Brain game exercises enhance cognitive abilities in older people


A University of California, Irvine-led study has found that online brain game exercises can enable people in their 70s and even 80s to multitask cognitively as well as individuals 50 years their junior.

This is an increasingly valuable skill, given today’s daily information onslaught, which can divide attention and be particularly taxing for older adults.

“The brain is not a muscle, but like our bodies, if we work out and train it, we can improve our mental performance,” said lead author Mark Steyvers, a UCI professor of cognitive sciences.

“We discovered that people in the upper age ranges who completed specific training tasks were able to beef up their brain’s ability to switch between tasks in the game at a level similar to untrained 20- and 30-year-olds.”

The findings, published in Proceedings of the National Academy of Sciences, underscore the cognitive cost of multitasking, which dilutes function by splitting focus, as well as the ways in which people across the lifespan can overcome the brain drain brought on by both the increasingly cluttered multimedia environment and the natural aging process.

For the study, Steyvers and his colleagues partnered with Lumosity, an online platform that offers a variety of daily brain training games.

They focused on data from “Ebb and Flow” – a task-switching game that challenges the brain’s ability to shift between cognitive processes interpreting shapes and movement.

Of the millions of people who played the game between 2012 and 2017, researchers randomly sampled the performance of about 1,000 users within two categories: those who ranged in age from 21 to 80 and had completed fewer than 60 training sessions; and adults 71 to 80 who had logged at least 1,000 sessions.

They found that the majority of older and highly practiced players were able to match or exceed the performance of younger users who had not played very much.

Any lead seniors had, though, significantly declined after the 21- to 30-year-olds had completed more than 10 practice sessions.

“Medical advances and improved lifestyles are allowing us to live longer,” Steyvers said. “It’s important to factor brain health into that equation. We show that with consistent upkeep, cognitive youth can be retained well into our golden years.”

The number of elderly people in the world is increasing rapidly. Taiwan will have become an aged society by 2018 and a super-aged society by 2025 (National Development Council, 2016).

To cope with aging populations, governments and institutions around the world have proposed various guidelines, such as successful aging (Rowe and Kahn, 1997), active aging (Foster and Walker, 2015) and healthy aging (World Health Organization, 2015).

The purpose of these guidelines is generally to propose how elderly people’s cognition, capacity and physical function can be maintained, to encourage their social participation and to emphasize the competence and knowledge that older people possess.

The idea of cognitive aging has gained attention as domain-specific, age-related cognitive changes that—at a minimum—affect attention, executive functioning, memory, language and visuospatial function, as indicated by neurochemical theory, localized theory and process theory (Dempster, 1992; Salthouse, 1996; West, 1996; Volkow et al., 1998; Bäckman et al., 2006; Clay et al., 2009; Drag and Bieliauskas, 2010; Craik and Rose, 2012; Turgeon et al., 2016).

Normal aging leads to changes in inhibition and selective attention.

These changes make older people more susceptible to the negative effects of divided attention, and task-switching is thus harder to perform (Kray and Lindenberger, 2000; Mayr and Kliegl, 2000).

One significant finding of related studies is that the aging-related decreases in working memory affect executive functioning.

Executive functioning is a high-order cognitive structure that uses and organizes large amounts of information to support goal-directed behavior (Dobbs and Rule, 1989; Wang et al., 2011).

The lower speed of time perceived by the elderly also affects their executive performance (Turgeon et al., 2016).

The age-related deficiency of executive function is a strong predictor of functional impairment in the elderly living in communities or assisted-living facilities (Wang et al., 2011).

In addition, the age-related memory decline has a particular effect on recollection ability during information finding and retrieval (Park et al., 2002). Recall is more difficult than recognition for elderly people, and their semantic memory appears to have a deficit (Naveh-Benjamin, 2000).

However, the related cues of familiarity, auditory context, and external context can help the recollection process of older people (Park et al., 1990; James and Burke, 2000;

Bastin and Van der Linden, 2003). Another change is the age-related decline in language ability performance, which is affected by inhibition capability, working memory and the recollection process.

This decline makes it more difficult for elderly people to understand sentences and recall text because of the great syntactic complexity these tasks involve (Gold and Arbuckle, 1995; DeDe et al., 2004).

According to previous studies, visuospatial abilities such as visuospatial attention, memory and orientation are also affected by age. Integrative visuospatial tasks such as problem solving (e.g., route-finding) and mental transformation (e.g., map reading) are sensitive to age and associated with executive function.

In addition, testing visuospatial access can more efficiently detect Alzheimer’s patients at the early stage of cognitive decline than can testing verbal access (De Federicis et al., 2016).

Pursuing these questions, an increasing number of studies have demonstrated that games can have a positive impact on senior citizens and can provide them with cognitive training (Flynn et al., 2007; Ackerman et al., 2010; Calvillo-G’amez et al., 2010; Anguera et al., 2015).

These empirical studies have proposed certain components that make cognitive training games successful, such as training content comprised of customized and adaptive tasks (Lachman, 2006), well-designed interaction via friendly interfaces (Schmiedek et al., 2010), and the accessibility of the devices (Lindenberger et al., 2008; Schmiedek et al., 2010).

While these components are important references for the formation of design guidelines, their effects on cognitive training are not agreed upon unanimously (Owen et al., 2010). The rapid development of the devices and users’ adjustability to the affordance of the devices introduce great variety and difficulty to systematic and empirical investigations (Van Muijden et al., 2012; Anguera et al., 2015).

In addition to the employment of advanced methods and techniques to collect neural and behavioral evidence, a few, yet critical, attempts have also been made at the situated effect of the training context (Rush et al., 2006; Trefry, 2010; Binder et al., 2015). The results have suggested a more comprehensive range of research for cognitive training game studies. Figure ​Figure11summarizes the relationships among aging theory, age-related cognitive changes and associated cognitive training games, and their effects revealed by the related studies.

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Figure 1
Aging cognition and cognitive training structure of related games.

An overview of the literature has shown that designing technology products with a friendly interface for elderly people requires that designers consider the declines in older users’ perception, sensation, motion and cognition (Drag and Bieliauskas, 2010; Lu and Yueh, 2015).

For instance, considering older adults’ declines in perception and sensation, decisions to use visual presentations such as reflective, decorative or animated images should be made cautiously (Namba et al., 1995; Green and Bavelier, 2003). Other design principles regarding auditory feedback (Charness and Jastrzembki, 2009; Fisk et al., 2009), haptic feedback (Lee and Kuo, 2001; Harada et al., 2013), and memory assistance (Ferreira and Pithan, 2005; Fisk et al., 2009; Sauve et al., 2015) have also been reported in related studies.

According to this review, the present study proposes five principles that should be considered during the development of the interface and interaction in a digital game for the cognitive training of elderly people:

(1) Provide clear and multisensory game instructions and suitable interaction.

(2) For the game context and tasks, adopt content and themes that are familiar to the user from daily life.

(3) Design several different tasks corresponding to the training of various cognitive capabilities; these tasks should be easy to complete and provide practice modes.

(4) Provide feedback on the training consequences.

(5) Engage users and stakeholders to evaluate the design and its effects.

This study proposes that for elderly adults, cognitive training games that are casual, contain familiar life contexts and have a user-friendly interface are necessary and satisfying.

In terms of game devices, a mobile tablet-based training app has several advantages that are especially beneficial for training older adults.

The most important benefit is that older adults perceive tablets as personal devices that they can carry with them easily; as a result, they can flexibly integrate training into everyday life (Binder et al., 2015).

For example, mobile devices are easier to carry and operate than portable devices (i.e., laptops) when the elderly have to move between day-care nursing homes and their own homes.

Moreover, the screen size of tablets fits older adults’ visual abilities better than smartphones, especially during tasks that are complex or involve a high cognitive load, such as reading (Werner et al., 2012; Yueh et al., 2012).

Because of these advantages of tablets, older adults have rapidly adopted mobile devices and expect mobile technology to flexibly support their leisure activities, social interactions and learning.

Although studies on digital games have provided valuable insight into cognitive training and also suggested design principles for the content and interactions, they have not frequently used multiple sources (such as stakeholder attitudes and qualitative and quantitative sources) for analysis, have not described the design processes of games according to users’ evaluations and have seldom tested games in a realistic context.

Elderly adults adopt a technological innovation when they see that it is useful in their lives (Hanson, 2010).

Understanding what components of cognitive training games affect elderly users’ experiences is necessary because the usability of mobile applications is of great importance.

Meanwhile, to address the need to clarify how older users’ cognitive functions can be enhanced by game training in a genuine context with stakeholders, this study adopted the research method framework of design-based research (DBR) to investigate the complex phenomenon.

DBR focuses on the development of hypotheses and a framework and the contribution to model formulation, rather than model estimation or validation. As a result, it can obtain a different outcome, such as new theory (Simon, 1969; Sloane and Gorard, 2003).

DBR typically triangulates multiple sources and types of data to connect intended and unintended outcomes of processes of enactment, and it increases the validity of findings through its typical partnerships and iteration (The Design-Based Research Collective, 2003). DBR enables researchers to grasp problems through iterative development and places emphasis on the authenticity of the context; it also enables a clearer understanding of the goals and implications of research, resulting in maximum design optimization (Joseph, 2004; Lin et al., 2014).

In the design of an optimized and user-friendly cognitive training game for elderly people, the specific research questions that must be answered are as follows:

(1) What types of cognitive training do elderly people accept in a mobile game? and

(2) What components are crucial to improving or reducing the usability of a cognitive training game for elderly people?

The current study involved collaboration among experts from the medical, interaction design and engineering fields, and it designed a cognitive training app for seniors in home or nursing home settings.

The iterative cycles and process that were employed to develop the app are described.

The needs, preferences, technological experience and cognitive deficits of older people were evaluated and considered in the design of the cognitive training app so that it would offer comprehensive support.

More information: Mark Steyvers el al., “A large-scale analysis of task switching practice effects across the lifespan,” PNAS (2019).

Journal information: Proceedings of the National Academy of Sciences
Provided by University of California, Irvine


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