July 25, 2016
Pittsburgh Post-Gazette
Gary Rotstein

The goal of warding off dementia is no game — it is one of the elusive holy grails of modern medicine, considering the 5 million-plus Americans afflicted and the billions in societal costs from Alzheimer’s and related diseases.

But what if simply playing a computerized speed training game somehow provided older adults a measure of protection from late-life mental decline, and what’s more, they didn’t have to do it every day or even continue it long-term at all. Wouldn’t it be great if years could go by with enduring benefits to the brain — most notably reduced rate of dementia — from having previously spent hours clicking a button at rapid pace to match images flashed on a screen?

That’s the premise of some tantalizing new findings from a broad, 10-year study of some 2,800 originally healthy seniors that were first publicized over the weekend at the Alzheimer’s Association International Conference in Toronto.

Jerri Edwards, an associate professor in the University of South Florida’s School of Aging Studies, reported that people who spent 10 hours at the start of the study practicing the speed processing game ended up developing dementia over 10 years at a rate 33 percent to 48 percent less than a control group. The greater reduction nationally came among those who participated in additional game sessions one and three years into the study.

The same benefits in dementia risk were not seen in two other groups in the study at six sites, including one based at Penn State University, that received classroom training in memory exercises and reasoning strategy.

“This is the first time a cognitive intervention has been shown to protect against dementia in a large, randomized, controlled trial,” Ms. Edwards announced.

That was of sufficient note for the Alzheimer’s Association to highlight the findings from the government-funded Advanced Cognitive Training for Independent and Vital Elderly study, also known as the ACTIVE study.

“It’s a step forward, absolutely, and we’re happy to share it,” said Heather Snyder, senior director of medical and scientific operations at the Alzheimer’s Association, though she added additional studies were needed to give the findings further credence and understanding.

Engaging in such cognitive training could be part of a broad recipe of lifestyle behaviors — including diet, exercise and other factors — that are effective in delaying or avoiding dementia, she said, but “such an incredibly complex disease as Alzheimer’s” still has many unknowns.

“We don’t understand exactly why speed processing may be beneficial, but there is an emergence of new studies trying to understand how using the brain in a certain way may be more protective, and how diet and lifestyle and all these factors all come together,” Ms. Snyder said. “We’re starting to figure out what might be in the recipe, and at this point we still don’t know what’s going to be beneficial for the most number of individuals.”

Michael Merzenich, a neuroscientist who is co-founder of Posit Science, is less tentative about findings of the ACTIVE study. He did not directly participate in the study, but a computer game marketed by Posit Science known as Double Decision is the updated version of what was used in the study.

He said he has been anticipating a finding that a computerized speed processing game such as Double Decision can reduce dementia, because prior findings from the ACTIVE study and other research had already shown other cognitive benefits, such as users retaining the ability to drive longer.

There was no significant reduction in dementia rate after the first five years of the ACTIVE study, but once another five years passed, people in their early 70s when the study started had reached their early 80s. The dementia risk grows as people age, and the difference in the game group from a control group became much sharper.

“If this was a drug, it’d be worth tens of billions of dollars and prescribed to just about every person in the universe,” Mr. Merzenich asserted.

Posit Science and other software companies market many computer games as cognitive training exercises intended to stimulate the brain. The current version of Double Decision is a visual attention game in which the player has to identify a vehicle in the center of the screen and also locate a Route 66 sign on the periphery of his field of view. As the task repeats itself, the images flash at quickening pace, forcing speedier decision-making.

As to how such a challenge could have long-enduring effects benefiting brain power, Dr. Merzenich said it has a strong effect on release of acetylcholine, an important neurotransmitter in the brain. There’s been increasing belief that the brain has plasticity, meaning it can rejuvenate with training at any age instead of necessarily deteriorating, and speed processing exercises are one manner that has proven effective in doing so, Mr. Merzenich said.

With such training, he said, “it means you have substantially higher levels of stimulation, and you’re going to be more engaged.”

Pamela Greenwood, a George Mason University associate professor of psychology who was not involved in the study, said while other research has shown cognitive benefits from such brain exercises, the idea that they can reduce dementia will be treated with “a lot of skepticism” until there are further such findings.

“It’s plausible that perceptual training of that kind can have durable effects, but how we can get from that to reduced Alzheimer’s is mysterious,” said Ms. Greenwood, who has used Posit Science games in other research. “We’ve found effects of training at that age range, but over a period of six weeks, not 10 years.”

Lesley Ross, an assistant professor in Penn State’s Department of Human Development and Family Studies, has been involved in speed training research that has shown benefits in reducing depression and extending the time frame in which people are able to keep driving. After five years of the ACTIVE study, participants in the group performed better on what are known as instrumental activities of daily living, such as managing a checkbook and maintaining a neat household.

“It is having an impact on these daily functions,” she said. “We’re seeing consistent transfer effects over long periods of time over multiple studies over multiple labs. I’m generally a skeptic, but it’s making me more of a believer than I would normally be.”