Monday, September 15, 2014

Online Cognitive Training: Does It Work?

by Tracy Jones
CTE Website Administrator


Claims appear on the web sites of Lumocity, JungleMemory, and Cognifit, three of the online programs designed to train the brain or improve cognitive function. The marketing prose generates interest and enthusiasm for the possibilities these programs offer. But do these programs actually work? Claims on the brain training web sites:
  • “Could you train your self-control with a technique that’s so easy, you can do it while you eat, flip channels, or brush your teeth?”—Lumosity
  • “Can what you do today keep your mind sharp decades in the future, despite harmful physical changes in the brain? A new study in the journal Neurology suggests that cognitively stimulating activities could mitigate the effects of physical brain deterioration. Start a long-lasting habit today: train now and stay sharp.”—Lumosity
  • “Jungle Memory is scientifically proven to boost learning outcomes for students with learning difficulties, including Dyslexia and Autistic Spectrum Disorder. Evidence from clinical trials demonstrates that Jungle Memory improves IQ, working memory, and grades”
  • “CogniFit brain training program reduces depression and improves cognitive function. CogniFit brain training program improves sleep quality and cognitive function among older adults with insomnia” 
The premise for cognitive training (sometimes called brain training) is that the capacity of working memory can be expanded through brain exercises, much like calisthenics improve overall physical health. The effectiveness of brain training is that the gains achieved through playing the online exercises and games will generalize, or transfer, to untrained cognitive functions. In other words, “Successful cognitive training programs will elicit effects that generalize to untrained, practical tasks for extended periods of time” (Jak, Seelye & Jurick).  
 
The appeal of web-based or mobile brain training is that they can be made “available to global audiences and accessible to nontechnical users, as they can be seamlessly updated with the latest features and content each time a player visits the site.…The engagement and polish of well-designed lifestyle games have the potential to interest large demographics and help players find the drive to participate more deeply in life-benefitting activities on a regular basis” (Baxter). “Novel cognitive training platforms, including computers and video games, can be readily disseminated to an older population” (Kuider, Parisi, Gross, & Rebok). Online brain training has the potential of replacing or supplementing traditional cognitive training that occurs in a group or individual format and requires much more logistical planning and execution, therefore incurring more cost. The potential benefits of successful brain training are far reaching. Jak et al. stated the following: “Enhancement of cognitive functioning has become increasingly important as the population ages and the prevalence of Alzheimer’s other dementias continues to rise. Even a modest delay in the onset of dementia would result in …numerous benefits to quality of life. Other clinical populations including patients with attention deficits, stroke, traumatic brain injury, spinal cord injury, and psychiatric disorders could benefit from cognitive enhancement. Also, there has been a trend for cognitively healthy individuals of all ages to turn to cognitive enhancement strategies with the hope of improving their cognitive functioning for personal efficiency, professional advantage, and/or academic success.” 
 
Findings 
 
The research materials supplied by the brain-training web sites provided very little peer-reviewed commentary or research data. Many of the studies had been written and conducted by employees of the companies, which brings to mind the issue of conflict of interest. As expected, the materials produced by the companies, found brain training to be beneficial for all demographics and learning needs. Hardy et al. described a number of studies that support cognitive improvement in older populations and evidenced generalization of specific cognitive skills to measures of real-world function. Additionally, the test subjects continued to demonstrate retention of those improvements 12 months after the training was completed. This success addressed the concerns that gains made with the online program dissipate rapidly after the learning experience ends. Additional studies were sponsored by the online training companies that produced positive results for young adults, children, and test groups with conditions that impact cognitive functions. 
 
A few independent studies support the claims of these online brain training companies. However, many of the studies qualify their findings with possible alternative causes for the success. Kuider et al. conducted a meta study to evaluate all studies to date that evaluated the effect of brain training on cognitively healthy older adults concluding that the “…neuropsychological software programs appear to positively impact cognitive performance”. Kuider et al. temper their resounding endorsement by stating that they were not able to conduct a traditional meta-analysis because of the variability of the studies evaluated and the wide variety of outcome measures used to report results. 
 
Although the study conducted by Jolles and Crone reports positive outcomes, they, too, propose that “Training-related changes in information processing are not necessarily caused by long- lasting alterations of the underlying brain structure…training may improve performance by encouraging children to use the strategy, without inducing structural changes of the brain that increase working memory capacity” Jolles and Crone caution that not all brain training is beneficial for all demographic groups. Also, they recommend that additional research is needed. 
 
A study conducted by Peretz et al. examines the difference between the gains made by conventional computer games versus personalized computerized cognitive training such as the programs in consideration in this article. Peretz et al. found that while both types of games improved cognitive performance, the personalized cognitive training was significantly more effective. The study conducted follow-up testing with the same subjects three months later where results continued to indicate significant retention of improvement. While these findings proved to be edifying, the authors concluded that “further studies are needed to evaluate the ecological validity of these findings”. 
 
Research That Denies Efficacy 
 
There appear to be an equal number of studies that provide evidence that cognitive brain training does NOT increase cognitive function. Melby-Lervag and Hulme conducted a comprehensive review of twenty-three studies of memory using meta-analysis and found that, “Memory training programs appear to produce short-term, specific training effects that do not generalize…current findings cast doubt on both the clinical relevance of working memory training programs and their utility as methods of enhancing cognitive functioning”. They went on to say, “Current training programs yield reliable, short-term improvements on both verbal and nonverbal working memory tasks”. There is no clear evidence of improvement long term or gains far-transfer effects. However, Melby-Lervag and Hulme qualified their findings by calling for additional work on improving the training methodology used by these online programs. If long-term retention improves, it is possible there may be discernable evidence of far-transfer, or generalization. 
 
Apter’s analysis of 10 years of working memory training research showed an adamant denial of the effectiveness of any type cognitive training, both on line and traditional, citing that the basic premise of the effort was erroneous. His thorough discussion of the theories put forth by noted researchers support the idea that short term memory or working memory has a fixed capacity and that the apparent increase in performance was due to the learning of strategies to better organize content, and did not demonstrate any increase in memory capacity. Apter pointed out that the research that produced these initial working memory theories was small in scale and inexact; therefore, not necessarily a solid basis on which to construct additional theory. Apter called into question Klingberg’s body of work that reported the success of the computerized programs by noting that Klingberg had been the inventor of Cogmed, the system he used in his studies, and also served on the board of the product’s marketing company. He went on to specify methodological problems surrounding the research, calling into question control and experimental conditions, no follow up on gained skill retention, and inadequate screening of the test subjects. He concluded by saying that the usefulness of “adaptive computerised training programmes such as CogMed and Jungle Memory is weak. They require significant amounts of user time, and are costly to buy”. 
 
Research that Neither Confirms or Denies Efficacy 
 
There is a body of research that provides mixed reviews. For example, the literary review by Jak, et al. had the following to say, “Unfortunately, many studies of electronic cognitive training programs are hindered by methodological limitations such as lack of an adequate control group, long-term follow-up and ecologically valid outcome measures.” Additionally, an article in the science journal Nature, reported that the largest trial to date in 2010 of brain training computer games found “absolutely no transfer effects” (Katsnelson). Scientists conducting the study supported their position through analysis of the data. However, Katsnelson went on to interview scientists who questioned the validity of the test pool and length of study, which negated any definitive findings. 
 
Conclusion 
 
All of the references cited in this article conclude with various recommendations for further study of the topic. The validity of the research that supports the claims of the online brain training programs is suspect because of possible conflict of interest by the study authors and questionable research methodologies (such as lack of control groups and inadequate length of study). The studies that deny efficacy consistently conclude their findings by stating that more study needs to be done to confirm the data. In addition, several studies neither confirm nor deny that online brain training works. This body of research also recommends additional studies be done to determine an outcome. Jak et al. aptly summarizes the position by this author regarding the findings generally found in all the studies, both positive and negative, “While data is promising and negative side effects from computer-based cognitive enhancement strategies are likely minimal, the current base of scientific evidence is insufficient to support many commercial claims of the efficacy of their computerized cognitive enhancement systems”. 
 
References 
 
Apter, B. B. (2012). Do computerised training programmes designed to improve working memory work? Educational Psychology In Practice, 28(3), 257-272. 
 
Baxter, M. (2011). Brain health and online gaming. Generations, 35(2), 107-109. Retrieved from http://search.proquest.com/docview/906523146?accountid=7113 
 
Hardy, J., Farzin, F., Scanlon, M., (2013, October) The science behind Lumosity version 2. Retrieved from http://cdn-hcp.lumosity.com/uploads/asset/file/49/The_Science_Behind_Lumosity_v2.2.pdf
   
Jak, A. J, Seelye, A. M, Jurick, S. M. (2013). Crosswords to computers: a critical review of popular approaches to cognitive enhancement. Neuropsychology Review, 1, 13-26. 
 
Jolles, D., Crone, E. (2012). Training the developing brain: a neurocognitive perspective. Frontiers in Human Neuroscience 6(76). doi: 10.3389/fnhum.2012.00076 
 
Katsnelson, A. (2010). No gain from brain training. Nature, 464(7292), 1111. Retrieved from http://search.proquest.com/docview/193894465?accountid=7113  
   
Kueider, A.M., Parisi, J.M., Gross, A.L., Rebok, G.W. (2012, July). Computerized Cognitive Training with Older Adults: A Systematic Review, PLoS ONE 7(7). doi: 10.1371/journal.pone.0040588  
 
Melby-Lervag, M. & Hulme, C. (2013, February). Is working memory training effective? A meta-analytic review. Developmental Psychology, 49(2), 270-291. doi: 10.1037/a0028228 
 
Peretz, C., Korczyn, A.D., Shatil, E., Aharonson, V., Birnboim, S., Giladi, N. (2011). Computer-based, personalized cognitive training versus classical computer games: a randomized double-blind prospective trial of cognitive stimulation. Neuroepidemiology. 36(2):91-9. doi: 10.1159/000323950.