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At last, a gold-standard study on brain training

Use it or lose itwww.shutterstock.com

The headlines

The Telegraph: Alzheimer’s disease: Online brain training “improves daily lives of over-60s”

Daily Mail: The quiz that makes over-60s better cooks: Computer brain games ‘stave off mental decline’

Yorkshire Post: Brain training study is “truly significant”

The story

A new trial shows the benefits of online “brain training” exercises including improvements in everyday tasks, such as shopping, cooking and managing home finances.

What they actually did

A team led by Clive Ballard of King’s College London recruited people to a trial of online “brain training” exercises. Nearly 7,000 people over the age of 50 took part, and they were randomly assigned to one of three groups. One group did reasoning and problem solving tasks. A second group practised cognitive skills tasks, such as memory and attention training, and a third control group did a task which involved looking for information on the internet.

After six months, the reasoning and cognitive skills groups showed benefits compared with the control group. The main measure of the study was participants’ own reports of their ability to cope with daily activities. This was measured using something called the instrumental activities of daily living scale. (To give an example, you get a point if you are able to prepare your meals without assistance, and no points if you need help). The participants also showed benefits in short-term memory, judgements of grammatical accuracy and ability to learn new words.

Many of these benefits looked as if they accrued after just three months of regular practice, completing an average of five sessions a week. The benefits also seemed to affect those who went into the trial with the lowest performance, suggesting that such exercises may benefit those who are at risk of mild cognitive impairment (a precursor to dementia).

How plausible is this?

This is gold-standard research. The study was designed to the highest standards, as would be required if you were testing a new drug: a double-blind randomised control trial in which participants were assigned at random to the different treatment groups, and weren’t told which group they were in (nor what the researcher’s theory was). Large numbers of people took part, meaning that the study had a reasonable chance of detecting an effect of the treatment if it was there. The study design was also pre-registered on a database of clinical trials, meaning that the results couldn’t be buried if they turned out to be different from what the researchers (or funders) wanted, and the researchers declared in advance what their analysis would focus on.

So, overall, this is serious evidence that cognitive training exercises may bring some benefits, not just on similar cognitive tasks, but also on the everyday activities that are important for independent living among the older population.

Tom’s take

This kind of research is what “brain training” needs. Too many people – including those who just want to make some money – have leapt on the idea without the evidence that these kind of tasks can benefit anything other than performance on similar tasks. Because the evidence for broad benefits of cognitive training exercises is sparse, this study makes an important contribution to the supporters’ camp, although it far from settles the matter.

Why might you still be sceptical? Well there are some potential flaws in this study. It is useful to speculate on the effect these flaws might have had, even if only as an exercise to draw out the general lessons for interpreting this kind of research.

First up is the choice of control task. The benefits of the exercises tested in this research are only relative benefits compared with the scores of those who carried out the control task. If a different control task had been chosen maybe the benefits wouldn’t look so large. For example, we know that physical exercise has long-term and profound benefits for cognitive function. If the control group had been going for a brisk walk everyday, maybe the relative benefits of these computerised exercises would have vanished.

Or just go for a walk.www.shutterstock.com

Another possible distortion of the figures could have arisen as a result of people dropping out during the course of the trial. If people who were likely to score well were more likely to drop out of the control group (perhaps because it wasn’t challenging enough), then this would leave poor performers in the control group and so artificially inflate the relative benefits of being in the cognitive exercises group. More people did drop out of the control group, but it isn’t clear from reading the paper if the researchers’ analysis took steps to account for the effect this might have had on the results.

And finally, the really impressive result from this study is the benefit for the activities of daily living scale (the benefit for other cognitive abilities perhaps isn’t too surprising). This suggests a broad benefit of the cognitive exercises, something which other studies have had difficulty showing. However, it is important to note that this outcome was based on a self-report by the participants. There wasn’t any independent or objective verification, meaning that something as simple as people feeling more confident about themselves after having competed the study could skew the results.

None of these three possible flaws mean we should ignore this result, but questions like these mean that we will need follow up research before we can be certain that cognitive training brings benefits on mental function in older adults.

For now, the implications of the current state of brain training research are:

Don’t pay money for any “brain training” programme. There isn’t any evidence that commercially available exercises have any benefit over the kinds of tasks and problems you can access for free.

Do exercise. Your brain is a machine that runs on blood, and it is never too late to improve the blood supply to the brain through increased physical activity. How long have you been on the computer? Could it be time for a brisk walk round the garden or to the shops? (Younger people, take note, exercise in youth benefits mental function in older age)

A key feature of this study was that the exercises in the treatment group got progressively more difficult as the participants practised. The real benefit may not be from these exercises as such, but from continually facing new mental challenges. So, whatever your hobbies, perhaps – just perhaps – make sure you are learning something new as well as enjoying whatever you already know.

Read more

The original study: The Effect of an Online Cognitive Training Package in Healthy Older Adults: An Online Randomized Controlled Trial

Oliver Burkeman writes: http://www.theguardian.com/science/2014/jan/04/can-i-increase-my-brain-power

The New Yorker (2013): http://www.newyorker.com/tech/elements/brain-games-are-bogus

The Conversation

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