There is a growing interest in cognitive training as a means to help maintain cognition in healthy adults, and perhaps slow the progression of dementia due to Alzheimer’s disease in those at risk. Given that a cure for Alzheimer’s appears years away, and with the record number of adults reaching age 65 each day, there is no surprise that that the growth of the cognitive training industry over the last decade is in the billions of dollars.
Cognitive training, also known as “brain fitness,” is a term to describe interventions involving performance of specific tasks relevant to aspects of cognitive functioning including memory, attention, language, and executive function. Cognitive training is based on a concept known as “neuroplasticity”—the idea that our brains can function better if given the right set of challenges. Modern research hypothesizes that the brain creates new neural pathways and alters existing ones when exposed to new experiences or information, thus improving working memory—at least short term.
But research has also demonstrated that achieving lasting results with cognitive training can be elusive. Some studies have reported mixed or inconclusive results on sustainable effects of cognitive training. In addition, adults differ substantially in their motivation to engage in cognitive training, as well as their belief that cognition can be modified.
So, what kind of cognitive training appear to work best? Computer games? Crossword puzzles? Which appear to improve and sustain cognition over the long term? Or do users simply end up as highly practiced test-takers?
The answer may lie in a recently published meta-analysis (Lampit, et al, Computerized Cognitive Training in Cognitively Healthy Older Adults: A Systematic Review and Meta-Analysis of Effect Modifiers, PLoS Medicine, November 2014) of 52 randomized controlled trials that included almost 5000 healthy adults age 60 or older. It showed that at least four hours of computer-based cognitive training in a group setting, under the supervision of a trainer, was most effective for overall improvement in cognition, memory, visuospatial skills, and processing speed than commercially sold products promoted for self-directed, home-based training. In addition, the study concluded that brain training should be limited to one to three times per week in order to “rest” the brain between training sessions. However, the study could not specify if cognitive training of any kind could prevent or delay dementia, nor could it demonstrate a lasting effect.
What we do know is that the sale of computerized cognitive training packages, which provide standardized, cognitively challenging tasks designed to “exercise” cognitive functions, is a lucrative and expanding business. There is some good evidence that group-based cognitive training, no more than 3 times a week, may have a limited but substantial effect on cognition, memory, visuospatial skills and processing speed, but not on attention or executive functioning. Finally, the issue of marketing getting ahead of science will continue to plague us as we still need more research to conclude that spending our dollars here is a truly a worthwhile pursuit.
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