ARTICLE IN BRIEF
In response to claims from high-profile athletes about the benefits of computerized brain training games, cognitive neurologists offer advice on how to separate the hype from the hope for patients.
In the days leading up to this year's Super Bowl, both New England Patriots quarterback Tom Brady and rival Falcons quarterback Matt Ryan said in interviews that they do “brain training” programs to help improve their play on the field. And they are not alone. The quarterbacks are among a growing number of athletes and non-athletes alike who report they are using computerized cognitive training programs with the hopes of boosting attention, processing speed, memory and other cognitive skills. And that is sure to get the attention of patients and prospective patients, experts told Neurology Today.
But these same experts said there is little evidence that brain training programs lead to better mental function in everyday life or, as many users hope, prevent cognitive decline. Neurologists and ethicists alike said they were concerned about managing the expectations of their patients who read these reports and come to them with questions about their benefits. Managing expectations is key, they told Neurology Today in interviews.
“Patients and families always want to know, ‘Should I spend my money on a brain training program?’” said David Gill, MD, a neurologist and medical director of the Memory Center at Rochester Regional Health.
Dr. Gill tells them that doing a brain training program, which typically involves paying for an online subscription to access, might make a person more facile at doing such games and tests, but “it is not clear if this type of brain training leads to improvements in daily life; whether they go on to be able to remember the grocery list” is another matter, he tells them.
“I advise people that at this point there is no consistent evidence that a dedicated program is better than doing things on your own to increase your mental, physical and social activity, however, some people may benefit from the structure of one of the organized programs,” Dr. Gill told Neurology Today.
James L. Bernat, MD, FAAN, a medical ethicist and neurologist who holds the Louis and Ruth Frank Professorship in Neuroscience at Geisel School of Medicine at Dartmouth, said he thinks it is important for physicians to help patients sort out what their goals are in using a brain training program. He makes a distinction between training and prevention.
Doing a computerized program aimed at boosting a specific skill, be it athletic or musical or operating machinery, may very well be worthwhile, in the same way that regularly doing crossword puzzles might enrich a person's vocabulary or help with word recall, he said.
“If it really is a form of training, I have no quarrel with that,” said Dr. Bernat, who added that the questionable goal has to do with prevention.
“Many middle-aged and older people want to protect themselves from developing Alzheimer's disease or other forms of dementia and they will do anything they can to prevent it,” Dr. Bernat said. In that regard, patients should be counseled that “there are no robust data” to show that brain training programs are effective, he said.
BRAIN GAME LAWSUITS
Indeed, the dearth of data has led to litigation. Last year, the maker of Lumosity agreed to pay $2 million to settle allegations by the Federal Trade Commission (FTC) that the company had made deceptive advertising claims about its brain games.
In announcing the settlement, Jessica Rich, director of the FTC's Bureau of Consumer Protection, said “Lumosity preyed on consumers' fears about age-related cognitive decline, suggesting their games could stave off memory loss, dementia, and even Alzheimer's.” She said the company “simply did not have the science to back up its ads.”
More unfavorable attention on the industry came last October when a group of researchers published a review of the scientific literature and concluded that “evidence that training with commercial brain-training software can enhance cognition outside the laboratory is limited and inconsistent.”
The scientists said they decided to conduct a comprehensive review after a large group of scientists issued a letter in 2014 that questioned claims made by the brain training industry, only to be followed by a second letter from another large group of scientists that said there was scientific evidence to support such programs. The review included 132 papers related to brain training programs.
“We find extensive evidence that brain-training interventions improve performance on the trained tasks, less evidence that such interventions improve performance on closely related tasks, and little evidence that training enhances performance on distantly related tasks or that training improves everyday cognitive performance,” the reviewers reported in Psychological Science in the Public Interest. They said many of the studies lacked scientific rigor.
A suggestion that there may be a long-term cognitive payoff from brain training programs came from a large government-funded, multisite study known as ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), first published in 2006, with the most recent findings reported in 2014 in the Journal of the American Geriatric Society. The study assigned more than 2,800 older adults to either one of three training programs aimed at memory, processing speed or abstract reasoning or to a non-intervention arm. A 10-year follow-up found that those who received the speed-of-processing training were less likely to have dementia, according to a report presented last year at the Alzheimer's Association annual meeting.
George Rebok, PhD, professor of mental health at Johns Hopkins University Bloomberg School of Public Health who studies cognitive training and was a site principal investigator for ACTIVE, cautioned that the trial was not designed specifically to look at dementia long term but rather on more immediate cognitive and everyday function. But he said the recent findings nonetheless suggest that brain training programs may have a lasting benefit. He said further research is warranted.
“We know that if you practice a test and are given strategies to take the test you are going to do better on the test,” Dr. Rebok said. “The real issue is ‘Does that training translate into anything beyond the training?’”
“We need to do the science,” he said. “There is such as array of different programs out there with many unsubstantiated claims being made.”
David S. Knopman, MD, FAAN, professor of neurology at the Mayo Clinic in Rochester, MN, said he was asked to present the “pro” side of pro-con panel on brain training games at last year's American Academy of Neurology Annual Meeting, though he in fact sees both sides of the argument.
“Staying cognitively active is in general a good thing later in life, but it doesn't have to involve a computer game.” he said. “It's not clear that commercial computerized games offer any advantage in real life.”
On the other hand, “if someone finds it's an enjoyable activity, fine,” he told Neurology Today.
Dr. Knopman said a possible downside is that the time spent on brain training programs will cut into time for other mentally stimulating and socially interactive activities, such as participating in a book club or Bible study or hanging out with grandkids. Spending money on a program that may be ineffective is another factor to consider, he said.
He said ideally the emphasis should be on staying mentally engaged, physically active and socially connected throughout the lifespan, not just as a last-ditch effort when old age approaches and worries about dementia increase.
GET FAMILIAR WITH PROGRAMS
Julie Robillard, PhD, assistant professor of neurology at the University of British Columbia, said clinicians need to do some digging and prepare themselves to have thoughtful discussions when patients inquire about brain games.
“Doctors should be aware of the landscape of products and tools available to patients and encourage them to be critical of claims that seem to be too good to be true and to read the fine print to have a good understanding of what they are getting into when signing up,” said Dr. Robillard, who studies issues at the intersection of health technology and ethics.
Dr. Robillard said that while some people might find brain games to be engaging and entertaining, the very same programs may “lead to false hopes as well as financial loss in the case of paid products.” She said users may also become needlessly worried or anxious if they perform poorly on a game or test.