Your brain is plastic.
I’m not talking about the kind of plastic we use for water bottles. What I mean, is that your brain embodies the quality of neuroplasticity, or the ability for brain areas to change in response to new life experiences. This attribute of brain plasticity explains how we can learn new things, how patients who lose their sight report increased sensitivity of another sensory system, and how the brain compensates for damage after a stroke. Becoming mindful and aware of how you think, and how your mind works are the first steps in increasing your neuroplasticity.
Cognitive training suggests that the neuroplasticity of our brains can not only be directed but also specified, in order to improve a discrete domain of everyday cognitive (thinking) function. This type of training has broader implications for the non-pharmacological care of patients who want to prevent or delay dementia, and for those who are already experiencing cognitive decline. As you may know, there are no pharmacologic treatments that have an appreciable benefit for people with dementia.
Does brain training work?
You may have read about brain training apps, like Lumosity, receiving criticism for alleging that their app has a protective effect against memory decline and even neurodegeneration. These claims for their specific app were too broad, and have not been demonstrated in randomized controlled clinical trials, nor in post hoc analyses of observed claims.
While Lumosity’s claims were debunked, it does not change the fact that cognitive training and brain training show promise in studies that look at improvements in mental ability as a direct result of specialized training.
For example, another online brain training program, Brain HQ, has been tested in clinical settings and showed significant benefits in memory and cognition; Brain HQ’s tasks are notably separated by cognitive domain -- a set of tasks for memory, a set of tasks for attention, and so on -- and are able to be tracked by the system, so training is always updated and progressing. This feature has been useful for clinicians, psychologists, and researchers studying the role of systematic brain training on cognitive improvement.
So yes, brain training does work, and the way it has been tested is part of how we know it works.
What does it train, specifically?
A common issue that divides the cognitive training field is how effective either single-component or multi-component training are at improving singular cognitive abilities, or even their potential for increasing function in untrained cognitive domains. Another notable controversy in the literature is whether those improvements generalize to everyday activities of daily living.
For example, there are tasks that improve social functioning in youth, tasks that improve verbal learning in schizophrenia patients, and even tasks that act on working memory and attention in typically developing adults.
Things like remembering where you parked your car, remembering where you put your car keys, and even changing your perspective on social situations, are all potential applications for cognitive training.
It helps to break it down like this:
Single-component: A task that trains one specific cognitive ability like memory, attention, processing, etc.
Multi-component: A task that trains multiple cognitive domains either simultaneously, or sequentially.
Near transfer: Abilities that the training is designed to directly induce change. Ex: an N-back task that causes a significant increase in working memory ability.
Far transfer: Abilities that training was not designed to directly influence, but has still somehow caused changes. Ex: someone engaging in a working memory task then demonstrating improvement in processing speed and life skills.
Multi-component task design has been shown to be more effective than a single-component task design by virtue of its ability to engender both near and far transfer. Both are important for clinical outcomes, which make sense; memory, for instance, declines simultaneously with attention and processing speed in older adult populations. Thus, a perfect task would induce both transfers to the betterment of the patient, but half the battle is understanding which tasks accomplish this, and in which population each task is most effective. Ideally, we engage in the transfer of single learning to things like improving activities of daily living!
Can brain training improve life skills and activities of daily living?
This question is the leading principle behind tasks that have “far transfer” potential; by improving multiple aspects of cognition, the hope is that generalization to life skills will occur. Through improving the building blocks that guide our perception such as memory, processing speed, or attention, we improve the functions that call on the storehouse of cognitive resources. Completing this type of training prior to having cognitive difficulties seems to show promise as well. This was most apparent in the National Institute of Aging-funded Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study completed in 2014, where older adult participants engaged in structured cognitive training and were followed up five and ten years post-study. The participants were all assumed cognitively normal by scores above 23 on the Mini Mental State Exam (MMSE), and their subjective reports of improvements in everyday tasks were tracked extensively.
Thus, the ACTIVE study demonstrated that cognitive training is effective and possibly even protective as it improves specific cognitive skills, such as the speed of processing information in people without dementia. Another noteworthy finding was that the benefits persisted over time and delayed the onset of MCI and its diagnosis.
Does brain training work for MCI and dementia patients?
Researchers for the ACTIVE study did not enroll participants with MCI or dementia specifically, but more recent studies are promising, demonstrating the role of brain training in delaying diagnosis-related cognitive decline in patients with MCI. There is even recent evidence demonstrating that brain training delays expected brain atrophy in amnestic MCI patients.
Some evidence suggests that if you begin training early enough, online brain training might offer some cognitive protection. A subset of ACTIVE study participants demonstrated continued improvement in cognitive abilities even 10 years post-study! Taken together, these results highlight the importance of early, multi-component cognitive training interventions for our most at-risk patients. Preventative measures for these populations are potentially more effective, as is the case for exercise and diet.
The Best Way To Do It!
To truly enhance cognition meaningfully requires a lifestyle-grounded approach that takes into account each patient’s clinical presentation. Getting seen and tested by a neuropsychologist will give patients a sense of their relative cognitive strengths and weaknesses, which is a great place to start. Then, the selection of which cognitive training tools to use, and which domains to focus upon becomes personalized. Make the cognitive fitness have some validity in your life, and practice “brain training” as you navigate your day.
It's always best to consider exercising your brain the same way you think about exercising your body: vary your exercise, create a routine so that you're doing it every day, and make it challenging. Imagine that you're building “brain muscle” as you build your neuronal pathways. Think of it like how you take any kind of medicine; dosing matters. Brain HQ recommends 60-90 minutes a week.
Easy access to computers has made it easy to brain-train online. Many of the online brain training platforms offer free memberships to access their tasks. I encourage readers to try out some of the memory tasks they offer and to track their progress! The training itself serves a good purpose; it gives you immediate feedback about your progress on a particular task and it can be very rewarding to watch your skills increase. The results may surprise you.
While the research in cognitive training and rehabilitation is updating us every day with best practices, the results we have seen so far are tremendously promising. A healthier brain can be trained, but to do so requires regularity, including adding novelty and challenge into the equation, while incorporating learning new things into your everyday mindset.
References:
Basak, C., Qin, S., & O'Connell, M. A. (2020). Differential effects of cognitive training modules in healthy aging and mild cognitive impairment: A comprehensive meta-analysis of randomized controlled trials. Psychology and aging, 35(2), 220–249. https://doi.org/10.1037/pag0000442
Chambon C and Alescio-Lautier B (2019) Improved executive functioning in healthy older adults after multifactorial cognitive training targeting controlled processes. J Syst Integr Neurosci 6: DOI: 10.15761/JSIN.1000218.
Fuchs, E., & Flügge, G. (2014). Adult neuroplasticity: more than 40 years of research. Neural plasticity, 2014, 541870. https://doi.org/10.1155/2014/541870
Hampshire, A., Sandrone, S., & Hellyer, P. J. (2019). A Large-Scale, Cross-Sectional Investigation Into the Efficacy of Brain Training. Frontiers in human neuroscience, 13, 221. https://doi.org/10.3389/fnhum.2019.00221
Harvey, P. D., Balzer, A. M., & Kotwicki, R. J. (2019). Training engagement, baseline cognitive functioning, and cognitive gains with computerized cognitive training: A cross-diagnostic study. Schizophrenia research. Cognition, 19, 100150. https://doi.org/10.1016/j.scog.2019.100150
Husseini, Z., nejati, V., Habibi, M. (2019). The Relationship between Poor Executive Functioning and Social Functioning and the Efficacy of Brain Training on Social Functioning. Journal of Rehabilitation Sciences & Research, 6(2), 95-100. doi: 10.30476/jrsr.2019.81558.1003
Lumosity To Pay $2 Million To Settle Ftc Deceptive Advertising Charges For Its "brain Training" Program
Mendoza Laiz, N., Del Valle Díaz, S., Rioja Collado, N., Gomez-Pilar, J., & Hornero, R. (2018). Potential benefits of a cognitive training program in mild cognitive impairment (MCI). Restorative neurology and neuroscience, 36(2), 207–213. https://doi.org/10.3233/RNN-170754
Voss, P., Thomas, M. E., Guercio, G. D., & Villers-Sidani, E. D. (2019). Dysregulation of auditory neuroplasticity in schizophrenia. Schizophrenia Research, 207, 3–11. doi: 10.1016/j.schres.2018.04.025
Zhang HF, Wang ZJ, Wang J et al (2019) Computerized multi-domain cognitive training reduces brain atrophy in patients with amnestic mild cognitive impairment. Transl Psychiatry 9:48