Imagine yourself immersed in a virtual reality game, traveling through a digital universe, slaying monsters, racing cars, climbing mountains. As you race through this universe, your pulse quickens, and your senses sharpen. Now imagine when you finish, a quick brain scan finds you boosted your brain’s capabilities. This game trains your brain just as a vigorous workout trains your body. Have fun, exercise your brain, and get smarter with digital games, a triple win. We are now on the threshold of this new technology and digital medicine is already enhancing brains.
Ann Linsey is a pioneer in this realm. At age sixty-five, she joined an innovative research study at the University of California at San Francisco (UCSF) to test whether playing a digital game could improve her cognitive skills. “As you get older, it seems harder to do more things at once,” she says.[i] Could playing a video game help Ann and others juggle multiple tasks?
Games as Digital Medicine
Adam Gazzaley and his neuroscience lab at UCSF, along with volunteers like Ann, set out to answer that question. Technology innovators, game makers, educational technologists, and neuroscientists have long believed that computer games could build cognitive skills, much like flight simulators train aircraft pilots. Could the thousands of hours spent playing video games provide lasting benefits beyond the fun and excitement of the game?
However, despite brave claims and anecdotal evidence, there was little data, until recently, to support the conjecture that gaming skills translated into general improvement on performance in real life.[ii] Could digital games targeted at specific brain functions increase such abilities?
The Neuroracer Game
Gazzaley’s UCSF team at the Neuroscape lab collaborated with Lucas Arts to design the video game Neuroracer. Their goal was to help improve the ability of older adults to switch smoothly from one task to another. Most people have had the experience of trying to do several things at once and then forgetting what their original goal was. As Ann Linsey noted and researchers have documented [iii] this ability to “multi-task” declines as people age.
Learners play Neuroracer seated at a familiar looking game console. They drive a virtual race car along a hilly and winding road that calls for fast thinking and quick maneuvers. When certain types and shapes of signs pop up, the player tags them with a button click.
The UCSF team had three research goals. First, they wanted to replicate and confirm earlier research showing that task switching skill (commonly mislabeled as “multi-tasking”) declines with age. Second, they wanted to find out if playing Neuroracer, which specifically targeted task switching skill, could improve this ability in older adults. Finally, Gazzaley hypothesized that improving task switching ability would also improve the closely related functions of attention and working memory.
To begin the first phase of this study, the team recruited about 30 participants, drawn from six different decades of life, from the 20s to the 70s. These participants played the game in the lab and set the baseline scores for later phases. The results confirmed the earlier research showing that younger game players scored significantly higher on Neuroracer than older players. The scores decreased in a smooth line, with task switching skill eroding beginning in the 20s and continuing with each passing decade. There was no steep decline, at say, 60 years old.
For the second phase, with this baseline established, Gazzaley and his team recruited 46 participants, aged 60-85 years old, one of whom was Ann Linsey. They ran these participants through a four-week training program on a version of Neuroracer that adapted to the player’s skill level. As the players improved their ability to switch between the driving task and the sign tagging task, the game got harder. At the end of the training period, these participants had improved their task switching skills impressively. In fact, these trained older players now scored higher than the untrained 20-year-olds in the preliminary study. Re-tested six months later, with no additional practice, these older players retained their improved task switching skill.
To achieve the third goal, Gazzaley tested the older Neuroracer players to see if playing the game targeted at improving task switching skill also improved attention and working memory. A battery of cognitive tests showed that working memory and sustained attention, although they were not specifically targeted by Neuroracer, also increased for these participants. Gazzaley explains that although the game emphasizes task switching, Neuroracer also calls on focused attention and working memory. These results support the idea that closely linked brain networks can improve together. Gazzaley’s team reported these astounding results in a cover story in the scientific journal Nature.
What is the Science?
What enables us to navigate our complex world each day? An ability that psychologists call “executive function” guides our brains. This “cognitive control” mechanism, the term used by neuroscientists, consists of these three separate abilities functioning together: attention, working memory, and cognitive flexibility. Attention is our ability to focus our thinking capacity on our specific goals. Working memory is the capacity to process and manipulate information based on what we’ve learned. Cognitive flexibility is our capacity to move between multiple goals. Working together, these abilities give us great power to discover, create, and thrive.
However, each of these abilities has important limitations. For example, we can focus our attention like a laser on a specific, narrow task, but we can’t focus anywhere near as well on a broad topic. That’s why chunking a big project into small tasks works so well. Also, working memory has a very limited capacity and persists for a very short time. That’s why we can easily forget a ten-digit phone number someone just gave us before we can enter it into our contact list.
Cognitive flexibility is also more limited than we like to think. Although it is a popular myth, neuroscientists now know there really is no such thing as true multitasking, just the ability to shift rapidly among tasks. Each time we shift tasks, our performance on each of these tasks suffers a bit. Our whole ability to make these shifts fluidly declines as we age, just as Ann Linsey noted above. When we overtax our cognitive flexibility, we find ourselves saying, “Now what was I doing?” or “Why did I come into the kitchen?” Our modern technology amps up these challenges as our media environment continually bombards us with ever more information, images, and enticements.
Gazzaley wants to flip this scenario and use modern technology to increase our cognitive control abilities. He knows this is possible because our brains can change. One of the most important findings in neuroscience is neuroplasticity, the ability of our brains to grow and change throughout life.
Scientists once thought the human brain was permanently set once it reached maturity. After that, the brain could learn, but could not add new brain cells. Brain cells once lost could not grow back. People could not regain abilities lost from disease or injury. But now we know that under the right conditions, the brain can develop and redevelop based on powerful experiences and the right stimulus. Gazzaley and his team demonstrated that playing specifically targeted video games could improve cognitive function and forge new neural networks.
Can I buy this now?
Using the successes in the lab, Gazzaley applied for and received a patent for the processes of neurological improvement they developed. He formed a company, Akili Interactive, to bring these lab results to the public. Akili conducted extensive field studies and enhanced the game technology. In June, 2020, the FDA approved EndeavorRX as a treatment for Attention Deficit Hyperactivity Disorder (ADHD). EndeavorRX, descended from Neuroracer, is the first-ever prescription video games. Akili now delivers this game therapy to children ages 8 to 12 with ADHD as part of their overall treatment program. Players access the game in their own homes on their own digital devices.
There is much hope for this whole avenue of digital medicine and the technology shows promise to improve a range of brain functioning. Chief Medical Officer Anil S. Jina says, [iv]“It basically improves attention control, which is one aspect of cognition, and that is part and parcel of many different disorders.” Akili is also testing this technology as a diagnostic tool for Alzheimer’s disease, a therapeutic treatment for depression, multiple sclerosis, cerebrovascular dementia, autism, and traumatic brain injury. In May 2021, Akili secured $160 million in funding for further development of treatments for cognitive disorders.
In addition, clinical trials are currently evaluating EndeavorRX as a treatment for COVID “brain fog,” the lingering cognitive symptoms experienced by some people who have recovered from COVID-19. New studies continue to document post-COVID cognitive impairment, including diminished working memory and faltering attention.
Although Gazzaley cautions that digital games are not a cure-all and that much work remains to be done, digital medicine shows great promise. Enthusiastic about her experience, Ann Linsey says, “It’s been exciting to discover the older brain can learn—and I’m glad my own brain helped make the discovery.”[v]
[iii]Age-Related Differences in Multiple Task Monitoring. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4162647/