two months of structured sensory input training. But the control group also improved, albeit to a smaller extent, suggesting that even watching videos (such as The History Channel) may help!

Improving the Parts, Helping the Whole?

One of the crucial questions for brain-training programs is whether or not the specific skills emphasized during training, such as improved auditory perception, actually generalize to other cognitive abilities. In other words, will practicing auditory perception lead to improved visual perception? And how long do training effects persist?

According to Sherry Willis and colleagues at Pennsylvania State University brain exercises that focus on training reasoning skills do translate into long-lasting improvements in daily life. The team looked at the effects of three non-computerized cognitive training modules (designed to narrowly target memory, reasoning, or processing speed skills) versus a no-contact control group in a sample of 2,832 cognitively-intact elders. The subjects received 10 one-hour sessions plus a booster at months 11 and 35. Surprisingly, at two years, there was no benefit on daily activities. But after five years the group trained in reasoning showed better performance on daily activities (an effect that was made more noticeable by the fact that some in the control group showed a decline). These results suggest that a short training session plus periodic boosters may induce long-lasting cognitive and functional benefits-sort of a “teaching a person to fish for life” effect.

Where Do We Stand Now?

The typical consumer of brain-training programs is part of the “worried well,” a group of individuals with normal brains but significant concerns about cognitive decline that comes with aging. Should you decide to try one or more commercially sold brain games, be forewarned that you may not see big improvements in your scores if you are already cognitively fit-a phenomenon referred to as the ceiling effect-or you may may max out soon due to frustration or boredom. And remember that despite their promises, no computerized brain fitness program has yet been proven to prevent the onset of Alzheimer’s disease or even to make brain cells any younger at a biological level. Improving your computer-determined “brain age” to a 29-year-old’s level will certainly give you a mental workout (and a nice ego trip!) but is currently about as well proven to reduce your risk for future memory loss as learning to hit a golf swing like Tiger Woods.

A related question is whether doctors can use brain games in ways analogous to cardiac rehab programs, to help people who already suffer from a mild memory disorder. The pioneering early work of psychiatrist David Loewenstein and colleagues at the University of Miami has demonstrated that a skills training cognitive rehab program (practicing skills such as paying bills, counting change and associating names with faces) helped individuals with early stage Alzheimer’s disease to improve on the tasks the were trained on, at least initially and for three months after the targeted intervention was completed. These benefits, though likely to degrade quickly in the face of a progressive dementia, certainly compare favorably to what has been shown with any commercial brain game.

Why Not Just Play Bridge?

Several studies have already demonstrated that exercise and socialization in later life have positive effects on cognition, and both of these are as easy as taking a walk and calling a friend. Even the simple act of practicing juggling for a week increases gray matter in brain areas involved in visual and motor activity (even if you never become very good at juggling!). What, then, is the rationale for using expensive brain games, which are essentially solitary activities that require you to shell out the bucks, sit on your gluteus maximus, stare at a screen and exercise little more than your index finger as it pushes the button on the mouse? The immediate answer is that we don’t know. We simply cannot say that brain games are better than activities such as learning a new language because no one has done those sorts of scientific comparisons. But perhaps both the hype and the promise (not to mention those tongue-firmly-in-cheek slogans) combined with a little personal financial investment is just what someone needs to find the right motivation to train their brain in a systematic manner. Think about how more effective it is to pay for a gym membership and feel obligated to go (especially when your trainer is also fit and attractive) compared with sitting in your garage alone in front of a bunch of dumbbells. On the other hand, maybe brain games lead to unnecessary frustration, boredom or even added isolation.

One thing remains clear: there is no serious harm to brain training other than the effect on your wallet (and the risk of some egg on your face if your seven-year old can play them better). And evidence is accumulating that they not only improve the skills they are designed to help, but likely generalize to other cognitive abilities and have some long-lasting benefits. If you’re working at them now, we advise you to keep it up! Perhaps computerized brain training will eventually evolve into a form of cyber-vaccine, in which socially-networked multiplayer training sessions every year will keep our brains forever young. In the meantime, you can get cheaper and easily accessed brain benefits the old-fashioned way: eat your fruits and vegetables, exercise, don’t be afraid to try new activities and be a social butterfly. Your brain will really thank you!