Sunday, April 6, 2014

Does Brain training “work”?

In clinical psychology, brain training has applications for children with ADHD by training working memory and attention, in TBI patients who are working to regain cognitive functioning, and for elderly populations who are experiencing aging and disease related declines in processing speed and memory. Lately, these brain training programs have even been marketed to the general public, and several friends have asked me whether “brain training” programs actually work. Cautiously, I have responded to them by asking what they mean by “work,” as the very delineation of something that either “works” or “doesn’t work” is too simple when it comes to the human brain.

In psychology research, how these programs “work” is divided into near transfer and far transfer. Near transfer is when a brain training program makes you better at the specific skill you are training. For example, does training yourself to shift attention between different topics, images, or tasks, make you better at shifting your attention between different topics, images, or tasks. Far transfer is when a brain training program makes you better at the skill you are training as well as skills that are related to the skill you are training. For example, does practicing retaining information in your short-term memory help you improve your reading comprehension?

When transfer occurs, either near or far, there is scientific value in understanding how that transfer impacts the brain. For example, if attention training demonstrates far transfer to a skill like reading, is there a change in the communication between different parts of the brain? Or do certain regions of the brain work less when completing specific tasks.
So far, there is clear evidence that near transfer occurs. Practicing one cognitive skill will relate to improved performance on tests of that skill in the future. Far transfer, on the other hand, is harder to demonstrate and isn’t as reliable. Thus, there has been little opportunity to evaluate the far transfer related changes that occur in the brain or explain how far transfer works.

Luckily, Dr. Maren Strenziok of George Mason University and her colleagues were interested in answering the question:

Does cognitive training transfer relate to changes in brain connectivity?

To address this question, they recruited 42 healthy adults with an average age of 69 years to participate in a brain training study. All of these participants completed an fMRI brain scan to assess brain functioning and the strength of connectivity between different structures within the brain. These participants also complete a series of psychological tests to measure performance in memory and reasoning.  Then, each participant was randomly assigned to one of three brain training games on the computer. These games were “Rise of Nations,” “Brain Fitness,” and “Space Fortress.”

“Rise of Nations” is a real-time strategy computer game. At the beginning of this game, the participant was assigned a nation and the object of the game is to increase that nation’s territory. This game has been previously shown to engage skills such as working memory, reasoning, task-switching, and visuo-spatial processing. “Brain Fitness” is an auditory perception game where participants were expected to match, detect, and discriminate sounds of high and low volume and tone, and follow complex instructions. “Space Fortress” is a complex game requiring the participant to navigate and destroy a space fortress which likely engaged attention shifting, inhibition, rule-learning, and hand-eye coordination. After the participants were assigned to their game, they participated in a learning paradigm in order to familiarize themselves with how to play the game. Participants were then asked to play their game for one-hour each day for 6 weeks. At the end of these 6 weeks, the participants returned to the laboratory to participate in a post-training scan of their brain as well as complete psychological tests aimed at measuring any changes in their memory or reasoning ability.

They found that “Rise of Nations” was associated with increases in mathematical reasoning, decreases in working memory, and no change in speed of cognitive performance. Participants who were assigned to “Brain Fitness” demonstrated no changes in working memory, and improvement in mathematical reasoning, and an increase in speed of cognitive performance. Finally, participants who were assigned to “Space Fortress” demonstrated increases in working memory ability, a decrease in mathematical reasoning, and an increase in speed of cognitive performance.

But do these changes in performance relate to changes in the way the brain works?

The short answer appears to be yes. Participants who were assigned to train in the Brain Fitness game demonstrated decreases in connectivity between the inferior temporal lobe (ITL) and the superior parietal cortex (SPC) compared with participants in the “Rise of Nations” group. The inferior temporal lobe is the part of the brain associated with visual processing, while the superior parietal cortex is the part of the brain associated with spatial reasoning and sensorimotor functioning. This suggests that training in auditory perception decreases the connectivity between these two structures in the brain, and results in faster performance on cognitive tasks, aka increased efficiency. This was also true when comparing “Space Fortress” to “Rise of Nations”. In comparison, “Rise of Nations” resulted in increased connectivity between the ITL and the SPC.

So, what does it all mean? From this study, it appears that games like “Rise of Nations” which create a sort of artificial world and involve developing strategies to advance within that world have some cognitive benefits but do not result in far transfer, or cognitive benefits that extend to skills outside of the game. Furthermore, playing this game may result in increased need for connectivity between structures within the brain in order to achieve the same results. In comparison, “Brain Fitness” and “Space Fortress” both demonstrated cognitive benefits outside of the skills engaged while playing the game, and also resulted in more efficient cognitive processing after only 6 weeks.

Obviously, one should consider the limitations of this study before using its results to justify buying Lumosity or dropping out of school to do Brain Metrix. This was a small study, of older adult participants, and far transfer was measured using psychological tests after a brief training, with no long-term follow-up. It would be enormously interesting to see whether these cognitive benefits remained months later. The utility of these results for the average adult who works, lives, and plans for the future is more compelling. Wouldn’t it be nice if we could be 3 lattes sharp at all times, read quickly, focus our attention exactly when we want to, and figure out how to solve problems on a dime. And wouldn’t it be nice if we could all play videogames for hours in order to achieve those goals? I imagine that the average person who asks me about whether these programs “work” is interested in these outcomes. This study shows us that practicing one skill repeatedly over time has near transfer and results in that skill improving. So, if you’re interested in something that “works” for one problem area in your life, then practicing that skill over-and-over-and-over will give you more bang for your buck. If you’re more interested in improving general cognitive functioning, there may be something to these programs that help you hone in on specific core domains of cognition such as working memory, attention shifting, and auditory perception. These domains of cognitive functioning influence many cognitive abilities and you’re likely to notice gains after as little as 6 weeks of daily practice.

Strenziok, M., Parasuraman, R., Clarke, E., Cisler, D. S., Thompson, J. C., & Greenwood, P. M. (2014). Neurocognitive enhancement in older adults: comparison of three cognitive training tasks to test a hypothesis of training transfer in brain connectivity. NeuroImage, 85, 1027-1039.

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