I often get asked by clients, family and friends whether video games, Sudoku and other similar puzzle activities make the brain stronger and prevent dementia. Is there data supporting that?
Let me start with cognitive training.
Cognitive training is a set of validated exercises that healthcare professionals, such as physical therapists, occupational therapists and neuropsychologists use to improve an individual's cognitive function, typically after a brain injury. The goal of these exercises is to improve attention, memory, reasoning and judgment.
The Advanced Cognitive Training for Independent and Vital Elderly, or ACTIVE, study was the first large-scale randomized trial to show that cognitive training improves cognitive function in community-dwelling older adults, and to show evidence of transfer of that training to daily function.
The ACTIVE training study focused on memory, reasoning, and speed of processing, because prior research indicated that these abilities show early age-related decline and are related to activities of daily living.
The training was conducted in small groups in 10 60 to 75-minute sessions over 5 to 6 weeks.
Memory training focused on improving verbal, episodic memory through instruction and practicing strategy use. Reasoning training focused on improving the ability to solve problems that contained a serial pattern.
Speed of processing training focused on visual search and ability to process increasingly more complex information presented in successively shorter inspection times.
In summary, ACTIVE was the first multi-site clinical trial to test the effects of cognitive training interventions on cognitive abilities and daily function.
Results at ten years demonstrate that cognitive training has beneficial effects on cognitive abilities. These results provide support for the development of other interventions, particularly those that target multiple cognitive abilities.
Results from ACTIVE demonstrated that each of the three cognitive training interventions, memory, reasoning and visual speed of processing affected their targeted, proximal and primary outcomes over both short and long term, one to five years of follow up periods and even at ten years. These changes reflected the restoration of the equivalent of six years in memory, four years in reasoning, and eight years in visual speed-of-processing, the biggest effect.
Only the visual speed-of-processing intervention had significant effects on a variety of health outcomes, including health-related quality of life, depressive symptoms and self-rated health that lasted up to five years. A study called the Iowa Healthy and Active Mind study compared cognitive training to crossword puzzles. Details about the cognitive training exercises can be found in the supplemental reading provided with the course. It addressed some of ACTIVE's limitations, such as allowing younger subjects to participate, so they started recruiting at the age of 55 and up. They divided the participants into four groups. One group that had five training sessions of two hours each on site. One group that had similar training, but got a booster session. One group that was given the software and instructions and asked to do the training at home, and a control group that only did crossword puzzles.
This study was novel, because it compared older and younger users. It also compared users in their own home with those in a supervised setting. And it looked at crosswords, which is an exercise most people think of when they think of brain training. The results of the study found that the group using the computerized exercise for just ten hours had significant gains in cognitive function, while the group doing crosswords on the computer for an equal period of time had no significant improvements. The group at home had no improvements in their cognitive function and speed, but the group with on-site training and a four-hour booster did the best. What about intellectual engagement for the elderly? What I mean by that is reading, doing handy crafts such as knitting, having political interests, meeting with friends in groups, gardening, playing cards, and so on? In a Swedish study by Carp et al, a total of 776 non-demented subjects aged 75 years and above were followed for more than 6 years to detect incident dementia cases.
These subjects were asked what kinds of activities they engaged in, and a score of one to three was assigned to each activity. The study showed that the higher the score, meaning the more activities these elderly people engaged in, the less the risk of dementia developing down the road.
These findings suggest that engaging in a broad spectrum of activities is more beneficial than being engaged in only one type of activity. Remember though that fitness training has both broad and specific effects on cognition. Meaning with just one exercise, you can target different domains, including executive function, spacial orientation and speed, whereas with cognitive training you should do a specific exercise to target each specific domain.