Brain training app used to treat memory condition

"Brain training games boost the memory and may reduce the risk of dementia, new research suggests," The Daily Telegraph reports.

Researchers used an app called Game Show to treat people with amnestic mild cognitive impairment.

Amnestic mild cognitive impairment, which is characterised by problems with short-term memory worse than expected for a person of that age, can be the first sign of dementia. But not everyone with this condition will go on to develop full-blown dementia.

The app game involved associating different geometric patterns with different locations. The small study, involving 42 adults, found playing games on the app for eight hours over four weeks improved the participants' performance in memory tests.

The participants also reported that they enjoyed playing the games and were motivated to continue using the app after the study ended. This would be important if the game was prescribed to help people with amnestic mild cognitive impairment in real life.

This research is in its very early stages. It's not yet clear whether the game would be able to improve the symptoms of people with this condition in everyday life, or slow the development of dementia.

As one expert commentator has pointed out, this type of training is unlikely to prevent or cure dementia, but may help with symptoms.

Get more advice on activities that may be useful for people with early-stage dementia.

Where did the story come from?

The study was carried out by researchers from the University of Cambridge and the University of East Anglia.

It was funded by a grant from Janssen Pharmaceutica/Johnson & Johnson, and the study's authors received funding from the Wellcome Trust, Eton College, and the Wallitt Foundation.

The authors note that they have consulted for or received grants from various medical companies.

The study was published in the peer-reviewed International Journal of Neuropsychopharmacology. It's open access, so it's free to read online.

Most UK news sources reported on the study using an appropriate degree of caution, given the early stage of the research.

The Times and The Daily Telegraph say that the app "may" reduce the risk of dementia or slow its progression in their headlines, and the Mail Online included a prominent section describing some of the study's limitations.

The Independent refers to the participants as having "early-stage dementia" in its headline, and the Mail Online also refers to them as having "early onset dementia". But this isn't quite correct.

The participants were older adults with mild cognitive impairment, a condition where people have problems with their memory that aren't severe enough to be classed as dementia. 

While people with mild cognitive impairment are at increased risk of developing dementia, not all will go on to develop the condition.

What kind of research was this?

This randomised controlled trial (RCT) assessed whether a new "brain training" app called Game Show might help people with a form of memory impairment with their memory difficulties. This study design is the best way to test treatments to see if they have an impact.

Participants in this study had amnestic mild cognitive impairment (aMCI). People with this condition have problems with memory that are worse than would be expected for a healthy person of that age, but not severe enough to be classed as dementia and don't affect their ability to perform everyday tasks independently.

The condition is more common in older people, and people with the condition are at increased risk of developing dementia.

The Alzheimer's Society reports that different studies have found between about 5 and 15% of people with aMCI develop dementia each year. The charity has published a factsheet on aMCI (PDF, 1.05Mb).

Amnestic mild cognitive impairment may also reduce motivation, which could have an impact on whether or not people with the condition take part in programmes that might help them, or stick with them.

There are no effective drug treatments for aMCI, but cognitive training – essentially a form of "brain training" – has been reported to show benefits.

The study's authors say that existing cognitive training programmes are reported to be boring and repetitive. They developed a cognitive training game and tested it to see if it would help with memory as well as be enjoyable to play.

What did the research involve?

The researchers enrolled 42 adults with aMCI and assigned them at random to either play Game Show for eight hours over four weeks, or just carry on with their usual clinic visits (the control group). They then tested their memory at the end of the four weeks.

The participants, who were about 75 years old on average, took a range of standard memory tests and had their symptoms assessed at the start of the study.

The two groups – game playing and control – were similar at the start of the study.

The participants took the memory tests again at the end of the four-week study.

The main assessment was the Cambridge Neuropsychological Test Automated Battery Paired Associates Learning (PAL), which assessed episodic memory, or the ability to remember locations and events.

This test involves being shown boxes at various positions on a touch-sensitive screen, and opening in a random order.

One or more boxes contain a pattern. The patterns are then shown again in the middle of the screen, and participants are asked to touch the box in which that pattern originally appeared.

The task increases in difficulty, starting with a single pattern, and ending with a series of eight patterns. If the participant makes an error, the patterns are shown again in their original positions, and the participant can try to locate them again.

The Game Show app employed a similar task of pattern and location mapping, but involved appealing and engaging visual displays, music, and a virtual "quiz show" host.

Participants in the group playing the game did so for an hour at a time on an iPad, and were supervised by the researchers while they did it.

After each hour of play, participants rated how much they had enjoyed the game and how much they wanted to continue playing, as well as their self-confidence and memory.

What were the basic results?

Playing the Game Show app improved various aspects of the participants' performance on the PAL test of episodic memory.

Compared with the control group, at the end of the four-week study Game Show players:

• made significantly fewer errors remembering where patterns were located in the two and three-pattern stages, but not at later, more difficult, stages
• took fewer goes to get the two-pattern stage correct, but not in the more difficult stages
• correctly located many patterns in their first go at each stage of the game

The people who played Game Show reported high levels of enjoyment and motivation to continue playing that lasted up to the end of the four-week study.

How did the researchers interpret the results?

The researchers concluded that episodic memory improved in people with aMCI by playing the Game Show cognitive training app.

Turning the training into a game improved motivation, and therefore engagement with the training.

The researchers suggest that the game "could complement [drug] treatments for aMCI and mild Alzheimer's disease", but more controlled trials are needed to confirm these findings and extend them to other groups.

Conclusion

This small trial suggests that an iPad game aimed at training episodic memory – memory of locations and events – can lead to improvements in this aspect of memory in older adults with aMCI.

The fact the study used a control group and an RCT design increases confidence in these findings.

But there are some important things to bear in mind at this very early stage:

• The study was very small – the authors acknowledge that it needs to be repeated in a larger sample of people to confirm the findings.
• The game hasn't been tried in people with dementia, so we don't know if it would help them.
• The study only followed participants for four weeks. More studies are needed to see how long the improvements last, especially if participants stop playing the game, and whether motivation to play the game is maintained in the longer term.
• The researchers largely focused on performance in specific tests of episodic memory. It isn't clear whether the benefits seen in these tests would mean that the participants' memories were better in everyday situations. The participants playing the game did rate their memory as better, but it's unclear if they just meant their memory performance in the game or their memory in general.
• The group that played the game did so under the supervision of research staff. This level of attention may have contributed to their feelings of motivation and confidence. The opposite is true of the control group, who knew they weren't getting to play the game. This could potentially contribute to the memory results seen. Ideally, in future studies the control group would have the same level of interaction with the research staff (an attention control) to make sure this doesn't have an effect.

As one expert commentator pointed out, this type of training is unlikely to prevent or cure dementia – but it may help with the symptoms.

With an ageing population, research like this is increasingly important. The use of technology like computerised touch screen games to deliver this training is very appealing, and could potentially be used in the home without the need for supervision.