May 14, 2013
The Wall Street Journal
Sumathi Reddy

The computer game’s concept is relatively simple. Find the matching motor vehicle and road sign amid a series of increasing distractions. Succeed and the challenge gets quicker and harder.

Cognitive-training games like this one, Double Decision, are designed to improve brain functions and are at the center of a growing body of research looking at their effectiveness as scientists strive to find ways to ward off the cognitive declines that usually come with age.

A government-funded study published this month found that playing Double Decision can slow and even reverse declines in brain function associated with aging, while playing crossword puzzles cannot. The study builds on an earlier large trial which found that older people who played various cognitive games had better health-related outcomes, driving records and performed better at everyday tasks such as preparing a meal.

Such research has led groups like AARP, the big seniors group, to jump on board and offer discounts for certain games that have shown proven benefits.

Doctors who work with the elderly say they get many questions about so-called brain games and exercises. Despite promising study results, some doctors say there still isn’t enough evidence to prove such exercises will help people in everyday life.

“What they do is they train you with a computer program to do better on a test” of cognitive function, said Barbara Messinger-Rapport, director of the Center for Geriatric Medicine at the Cleveland Clinic in Ohio. “But does that mean you do better on real-life activities that utilize those skills such as driving …or managing your medications?”

Fredric Wolinsky, lead researcher for the latest study and a professor at the College of Public Health at the University of Iowa, said previous studies have demonstrated there are real-world benefits to playing certain computer games, including a reduction in depression symptoms. A study published in 2011 as part of a multi-year, government-funded trial, known as ACTIVE, showed that participants followed for six years had a 50% lower rate of motor-vehicle accidents following cognitive training, said Dr. Wolinsky, who didn’t participate in that research. The study appeared in the Journal of the American Geriatrics Society.

The latest study, called the Iowa Healthy and Active Minds Study, published this month in the online journal PLOS ONE, was a randomized controlled trial involving 681 healthy people. Participants were divided into two age groups—from 50 to 64, and 65 and over. People in each group were assigned either to play Road Tour, which has since been renamed Double Decision, or to do computerized crossword puzzles; some did the exercises in the lab and others at home.

Double Decision briefly displays an image of a vehicle and a particular road sign. As the screen continually shifts, and assorted vehicles and road signs come and go, players must watch out for and identify the particular vehicle and sign that appeared at the game’s start. The game becomes more challenging as players advance levels, forcing them to quicken their mental speed as distractions multiply and images become harder to distinguish. The study, which was funded by the National Institutes of Health, involved playing the game a minimum of 10 hours over a five-to-eight-week time period. One group played for an additional four hours after 11 months.

Before beginning the study, participants were given standard cognitive tests, many involving executive-function tasks such as concentration and shifting from one mental task to another. The results were ranked relative to the average performance on those tests for the participants’ age group.

The same tests were administered a year later. People assigned to do crossword puzzles showed typical cognitive one-year declines, Dr. Wolinsky said. But the groups who played the computer game showed a clear improvement compared with the normal loss of cognitive function as people age. The amount of improvement ranged from two to seven years, depending on which executive function was being tested. People who worked at home improved at the same rate as those who were in the lab.

Improvements in the younger group matched those among the older participants. “That’s really important,” said Dr. Wolinsky. It suggests “we are able to start the recovery process sooner, rather than waiting until the cognitive decline has become so large.”

The study followed similar research—the ACTIVE trial—also sponsored by the NIH. In that trial, about 2,800 elderly participants showed improved memory, reasoning and visual processing speed after playing an earlier version of the Double Decision game, said Dr. Wolinsky, who also worked on that earlier research.

The ACTIVE study also tested the time it took to do daily activities, like preparing a meal, and performance tests, such as reading price tables to pick the best telephone provider, Dr. Wolinsky said. Participants showed improved performance compared with those who didn’t get such cognitive training.

In the latest study, Dr. Wolinsky said he chose to use the updated Double Decision game in part because it is available for home users. In comparing computer-game use with another activity, he said he chose crosswords because many older people enjoy the puzzles and the general perception is that they keep the brain and mind active and engaged.

San Francisco-based Posit Science Corp., the company that makes Double Decision and other brain games, expects soon to participate in multisite studies looking at the impact such games could have in delaying or possibly preventing the onset of Alzheimer’s disease, said Michael Merzenich, a professor emeritus at the University of California, San Francisco and chief scientific officer of Posit Science.

AARP recently began offering its members discounts on several Posit Science games, said Deborah Abernathy, director of AARP Brain Health. “Their exercises, specifically, we found were very helpful. They’re fun, they’re short and they’re easy to do and they’re online,” she said.

Dr. Wolinsky said he doesn’t currently have a financial relationship with Posit Science. He did consulting work with the company for a total of 15 days from 2007 to 2009 as part of the analysis of the earlier ACTIVE study, he said.

Dr. Wolinsky said the next study he expects to pursue will use functional MRI imaging to measure changes in the brain in people participating in cognitive-training exercises, he said.

P. Murali Doraiswamy, a professor of psychiatry at Duke University Medical Center in Durham, N.C., said the Iowa study was one of the best and most rigorous to show the benefits of brain training in older age. But a problem with brain-training games is that people often get bored and don’t continue with them. “It’s a very promising area,” he said. “I think what we have to do is we have to make the games fun.”