Computer games have been part of Janet Perry’s life for so long that her grown children refer to them as “Mother’s silly games.” But the California woman’s digital dalliance has turned more earnest over the last year as she switched to so-called brain-training games that are more rigorous, more diverse, and seemingly more in line with her current mission: to stay sharp.
Diagnosed with multiple sclerosis (MS) at 43, Perry’s physical abilities have noticeably diminished over the last two decades. Walkers and scooters are now part of her routine — but so too are splashy online Lumosity games that find her virtually whizzing around racetracks, tracking diner patrons’ meal orders, and recalling swimming animals’ positions in a swiftly moving river.
Now 61, the needlepoint artist, teacher, and writer is determined that her cognitive abilities, which can deteriorate with MS, won’t fade in lockstep with her mobility. So, every day for 20 minutes, she flexes her mental muscles with games meant to test skills such as working memory, processing speed, pattern recognition, and problem solving.
“I decided to do it as a form of preventive maintenance to minimize problems that might occur,” says Perry, whose mild MS-related cognitive issues are so far confined to difficulty following overly complex writing. “Since my physical difficulties have increased as time has gone on, I thought my cognitive difficulties might, too, and that I should do something about that. This was something I could do on the computer and it was very cool, so I thought it made sense to start.”
It also appears to work in the way she hoped. Perry’s overall scores on the brain-training games — brightly displayed after each one — have more than doubled since she undertook her regimen. But she’s not aiming for the training to better her brain — just maintain it. “From my point of view,” Perry explains, “keeping my function is more important than improving it. I’m happy enough to know my own scores are improving.”
Perry would seem an ideal candidate for the popular brain-training games and apps — products dubbed “brain games” — that have proliferated in our virtual lives since the turn of the millennium. Aimed especially at older adults worried about losing their edge, some of the programs have claimed to offer remarkable effects, including the ability to halt memory loss or even Alzheimer’s disease.
The research behind these statements, however, is questionable. In 2016 the Federal Trade Commission (FTC) imposed stiff fines on two companies, Lumosity and LearningRx, for false advertising. The FTC said the firms had deceived consumers by claiming their games could lead to outcomes such as reversing cognitive decline or improving school grades.
What is the science behind the “gamification” of brain health? And can these games actually enhance real-world performance in our jobs, schools, and personal lives?
Cognitive games have a long history — think crossword puzzles, Sudoku, and other fun tests of mental agility — but it wasn’t until our societal plunge into the online universe that computerized brain training hit the mainstream. In 2005 Nintendo’s Brain Age game became one of the first such products mass-marketed to consumers, signaling a shift in the collective consciousness: Cognitive training had become something we could buy.
Today Nintendo is one among many in the brain-training space, with some companies targeting narrow special-interest groups. With its punchy graphics, Lumosity, which has advertised extensively on radio, TV, and online, currently offers more than 50 games that each claim to measure a specific cognitive skill; one ad says, “We transform science into delightful games.” LearningRx boasts 95,000 clients; its home page says that the brain can be trained to “learn easier, think faster, and perform better.”
Also in the market are firms such as Posit Science, which teamed with AARP to offer brain-training software as part of a Staying Sharp membership; Cogmed, whose working memory software is marketed to schools and therapists with claims of helping users resist distractions; and CogniFit, which has promised to “add useful cognitive training programs for your daily life.”
The intuitive appeal of these games seems clear to both scientists and regular folks: if you enhance your brain skills, you’ll do better in life. And the games aren’t just for older adults, experts say, though the idea of preventing brain drain is especially pressing to those in middle age and beyond.
“I don’t know anyone who wouldn’t want to be smarter, if that’s possible,” says Joseph Kable, a brain-game investigator and an associate professor of psychology at the University of Pennsylvania. “And there are no negative side effects to playing these games, other than lost time. So there’s a sense of, ‘If there’s a chance that it would make me smarter, let me give it a shot.’”
Daniel J. Simons, a professor of psychology at the University of Illinois at Urbana-Champaign and the lead author of a recent comprehensive review of the brain training literature, points out that it’s difficult not to get sucked in by the idea of an instant solution.
“One reason the games are so appealing to people is that learning new things is hard, and it takes a lot of effort to become good at something,” he says. “Everyone, as they get older, is worried about a failing memory and cognitive decline. There’s a real appeal to the quick fix, especially if it’s fun.”
Others in the scientific community worry that the harms caused by these games go much deeper, including the financial loss and opportunity costs of playing them, the false hope they raise, misuse of the healthcare system, and a negative impact on the patient-physician relationship.
Given the attraction of a quick fix, perhaps it isn’t surprising how huge the cognitive training industry has become. Most brain-training companies are privately held and don’t divulge revenues, so it’s difficult to pinpoint how much consumers spend on games, apps, and other such products. According to a 2015 report by the market research firm SharpBrains, which attempts to track the industry, the total digital brain-health market logged sales of $210 million in 2005, $600 million in 2009, and $1.3 billion in 2013. SharpBrains also predicted a total of $6.15 billion in yearly sales by 2020.
That’s why so much was at stake when the FTC came down on Lumosity and LearningRx. Lumosity paid $2 million to settle a judgment charging that the company had deceived consumers with claims its program could help users perform better at work and school, as well as delay cognitive impairment related to age or other major medical conditions, such as stroke or ADHD. At that time, Lumosity’s online and mobile game apps ranged in price from $14.95 per month to just under $300 for a lifetime membership. (Prices have since dropped to $11.95 per month and just under $240 for a lifetime membership.)
A few months later, the FTC set its gaze on LearningRx, saying the company’s programs were deceptively claiming to be clinically proven to permanently improve the health of people with conditions such as autism and Alzheimer’s disease. The company had also contended that its training significantly improved school grades, college admission test scores, career earnings, and job and athletic performance.
“Lumosity preyed on consumers’ fears … but Lumosity simply did not have the science to back up its ads,” said Jessica Rich, an FTC spokesperson, at the time of the fining. Later, the FTC issued a similar scolding to LearningRx.
Where did these companies go wrong? The problem with their claims, experts say, is that the studies supposedly supporting them were often riddled with weaknesses. They were too small and rarely measured real-world outcomes, relying instead on self-reports. In most cases, the study’s intervention group — the people doing brain-training games — was not compared with a placebo group performing a similar task.
“If you really want to draw the inference that brain training did something, you have to control for the critical ingredient,” Simons explains. “In medicine, you can control for a placebo effect by having a placebo pill that looks and tastes like the drug … but with research on cognitive interventions, you can’t do that. Many studies don’t take any steps to address this problem.
“Several companies still have claims on their websites that are misleading, deceptive, or wrong,” he adds. “Ideally, companies would only make claims that have been shown to be true in independent tests. But making accurate claims does not necessarily sell more products. Historically, overhyping your products is what works.”
“Everyone, as they get older, is worried about a failing memory and cognitive decline.”
Simons’ exhaustive 2016 research on whether brain-training games work — perhaps the most definitive roundup of existing evidence to date — was inspired by controversy. In 2014, two groups of international scientists issued contradictory consensus statements: The first, authored by more than 70, contended that the games don’t provide a “scientifically grounded” way to improve cognitive function or hinder cognitive decline. The second, issued by a group of 133 researchers (including some who were compensated by brain-training companies), countered that the research literature is full of examples of the benefits.
Reviewing more than 300 published papers on brain-training effects, Simons and his team came to some stark conclusions about the games’ ability to enhance performance on other tasks. Playing a game makes you better at the game, they found; but there’s no strong evidence that skills learned in a cognitive game carry “far transfer” effects to an unrelated task, such as overall improvements in memory or processing speed.
“There’s plenty of evidence that if you practice something that you get better at it … there’s no arguing there,” Simons says. “The real question is, does practicing one thing improve other things? We found almost no evidence for improvements from these games on objectively measured, real-world performance [in other cognitive tasks].”
Another recent major study of 128 young adults by Kable and colleagues backs this conclusion. Kable’s group found that brain-training games offer no superior effects to regular video games on healthy brains. Published in July 2017 in the Journal of Neuroscience, it was the first large effort to use brain imaging along with brain-training games to visualize the programs’ effects. It also avoided the design flaw so common to other research by having participants in the control group do a similar task.
“It’s very clear that if you engage in a purposeful practice with a game or sports activity, you can get better at that particular game,” says Neil Charness, a professor of psychology at Florida State University. His 2017 research on 60 older adults also found little evidence of any skills transfer from brain games to distantly related tasks.
“But taking the skills learned in one game and moving them to another game — that has been the Holy Grail of gamification efforts, but has failed consistently,” Charness concludes.
A Different Take
Do brain-training effects change when the brains in question aren’t healthy? A small swath of research on people whose brains are compromised — by dementia or stroke, for instance — suggests that cognitive games may offer certain limited advantages to these groups.
A small 2017 study from the University of Cambridge in the United Kingdom suggests that a novel learning and memory game delivered via iPad could help patients with mild cognitive impairment (MCI), a precursor for Alzheimer’s disease. Compared to a control group that did nothing unusual, a group of 21 iPad-playing patients with MCI saw their episodic memory (the unique memory of a specific event) and visual-spatial abilities “robustly” improve, researchers said. And participants logged significantly fewer errors on a repeat-pattern task.
Meanwhile, a 2016 study of stroke patients randomly assigned half to an eight-week brain-training Lumosity program, while the control group received general information about the brain each week. Neuropsychological tests and questionnaires showed brain training produced limited effects on users’ working memory and speed.
But as with studies on healthy brains, experts say, research on people with documented cognitive problems often tracks a short time frame and can be fraught with biases such as self-reported results.
“Rehabilitation after a stroke is another place where evaluating the efficacy can be really tricky, because in the first year after a stroke, there’s a natural recovery,” Kable explains. “So, what you really want to know is, are the games getting people to a higher place than they otherwise would have reached?”
Simons isn’t convinced that any of the studies on delaying the effects of Alzheimer’s disease using brain games hold water. He and Charness suggest instead that those with memory loss learn how to compensate in practical ways for any mounting deficits.
“If you want to avoid people being defrauded, train them at recognizing frauds. If you want them to drive better, train them at driving. Train for narrow abilities versus broad ability,” Charness says. “My hunch is, intervening at a broad cognitive level is not going to pay off; but intervening at things that put you most at risk for losing your independence may be the way to go.”
Can Virtual Reality Brain Games Effectively Screen for Dementia?
Video games used to be just for kids — or at least that was the perception. But with national figures estimating that nearly 1 in 2 people over age 50 now play digital games, perhaps it was only a matter of time before research examined whether this leisurely pastime could be converted to something decidedly more serious: dementia screening.
A 2015 Greek study did just that, using a virtual-reality supermarket cognitive-training game to screen patients for mild cognitive impairment (MCI), which often precedes Alzheimer’s disease and is characterized by memory problems and diminished abilities to do complex tasks.
Published in the Journal of Alzheimer’s Disease, the study looked at two small groups of older adults — 21 who were healthy and 34 with MCI. All played the virtual-reality supermarket game and underwent a battery of standard “neuropsych” tests typically used to diagnose MCI, which evaluate cognitive abilities such as attention, memory, language and processing speed.
The results were noteworthy: The virtual-reality game correctly plucked out 87 percent of the folks with MCI, comparable to the diagnostic accuracy of the neuropsych testing considered to be the gold standard. If it works just as well — and theoretically can be done from home, with results tracked remotely over time — why not turn a not-so-fun assessment into something more enjoyable?
Not so fast. Neil Charness, director of Florida State University’s Institute for Successful Longevity, points out one big problem with using virtual reality for dementia screening on a widespread basis. About 1 in 4 people, he says, experience a type of motion sickness known as “sim sickness” while driving in simulators due to a disconnect between what their eyes see and what their body feels.
“It’s a disordered feeling akin to ingesting a toxin affecting the neurological system, which tends to be more of a problem as you get older,” says Charness, whose own research has utilized virtual-reality driving simulators with older adults.
Since dementia affects the brain’s ability to process what’s being seen, sim sickness may be even more of an issue for someone with the condition, he says. Older adults also depend more on their vision to maintain balance than younger people. But if sim sickness were to affect a significant percentage of those being screened for dementia using virtual-reality games, Charness wonders how accurate — or fair — that would be.
“I’d be concerned that a high proportion of people would have negative effects within it, which would interfere with your ability to measure what you’re trying to measure,” Charness adds. “I’m not saying throw it out, but my question would be, how much better would virtual reality screening be than standard tests and how do you standardize when you could be inducing even a mild sickness that could impair people’s performance?”
No One-Stop Shop
Not all the evidence destroys the theory that brain-training games might stave off cognitive decay. A January 2017 paper in Neuropsychology Review examined seven types of brain-training programs in 26 studies on healthy older adults, cautiously concluding that at least some commercially available games and apps can boost healthy brain aging. How? By stimulating neuroplasticity — the brain’s ability to change in response to learning or experience.
But the games are still not a magic bullet, experts contend.
“If the gamification is part of a suite of activities such as crossword puzzles and Sudoku … I think that’s potentially useful for some people -— perhaps for those who already find such activities to be engaging or like a hobby,” says Tim Bogg, an associate professor of psychology at Wayne State University in Detroit, whose work showed the cognitive research on transfer effects to be unreliable. “But if you’re solely relying on those games to stimulate cognitive ability, or maintain it, or improve it in some way, it’s inherently limited. Some amount of cognitive decline is a normal part of aging. So the idea that we can stop it in some way, while that might have a lot of appeal, it’s just not how we’re built. It’s more about what we can do to reduce some of the natural declines that happen over the life course.”
Bogg and others point instead to regular weekly leisure-time physical activity, whether brisk walks or all-out workouts, as a widely supported stay-sharp tactic, and one that’s backed by evidence still lacking in the brain-training realm. Charness, also director of Florida State University’s Institute for Successful Longevity, is a proponent of “exer-gaming,” which combines exercise and brain games and, he predicts, will become increasingly popular in coming decades.
“People don’t like to exercise. But the beauty of video games is that they’re very carefully designed to get people engaged in an activity because it’s enjoyable,” Charness says. “One of the things we struggle with when we’re getting people to change their behaviors is finding a way to keep them engaged in something they wouldn’t normally do. Exer-gaming has the compulsive attraction of video games, plus exercise.”
Another boost to an aging brain? A rich social life, Charness says, along with higher levels of education. “Maybe you should be going out and taking courses,” he suggests.
Perry, whose year of brain games has offered her peace of mind, espouses a similarly integrated approach as she ages. In addition to her daily Lumosity regimen and professional commitments, Perry reads voraciously, critiquing books for an online book review website and participating in a book club.
“Engaging in an intellectual life also makes a difference in keeping your cognitive abilities up,” she says. “My husband and I don’t just spend our lives letting our lives happen to us — we go out and engage.”
“Ideally, companies would only make claims that have been shown to be true in independent tests. But making accurate claims does not necessarily sell more products.”