Anguera JA, Boccanfuso J, Rintoul JL, Al-Hashimi O, Faraji F, Janowich J, Kong E, Larraburo Y, Rolle C, Johnston E, Gazzaley A.
Video game training enhances cognitive control in older adults.
Nature. 2013 Sep 5;501(7465):97-101.
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This is a well-designed video game training study reporting improvement in cognitive control in older adults. It was conducted by a well-established and respected group of investigators. The findings, as the authors acknowledge, are preliminary, given the limited sample size of 46 healthy older adults with 16 receiving multitasking (MMT) training and 15 receiving single task (SST) training.
Some strengths of the study include: 1) the baseline study conducted prior to training study to examine performance levels of two key tasks across a wide age range; 2) development of an adaptive staircase algorithm that guided the adaptive training paradigm; 3) examination of transfer to working memory and attention tasks; 4) 6-month follow-up; 5) inclusion of an active training condition that involved training on 2 single tasks (signs, driving); and importantly the examination of neural activity related to training improvement.
However, to review and evaluate the training findings, it is important to understand the actual focus of the training and what types of transfer measures were examined. From the Nature article and supplementary material, the primary focus of MMT was on the speed component of the multitasking performance of the subjects, not to improve accuracy on multitasking per se. Prior to training, thresholds for the sign and drive tasks were determined for each individual such that each participant would perform at 80 percent accuracy at baseline. That accuracy is a high baseline criterion, and is often the criterion set for end of training success for studies focusing on improvement in accuracy on a cognitive task. The supplementary material indicates that several subjects were not enrolled due to inability to meet the 80 percent accuracy criterion at baseline. In future work with MCI or dementia subjects, a focus on improvement in accuracy of multitasking, rather than solely on speed of multitasking would need to be considered.
Given the focus on improved speed of performing multitasking, it is not surprising that the working memory and attention tasks that did show transfer effects also had reaction time as a dependent variable. The tasks also involved recognition rather than recall in working memory. Many of the standard working memory (updating) tasks focus on accuracy and recall, not on reaction time solely.
Training on a simulated driving task added some real world value to the findings and appears to have increased participant motivation and interest in the training. However, future research would need to validate the training task with more direct measures of driving performance.
As in much cognitive training research, the subject sample is positively selected. Notably, subjects who were on hypertension medications were excluded (Methods Summary), which would result in exclusion of a considerable portion of cognitively normal elderly.
The design of the baseline study that compared performance at different ages is cross-sectional is cross sectional and thus the findings show age differences in multitasking cost, not intra-individual longitudinal change. The slope (Fig 2) is steeper at age 40 - 60 years than reported by longitudinal studies that have examined working memory with accuracy as the dependent outcome in cognitively normal elderly.
The examination of neural correlates of training improvement is to be highly commended. Focus on the default mode network and the medial prefrontal node has the potential to contribute to current research on the default mode network as an early measure of preclinical dementia.
Lastly, the maintenance of training effects at 6 months is encouraging. The ACTIVE trial has recently reported maintenance of training effects at 10-year follow-up (Rebok, G. et al., in press).