Do brain games work?
We spend more than $1 billion a year trying to keep our minds limber. But we’re often left asking the same big question.
The Brain Fit Club looks like any other gym: Hardwood floors gleam under bright lights, a big flat-screen television monitor hangs on the back wall. But some things are different: There are no towels and no mirrors, for instance, and computers perch expectantly on ledges along the wall. Those are the "brain treadmills," where the heavy mental lifting happens under the steady gaze of personal brain trainer Bonnie Wong.
Many members of the Brain Fit Club are patients at Beth Israel Deaconess Medical Center, which houses the gym on the second floor of a building in Longwood. Some come with head injuries like concussions, some have suffered strokes, others degenerative brain conditions like Parkinson's or signs of Alzheimer's. More than a few fear they're getting dementia. All members, including those who are currently healthy, hope brain training will help them maintain their mental sharpness just a little longer.
"They're healthy, but they're worried," says Wong, a neuropsychologist at the hospital. "You get bombarded with ads about Lumosity or other computerized training programs" — and here she intones like a TV huckster — "for $10 a month you can reverse aging!" The goal of the Brain Fit Club is to cut through the hype about computerized brain training and show what really works and what doesn't.
There's intense interest — and the potential for big money — in the world of brain games. Lumosity, the San Francisco-based brain games company founded in 2005, claims 60 million users (many pay $14.95 a month, but there is also a free version of the software). The market for Lumosity and competitors like Cogmed and Posit Science is growing 25 percent a year, according to SharpBrains, a neuro-wellness research firm. SharpBrains pegged 2013 spending on brain fitness hardware and software — not including paper-based products or in-person classes — at $1.3 billion worldwide. It expects to see that figure rise to $6 billion by 2020.
The big spenders are, no surprise, baby boomers, the youngest of whom are hitting 50 this year. They account for about half of the market. Spending on brain training for kids accounts for another 20 percent, a big chunk of that through schools that buy packages like Cogmed, which claim to boost student performance and even intelligence. Perhaps in anticipation of the wave of boomers, the Centers for Medicare & Medicaid Services recently began accepting comments on a proposal that could lead to reimbursements for some costs associated with brain games.
We live in an age where advances in public health and medicine have extended the length and quality of our lives, but "brain health hasn't kept up with the pace," says Dr. Alvaro Pascual-Leone, a professor at Harvard Medical School who cofounded the Brain Fit Club with Wong in 2012. Part of the point of the Beth Israel center is to level the playing field a bit, studying how we might make sure older brains stay as healthy as older bodies. "The brain at 70 or 80 is not and should not be the same as an 18-year-old brain," Pascual-Leone says, "but it should function as best it can regardless of age."
Medical research has established that our brains remain plastic, or able to change, for most of our lives. They can even function pretty well when they're damaged. The Nun Study, started in 1986, has found that a number of elderly nuns showed no symptoms of Alzheimer's, though autopsies showed their brains had all the signs of advanced disease. Researchers found that almost all of these women wrote idea-dense, grammatically complex prose earlier in their lives, and that they benefited from cognitive reserve, the idea that our brains can build up a reservoir of mental capacity that keeps us able to function even if our brain suffers injury or illness.
The nuns were certainly not using software to boost their brains (as the psalmist would say, the righteous will still bear fruit in old age). But in our more technological age, we expect we can maintain right thinking in other ways — hence the wave of interest in brain games, the flood of news stories on the "top 10 brain-training apps," and the seemingly never-ending ads for Lumosity.
But working against the brain fitness trend is its own hype. Posit Science, a 12-year-old company in San Francisco, says its BrainHQ is backed by 70 studies proving its effectiveness. Cogmed, founded in Sweden in 2001 and now owned by Pearson, claims more than 45 studies support its assertions of efficacy. Lumosity is more restrained, with only nine studies. But last year The New Yorker, drawing on research that found that the major studies of brain training showed little lasting impact, dubbed brain game science "bogus."
The Brain Fit Club's Pascual-Leone, who also directs Beth Israel's Berenson-Allen Center for Noninvasive Brain Stimulation, is more measured. "I don't think there is any doubt that the scientific studies and research still need to clarify the impact this will have," he says. "We're very open to the Brain Fit participants about that."
There is, though, science enough to suggest playing brain games isn't stupid. Last fall, the journal Nature featured the video game NeuroRacer as its cover story. By playing NeuroRacer, adults 60 to 85 were able to develop multi-tasking skills on par with 20-year-olds. NeuroRacer's lead researcher, Adam Gazzaley, also cofounded Akili Interactive Labs in Boston and San Francisco to develop the technology into a commercial product. Another long-running research project, the Advanced Cognitive Training for Independent and Vital Elderly study, recently reported that even after 10 years, subjects who had used brain training programs had better reasoning and task processing speeds than control groups.
At worst, researchers say, brain games can't hurt anything, outside of your wallet. "I've never heard of anyone wearing out their brain — except on drugs," observes Dr. Benjamin Wolozin, a professor of pharmacology and neurology at Boston University.
Studies touted by brain training companies can be self-serving, but they do demonstrate that games can boost things like cognitive control, response inhibition, and working memory (even if you're not a nun). The question is, do the games make our brains better, or just better at playing the games?
Wong says that though there must be more research, "there is a very great potential for these games" — and one of the goals of the Brain Fit Club is to see how much.
One challenge for brain training is that we lack basic base lines, brain equivalents for a body mass index. Wong starts her patients with a 90-minute cognitive assessment, as well as another 45 minutes or so to measure gait and balance. These two-plus hours are used to develop a profile for each patient and customize a plan of mental and physical exercises.
That sets the Brain Fit program apart from brain training computer programs, says Wong, who is preparing a paper on the various commercial products. The programs rotate people through exercises aimed at multiple cognitive domains, some of which may be unnecessary. They also may not focus intensely enough on each user's actual problems. (The Brain Fit Club uses products from companies such as Cogmed and Posit Science, but does not endorse any particular one.)
Perhaps the Brain Fit base line assessment might lead to a base line measure for healthy brains, or perhaps a tool like BrainBaseline, a free iPad app, will do it. That would be a step forward. "People understand that doing crossword puzzles is not the most efficient or effective way to train the brain," says SharpBrains CEO Alvaro Fernandez, but we don't know what is.
By contrast, physical fitness has demonstrable impact — we can measure bigger muscles, smaller waistlines, and flexibility. The good news for gymgoers: Physical fitness helps blood flow to the brain, a good thing. Beth Israel's Brain Fit Club has hardwood floors because tai chi and yoga classes are also part of the regimen.
Games can spur both physical and mental exercise, says Yuval Malinsky, who started Newton-based Vigorous Mind in 2006. Back then, his company just produced mental exercises, distributed on CD-ROMs. But even in the early days, Malinsky says, it was clear that exercises by themselves were not enough to keep seniors' brains well. He shifted the company's software to offer up eight different ways to maintain a holistic brain wellness, not just brain fitness. Vigorous Mind, which now offers its tools online, has focused on senior living facilities, though it plans to launch a consumer version of its software by early 2015.
Malinsky acknowledges that in a study of the software's impact, "what we couldn't demonstrate, what everyone in the industry is trying to demonstrate, is how getting better at [brain] exercises translates into functioning better." He says the programs are still too new to have built up the proof they need, but he thinks it will happen.
Bonnie Wong does not disagree. She does, though, relate the story of a patient in his 70s who reported that, after working on the programs recommended for him, he can now find his car in parking lots. "He was really happy," Wong says. "He said, 'I'm not being yelled at by my wife for losing the car!' "