People who play video games improve with practice, but does the improvement translate into real-life cognitive benefits?
Adam Gazzaley, MD, PhD, and colleagues at the University of California, San Francisco (UCSF), reported there were improvements in attention, working memory, cognitive control, and multitasking in 16 older adults ages 60-85 who played a simulated driving game called NeuroRacer for a total of 12 hours over four weeks. The game involves using a joystick to guide a car on the computer screen along a winding road while responding to a variety of road signs — some of which require action, and others that don't. The resulting mental “cost” of this type of multitasking increases with age, causing performance to decline. The findings were published Sept. 5 in Nature.
“We were able to show they got better at multitasking on the game itself in an impressive way — even better than untrained 20-year-olds,” said Dr. Gazzaley, associate professor of neurology, physiology and psychiatry, and director of the Neuroscience Imaging Center UCSF. “But even more importantly, they also got better at a working memory task, and a sustained attention task. When you train certain fundamental cognitive abilities you see transfer to fields that were not specifically trained, and we're starting to pull out some of the neural correlates of this plasticity.”
Electroencephalography readings suggest that those correlates involve increased theta wave activity in the medial prefrontal cortex, a brain region involved in working memory, sustained attention, and task switching. The researchers noted a burst of activity in that region within a third of a second after a road sign appeared on the screen, requiring action on the part of the player.
“That activity was deficient in older adults before training, but after training it reached or exceeded young adult levels,” said Dr. Gazzaley. “The brain must possess some core cognitive control mechanism with network properties that overlap across different tasks.”
The researchers suspect that an increase in theta activity in the medial prefrontal area reflects suppression of the default network, which activates when the brain is not engaged in a specific task. When people master a skill such as driving in the real world they tend to go on “automatic pilot,” which allows the mind to wander while performing the task. NeuroRacer prevents this by becoming more difficult as the player's proficiency increases, thereby discouraging activity of the default network.
The failure to suppress the default network, associated with daydreaming and mind wandering, could result in distraction and a failure to attend fully to cognitive tasks, the researchers suspect. “NeuroRacer training may benefit cognitive control abilities by improving the ability of older adults to suppress the default network during task engagement, a process known to be compromised in ageing,” they wrote.
Dr. Gazzaley and his colleagues began their research by evaluating the multitasking ability of 174 participants ranging in age from 20 to 79, who played a version of NeuroRacer that required them to respond to signs while using a joystick to “drive” a car moving down a road on a computer screen. As expected, the ability of the players to multitask decreased in a linear fashion according to age, with the largest drop occurring between players in their 20s and in their 30s.
In a second experiment, the researchers randomly assigned 46 older adults to one of three groups. One group played a version of NeuroRacer that required multitasking. Another group played a version that involved responding to road signs or driving, but not both at the same time. A third group did not play the game. Members of the first two groups played NeuroRacer at home on a laptop one hour a day, three days a week, for four weeks. Assessment showed that the multitasking ability of members in the first group improved dramatically, with the mental “cost” of multitasking dropping from -64.2 percent to -16.2 percent. Even without “booster sessions,” the cost had risen only to -21.9 percent after six months. The improvement among the older players left them more efficient at multitasking than 20-year-olds, whose mental cost was measured at 36.7 percent during their first session playing NeuroRacer.
Finally, the researchers determined through electroencephalography readings that the amount of theta activity in the medial prefrontal cortex, which increased most among those who played the most demanding version of NeuroRacer, correlated with performance improvements on the Test of Variables of Attention (TOVA), indicating general improvements in sustained attention and working memory. This suggests “a common, underlying mechanism of cognitive control was challenged and enhanced” by playing the multitasking version of NeuroRacer, the researchers stated. If that's true, then a game like NeuroRacer might exploit neuroplasticity to produce improvements in attention-deficit disorder, autism, and other conditions, according to Dr. Gazzaley.
The improvements in multitasking performance on the game detected in the older players persisted for six months, arousing interest in NeuroRacer as a means of slowing cognitive decline, but there are no plans to commercialize the game.
“I've been asked to get this game out there commercially right now, but that's not our plan,” said Dr. Gazzaley, a co-founder of a Akili Interactive Labs, a Boston company developing a similar game called “Project Evo,” which is entering clinical trials to test its ability to improve depression, attention deficit, and some forms of autism — disorders believed to be exacerbated by a decline in cognitive abilities.
“We're studying children playing this game, both healthy children and those with autism and attention-deficit hyperactivity disorder. It will require careful validation to determine if there are effects, but they certainly have problems with interference and cognitive control.”
Kirk R. Daffner, MD, lead author of a recent paper in Brain Research on age-related differences in selective attention, found the Nature paper intriguing.
“I think this was a carefully designed, thoughtful study,” said Dr. Daffner, chief of the Division of Cognitive and Behavioral Neurology at Brigham and Women's Hospital, and J. David and Virginia Wimberly professor of neurology at Harvard Medical School. “Some of the results are consistent with a growing literature in cognitive aging suggesting that mental and physical stimulation and activity are beneficial across the lifespan. This study is part of a line of inquiry that says that older individuals should take seriously the potential benefit of keeping their minds very active and engaged.”
While it seems plausible to him that improvements in playing NeuroRacer would also improve other cognitive abilities, he would like to see more evidence. “The fact that it's logical and intuitive doesn't mean it's true,” he said. “To what extent do these kinds of interventions improve day-to-day cognitive functioning, and decrease the likelihood of cognitive decline and dementia? These remain important open questions for this whole area of research.”
Daphne Bavelier, PhD, lead author of a 2010 paper in Current Biology that found that playing video games produced improvements in the ability to predict events, considers the evidence of generalized cognitive improvement provided by Dr. Gazzaley and his colleagues to be persuasive.
“Well-designed studies always have two groups — one that does the experimental intervention, and one that does not,” said Dr. Bavelier, a research professor at the Brain and Cognitive Sciences department at the University of Rochester, NY, and a member of the faculty at the Université of Geneva, Switzerland. “Everyone is pre- and post-tested in the same way. In their study, participants in the older adult study were divided into two groups — one that trained on the NeuroRacer game, and one that trained on an altered version of the game where the dual-tasking was decoupled. It is critical to always compare across two equally active groups.”
Barry Gordon, MD, PhD, editor-in-chief of the journal, Cognitive and Behavioral Neurology, said the Nature paper was “excellently planned and executed.”
Dr. Gordon, therapeutic cognitive neuroscience professor at the Johns Hopkins Medical Institutions, was impressed by the size of the effects produced by playing NeuroRacer.
“That's impressive in and of itself,” he said. “Obviously what's necessary is replication and extension to see if results hold up, and can be teased apart.”
TUNE IN: Will playing a video game improve cognition in normal older adults? In some ways, yes, according to Adam Gazzaley, MD, PhD, and colleagues at the University of California, San Francisco. They reported in a Sept. 5 paper in Nature there were improvements in attention, working memory, cognitive control, and multitasking in 16 older adults ages 60-85 who played a simulated driving game called NeuroRacer for a total of 12 hours over four weeks. In this video, Dr. Gazzaley and a coauthor Joaquin Anguera, PhD, describe their findings as study participants play the game using a joystick to guide a car on the computer screen along a winding road while responding to a variety of road signs. Watch the video here: http://bit.ly/aNQ4KB.
LINK UP FOR MORE INFORMATION:
•. Anguera JA, Boccanfuso J, Rintoul JL, et al. Video game training enhances cognitive control in older adults. Nature
•. Haring AE, Zhuravleva TY, Alperin B, et al. Age-related differences in enhancement and suppression of neural activity underlying selective attention in matched young and old adults. Brain Research
•. Green CS, Pouget A, Bavelier D. Improved probabilistic inference as a general learning mechanism with action video games. Current Biol 2010;20(17):1573–1579.© 2013 American Academy of Neurology
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