Enhancing Cognitive Functioning in Healthly Older Adults: a Systematic Review of the Clinical Significance of Commercially Available Computerized Cognitive Training in Preventing Cognitive Decline
Successfully assisting older adults to maintain or improve cognitive function, particularly when they are dealing with neurodegenerative disorders such as Alzheimer’s disease (AD), remains a major challenge. Cognitive training may stimulate neuroplasticity thereby increasing cognitive and brain reserve. Commercial brain training programs are computerized, readily-available, easy-to-administer and adaptive but often lack supportive data and their clinical validation literature has not been previously reviewed. Therefore, in this review, we report the characteristics of commercially available brain training programs, critically assess the number and quality of studies evaluating the empirical evidence of these programs for promoting brain health in healthy older adults, and discuss underlying causal mechanisms. We searched PubMed, Google Scholar and each program’s website for relevant studies reporting the effects of computerized cognitive training on cognitively healthy older adults. The evidence for each program was assessed via the number and quality (PEDro score) of studies, including Randomized Control Trials (RCTs). Programs with clinical studies were subsequently classified as possessing Level I, II or III evidence. Out of 18 identified programs, 7 programs were investigated in 26 studies including follow-ups. Two programs were identified as possessing Level I evidence, three programs demonstrated Level II evidence and an additional two programs demonstrated Level III evidence. Overall, studies showed generally high methodological quality (average PEDro score = 7.05). Although caution must be taken regarding any potential bias due to selective reporting, current evidence supports that at least some commercially available computerized brain training products can assist in promoting healthy brain aging.
KeywordsComputerized cognitive training Brain training Cognition Dementia Alzheimer’s disease
TS is supported by the Australian Postgraduate Award from the University of Western Australia, the Research Excellence Award from Edith Cowan University and the Freemasons of Western Australia Education Grant 2010 and 2011. TS and MW reviewed the study abstracts and program relevant websites. All authors reviewed and approved the final manuscript. The McCusker Alzheimer’s Research Foundation Inc. contributed financial and in kind support.
- AccessEconomics (2004). Delaying the onset of Alzheimer’s disease: projections and issues. Google Scholar
- Ball, K. K., Wadley, V. G., & Edwards, J. D. (2002b). Advances in technology used to assess and retrain older drivers. Gerontechnology, 1(4), 251–261.Google Scholar
- Ballesteros, S., Prieto, A., Mayas, J., Toril, P., Pita, C., Ponce de León, L., et al. (2014). Brain training with non-action video games enhances aspects of cognition in older adults: a randomized controlled trial. Frontiers in Aging Neuroscience, 6, 277. doi: 10.3389/fnagi.2014.00277.PubMedPubMedCentralCrossRefGoogle Scholar
- Ballesteros, S., Mayas, J., Prieto, A., Toril, P., Pita, C., Laura, P. D. L., et al. (2015a). A randomized controlled trial of brain training with non-action video games in older adults: results of the 3-month follow-up. Frontiers in Aging Neuroscience, 7, 45. doi: 10.3389/fnagi.2015.00045.PubMedPubMedCentralGoogle Scholar
- Bamidis, P. D., Fissler, P., Papageorgiou, S. G., Zilidou, V., Konstantinidis, E. I., Billis, A. S., et al. (2015). Gains in cognition through combined cognitive and physical training: the role of training dosage and severity of neurocognitive disorder. Frontiers in Aging Neuroscience, 7, 152.PubMedPubMedCentralCrossRefGoogle Scholar
- Barnes, D. E., Yaffe, K., Belfor, N., Jagust, W. J., DeCarli, C., Reed, B. R., et al. (2009). Computer-based cognitive training for mild cognitive impairment: results from a pilot randomized, controlled trial. Alzheimer Disease and Associated Disorders, 23(3), 205–210. doi: 10.1097/WAD.0b013e31819c6137.PubMedPubMedCentralCrossRefGoogle Scholar
- Brainage.com official site - brain age: concentration training for Nintendo 3DS. http://brainage.nintendo.com/. Accessed 16 Sept 2015.
- Brainhq.com. http://www.brainhq.com/#. Accessed 15 Sept 2015.
- Cameirão, M. S., Badia, S. B. I., Oller, E. D., & Verschure, P. F. M. J. (2010). Neurorehabilitation using the virtual reality based Rehabilitation Gaming System: methodology, design, psychometrics, usability and validation. Journal of NeuroEngineering and Rehabilitation, 7, 48. doi: 10.1186/1743-0003-7-48.PubMedPubMedCentralCrossRefGoogle Scholar
- Cogmed.com cogmed working memory training. http://www.cogmed.com/. Accessed 17 Sept 2015.
- Cohen, J. (1988). Statistical power analysis for the behavioral sciences. New York: Academic.Google Scholar
- Dakim.com Dakim brainfitness. https://www.dakim.com/. Accessed 17 Sept 2015.
- Edwards, J. D., Valdés, E. G., Peronto, C., Castora-Binkley, M., Alwerdt, J., Andel, R., et al. (2013). The efficacy of InSight cognitive training to improve useful field of view performance: A brief report. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 70(3), 417–422. doi: 10.1093/geronb/gbt113.CrossRefGoogle Scholar
- Fernandez, A. (2010). Transforming brain health with digital tools to assess, enhance and treat cognition across the lifespan: the state of the brain health market. <http://www.sharpbrains.com/executive-summary/>. Accessed 9 Feb 2011.
- Frantzidis, C. A., Ladas, A.-K. I., Vivas, A. B., Tsolaki, M., & Bamidis, P. D. (2014). Cognitive and physical training for the elderly: Evaluating outcome efficacy by means of neurophysiological synchronization. International Journal of Psychophysiology, 93(1), 1–11. doi: 10.1016/j.ijpsycho.2014.01.007.PubMedCrossRefGoogle Scholar
- Galante, E., Venturini, G., & Fiaccadori, C. (2007). Computer-based cognitive intervention for dementia: Preliminary results of a randomized clinical trial. The Italian Journal of Occupational Medicine and Ergonomics, 29(3 suppl B), B26–B32.Google Scholar
- Geyer, J., Insel, P., Farzin, F., Sternberg, D., Hardy, J. L., Scanlon, M., et al. (2015). Evidence for age-associated cognitive decline from internet game scores. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 1(2), 260–267.Google Scholar
- Hardy, J., & Scanlon, M. (2009). The science behind lumosity. Google Scholar
- Lumosity.com brain games & brain training - lumosity. http://www.lumosity.com/. Accessed 17 Sept 2015.
- Mahncke, H. W., Connor, B. B., Appelman, J., Ahsanuddin, O. N., Hardy, J. L., Wood, R. A., et al. (2006). Memory enhancement in healthy older adults using a brain plasticity-based training program: A randomized, controlled study. Proceedings of the National Academy of Sciences, 103(33), 12523–12528.CrossRefGoogle Scholar
- Merzenich, M. M. & Jenkins, W. M. (1993). Cortical representation of learned behaviors. In P. Andersen (Ed.), Memory Concepts (pp. 437-453). Amsterdam: Elsevier.Google Scholar
- Merzenich, M. M. & Jenkins, W. M. (1999). In S. Levy-Reiner (Ed.), The adaptable brain (Vol. II, pp 37-50). Washington, DC: Library of Congress. Google Scholar
- Mybraintrainer.com brain exercises, brain age test and cognitive exercises by MyBrainTrainer. http://www.mybraintrainer.com/. Accessed 17 Sept 2015.
- Ngandu, T., Lehtisalo, J., Solomon, A., Levälahti, E., Ahtiluoto, S., Antikainen, R., et al. (2015). A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): A randomised controlled trial. The Lancet, 385(9984), 2255–2263.CrossRefGoogle Scholar
- Pascual-Leone, A., Amedi, A., Fregni, F., & Merabet, L. B. (2005). The plastic human brain cortex. Neuroscience, 28(1), 377–401.Google Scholar
- Peretz, C., Korczyn, A. D., Shatil, E., Aharonson, V., Birnboim, S., & Giladi, N. (2011). Computer-based, personalized cognitive training versus classical computer games: A randomized double-blind prospective trial of cognitive stimulation. Neuroepidemiology, 36(2), 91–99.PubMedCrossRefGoogle Scholar
- Rebok, G. W., Ball, K., Guey, L. T., Jones, R. N., Kim, H. Y., King, J. W., et al. (2014). Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults. Journal of the American Geriatrics Society, 62(1), 16–24.PubMedPubMedCentralCrossRefGoogle Scholar
- Rosen, A. C., Sugiura, L., Kramer, J. H., Whitfield-Gabrieli, S., & Gabrieli, J. D. (2011). Cognitive training changes hippocampal function in mild cognitive impairment: A pilot study. Journal of Alzheimer’s Disease, 3, 349–357.Google Scholar
- Ruthirakuhan, M., Luedke, A. C., Tam, A., Goel, A., Kurji, A., & Garcia, A. (2012). Use of physical and intellectual activities and socialization in the management of cognitive decline of aging and in dementia: A review. Journal of Aging Research, 2012, 384875. doi: 10.1155/2012/384875.PubMedPubMedCentralCrossRefGoogle Scholar
- Scanlon, M., Drescher, D., & Sarkar, K. (2007). Improvement of visual attention and working memory through a web-based cognitive training program. A Lumos Labs White Paper.Google Scholar
- Shah, T., Verdile, G., Sohrabi, H., Campbell, A., Putland, E., Cheetham, C., et al. (2014). A combination of physical activity and computerized brain training improves verbal memory and increases cerebral glucose metabolism in the elderly. Translational Psychiatry, 4(12), e487.PubMedPubMedCentralCrossRefGoogle Scholar
- Shao, Y.-K., Mang, J., Li, P.-L., Wang, J., Deng, T., & Xu, Z.-X. (2015). Computer-based cognitive programs for improvement of memory, processing speed and executive function during age-related cognitive decline: a meta-analysis. PloS One, 10(6), e0130831.Google Scholar
- Shatil, E. (2013). Does combined cognitive training and physical activity training enhance cognitive abilities more than either alone? a four-condition randomized controlled trial among healthy older adults. Frontiers in Aging Neuroscience, 5, 8. doi: 10.3389/fnagi.2013.00008.PubMedPubMedCentralCrossRefGoogle Scholar
- Smith, G. E., Housen, P., Yaffe, K., Ruff, R., Kennison, R. F., Mahncke, H. W., et al. (2009). A cognitive training program based on principles of brain plasticity: Results from the improvement in memory with plasticity-based adaptive cognitive training (IMPACT) study. Journal of the American Geriatrics Society, 57(4), 594–603.PubMedPubMedCentralCrossRefGoogle Scholar
- Strenziok, M., Parasuraman, R., Clarke, E., Cisler, D. S., Thompson, J. C., & Greenwood, P. M. (2014). Neurocognitive enhancement in older adults: Comparison of three cognitive training tasks to test a hypothesis of training transfer in brain connectivity. NeuroImage, 85, 1027–1039. doi: 10.1016/j.neuroimage.2013.07.069.PubMedCrossRefGoogle Scholar
- Tárraga, L., Boada, M., Modinos, G., Espinosa, A., Diego, S., Morera, A., et al. (2006). A randomised pilot study to assess the efficacy of an interactive, multimedia tool of cognitive stimulation in Alzheimer’s disease. Journal of Neurology, Neurosurgery & Psychiatry, 77(10), 1116–1121.CrossRefGoogle Scholar
- Walser, R. F., Meserve, B. B., & Boucher, T. R. (2009). The effectiveness of thoracic spine manipulation for the management of musculoskeletal conditions: A systematic review and meta-analysis of randomized clinical trials. The Journal of Manual & Manipulative Therapy, 17(4), 237–246. doi: 10.1179/106698109791352085.CrossRefGoogle Scholar
- Willis, S. L. (1987). Cognitive training and everyday competence. Annual Review of Gerontology & Geriatrics, 7, 159–188.Google Scholar
- Wolinsky, F. D., Unverzagt, F. W., Smith, D. M., Jones, R., Stoddard, A., & Tennstedt, S. L. (2006a). The ACTIVE cognitive training trial and health-related quality of life: protection that lasts for 5 years. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 61(12), 1324–1329.CrossRefGoogle Scholar
- Wolinsky, F. D., Vander Weg, M. W., Howren, M. B., Jones, M. P., & Dotson, M. M. (2013). A randomized controlled trial of cognitive training using a visual speed of processing intervention in middle aged and older adults. PloS One, 8, (5), e61624. doi: 10.1371/journal.pone.0061624.
- Woods, S. P., Weinborn, M., Velnoweth, A., Rooney, A., & Bucks, R. S. (2012). Memory for intentions is uniquely associated with instrumental activities of daily living in healthy older adults. Journal of the International Neuropsychological Society, 18(1), 134–138. doi: 10.1017/S1355617711001263.PubMedCrossRefGoogle Scholar
- Woodward, M., & Brodaty, H. (2007). Dementia risk reduction: the evidence: Alzheimer’s Australia. Google Scholar