Training your brain may improve focus and attention

By Sandee LaMotte, CNN

(CNN) — Brain-training games are all the rage, but whether they prevent cognitive decline has been debatable. Studies in recent years have gone back and forth on the topic, with no definitive conclusion.

Many people have started playing Wordle or doing crossword puzzles, but those brain ticklers don’t appear to improve overall cognition, CNN Chief Medical Correspondent Dr. Sanjay Gupta recently told viewers on CNN.

“What crossword puzzles and word games are probably really good at is making you better at crossword puzzles and word games,” Gupta said. “People often use brain-training exercises with the hopes of reducing their risk (of dementia). Truth is, there’s not a lot of data on this to suggest it actually reduces your risk for dementia.”

But there’s a new twist to that scientific conundrum: According to a new clinical trial, the success of brain training in slowing cognitive decline may depend on the type of game and how it affects certain neurotransmitters in the brain.

Brain games that focus on boosting attention and improving processing speed — like BrainHQ’s Double Decision and Freeze Frame — appear to preserve acetylcholine, a key neurotransmitter, according to the new research.

Acetylcholine is an “excitatory” neurotransmitter and neuromodulator, which “functions like a switch to make the brain more awake, more focused and attentive,” said senior study author Etienne de Villers-Sidani, an associate professor in the Department of Neurology and Neurosurgery at McGill University in Montreal.

When acetylcholine is activated, it changes the activity of the entire brain, said Dr. Michael Merzenich, professor emeritus at the University of California, San Francisco and co-founder and chief scientist of Posit Science, which makes BrainHQ, a for-profit brain-training company.

An elder statesman in the field of neuroplasticity, Merzenich and two other scientists received the prestigious Kavli Award in Neuroscience in 2016 for their groundbreaking discoveries that the adult brain could change, adapt and create new neural connections throughout life. Prior to their discoveries, it was thought that the brain was unable to change or regenerate after a certain point in early adulthood.

“This is the first human study to document an upregulation of acetylcholine, which is absolutely crucial for sustaining brain plasticity in aging,” Merzenich said.

Upregulation causes a cell to add more receptors for a neurotransmitter, thus boosting its ability to respond.

“This is an important study because the training had a brain-wide impact — it’s not limited to the very narrow set of processes that people were trained on,” Merzenich said. “We’re talking about a fundamental physical chemical change that we know really matters as a contributor to brain health.”

The discovery adds to existing knowledge about how to prevent cognitive decline, said preventive neurologist Dr. Richard Isaacson, director of research at the Institute for Neurodegenerative Diseases in Boca Raton, Florida.

Eating a well-balanced diet, improving sleep and getting regular exercise are all proven ways to enhance brain power and overall vitality. Research has also showed that engaging the brain in new ways builds cognitive reserve, which is how the brain can maintain its functioning in the face of aging, damage or early stages of disease.

Brain training can be one of the many ways to build cognitive reserve, Isaacson said.

“There is no one magic pill to prevent dementia, but a combination of interventions can help people take control in the fight against Alzheimer’s,” he said. “Because of the science, I’ve suggested these exact BrainHQ tests as a component of a cognitive engagement plan, along with learning a new language, playing a new instrument or taking up a new hobby, like dancing or photography.”

The games they played

The study, published Tuesday in the peer-reviewed gaming journal JMIR Serious Games, randomized 92 relatively healthy older adults from Quebec into two groups. Each group was asked to do 30 minutes of daily brain training for 10 weeks.

The control group played the card game Solitaire and Bricks Breaking Hex — which requires the user to break bricks in groups of the same color — at their own pace. The intervention group played BrainHQ’s Double Decision and Freeze Frame modules, which became progressively harder as players improved.

Freeze Frame displays a target image and then a series of other images, asking the user to click “no” for every wrong image. Double Decision briefly shows the user one of two cars in a desert, along with a Route 66 sign that can appear anywhere on the screen. To do the training correctly, the player must quickly click on the correct car and the location of the sign.

An earlier version of Double Decision was used in the 2001 ACTIVE trial (Advanced Cognitive Training for Independent and Vital Elderly), which found that cognitive gains from the training were still present at a five-year follow-up.

Cognitive and other testing was done before and after the training and at a three-month follow-up. Acetylcholine was measured by PET scans.

According to the scans, the intervention group had a 2.3% increase in the upregulation of acetylcholine after the 10-week high speed training. The improvement was in key areas of the brain responsible for memory and decision-making, said functional imaging specialist Dr. Raj Attariwala, founder and medical director of AIM Medical Imaging in Vancouver, who was not involved in the study.

This improvement nearly countered the average 2.5% decline in acetylcholine that occurs naturally in each decade of life. The control group, however, had no significant benefit.

Although the study advances science in the field, it’s too soon to draw conclusions because the “work is early stage (and) effect sizes are small,” said brain game researcher Aaron Seitz, a joint professor of psychology, game design, and physical therapy, movement and rehabilitation services at the Northeastern University Bouvé College of Health Sciences in Boston. He was not involved with the study.

“It will be important for others to replicate these findings before we can reliably conclude that acetylcholine production is upregulated by these types of computerized exercises,” Seitz said.

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