Brain Training Games - Who's winning? or Another Open Letter on Brain Training Games

theconversation.com

In October, an opening salvo by 70 scientists took aim, in the form of an open letter (Stanford Center on Longevity) on a $1.3 billion dollar business. In the letter they question the claims of brain training games as a "magic bullet" in the fight against cognitive decline. This week, Michael Merzenich (who is the founder of BrainHQ) rounded up the troops and responded along with 126 scientists in their own open letter (Cognitive Training Data) addressing the questions and criticisms of the original open letter.

The original letter concluded with 5 recommendations for how we should move forward regarding brain health, aging and cognitive training:

1. Much more research needs to be done before we understand whether and what types of challenges and engagements benefit cognitive functioning in everyday life. In the absence of clear evidence, the recommendation of the group, based largely on correlational findings, is that individuals lead physically active, intellectually challenging, and socially engaged lives, in ways that work for them. Before investing time and money on brain games, consider what economists call opportunity costs: If an hour spent doing solo software drills is an hour not spent hiking, learning Italian, making a new recipe, or playing with your grandchildren, it may not be worth it. But if it replaces time spent in a sedentary state, like watching television, the choice may make more sense for you.
2. Physical exercise is a moderately effective way to improve general health, including brain fitness. Scientists have found that regular aerobic exercise increases blood flow to the brain, and helps to support formation of new neural and vascular connections. Physical exercise has been shown to improve attention, reasoning, and components of memory. All said, one can expect small but noticeable gains in cognitive performance, or attenuation of loss, from taking up aerobic exercise training.
3. A single study, conducted by researchers with financial interests in the product, or one quote from a scientist advocating the product, is not enough to assume that a game has been rigorously examined. Findings need to be replicated at multiple sites, based on studies conducted by independent researchers who are funded by independent sources. Moreover, participants of training programs should show evidence of significant advantage over a comparison group that does not receive the treatment but is otherwise treated exactly the same as the trained group.
4. No studies have demonstrated that playing brain games cures or prevents Alzheimer’s disease or other forms of dementia.
5. Do not expect that cognitively challenging activities will work like one-shot treatments or vaccines; there is little evidence that you can do something once (or even for a concentrated period) and be inoculated against the effects of aging in an enduring way. In all likelihood, gains won’t last long after you stop the challenge.

Or as the Cognitive Training Data response letter summarizes:

1. More research needs to be done.
2. Physical exercise is good for physical health and brain health.
3. A single study generally is not conclusive and needs to be integrated into a larger body of evidence.
4. No study, to date, has demonstrated that brain training cures or prevents Alzheimer’s disease.
5. Cognitively challenging activities have not been shown to work like one-shot treatments or vaccines.

After agreeing with many points from the original letter, the response letter finely gets down to brass tacks (emphasis my own):

"We cannot agree with the part of your statement that says 'there is no compelling scientific evidence' that brain exercises 'offer consumers a scientifically grounded avenue to reduce or reverse cognitive decline'.” 

They go on to offer their own talking points:

1. The training basis of the literature that shows that brain plasticity exists throughout the brain and throughout life
2. The many demonstrations of the effectiveness of well-designed plasticity-based training regimens 
3. The specific findings of efficacy in the area of aging, your statement derogates the time, effort, and expertise of the thousands of scientists and clinicians engaged in designing, conducting, analyzing, publishing, and reviewing the research. It also diminishes the contribution of thousands of volunteer research participants who gave their time and effort to these studies, and the time, effort, and expertise of the grant-makers who awarded the funding for most of these studies through the National Institutes of Health, other government agencies, and foundations. In addition, it short-changes the taxpayers who funded this well-conducted research.

Reading through these talking points, the one that stands out to me is number 3, wow does it pull at your heartstrings! They call out the SCL and say that their claims are hurtful, not just to the scientists making the claims that brain games work for consumers, but that they are hurting the participants, the NIH, and the taxpayers funding all of that amazing research. But lets go back to the quote that the brain training scientists were most upset about, the one questioning whether consumers actually benefit from brain training. I don't think the SCL scientists in the original letter are arguing that our brains aren't plastic and that dedicating minutes or hours a day in an engaged activity won't change (whether for the better or worse) our cognitive functioning. I think the crux of their argument is whether it is worth consumers time and money to play these games and gain skills that are both relevant to the real-world and long lasting. The point that the SCL researchers (here is as good a place as any to mention that of the 197 scientists signing the two letters, 8 have conflicts of interest, 1 of 70 in the first letter and 8 of 127 in the response) are making is that consumers may not care to improve at statistically significant levels in their performance on the game itself or on related laboratory tests of neurocognitive functioning, they want to stop forgetting their keys and leaving the stove on.

I keep highlighting the word consumer because these games cost money and as I said above they are part of a growing $1.3 billion business. So as others have suggested, its not whether the games, "work" or not, its whether a consumer could just be more physically active, get more sleep and try to be less stressed and see the same or greater improvements in cognition without spending hundreds of dollars a year. In attempting to look up the cost of a few games, it was almost impossible to find the information on their websites. 

  

BrainHQ - $6/month annually (on sale from $8)
Cogmed - $500 (on sale from $1500) - this is a program sold to clinicians who can then administer to clients
Lumnosity - $6.95/month annually
Memorado - ~$5.40/month annually
Fit brains - $9.99/ year

So the point of these two letters aren't whether playing a brain game "helps" you or not, its whether the investment of time and money in brain games is significantly better than say keeping a physically and socially active lifestyle. Perhaps the best piece of advice comes from Art Kramer who once responded to my question of his advice for warding off cognitive decline in aging as, "join a book club that walks and drinks wine during the meeting."