Brain Training: Is It Really Use It Or Lose It?

According to Yuko Hara, PhD, director of Aging and Alzheimer's Prevention at the Alzheimer's Drug Discovery Foundation "Brain training, while not a scientific term with an established definition, it typically refers to tasks or drills that are designed to strengthen specific aspects of one's cognitive function."

"Cognitive training involves performing a definitive task or set of tasks where you increase attentional demands to improve focus and concentration and memory," said Manuel Montero-Odasso, MD, PhD, director of the Gait and Brain Lab, Parkwood Institute, London, Ontario. "You try to execute the new things that you've learned and to remember them."

"When we try to activate networks mainly in the frontal lobe, the prefrontal cortex, a key mechanism underlying this process is enhancement of the synaptic plasticity at excitatory synapses, which connect neurons into networks; in other words, we generate new synapses, and that's how we enhance brain health and cognitive abilities,” explains Montero-Odasso, who is also a team leader at the Canadian Consortium on Neurodegeneration in Aging and team co-leader at the Ontario Neurodegenerative Research Initiative. "Cognitive training creates an anatomical change in the brain."

"It's now well understood that the brain can rewire itself at any age and in almost any condition," said Henry Mahncke, PhD, CEO of the brain training company Posit Science/BrainHQ. "In kids and in younger and older adults, whether with healthy or unhealthy brains, the fundamental way the brain works is by continually rewiring and rebuilding itself, based on what we ask it to do."

"We can build an adaptive brain and give it exercises to rewire in a healthy direction, improving cognitive abilities like memory, speed, and attention," said Mahncke.

However, the concept of brain training is not without some controversy, and some manufacturers of so-called brain games have been criticized or even fined for making unsubstantiated claims. Some studies have found that brain training does improve performance on specific tasks but has less evidence of improved performance on closely related tasks or improving everyday cognitive performance. 

"The general consensus is that for most brain-training programs, people may get better at specific tasks through practice, but these improvements don't necessarily translate into improvement in other tasks that require other cognitive domains or prevention of dementia or age-related cognitive decline," Hara said noting that most programs "have not been rigorously tested in clinical trials" — although some, such as those featured in the ACTIVE trial, did show evidence of effectiveness.

"Asking whether brain training works is like asking whether small molecules improve health," said Mahncke, noting that some programs are not evidence-based but his company BrainHQ and some others are "backed by robust evidence in their ability to stave off, slow, or even reverse cognitive changes."

Mahncke explains that our brains "get noisy as people get older, like a radio which is wearing out, so there's static in the background. This makes the music hard to hear, and in the case of the human brain, it makes it difficult to pay attention." The exercises are "designed to tamp down the 'noise,' speed up the brain, and make information processing more accurate."

Mahncke said the BrainHQ’s approach is "to improve the overall processing system of the brain with speed, attention, working memory, and executive function, which will in turn impact all skills and activities."

Mahncke cites several supporting studies such as the IMPACT Study and the Active Study which both tested the effects of different cognitive training programs on cognitive function and dementia showing clinically significant improvements in multiple secondary measures of attention and memory.

Montero-Odasso was involved with the SYNERGIC Studyshower greater clinically meaningful improvements in the multidomain intervention larger than seen in previous pharmaceutical trials among those with mild cognitive impairment or mild dementia. 

"We found that older adults with MCI who received aerobic-resistance exercise with sequential computerized cognitive training significantly improved cognition," Montero-Odasso said. "The cognitive training we used was called Neuropeak, a multidomain lifestyle training delivered through a web-based platform developed by our co-leader Louis Bherer at Université de Montréal."

Montero-Odasso said that the purpose "is to challenge your brain to the point where you need to make an effort to remember things, pay attention, and later to execute tasks. The evidence from clinical trials, including ours, shows this type of brain challenge is effective in slowing and even reversing cognitive decline."

However, formal brain training is not the only way to improve brain plasticity, observational studies suggest associations between improved performance and lower dementia risk by engaging in a range of number or word puzzles, cards, board games, crosswords, and Sudoku.

Some studies even suggest that technology might help to preserve cognitive reserve, such as a US longitudinal study finding that those who use the internet had half the risk of dementia compared to those who never used the internet. 

"Engaging in mentally stimulating activities can increase 'cognitive reserve' — meaning, capacity of the brain to resist the effects of age-related changes or disease-related pathology, such that one can maintain cognitive function for longer," Hara said. "Cognitively stimulating activities, regardless of the type, may help delay the onset of cognitive decline."

Activities that are stimulating to the brain such as learning a new language, or learning a new game or puzzle, a new dance, and learning how to play a musical instrument all help to improve cognitive fitness, it is the newness of the activity that is key to increasing and/or preserving cognitive reserve. 

"Just surfing the internet, playing word or board games or doing crossword puzzles won't be enough if you've been doing these things all your life," said Montero-Odasso. "It won't hurt, of course, but it won't necessarily increase your cognitive abilities."

"For example, a person who regularly engages in public speaking may not improve cognition by taking a public-speaking course, but someone who has never spoken before an audience might show cognitive improvements as a result of learning a new skill," said Montero-Odasso. "Or someone who knows several languages already might gain from learning a brand-new language."

According to Montero-Odasso dancing is "an ideal activity because it's physical, so it provides the exercise that's been associated with improved cognition. But it also requires learning new steps and moves, which builds the synapses in the brain. And the socialization of dance classes adds another component that can improve cognition."

"There's no reason that evidence-based training can't be offered in senior and community centers, as yoga and swimming are," said Mahncke. "It doesn't have to be simply something people do on their own virtually." While Zoom classes and Medicare reimbursements are "good steps in the right direction, but it's time to expand this potentially life-transformative intervention so that it reaches the ever-expanding population of seniors in the United States and beyond."