Is It Really Smart to Teach Old Brains New Tricks?
Tuesday, August 12, 2008; Page HE01
Throw all the money you like at computer brainteasers. Just don't bet the popular games will protect your gray matter any better than a host of other activities, many of them free.
Some aging experts worry that, when it comes to mind games, the marketing has galloped ahead of the science and that consumers and retirement communities may be plunking down hundreds, even thousands, of dollars on products with little evidence to support their claims. The brain-game craze began with the 2005 launch of Nintendo's Brain Age. The video game's latest version challenges you to speed-memorize 25 numbers, beat the computer at rock-paper-scissors and tell time on an upside-down clock.
Given recent research suggesting some mind work might maintain or even improve aging brains, gamemakers are hot to bill their products as something more than just entertainment.
"Everybody's looking for a computer game," says psychologist Judah Ronch, a professor of practice at the Erickson School of Aging, Management and Policy at the University of Maryland Baltimore County. "Is there any evidence that they're any better [at staving off dementia than exercise or social engagement]? No. But because of the commercial potential, people are beating that horse and hoping it comes in."
Last year, revenue for the brain fitness software market reached $225 million, up from $100 million in 2005, according to SharpBrains, a company that tracks the cognitive fitness market. Consumers spent $80 million of that, up from $5 million in 2005; the rest came from school systems, the military, corporations, sports teams, senior facilities and other health organizations. SharpBrains expects the growth to continue.
To sell their products, ranging in price from $20 to more than $2,000, gamemakers lean heavily on science suggesting a benefit to cognitive training. For example, the game Brain Age: Above a brain diagram, Nintendo exhorts you to get "the most out of your prefrontal cortex." (Brain Age sells for $19.99 if you already own the $130 Nintendo DS system to play it on.) MindFit (a $139 CD-ROM) promises to "help you improve and maintain your quality of life. You can stay totally healthy longer." [m]Power ($2,499 for an at-home version, including a computer with a touch screen, coming out later this year; an institutional version, licensed for 20 users, sells for $6,000) bills itself as "a powerful new weapon in the fight against Alzheimer's disease."
Many makers include an impressive roster of academic experts on their publicity materials. Ronch, for example, is an unpaid adviser to Dakim Inc., developer of [m]Power. Makers also cite "scientific studies" in support of their claims. MindFit, for example, says research shows the game improves reaction time by 12.5 percent, short-term memory by 18 percent, memory recall by 14 percent and hand-eye coordination by 16.5 percent.
That may be less impressive than it sounds. "We've known for a hundred years that most training is highly specific," says psychologist Timothy Salthouse, director of the Salthouse Cognitive Aging Lab at the University of Virginia. "Training on one kind of memory does not necessarily have any kind of impact on other kinds of memory."
In other words, you may get better with practice at matching pictures of ice cream cones or frogs from rapidly changing images or mastering obscure facts about famous people. (James Joyce was afraid of dogs.) But whether that translates into brain protection -- or confers benefits beyond those offered by square-dancing, eating blueberries or simply yukking it up with friends -- is anybody's guess.
"The jury is out on the mental fitness stuff," says neuroscientist Denise C. Park, the T. Boone Pickens Distinguished Chair in Clinical Brain Science at the University of Texas at Dallas. She notes that epidemiological studies suggest that people who are mentally engaged tend to get Alzheimer's later than others. But no one knows yet if mental stimulation keeps you healthier or if healthier people are better able to perform mentally stimulating activities.
Some of the hope -- and the hype -- around cognitive training stems from a clinical trial of 2,832 people age 65 and older, published in 2006 in the Journal of the American Medical Association. In the study, known as ACTIVE, for Advanced Cognitive Training for Independent and Vital Elderly, participants were randomly assigned to training groups in memory, reasoning strategies or speed-of-processing tasks. All three groups improved in their area of training, compared with a control group; the improvement continued for five years. After five years, one group (trained in reasoning) also reported less functional decline in daily living activities such as balancing a checkbook or driving.
But experts say it's too soon to know if there are long-term gains from computer brain games.
"I see people in my clinic every week who have cognitive complaints," says Jason Brandt, a professor of psychiatry and neurology at Johns Hopkins School of Medicine. "I say save your money. Invest in a memo pad and a pencil, and keep it in your pocket."
In the meantime, Brandt is working with Dakim to put [m]Power to the test in a clinical trial, something few games have undergone. That's exactly what's needed, says Molly Wagster, chief of the Neuropsychology of Aging Branch at the National Institute on Aging. "What is missing often from these products that are on the market is the research," she says.
One of the few companies to conduct a clinical trial is Posit Science. In its study, conducted from 2006 to 2007, 468 participants, average age 75, were randomly assigned to two groups; one used the company's Brain Fitness program ($395) while the other watched educational DVDs and took quizzes. After 10 weeks of training, those in the Brain Fitness group improved their speed of processing and some measures of memory compared with the control group. The study has been presented at professional meetings but not yet published.
Scientific interest in cognitive fitness continues. Last year NIA and the McKnight Brain Research Foundation brought top researchers together for a "cognitive aging summit," in which they mapped a research agenda. In addition to supporting the ACTIVE study, NIA has funded projects to learn more about the effects of exercise, diet, social engagement and mental stimulation on long-term brain health. Imaging technology can show as never before what interventions actually work to create brain cell growth and new neural pathways.
One such effort involves elderly beagles, animals that, much like their owners, often have age-related memory and learning impairments, including the beta-amyloid plaques found in the brains of Alzheimer's patients. Although they can't paw a keyboard, they still can master brain-boosting games, such as finding the odd object among a group of four. Several published studies, including one in 2005 in the peer-reviewed Neurobiology of Aging, found that old beagles given a diet rich in antioxidants, social engagement with a kennel buddy, regular walks and challenging tasks had significantly better spatial memory and reduced brain pathology, compared with a control group.
At the University of Texas, Park recently launched a study out of a shopping mall, where she's recruiting 350 older people to form three groups: One will learn PhotoShop and digital photography, another will learn how to quilt, and the third will socialize. Participants will undergo before-and-after brain imaging and cognitive function tests to see if and how these activities affect brain health. Park wonders whether free social or physical activities might be better for older people, especially those on fixed incomes, than computerized brain fitness exercises.
"If people get too engrossed in these computer games, maybe they're not exercising or engaging with other people," she says.
And if not properly designed, adds Ronch, the activities could frustrate people, making them lose confidence -- which actually undermines cognitive health. J. Lee Dockery, a trustee of the McKnight brain research foundation, says whatever the chosen activity, people must enjoy doing it for it to "stick."
"My mother will be 92 and has severely compromised cognition," he says. "To keep her strong I got her weights for her ankles and arms. They're lying on the shelf."
Beth Baker last wrote for Health about games to help family members connect with relatives with dementia. Comments:firstname.lastname@example.org.