January 6, 2010
Scientific American
Kasper Mossman

In the film noir classic Double Indemnity, insurance agents are presented as cold-blooded in their pursuit of the facts. But it wasn’t until Isaw a recent advertisement for Allstate, the insurance company, that I realized how seriously insurance agents take neuroscience. Allstate was advising parents to vote for graduated driver-licensing laws because teenagers’ “dorsal lateral prefrontal cortexes” are immature.

There’s a reason, as this ad implies, that there are age brackets for auto insurance premiums. We drive the way we do because of our brains, which start off immature, pass through an all-too-brief peak and, often, descend slowly into decrepitude.

One big factor in driving ability is how the brain processes vision. There is no doubt that overall vision declines with age. What also declines is “useful field of view” (UFOV), the area of visual field over which you can acquire information without moving your eyes or head. And smaller UFOVs have been correlated with a higher probability of getting into an accident.

Some age-related decline in visual performance is irreversible. But that doesn’t mean there is nothing to be done about it. The brain is plastic, meaning it can respond to new activity by growing new connections. This is where computer training programs come in. Clinical trials such as ACTIVE, which in the late 1990s enrolled 2,802 seniors in a study of the long-term efficacy of training memory, reasoning and speed of processing, have shown that regular use of these programs can improve general cognitive function.

Something similar can happen with visual processing as well. In a 2003 paper in the journal Nature, psychologist Shawn Green and neuroscientist Daphne Bavelier of the University of Rochester found that playing action video games such as Medal of Honor improved markers of visual processing, including UFOV. According to Green and Bavelier, playing such games “is capable of radically altering visual attentional processing.”

Two companies that provide cognitive training software also offer products for people who specifi-cally want to improve their visual systems: InSight, made by PositScience in San Francisco, and Cognifit Senior Driver, by Israel’s Cognifit. Previously I reviewed computer programs designed to improve cognition [see “Brain Trainers,” by Kaspar Mossman; Scientific American Mind, April/May/June 2009]. Recently I tackled visual-processing software. I took InSight and DriveFit out for weeklong test drives. I even roped my mother, Marie Mossman, who is 66, into trying them out, to see how they worked for their older target audience.

And I decided to compare these games with the popular Grand Theft Auto, after reading about a six-year-old boy in Virginia who had safely driven his mother’s Ford Taurus to school at more than 60mph. The kid had trained on Grand Theft Auto. Could this popular, fast-paced video game provide adventurous seniors with an addictive, playable alternative to training software?

Get Your Motor Running
Cognifit offers software for cognitive training and also for improving function of the visuocortical system in drivers. I tested Cognifit Senior Driver ($19.95 a month or $179 a year), which Cognifit released online in October 2009. (My mother used Golden DriveFit, an earlier CD-based version.)

First I underwent a preliminary assessment to establish a baseline. Once past this level, I encountered a range of exercises. One game was designed to strengthen “divided attention,” in which you basically play the classic video game Pong while hitting the space bar each time two identical objects appear in the periphery. It puts a drag on the brain that has an eerie similarity to the way I feel when I have to make a left turn from a side street onto a busy boulevard, tracking traffic right, left and ahead. “The jury is still out on whether divided attention really exists,” says Shlomo Breznitz, a professor of cognitive psychology and founder and president of Cognifit. “It could be just very effective switching” of attention from one task to another.

In its analysis of drivers’ performance, Breznitz says, Cognifit found that as we age we lose the ability to spot speedy incoming objects on our right-hand side. “The preference for the left-hand side is very pronounced, especially if you have only a short time,” he says, noting the phenomenon is most likely related to left-hemisphere motor dominance. The Cognifit Senior Driver game Sign Posts is designed to strengthen peripheral vision. A road sign-such as a warning that deer may be on the road-appears briefly on either the extreme left or right of the screen. Then the player is shown four signs and asked whether any of them match the first one. An algorithm adapts to any potential weakness on the right-hand side.

Cognifit Senior Driver also features an exercise that ostensibly improves hand-eye coordination by requiring you to click on a circle and maneuver it through a maze. It’s a fiddly job. My mother found the coordination game hard, which is understandable. She was using a laptop with a touch pad instead of a mouse. This experience raises an important point: not many older people have an ergonomic setup, which would make the program easier to use.

Another game asks the user to estimate the relative speeds of objects moving across the screen-some shaped like cars, some not. This feature would appear eminently important for a driver, although Breznitz admits the program cannot reproduce reallife experience. “But we’re not interested in simulating the real thing,” he says. “We’re forcing the brain to do something that is not like something you’ve done before.” This aspect is, it turns out, an important theme in brain training.

Cognifit Senior Driver was hard work for me, as Golden DriveFit was for my mother. “I find practicing the games tiring,” she remarks. She would be more willing to persevere if Cognifit had commercial partners that would redeem points scored for real products: “Even a latte would be a motivator for me.” Breznitz says that she may have found Golden DriveFit hard because it does not have the intelligent adaptive feature that was incorporated into Cognifit Senior Driver. I tried both versions and found that whereas Cognifit Senior Driver was indeed more nimble than Golden DriveFit at matching my skill level, the basic grind of repetitive tasks remained the same in the later version.

My mother performed best on a short-term spatial-memory task featuring spaceships and worst on split attention. In defense of her generation’s inability to keep up with computer-trained youth, she reminds me that youngsters have deficits, too: “Sure, older people need to work on divided attention. But maybe younger people should be working on stretching their attention spans.”

After using Golden DriveFit, my mother did not immediately notice any improvement in her driving. But she lives in northern New Brunswick, Canada, where traffic is light, intersections are simple and the greatest road hazard is a wayward moose. “I can imagine that in a busy city this program would be more helpful,” she offers.

When I previously reviewed brain-training programs, I found afterward that I was better able to recall phone numbers. It’s as if they are on flash cards that pop up when you need them. My mother had a similar experience-an improvement in her memory, not in her driving. “I did remember a page number [in a book] that I wouldn’t normally expect to,” she says.

Head Out on the Highway
The next program I test-drove was InSight ($395 for PC or Mac) from PositScience. Four of the five games that make up InSight are based on exercises in a standard test developed by Karlene Ball and Dan Roenker, the academics who created the concept of UFOV. Ball and Roenker founded the company Visual Awareness to market their test to insurance companies, among other clients. PositScience has redesigned the exercises to be more fun and to improve visual memory as well as UFOV. The fifth game is Sweep Seeker, which increases the speed of cerebral neurons that receive input from the eye.

“People don’t appreciate that most activities are whole brain,” says Henry Mahncke, a PositScience scientist. “It’s tempting to say you’re targeting a tiny piece.” But when you drive, more than just one brain region is involved. Your eyes send information to the primary visual cortex and other parts of the occipital lobe; processed data move to the parietal lobe, which deals with orientation and attention. The frontal lobes make decisions and command the motor cortex to stomp on the brake if a pedestrian is in front of the car. “It’s superimportant to understand the flow of information,” Mahncke says. MRI images show that the exercises in InSight activate important regions in the visual path. In the long term, he says, “physical wet changes occur-new synapses are built, existing ones strengthened. Fatty myelin wraps axons more thickly.”

A session with InSight lasts about 45 minutes, compared with 20 minutes for Cognifit Senior Driver. You play a suite of games, and the first time you play each game, InSight subjects you to a grueling assessment. These assessments are InSight’s main drawback. I found InSight much more fun to use than its older sibling, the cognitive training program Brain Fitness. But sometimes the gratification seems excessive. Every once in a while Sweep Seeker seems to play itself, as you trigger a cascade of tiles that align and evaporate-much like the orgasm of bells and lights that pinball machines can sometimes have.

The excess is deliberate, according to Michael Merzenich, co-founder and chief scientific officer of PositScience. Playing video games has been shown to release dopamine, a neurotransmitter important in reward circuitry. “It’s known that symptoms of Alzheimer’s often disappear when you go to Vegas,” he says.

In Sweep Seeker a set of parallel lines appears on a small TV screen, and the lines move quickly to either converge or diverge; these are known as Gabor patterns. You must decide what just happened, a process designed to improve the performance of neurons in the early visual cortex. “The main thing we’re trying to achieve is to get users to remember and reconstruct information spatially,” Merzenich says. “That’s why we pound on something as dumb as making quick decisions about lines going in or out. We’re trying to improve the quality of extraction.”

In Bird Safari, which targets UFOV, you see a bird at the center of the screen, and shortly afterward it disappears to be replaced by a flock of birds that flicker briefly at the periphery. You must click in the sector that contained the single bird that matched the one you were first shown. Bird Safari and Jewel Diver-a shell game in which you track jewels hidden behind bubbles that jitter around the screen-have no direct connection to driving. But, as with Cognifit Senior Driver’s Pong game, when you play them you can feel mental muscles stretching like they do when you’re at a five-way intersection with a complex rush-hour traffic pattern.

Unfortunately, I did not have the benefit of my mother’s view of what it is like for older drivers to use this program. When she installed and tried to use InSight, some computer glitch made her repeat the first assessment over and over. “It’s not the sort of thing that kids get playing and don’t want to stop,” she says drily. PositScience tech support was unable to solve her issue, and so she could not run the full program.

Looking for Adventure
“People think these programs are looseygoosey,”says Merzenich of his company’s InSight. “But we’re beyond that. What people don’t get is that it’s actually medicine, and not too far in the future they’ll understand.”

If brain training is medicine, Cognifit and InSight are penicillin-and Grand Theft Auto is crack. The action-packed GTA series of video games has been lambasted for gratuitous violence. But there’s no denying they are fun. When I “test-drove” Grand Theft Auto, in Vice City, set in Miami, my lunch hours evaporated. Drive on the wrong side of the road, flatten pedestrians and steal their money, carjack ambulances-it lets you do anything. But I did wonder exactly what beneficial effect my brain might receive from my attempt to mow down 30 gang members with a submachine gun.

Bavelier, a professor of brain and cognitive sciences, has found that action video games have a remarkable and lasting effect on the visual system, one that goes far beyond the games themselves. “They’re good for basic vision, attention and how you monitor the visual scene,” she says. And the shooting rampages? “You get better at monitoring several different objects in your field of view-this is called object-based attention.” Bavelier has found that three key factors determine the power of an action video game to improve the visual system: it must demand speed of processing; it must require flexible allocation of resources; and the user must gain self-confidence through mastery.

My mother, perhaps not surprisingly, had no interest in playing Grand Theft Auto, so I had to do the training myself. I can report that Grand Theft Auto has a considerable effect on a driver’s brain. It weakens inhibitions. As I piloted the family Subaru on a shopping trip, I was more aware of pedestrians on the sidewalk, but a little voice in my head was telling me to run them over and score their cash and drugs. My better nature was appalled. Perhaps playing this game improved my object-based attention, but complex psychology was at play, making it hard to figure out whether there was a net benefit for drivers-or insurance companies-to playing this particular video game. And, no surprise, its stimulation is best suited to young men with high testosterone levels.

Coming Your Way: Discounts?
I asked clinical neuroscientist Peter Snyder whether programs such as InSight and Cognifit Senior Driver actually work at improving brain function and driving ability in older drivers. Snyder recently reviewed the brain-training scientific literature [see “o Brain Trainer Games and Software Work?,” Head Lines, by Robert Goodier; Scientific American Mind, July/August 2009]. He concluded that only PositScience was justified in claiming that its cognitive training product worked.

The problem, according to Snyder, is that it is difficult to measure improvements in specific tasks, because the tests to do so are too similar to the tasks themselves. But with visual processing (as opposed to cognition), Snyder says, it is likely that we will be able to get a straight answer, because the training-in games such as Jewel Diver-is so different from actual driving. As for whether either program helps to improve driving, he says that “it’s a hell of a lot easier to measure progress in a driving simulator than to design studies to determine whether older people think better.” He is “guardedly optimistic” that InSight and Cognifit Senior Driver might work as their makers claim.

To establish whether using these programs to improve driving skills really works, Allstate has partnered with PositScience in an ongoing study. More than 5,000 Allstate customers in Pennsylvania, all older than 50, trained with InSight; the company is currently comparing the accident numbers of these drivers with those of a control group.

“If completing the software does indeed improve driving,” says Krissy Posey, an Allstate spokesperson, “Allstate hopes to offer discounts to drivers.” The flip side is that premiums will probably rise for those who fail the UFOV test or can’t complete InSight. But those who would call this unfair will face insurance agents as implacable as Barton Keyes, claims adjuster for the fictitious Pacific All-Risk in Double Indemnity, who was certain that Phyllis Dietrichson’s husband could not possibly have fallen to his death from a slow-moving train.