Video Game Revs Up Brain Power

Even healthy aging brains can have a tough time concentrating in the middle of distractions and especially while multitasking. A video game designed to challenge these specific cognitive deficits appears not only to improve these deficits but also shows mental benefits beyond the targeted training, reports a study published September 5 in the journal Nature (Anguera et al., 2013).

The study adds more evidence that challenging the brain can drive plasticity and improve function and may have implications for improving cognitive declines associated with multiple sclerosis (MS), according to the authors and others contacted by MSDF.

In the most compelling finding, the brains of older adults (ages 60 to 85) performed as efficiently at the "NeuroRacer" video game after a month of practice as those of untrained 20-year-olds. The specific multitasking improvements lasted 6 months without additional practice. More interesting, researchers found broader effects. The game players showed enhanced sustained attention and working memory. The results were supported by a neural marker of cognitive processing as measured with electroencephalography (EEG), which correlated with the improvements.

In MS, the cognitive deficits vary widely among individuals but tend to be primarily deficits in memory and processing speed, which interfere with multitasking abilities, said Victoria Leavitt, Ph.D., a neuropsychologist at the Kessler Foundation in West Orange, New Jersey, in an interview with MDSF.

"It's exciting if you can give someone a treatment that generalizes to other cognitive domains," said Leavitt, who was not involved in the study. Leavitt and her colleague James Sumowski, Ph.D., a neuropsychologist, have shown that intellectually enriching leisure activities, such as reading and blogging, may protect against cognitive impairment in people with MS (Sumowski et al., 2013). They are conducting a pilot randomized controlled trial to test other cognitive interventions (reading, writing, games) on people with MS using an iPad.

In the new study, researchers at the University of California, San Francisco, teamed up with professional video-game designers to see whether they could challenge and improve specific deficits in cognitive control they had documented in aging adults, said senior author Adam Gazzaley, M.D., Ph.D., a neurologist and cognitive neuroscientist, in a telephone briefing hosted by Nature. The team designed a three-dimensional video game to challenge two competing brain processes. The game is played on an Apple laptop with a joystick.

The game, called NeuroRacer, demands that players identify signs correctly by pressing a button and also drive a twisty, hilly road with a joystick that turns the car left and right and moves forward and back to give it more or less gas for going up and down the hills.

Led by postdoctoral fellow Joaquin Anguera, Ph.D., the researchers conducted three main experiments. First, they found that multitasking performance declined steadily, decade by decade, from age 20 to 79—even though each of the 174 tested individuals played at a customized challenge level matched to their abilities to perform the sign and driving tasks separately. They measured the performance by the decline in speed and accuracy of sign identification when the driving task was added.

Next, a new group of older people (ages 60 to 85) showed an increase in performance after playing the multitasking game at home for 1 hour a day, 3 days a week, for 1 month, compared to controls who didn't play or played a version with only a single task. The home multitasking version rewarded players who improved in both tasks by moving up levels of challenge. The improvements correlated with EEG changes measured at pre- and post-training visits to the lab. At a 6-month follow-up, the multitaskers had held onto their performance gains without practice.

Finally, the researchers tested the impact on other cognitive abilities. The older individuals who showed the biggest increase in multitasking ability in the game also showed the biggest increase in separate tests that measured sustained attention and working memory.

The video-game training worked because it was specifically designed to challenge neural circuits with specific deficits, much like drugs aim to target certain molecular pathways, Gazzaley said. He envisioned a scenario in which the video game would undergo testing in larger trials and perhaps regulatory review by the Food and Drug Administration.

Another population, such as people with MS, might also have similar deficits and may benefit from specially designed video-game training, he told MSDF. However, the game would need to be developed with MS experts and specifically address the cognitive deficits. "Just because there is a challenge to the brain doesn't mean it will have a strong impact," Gazzaley said. "There is a difference between basing [a challenge] on a good idea and validating it through a blinded experiment."

In a recent study, MS researchers at Sheba Medical Center in Israel called for "the need for repeated cognitive assessment as well as interventions tailored to the magnitude and profile of cognitive impairment as the disease progresses" (Achiron et al., 2013).

Gazzaley and his colleagues said they were incubating four other video games designed to diagnose deficits, assess underlying neural mechanisms, and enhance cognitive abilities in other conditions, including attention deficit disorder in young adults and depression. NeuroRacer is being adapted for mobile devices by a Boston-based company for further clinical testing, he said.

Key open questions

• What specific cognitive deficits associated with MS could be diagnosed, assessed, and treated by a targeted video game?

Disclosures

Adam Gazzaley is co-founder and chief science adviser of Akili Interactive Labs, a newly formed company that develops cognitive training software. He has a patent pending, “Enhancing cognition in the presence of distraction and/or interruption,” for a game–based cognitive training intervention that was inspired by this research.