• Does brain training really work? by Dr Jack Lewis

    BBC study slams brain training – but don’t throw your Nintendo DS away just yet…

    Since Dr Kawashima’s Brain Training (UK) / Brain Age (US) game was launched on the Nintendo DS in 2005 a great buzz has been generated by the enticing prospect of sharpening up our mental faculties. Indeed, claims that it can improve memory, make us smarter, sharpen reaction times and improve general brain power have convinced over 3 million of us in the UK alone to buy this game (including me! – I’m in the process of writing a review on it, so watch this space). Then, in 2007, Lumos Labs launched “Lumosity” – a web-based, subscriber-accessed, brain training program with an ever-expanding range of colourful and engaging brain training games. Just one year later Lumos labs managed to attract $3,000,000 in private investment to further develop their cognitive training offerings. Brain training has become a billion dollar global industry.

    In a previous blog I suggested that there is nothing special about each individual brain training game – I argued that the same benefits would be achieved by picking up a puzzle book containing number games, word puzzles and problem solving tasks on a daily basis:

    http://www.drjack.co.uk/brain-teasers-brain-training/

    However what these commercial offerings do provide is a structured training program, consisting of a wide variety of different games and puzzles, the opportunity to measure and keep track of your progress and the convenience that might encourage you to train for long enough and regularly enough to notice some benefits. The only problem is that in the 5 years since these games were launched there has not been a single shred of independent evidence (to my knowledge) that these games actually benefit brain functions useful in everyday life, rather than just the inevitable performance improvements in the games themselves. We already know that practice makes perfect. There have been reports that brain training works – but these studies were invariably linked to the very companies that had a vested interest in such findings.

    Doubts started to be voiced in early 2009, for instance, Which? magazine assembled a panel of experts who concluded that Brain Training on the DS had no “functional impact on life whatsoever”. By the autumn of 2009 the BBC had clocked that is was high time that the concept of Brain Training was put to the test and set the “biggest brain training experiment ever” in motion – an independent clinical trial the results of which would be published in a suitable peer-reviewed journal. They asked distinguished scientists from the University of Cambridge (Dr Adrian Owen, MRC Cambridge Brain Unit) and King’s College London (Professor Clive Ballard, director of research for the Alzheimer’s Society) to design a suitable experiment involving 11,000 participants, which ultimately led to the conclusion that “Brain Training Games Don’t Make Us Smarter”:

    http://www.bbc.co.uk/labuk/results/braintestbritain/1_results_summary.html

    However, lack of proof of a brain training effect is not the same as proving beyond all reasonable doubt that brain training doesn’t work. At the bottom of this piece is a list of 5 reasons why the results of Bang Goes the Theory’s Lab UK study does not necessarily mean that brain training on consoles like the Nintendo DS is ineffective. These are centred around the following facts: they created their own games rather than using commercially-available ones (maybe their games were not as effective?), they required people to train only 3 times per week (maybe it would have worked with a more intense training regime?) and the games involved people sitting at a PC using mouse and keypad to register responses (i.e. they missed out on the technological advances of touch screen and voice recognition in the Nintendo DS). They have certainly demonstrated that the games they created, when played infrequently, across a relatively short period of time, using an outdated user control interface (that slows down the speed at which responses can be made in time-critical games), did not lead to improvements in a separate set of ‘benchmarking’ games that may or may not have been sensitive enough to detect improvements in attention, memory and problem solving skills. However, their failure to detect any improvements whatsoever (in the under 60’s at least) could boil down to any of these factors or more likely a combination of them. I’m not suggesting for a minute that these results are invalid. All I’m saying is that the proverbial jury is out regarding the putative efficacy of brain training – we must wait until more evidence has been gathered before potentially throwing the brain-train-baby out with the bathwater.

    The compromises that they had to make in order to pull off such a large clinical trial are inevitable, but may have hampered their ability to capture any discernible effect. In order to get such large numbers of people to participate they clearly needed to avoid requiring people to give up their time too often and for an unnecessarily protracted period of time; otherwise people would have dropped out of the trial like flies. What led them to create their own games, rather than testing existing ones, may have involved the desire to avoid the potential wrath of powerful multinational companies. Even if they had been brave enough to wish to test the actual games to which the claims were attached the BBC would never have got away with wasting license fee payers money by coughing up the cash to issue each of these volunteers with a Nintendo DS – even if it would mean benefiting from the advances of speed-enhancing touch screen and voice-recognition technologies. Yet until further clinical trials, including some that investigate the potential of brain training in a way that gives it the best possible chance to shine, have confirmed or contradicted the current findings – I myself will not be throwing my DS away just yet.

    If I was Nintendo I would wish to tackle this issue head on. I would ask an independent scientific body to find a suitable group of research scientists who could conduct a fully independent study totally uncorrupted by any conflicts of interest. This group should together combine a thorough understanding of the human brain with specific experience in measuring the cognitive abilities of healthy individuals – perhaps an education specialist, an occupational psychologist and a neuroscientist. They would oversee a further large-scale, independent, clinical trial that implements a more intense training program based on the best brain training game in the Nintendo DS armoury. I would develop a battery of tests that are able to capture improvements in brain function that actually come in useful during everyday life, as opposed to performance improvements in a rather arbitrary batch of computer games.  For instance, if a person’s ability to tot up the cost of a batch of 10 items in a shopping basket improves as a result of intense brain training, they will be better able to spot when a cashier over or under charges them at the till and it would become possible to confidently state that they have benefited from the brain training in a meaningful way. If they are better able to remember a route on a map after training, then they will be less likely to suffer the stress and inconvenience of getting lost. If they are better able to pay attention to and ultimately recall verbal instructions, in an environment containing a cacophony of visual and acoustic distractions, then the benefits from brain training may actually help them in real life. To ensure participants stay with the program to the very end I would incentivise the much more intense training regime with cash rewards e.g. if they successfully completed 1 month of 2×30 minute training sessions per day they would receive a cash bonus, 2 months and they get a double cash bonus plus a further prize and if they complete the full 3 months they would get a quadrupled cash bonus. I would dish out 10,000 Nintendo DS consoles to individuals who would benefit most from the alleged cognitive improvements that are expected to occur – the chronically unemployed perhaps. That way, whether or not any improvements in cognitive function was detected, any improvement in the employment status of these 10,000 compared to a control group of another randomly selected 10,000 (who have also been receiving job seekers allowance for a prolonged period), would give Nintendo a possible second bite of the cherry by demonstrating a generic improvement in motivation levels and the power to benefit society as a whole. In addition to the milestone incentives, if they did look to keep unemployed hands and minds busy, it might also help to improve brain training dedication by dangling a carrot over the “high score leader board” – whereby those that achieve the best scores overall could be given paid work experience in a role that utilises the skills tapped by each specific game. Just think of the headlines: “Intense Brain Training DOES Improve Mental Abilities AND Gets The Chronically Unemployed Back Into Work”

    Get Dr Jack Lewis’s daily #braintweet by following him on Twitter: www.twitter.com/DrJackLewis

    5 Potential Flaws with the Lab UK Brain Training Study:

    1. At least 3 times per week for 6 weeks
      1. POTENTIAL FLAW: the training regime is very sparse. In other words not surprising that there was no significant improvement because it didn’t tax the participants brains hard enough to benefit memory, planning, problem solving etc.
      2. REASONING: I would expect multiple training sessions EACH AND EVERY DAY to be necessary for significant improvements because the brain is only likely to invest resources in building better lines of communication between brain areas supporting a certain function if it is really needed (i.e. often used)
      3. SOLUTION: a commuter training regime – twice per day (on bus or train) on the way to and from work or school. Perhaps longer sessions at the weekend.
      4. BONUS: using dead time when people would otherwise be staring into space – even if it doesn’t translate into long term improvements such a brain training regime definitely helps to wake up a sleepy brain (it works for me!!)
    1. Brain training transfer to other brain skills like memory, planning or problem solving
      1. POTENTIAL FLAW: improvements in memory, planning or problem solving may have occurred but were not successfully detected
      2. REASONING: the selected tests may not have been sensitive enough to detect subtle improvements that occur with such a sparse training regime.
      3. SOLUTION: use more sensitive tests or increase frequency of training.
    1. Choice of brain training games
      1. POTENTIAL FLAW: brain training games may not have been sufficiently taxing to elicit significant improvements
      2. REASONING: the games were not those used by Dr Kawashima’s Brain Training and so the results of this experiment might not be applicable
      3. SOLUTION: perform a study using the actual Nintendo DS game and console.
    1. No improvement in PC-based brain training games compared to just using the internet
      1. POTENTIAL FLAW: this does not capture the ability of the Nintendo DS to do brain training on-the-go, nor voice activated responses, nor faster responses enabled by touch screen technology – scribbling a letter/number or tapping at a certain location.
      2. REASONING: portability of Nintendo naturally lends itself to more intense training regime, writing on touch screen lends itself to faster responses than a keypad or mouse, voice activation allows verbal responses i.e. exercises different brain areas.
      3. SOLUTION: compare brain training games on Nintendo DS to normal games on Nintendo DS in order to take these important issues into account.
    1. Further investigation into effects of brain training in 60+ year olds
      1. POTENTIAL FLAW: Brain training must have shown some promise in the elderly yet it’s reported negatively to fit into “BRAIN TRAINING DOESN’T WORK” headline
      2. REASONING: Usually studies inflate even weak results to justify the study. Here they seem to want the negative findings and hence the improvements in the elderly are downplayed until further investigation.
      3. BONUS: Clearly you CAN teach an old dog new tricks!
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