Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Sunday, May 24, 2015

Tools to Prevent Cognitive Decline?

I like to play Hitori. For those not familiar, it's another one of those Sudoku-type games that are great for convincing yourself you're doing something useful, i.e. keeping your reasoning skills sharp, when you're probably just wasting time. Those games-minesweeper, ken-ken, pixel games (I'm partial to Pic-a-Pix), are all wonderful for dealing with mild anxiety. They require just enough concentration to be distracting, but not enough to really be a strain, or make you feel like it's an effort to play.

But today, I was playing Hitori, and the site came up with one of its weird ads. This particular site may be a little sketchy, which is why I didn't link to it, because when I first started playing, I got ads for what seemed like mail-order brides from Eastern Europe. I'm not sure what text Big Brother Google was reading in my emails that made it believe those ads would appeal to me, but that's what I got. Those ads went away pretty quickly.

Then I started to get ads for devices to treat depression. At least that's not so surprising, given my professional searches and email exchanges. One of these days, I'll read up on the research on that device, the Fisher Wallace Stimulator, which you use for 20 minutes once or twice a day.

Then the ads moved on to brain games like Lumosity. Again, not surprising, since Hitori is another brain game. I've tried out Lumosity, for free, and I found some of the memory games challenging. I didn't use it long enough to see if my memory improved.

Today, I got an ad for cremation planning. I did celebrate a birthday earlier this month, but not one that puts my age at death's door. So I guess people are using games like Hitori to ward off dementia and their expected mental decline due to aging.

Lumosity claims to take standard neuropsych testing out of the lab, and turn it into games. It adds new games, and then tailors a program "for you". There's a whole section on their research, some of which is performed in Lumos Labs. The site has 13 summaries of peer reviewed papers, including topics like cognitive training in cancer survivors, training for girls with Turner's syndrome, Lumosity in the classroom, Lumosity for emotion regulation, etc.

There's one study called, Investigating the effects of Lumosity cognitive training for healthy adults:

Twenty-three volunteer participants were randomly assigned to one of two groups: a training intervention group or a waitlist control group. Intervention group participants completed Lumosity training 20 minutes a day for 5 weeks. At the end of the training period, participants in this group saw improved performance on a divided visual attention assessment in which the user must identify a central target and report the location of a peripheral target, and on a forward and reverse working memory assessment in which the user must click in the same or opposite order that they were highlighted. Control participants, on the other hand, who did not undergo Lumosity training, did not show changes in performance on these assessments.

The original article, published in Mensa Research Journal, is here.

Another study, not performed at Lumos, examined use of Lumosity in adults with MCI. The summary is this:

Dr. Maurice Finn, a clinical psychologist and researcher at the University of New South Wales in Sydney, Australia found that training with Lumosity improved visual attention performance on the Cambridge Automated Neuropsychological Test Battery (CANTAB) in patients with Mild Cognitive Impairment (MCI). 

The original article, in Brain Impairment, concludes:

Results indicated that participants were able to improve their performance across a range of tasks with training. There was some evidence of generalisation of training to a measure of visual sustained attention. There were no significant effects of training on self-reported everyday memory functioning or mood. The results are discussed along with suggestions for future research.

There's a poster about age-related effects on learning. And another poster about Lumosity's Brain Performance Test (BPT).

There's also a link to ongoing research topics.

Basically, there's a lot of self-serving noise, which doesn't mean Lumosity isn't helpful, but it doesn't mean it is, either. It seems to me that these studies measure improvement on their own tasks, or games, as they call them. It's not clear what these improvements imply for the rest of life.

On the flip side, there's this piece in Science, indicating that:

Aging baby boomers and seniors would be better off going for a hike than sitting down in front of one of the many video games designed to aid the brain, a group of nearly 70 researchers asserted this week in a critique of some of the claims made by the brain-training industry. 


For those who choose to play brain games regardless, recent research suggests that playing some video games developed solely for fun may be as effective, or more, than those developed for cognitive self-improvement. Scientists at Florida State University randomly assigned 77 undergraduates to play either Lumosity or the popular video game Portal 2, in which players take on the roles of robots to solve interactive puzzles to face off against a “lethally inventive, power-mad A.I. named GLaDOS.” After 8 hours of play, Portal 2 players scored higher than Lumosity players on three standard cognitive tests of problem-solving and spatial skill, and Lumosity players “showed no gains on any measure,” the team reported online this summer inComputers & Education.

A 2010 Systematic Review of the Literature, published in the Annals of Medicine, found:

...high-quality evidence for only 1 factor's effect on cognitive decline. Cognitive training on processing speed or reasoning showed a decreased risk for cognitive decline in the specific targeted cognitive abilities over a 2-year follow-up, and the evidence was rated as high-quality primarily on the basis of 1 RCT . Observational studies of self-reported engagement in cognitively stimulating activities suggest an association with less cognitive decline, but this exposure is probably different from the cognitive training used in the RCT.

A chapter from the Handbook on the Neuropsychology of Aging and Dementia
Clinical Handbooks in Neuropsychology 2013, pp 167-192, indicates:

Specific dietary changes rich in vegetables, fruits, and fish and low in carbohydrates and saturated fat are advisable, with particular emphasis in patients at risk of developing Alzheimer’s disease (AD) or vascular dementia. Patients should remain active physically and mentally. Physical exercise is among the best of all potential interventions against AD.

One study with an n of 488 initially cognitively intact subjects found that doing crossword puzzles delayed the onset of accelerated memory decline by 2.54 years, in those subjects who ultimately developed dementia. It's not clear from the abstract if doing crossword puzzles kept subjects from developing dementia, at all-I assume that's not what they were studying, or able to study.

The most frequent preventive factor I could find was physical activity. But it's clear that there's something unclear here. So maybe I should stop playing Hitori and swim more. Or maybe I should stop researching whether I should stop playing Hitori.


  1. Needless to say - a lot more research is required.

    For now, I tend to view it s a Vitamin D effect. So many people have the problem (Vitamin D deficiency, physical and cognitive inactivity, poor diet short on vegetables) and the conditions that we are trying to prevent have such high prevalence in 60 - 85 year olds that any one of them could be considered a problem or a cure.

    I always look to the extreme cases like geniuses who contracted AD despite world class intellectual activity. To me that makes the brain enrichment hypothesis much less likely. Considering the disease mechanisms seems to do the same thing.

    1. I don't know what to make if any of it, except to do what your grandmother said and eat a varied diet and keep mentally and physically active.

  2. My guess is that grandmother's advice will prevent vascular dementias to some degree, but it won't do much for Alzheimers or other dementias. The problem is that there are significant areas of overlap. That may account for some of the findings of delayed onset of cognitive decline in some of these groups but I think that is more or less methodological.

  3. "...recent research suggests that playing some video games developed solely for fun may be as effective, or more, than those developed for cognitive self-improvement."

    I've certainly found that to be the case in my experience.

    I don't know if it will stave off dementia or Alzheimers but there's something to be said for an enjoyable activity vs passive TV watching or the boring, repetitious cognitive enhancer game apps I've tried.