Cognitive training to promote brain health has generated a lot of interest and some controversy. New findings (PDF) from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study released on July 24th, 2016 show that playing a brain training game may reduce the risk of developing dementia and prevent cognitive decline.
Scientists have known for years that lifelong learning is associated with cognitive health, and higher levels of cognitive activity at mid- or late-life are linked to delayed onset of cognitive impairment. But manufacturers of brain games have been criticized, and even fined, for not providing scientific evidence that they can prevent dementia. Now, for the first time, evidence shows that a certain type of brain exercise is effective.
The ACTIVE study is a large, 10-year clinical trial that tested the effects of different cognitive training programs on the incidence of cognitive decline and dementia in 2,832 healthy older adults (average age 73.6 years). The volunteers were randomly assigned to one of the following four groups: 1) memory training, 2) reasoning training, 3) computerized speed-of-processing training, and 4) no training. Participants in the training groups completed ten 60–75 minute training sessions over 5 weeks, and some participants received "booster" sessions (additional training after 1 and 3 years). Researchers followed up with the participants after 1, 2, 3, 5, and 10 years to measure their cognitive and functional changes.
After 10 years, people assigned to the speed-of-processing training had a 33 percent lower incidence of cognitive impairment and dementia than people receiving no training. The protective effect remained, even after adjusting for factors such as age, sex, race, and physical function. People who completed the "booster" sessions (up to 4 hours of additional training) had an even greater reduction—by 48%—in the incidence of cognitive impairment and dementia. When an effect is greater with more treatment, commonly referred to as a "dose-response relationship", there is more confidence that the treatment, in this case the speed-of-processing training, may be causing the effect.
Interestingly, people in the memory or reasoning training group did not experience this protective benefit. We cannot yet be sure that the benefits of speed-of-processing training are unique—the study only tested it against the no training group—but the preliminary data does suggest that it works better than the other types of training. The speed-of-processing training program was designed to improve the speed and accuracy of a person’s visual attention. In a computer screen, the participant identifies an object (e.g., a truck) at the center while at the same time identifying a target in the periphery (e.g., a car). As the participant gets more answers correct, the speed of presentation gets faster and the objects become increasingly similar. This type of brain training is available online as an exercise called "Double Decision" in BrainHQ.
While these results are exciting and promising, the study has not yet been published in a peer-reviewed journal. The results will need to be replicated in another study in order to be certain that these effects are consistent and reliable. And some questions remain for future studies. The ACTIVE study examined healthy older adults—it is currently unknown whether this type of training is protective in people who are already suffering from cognitive decline or if it will protect younger people from cognitive decline and dementia many decades later. Also, what kinds of changes are occurring in the brain when people participate in this type of brain training? The mechanism in which brain training may offer protection is not known and warrants investigation.
Still, the ACTIVE trial is the first study to demonstrate that a lifestyle intervention may reduce dementia risk, which is good news for brain health.
Yuko Hara, PhD, is Director of Aging and Alzheimer's Prevention at the Alzheimer's Drug Discovery Foundation. Dr. Hara was previously an Assistant Professor in Neuroscience at the Icahn School of Medicine at Mount Sinai, where she remains an adjunct faculty member. Her research focused on brain aging, specifically how estrogens and reproductive aging influence the aging brain's synapses and mitochondria. She earned a doctorate in neurology and neuroscience at Weill Graduate School of Medical Sciences of Cornell University and a bachelor's degree in biology from Cornell University, with additional study at Keio University in Japan. Dr. Hara has authored numerous peer-reviewed publications, including articles in PNAS and Journal of Neuroscience.
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