Folks who think just working on crossword puzzles or playing sudoku will keep their brains sharp are apt to be disappointed. Regular video games don’t hold much promise, either, though all those activities can be enjoyable.

Whether the brain can be trained to improve has been fodder for ad campaigns and promises for years, which often failed to deliver. The Federal Trade Commission has cracked down hard on what it views as deceptive advertising by some brain game companies.

But many experts do believe brain-training games that target specific parts of the brain to improve speed, processing accuracy and focus have great potential to heal and strengthen brains, whether they’re simply aging, or impacted by depression, dementia and other neurocognitive ills.

The key is whether they’ve held up under peer-reviewed studies and in clinical trials. Claims must be evidence-based, said Greg Bayles, associate director of the University of Utah’s Therapeutic Games and Apps Lab and an adjunct professor of entertainment arts and engineering.

“Many of the programs marketed as brain health, baby development and brain development are loosely rooted in neuropsychology and not validated as being effective,” said Bayles, part of a team working on a brain-training program called Neurogrow for depression and mental decline among older adults.

Although most brain games and brain-training programs are not backed by scientific research, there are exceptions — and new market entries being developed as the science of brain training becomes better understood.

Individuals and families have a lot at stake. Cognitive decline and Alzheimer’s dementia are scary specters, said Henry Mahncke, CEO of Posit Science, maker of BrainHQ.

He said surveys have repeatedly shown that as people head into their 60s, 70s and 80s, worry about brain health looms larger than worry about financial health, relationships and even whether they will be able to keep driving.

Does brain training work? Mahncke thinks that’s “a terrible question. “Certain kinds of brain training have been shown to drive certain kinds of benefits in certain kinds of people.”

The Deseret News asked Bayles and Mahncke about brain-training programs because theirs have yielded hopeful results in clinical trials or randomized studies — and they’re among programs that federal health agencies deem worthy of investment for more study.

Investing in the hope

The scientific community doesn’t agree on the value of apps and games that claim to improve the brain. “Do Brain-Training Programs Work,” published in late 2016 in the journal Psychological Science in the Public Interest, noted a consensus letter from one group of international scientists saying such programs don’t work and a response from another international group of scientists saying studies are “replete with demonstrations of the benefits for brain training for a wide variety of cognitive and everyday activities.”

There are many brain training approaches on the market and a lot of them are entertaining, even fun. The best way to tell if they actually work is to see whether they’ve been tested — and what those studies show, according to Mahncke and Bayles.

The federal government’s been betting big bucks there’s something real amid the hoopla surrounding brain games and brain-training apps. In a University of Utah lab, researchers led by clinical neuropsychologist Sarah Shizuko Morimoto are going after depression in older adults with the Neurogrow program. Morimoto recently received a large grant from the National Mental Health Institute to do new clinical trials.

Neurogrow has had such trials in New York and Utah. There’s an ongoing clinical trial in Connecticut and a couple of other places, Bayles said. “Those are the building blocks for us to be able to make the claim that it’s not one psychologist working on a project that’s having the desired effect on patients.”

Posit’s BrainHQ is among the more studied programs and the government’s interested in it, too. The National Institute on Aging, under its Alzheimer’s Disease Initiative, recently awarded the company $465,000, to team up with the YMCA in San Francisco to come up with a community-based dementia-prevention program. It’s to be patterned after the Diabetes Prevention Program, a community-based behavior modification program.

Additionally, several years ago, the Department of Defense funded a clinical trial involving soldiers and vets coming back from conflicts where they suffered blast injuries. They compared BrainHQ to regular video games and showed it improved cognitive function four or five times as much as ordinary video games.

Brain training not all the same

The Neurogrow and BrainHQ programs are quite different from each other, though they share aspects and goals, including focus, speed and accuracy.

Over four weeks, those using Neurogrow spend more than 30 hours “playing.”

“A lot of people say, ‘I want to do that,’ but they think it’s going to be 15 minutes here and there when they want,” Bayles laughs. It’s not like that. Rather, Neurogrow is structured, exhausting — and effective, according to the clinical trials that have been done so far.

The program is being developed and tweaked even as it is being used in clinical trials, which is nothing new to software development. But that kind of evolving, “little chunks” design is unusual in clinical trials, Bayles said.

In the Neurogrow game, a player might be told to only water peonies with the blue watering can. Then new types of flowers might be added to test the ability to only water peonies.

“This process of introducing new colors and watering cans progresses until there are multiple types of plants and flowers, multiple watering cans, multiple weather conditions and other complicating factors that make the tasks increasingly difficult over time,” said Bayles. 

Sometimes cognitive decline in older adults gets in the way of traditional depression treatments like medication and therapy, he said. “But it turns out that if you can treat the underlying conditions — things like loss of short-term memory or loss of executive functioning, then you can actually improve the fundamental response to therapy and medication.”

The researchers don’t expect the program to replace traditional treatments for depression like therapy or medication. But they’re convinced it’s another strong tool that will work with them to improve treatment.

Brain training seems to work best when a program dynamically adjusts the rules people have to follow and the requirements that players or patients have to accomplish, challenging them to adapt and follow a changing set of instructions. It’s not simple memory work.

That’s one reason crossword puzzles “do not improve cognitive health, as far as we can tell, on their own,” said Mahncke. “The kind of person who chooses to do crossword puzzles is the kind of person who has good working memory and attention and thinking skills. And that’s why it looks like there’s an association.”

Brain training uses challenges and games to help improve speed, focus and accuracy and bolster brains. In BrainHQ’s Double-Decision challenge, the player has to keep track of which car flashes on the screen, as well as where the cow and sign are. It gets more complicated as it goes and the elements change and move, too.
Brain training uses challenges and games to help improve speed, focus and accuracy and bolster brains. In BrainHQ’s Double-Decision challenge, the player has to keep track of which car flashes on the screen, as well as where the cow and sign are. It gets more complicated as it goes and the elements change and move, too. | Posit Science BrainHQ

The BrainHQ app takes a different approach.

The app has dozens of brain exercises that target different parts of brain strength. For instance, one challenge displays vehicles that are similar. One of the vehicles flashes on the screen along with a road sign that moves around. It’s a fleeting glimpse before you need to indicate which vehicle it was and the location of the now-long-gone sign.

Another has an increasing number of bubbles that you’re supposed to track as other bubbles appear and they all weave in and around each other.

Yet another asks you to remember a particular photo and not confuse it with similar ones that flash quickly on the screen, or to pick out in milliseconds a butterfly that’s different from others, though colors are the same.

What the two programs have in common is the need to concentrate, move fast and focus, As you get better at it, the challenges keep getting harder. Mahncke said BrainHQ activities have different goals, from emphasizing speed to attention to details, to social cognition and working memory.

“The brain has a lot of different parts and a lot of different specialization. And we wanted to improve speed and accuracy in all those parts,” he said.

People doing real brain training can see measurable results, Bayles and Mahncke separately told the Deseret News.

Neurogrow users often say they feel changes in their brain, which makes them very motivated, Bayles said. “We have very low attrition rates because they know that it’s helping them.”

“What we reliably see with these kinds of exercises is they do improve cognitive function, memory, attention, speed — and they improve real-world function as well,” said Mahncke. “They generalize to things like driving safely or reducing depressive symptoms or preserving independent activities of daily living.”

Brain training’s promise

Let’s bury an old myth that the brain is static tissue. It’s not true. Imaging and other scientific tools show the brain continues to develop, since the process of neurogenesis carries on throughout life as long as the brain is stimulated, Bayles said.

“The brain changes itself by learning and experience. And as long as we can learn new things and have new experiences, that’s always going to change our brain. That is a scientific fact,” said Mahncke.

“We know that we can improve your brain function in all the ways we talked about,” Mahncke said. “People don’t say, this is the body I have and I can’t change it. They know — whether they choose to do it or not — that they can improve heart health by exercising or build muscles by lifting weights.” 

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He likens it to preventing Type 2 diabetes, which is — despite genetic risk factors — “fundamentally a behavioral disease.” People who eat the wrong foods and don’t exercise much are more likely to get the disease. The Diabetes Prevention Program has substantially reduced the number of people who develop Type 2 diabetes by showing people how to improve their metabolic health.

“This is very much where I believe the field is going to go: that dementia is a preventable disorder that we can affect by improving brain health in all these kinds of ways,” said Mahncke.

Both Mahncke and Bayles are convinced the brain can be retrained to overcome age-related and other challenges. But efforts can’t be one-size-fits-all. Brain training has to target specific parts of the brain with tasks that stimulate plasticity and neuronal growth, keener focus and more.

A brain is roughly 3.5 pounds of wet tissue that can be made healthier or less healthy based on a complex set of factors — just like any organ, Mahncke said.

You do different types of exercises for your brain, just like you do for your body, Bayles said. “You've got lots of different centers in the brain that perform different functions.”

He noted that with both dementia and depression, the frontal cortex is very important. But other parts of the brain need a workout, too.

Pharmaceuticals are tailored to specific problems and Bayles thinks software can be tailored the same way. 

“I think it’s possible to treat things like Alzheimer’s or even social things like shyness with clinical interventions that are software-based; I just think that they have to be developed very specifically for that thing,” Bayles said.

He doubts a program would effectively treat Alzheimer’s and schizophrenia and depression and memory loss. “I think the reality is we’re going to have to develop these targeted treatments for each of them individually, and maybe there will be some crossover. We are seeing that in our intervention for depression. Patients with Alzheimer's are also responding well to it.”

Is it ever too late to strengthen your brain? Both men say no.

“At least in our studies, we have had phenomenal results regardless of age and regardless of condition,” Bayles said. 

Lifetime prevention

Brain training is joining a list of tools that can nurture healthy brains that includes physical exercise, nutrition, controlling stress, social contact, sleep and other behavioral changes that are good for the brain.

Improving cognition doesn’t happen by just keeping your brain “busy.” Nor does improving your brain speed and accuracy require a brain training video program, said Mahncke.

Learning a foreign language can provide big benefits to brain health.

So can picking up tennis, which requires being fast and accurate as you figure out where that ball is and where it’s going.

Learning to play a musical instrument is great for the brain.

Even stimulating conversations help.

And physical exercise is one of the main ingredients for brain health.