A number of studies have shown how playing video games can lead to structural changes in the brain, including increasing the size of some regions, or to functional changes, such as activating the areas responsible for attention or visual-spatial skills.
New research from the Universitat Oberta de Catalunya (UOC) has gone further to show how cognitive changes can take place even years after people stop playing.
This is one of the conclusions from the article published in Frontiers in Human Neuroscience.
The study involved 27 people between the ages of 18 and 40 with and without any kind of experience with video gaming.
“People who were avid gamers before adolescence, despite no longer playing, performed better with the working memory tasks, which require mentally holding and manipulating information to get a result,” said Marc Palaus, who has a Ph.D. from the UOC.
The article stems from Palaus’ doctoral thesis, which was supervised by Elena Muñoz and Diego Redolar, researchers in the UOC Faculty of Health Sciences’ Cognitive NeuroLab.
They were co-authors of the article alongside Raquel Viejo, another researcher from the group.
The results show that people without experience of playing video games as a child did not benefit from improvements in processing and inhibiting irrelevant stimuli.
Indeed, they were slower than those who had played games as children, which matched what had been seen in earlier studies.
Likewise, “people who played regularly as children performed better from the outset in processing 3-D objects, although these differences were mitigated after the period of training in video gaming, when both groups showed similar levels,” said Palaus.
Combining transcranial magnetic stimulation
The study lasted a month and the researchers analyzed participants’ cognitive skills, including working memory, at three points: before starting the training in video gaming, at the end of the training, and fifteen days later.
The video game used was Nintendo’s Super Mario 64.
The study also included 10 sessions of transcranial magnetic stimulation. This is non-invasive brain stimulation through the skin without the need to get to the brain tissue that temporarily changes the brain’s activity.
“It uses magnetic waves which, when applied to the surface of the skull, are able to produce electrical currents in underlying neural populations and modify their activity,” explained Palaus.
The researchers wanted to find out if combining video gaming and this kind of stimulation would improve cognitive performance, but that didn’t turn out to be the case. There are a number of possible causes, including the experimental nature of the parameters for the stimulation.
“We aimed to achieve lasting changes. Under normal circumstances, the effects of this stimulation can last from milliseconds to tens of minutes. We wanted to achieve improved performance of certain brain functions that lasted longer than this,” said Palaus.
Strengthening cognitive skills
In this case, the video game used was a 3-D platform adventure, but there are many genres of video game which can influence cognitive functions differently.
According to Palaus, what most have in common is that they involve elements that make people want to continue playing, and that they gradually get harder and present a constant challenge.
“These two things are enough to make it an attractive and motivating activity, which, in turn, requires constant and intense use of our brain’s resources.”
“Video games are a perfect recipe for strengthening our cognitive skills, almost without our noticing.”
Nonetheless, he stressed that these improvements only have a limited effect on performance of other activities not linked to video gaming, as is the case with most cognitive training.
ideo gaming refers to the experience of playing electronic games, which vary from action to passive games, presenting a player with physical and mental challenges. The motivation to play video games might derive from the experience of autonomy or competing with others, which can explain why video gaming is pleasurable and addictive [1].
Video games can act as “teachers” depending on the game purpose [2]. Video gaming has varying effects depending on the game genre.
For instance, an active video game can improve physical fitness [3,4,5,6], whereas social video games can improve social behavior [7,8,9]. The most interesting results show that playing video games can change cognition and the brain [10,11,12,13].
Earlier studies have demonstrated that playing video games can benefit cognition. Cross-sectional and longitudinal studies have demonstrated that the experience of video gaming is associated with better cognitive function, specifically in terms of visual attention and short-term memory [14], reaction time [15], and working memory [16].
Additionally, some randomized controlled studies show positive effects of video gaming interventions on cognition [17,18]. Recent meta-analytical studies have also supported the positive effects of video gaming on cognition [10,11,12,13].
These studies demonstrate that playing video games does provide cognitive benefits.
The effects of video gaming intervention are ever more widely discussed among scientists [13]. A review of the results and methodological quality of recently published intervention studies must be done.
One systematic review of video gaming and neural correlates has been reported [19]. However, the technique of neuroimaging of the reviewed studies was not specific. This systematic review reviewed only magnetic resonance imaging (MRI) studies in contrast to the previous systematic review to focus on neuroplasticity effect.
Neuroplasticity is capability of the brain that accommodates adaptation for learning, memorizing, and recovery purposes [19]. In normal adaptation, the brain is adapting to learn, remember, forget, and repair itself.
Recent studies using MRI for brain imaging techniques have demonstrated neuroplasticity effects after an intervention, which include cognitive, exercise, and music training on the grey matter [20,21,22,23,24] and white matter [25,26,27,28,29]. However, the molecular mechanisms of the grey and white matter change remain inconclusive.
The proposed mechanisms for the grey matter change are neurogenesis, gliogenesis, synaptogenesis, and angiogenesis, whereas those for white matter change are myelin modeling and formation, fiber organization, and angiogenesis [30].
Recent studies using MRI technique for brain imaging have demonstrated video gaming effects on neuroplasticity. Earlier imaging studies using cross-sectional and longitudinal methods have shown that playing video games affects the brain structure by changing the grey matter [31,32,33], white matter [34,35], and functional connectivity [36,37,38,39].
Additionally, a few intervention studies have demonstrated that playing video games changed brain structure and functions [40,41,42,43].
The earlier review also found a link between neural correlates of video gaming and cognitive function [19]. However, that review used both experimental and correlational studies and included non-healthy participants, which contrasts to this review. The differences between this and the previous review are presented in Table 1.
This review assesses only experimental studies conducted of healthy participants. Additionally, the cross-sectional and longitudinal studies merely showed an association between video gaming experiences and the brain, showing direct effects of playing video games in the brain is difficult.
Therefore, this systematic review specifically examined intervention studies. This review is more specific as it reviews intervention and MRI studies on healthy participants. The purposes of this systematic review are therefore to evaluate the beneficial effects of video gaming and to assess the methodological quality of recent video gaming intervention studies.
Table 1
Differences between previous review and current review.
| Difference | Previous Review | Current Review |
|---|---|---|
| Type of reviewed studies | Experimental and correlational studies | Experimental studies only |
| Neuroimaging technique of reviewed studies | CT, fMRI, MEG, MRI, PET, SPECT, tDCS, EEG, and NIRS | fMRI and MRI only |
| Participants of reviewed studies | Healthy and addicted participant | Healthy participants Only |
Discussion
This literature review evaluated the effect of noncognitive-based video game intervention on the cognitive function of healthy people. Comparison of studies is difficult because of the heterogeneities of participant ages, beneficial effects, and durations. Comparisons are limited to studies sharing factors.
Participant Age
Video gaming intervention affects all age categories except for the children category. The exception derives from a lack of intervention studies using children as participants.
The underlying reason for this exception is that the brain is still developing until age 10–12 [52,53]. Among the eligible studies were a study investigating adolescents [40], six studies investigating young adults [41,42,43,47,49,51] and two studies investigating older adults [48,50].
Differences among study purposes underlie the differences in participant age categories. The study by Haier et al. was intended to study adolescents because the category shows the most potential brain changes.
The human brain is more sensitive to synaptic reorganization during the adolescent period [54]. Generally, grey matter decreases whereas white matter increases during the adolescent period [55,56]. By contrast, the cortical surface of the brain increases despite reduction of grey matter [55,57].
Six studies were investigating young adults with the intention of studying brain changes after the brain reaches maturity. The human brain reaches maturity during the young adult period [58]. Two studies were investigating older adults with the intention of combating difficulties caused by aging.
The human brain shrinks as age increases [56,59], which almost invariably leads to declining cognitive function [59,60].
Beneficial Effects
Three beneficial outcomes were observed using MRI method: grey matter change [40,42,50], brain activity change [40,43,47,48,49], and functional connectivity change [41]. The affected brain area corresponds to how the respective games were played.
Four studies of 3D video gaming showed effects on the structure of hippocampus, dorsolateral prefrontal cortex (DLPFC), cerebellum [42,43,50], and DLPFC [43] and ventral striatum activity [49]. In this case, the hippocampus is used for memory [61] and scene recognition [62], whereas the DLPFC and cerebellum are used for working memory function for information manipulation and problem-solving processes [63].
The grey matter of the corresponding brain region has been shown to increase during training [20,64]. The increased grey matter of the hippocampus, DLPFC, and cerebellum are associated with better performance in reference and working memory [64,65].
The reduced activity of DLPFC found in the study by Gleich et al. corresponds to studies that showed reduced brain activity associated with brain training [66,67,68,69]. Decreased activity of the DLPFC after training is associated with efficiency in divergent thinking [70]. 3D video gaming also preserved reward systems by protecting the activity of the ventral striatum [71].
Two studies of puzzle gaming showed effects on the structure of the visual–spatial processing area, activity of the frontal area, and functional connectivity change. The increased grey matter of the visual–spatial area and decreased activity of the frontal area are similar to training-associated grey matter increase [20,64] and activity decrease [66,67,68,69].
In this case, visual–spatial processing and frontal area are used constantly for spatial prediction and problem-solving of Tetris. Functional connectivity of the multimodal integration and the higher-order executive system in the puzzle solving-based gaming of Professor Layton game corresponds to studies which demonstrated training-associated functional connectivity change [72,73]. Good functional connectivity implies better performance [73].
Strategy gaming affects the DLPFC activity, whereas rhythm gaming affects the activity of visuospatial working memory, emotional, and attention area. FPS gaming affects the structure of the hippocampus and amygdala. Decreased DLPFC activity is similar to training-associated activity decrease [66,67,68,69].
A study by Roush demonstrated increased activity of visuospatial working memory, emotion, and attention area, which might occur because of exercise and gaming in the Dance Revolution game. Results suggest that positive activations indicate altered functional areas by complex exercise [48].
The increased grey matter of the hippocampus and amygdala are similar to the training-associated grey matter increase [20,64]. The hippocampus is used for 3D navigation purposes in the FPS world [61], whereas the amygdala is used to stay alert during gaming [74].
Duration
Change of the brain structure and function was observed after 16 h of video gaming. The total durations of video gaming were 16–90 h. However, the gaming intensity must be noted because the gaming intensity varied: 1.5–10.68 h per week. The different intensities might affect the change of cognitive function.
Cognitive intervention studies demonstrated intensity effects on the cortical thickness of the brain [75,76]. A similar effect might be observed in video gaming studies. More studies must be conducted to resolve how the intensity can be expected to affect cognitive function.
Criteria
Almost all studies used inclusion criteria “little/no experience with video games.” The criterion was used to reduce the factor of gaming-related experience on the effects of video gaming. Some of the studies also used specific handedness and specific sex of participants to reduce the variation of brain effects.
Expertise and sex are shown to affect brain activity and structure [77,78,79,80]. The exclusion criterion of “MRI contraindication” is used for participant safety for the MRI protocol, whereas exclusion criteria of “psychiatric/mental illness”, “neurological illness”, and “medical illness” are used to standardize the participants.
Limitations and Recommendations
Some concern might be raised about the quality of methodology, assessed using Delphi criteria [45]. The quality was 3–9 (mean = 6.10; S.D. = 1.69). Low quality in most papers resulted from unspecified information corresponding to the criteria. Quality improvements for the studies must be performed related to the low quality of methodology. Allocation concealment, assessor blinding, care provider blinding, participant blinding, intention-to-treat analysis, and allocation method details must be improved in future studies.
Another concern is blinding and control. This type of study differs from medical studies in which patients can be blinded easily. In studies of these types, the participants were tasked to do either training as an active control group or to do nothing as a passive control group. The participants can expect something from the task.
The expectation might affect the outcomes of the studies [81,82,83]. Additionally, the waiting-list control group might overestimate the outcome of training [84].
Considering the sample size, which was 20–75 (mean = 43.67; S.D. = 15.63), the studies must be upscaled to emphasize video gaming effects. There are four phases of clinical trials that start from the early stage and small-scale phase 1 to late stage and large-scale phase 3 and end in post-marketing observation phase 4.
These four phases are used for drug clinical trials, according to the food and drug administration (FDA) [85]. Phase 1 has the purpose of revealing the safety of treatment with around 20–100 participants. Phase 2 has the purpose of elucidating the efficacy of the treatment with up to several hundred participants.
Phase 3 has the purpose of revealing both efficacy and safety among 300–3000 participants. The final phase 4 has the purpose of finding unprecedented adverse effects of treatment after marketing. However, because medical studies and video gaming intervention studies differ in terms of experimental methods, slight modifications can be done for adaptation to video gaming studies.
Several unresolved issues persist in relation to video gaming intervention. First, no studies assessed chronic/long-term video gaming. The participants might lose their motivation to play the same game over a long time, which might affect the study outcomes [86]. Second, meta-analyses could not be done because the game genres are heterogeneous.
To ensure homogeneity of the study, stricter criteria must be set. However, this step would engender a third limitation. Third, randomized controlled trial video gaming studies that use MRI analysis are few. More studies must be conducted to assess the effects of video gaming.
Fourth, the eligible studies lacked cognitive tests to validate the cognitive change effects for training. Studies of video gaming intervention should also include a cognitive test to ascertain the relation between cognitive function and brain change.
Conclusions
The systematic review has several conclusions related to beneficial effects of noncognitive-based video games. First, noncognitive-based video gaming can be used in all age categories as a means to improve the brain.
However, effects on children remain unclear. Second, noncognitive-based video gaming affects both structural and functional aspects of the brain. Third, video gaming effects were observed after a minimum of 16 h of training. Fourth, some methodology criteria must be improved for better methodological quality. In conclusion, acute video gaming of a minimum of 16 h is beneficial for brain function and structure. However, video gaming effects on the brain area vary depending on the video game type.
reference link : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826942/
More information: Marc Palaus et al. Cognitive Enhancement via Neuromodulation and Video Games: Synergistic Effects?, Frontiers in Human Neuroscience (2020). DOI: 10.3389/fnhum.2020.00235
