Screenshot from Posit Science's 'Double Decision,' a cognitive intervention used in the ACTIVE study. (Posit Science)
We've seen -- and done -- some negative coverage of the so-called brain training industry, in which companies provide computerized games that ostensibly improve memory, attention, and other mental capabilities while -- so some of the ads suggested -- warding off cognitive decline. In January, one of the leading brands in this space, Lumosity made a deal with the Federal Trade Commission to cough up $2 million for partial refunds as compensation for deceptive advertising.
And yet, even the doubters haven't entirely ruled out the possibility that some form of cognitive training may be beneficial. A 2014 statement from dozens of cognitive scientists taking the industry to task for making claims without evidence also acknowledged "some intriguing isolated reports do inspire additional research.”
Now, there may be some solid evidence that the training works. On July 24, at the Alzheimer’s Assn.’s International Conference in Toronto, researchers of a long-range study announced that a relatively small amount of cognitive training resulted in a significant reduction in the risk of developing cognitive decline or dementia over 10 years.
The results are still preliminary, as the study is currently under review for publication in a peer-reviewed journal.
The ACTIVE Study
The Advanced Cognitive Training for Independent and Vital Elderly, or ACTIVE, study divided 2,785 participants with an average age of almost 74 into three intervention groups and one control group. The intervention groups received, respectively, classroom-based memory strategies, classroom-based reasoning strategies and computerized speed-of-processing training in the form of a game by Posit Science, a for-profit company that offers subscriptions to its "brain training exercises" for a monthly fee.
Ten years later, the people in the speed-of-processing training experienced reduced cognitive decline; the other two interventions showed a statistically insignificant impact and a control group that received no training received no benefit.
A release from the Alzheimer's Association described the game/training that the study participants received:
The user identifies an object (i.e., a truck) at the center of his/her gaze while at the same time identifying a target in the periphery (i.e., a car). As the user gets the answers correct, the speed of presentation becomes progressively briefer, while the targets become more similar. In the more difficult training tasks, the target in the periphery is obscured by distracting objects
Participants only played the Posit game for an hour, in 10 sessions over five weeks. Yet 10 years later, just 73 out of 698 people who received the training developed dementia or exhibited cognitive decline, compared with 97 out of 695 in the control group.
That's a 33 percent reduction in risk for the intervention group. Furthermore, subjects who received an additional four sessions one year after the original training and four more sessions about three years after showed a whopping 48 percent reduction in risk for the same conditions.
The ACTIVE study, which is being run by scientists from multiple institutions, had previously found people who took the Posit training reported the same or greater ability to perform the so-called instrumental activities of daily living, like doing laundry and managing medication, compared to a control group.
The ACTIVE experiments have been ongoing and are well-respected. Dr. Murali Doraiswamy, of the Duke Institute for Brain Sciences, calls it "the best trial in the field." The New Yorker reports that more than 50 peer-reviewed scientific papers have come out of it, and the study is funded in part by the National Institute on Aging.
'Sufficiently Strong Evidence'
The chief science officer for the Alzheimer’s Association, Maria C. Carrillo, cautiously backed the results, saying the organization "believes there is sufficiently strong evidence to conclude that lifelong learning and certain types of cognitive training may reduce the risk of cognitive decline. These new 10-year finds are evidence that it may hold true for dementia as well as cognitive decline."
Some cognitive scientists were impressed with the results.
“That’s a spectacular finding,” Susanne Jaeggi, the director of the Working Memory and Plasticity Laboratory at the University of California, Irvine, and a signatory of the 2014 statement slamming brain training companies, told The New Yorker. "We didn’t have any evidence that computerized training had any preventive effects on dementia. You could argue that this study provides evidence that it is possible."
Dr. Ronald Petersen, director of the Mayo Clinic Alzheimer's Disease Research Center told Reuters, "At first blush, that's kind of a big deal. This may even be clinically relevant."
Dr. Doraiswamy, from Duke, said that until the results are replicated, no conclusion can be reached. "I remain optimistic but do not consider it to be definitive. I also want to see an independent body like the FDA vet it since they will have access to all the data whereas we are just seeing what is being presented."
So Little Yields So Much?
Other researchers expressed a sense of wonder that just 10 hours of cognitive training could result in such a big benefit.
"It’s hard to understand how such a brief intervention could have a long-lasting impact,” Dr. Howard Fillit, executive director of the Alzheimer’s Drug Discovery Foundation, which supports pharmaceutical research on the disease, told STAT. "But you have to respect the data.”
Jaeggi, the expert interviewed by The New Yorker, said: “If you stop doing it after 10 or even 14 sessions, how on earth can you continue to have these effects 10 years later?”
A potential answer, from STAT:
One possibility is a bootstrapping effect. Maybe people who received speed-of-processing training “did something different over the years,” said Laurie Ryan, who oversees Alzheimer’s research at the National Institute on Aging. “Maybe they changed their lifestyle in some way,” with the training giving them a little cognitive boost that they parlayed into more reading, more travel, more social engagement, and more of other activities that boost “cognitive reserve,” the brain’s cushion against dementia.
In fact, some ACTIVE participants told scientists that the cognitive boost they felt from the training inspired them to enroll in classes at a local college or keep driving, said Rebok, both of which can keep people socially and intellectually engaged.
In any event, Dr. Michael Merzenich, a co-founder and chief scientific officer of Posit Science, did not think there was any mystery to it. "We’re not a bit surprised that this simple thing was protective," he told me over the phone. He said speed-of-processing functioned as a sort of "master switch" for the brain.
"It’s a very straightforward result," he said. "It’s hard to deny the truth of it."