Does Brain Training Really Work?

This post was edited by Mike Battista, Director of Science and Research at Creyos (formerly Cambridge Brain Sciences).

You may have heard the term “brain training” in the news, from cognitive research, or even from ads on your favorite phone game. Brain training tools, apps, and games claim to boost consumers’ brain health when they solve daily puzzles.

But does brain training really work?

With so many tools available, it can be tough to discern which are helpful—and which are making spurious claims. In this article, we’ll cover the ins and outs of brain training, assess claims of its effects on brain health, and explore how cognitive functioning is measured. By the end, you’ll have a better idea of how to advise your patients on how to improve their brain health!

What Is Brain Training?

“Brain training”, also called “cognitive training”, is a general term referring to any app or game-based virtual exercise that is said to improve cognitive abilities.

That’s a pretty broad definition—which is one of the shortcomings of brain training tools. Different apps and articles say different things about how brain training works, and even define brain training differently.

Some compare brain training programs to physical workouts but don’t tell you what, exactly, is being exercised. Others claim that brain training has cognitive benefits such as improving neural connections or brain plasticity. Most simply describe the supposed effects of brain training—that is, improved cognitive skills.

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Brain Training and Cognitive Skills

Some of the cognitive skills brain training programs are said to develop include:

• adaptability
• decision making
• emotional regulation
• executive function
• focus
• memory
• problem-solving
• reasoning

Types of Brain Training Activities

Some activities said to help train up cognitive skills include:

• Apps. Popular brain training apps include Lumosity and BrainHQ.
• Games. Video games like Brain Age are some of the most vocal sources of the brain training games trend.
• Puzzles. Crossword and jigsaw puzzles are often said to build cognitive functioning.
• Creative pursuits. Practicing creativity means solving problems. This can be while painting, writing, crocheting, or any creative hobby your patients enjoy!
  
  

Does Brain Training Really Work?

Brain-training apps and games claim to “boost your brain,” but what does that really mean? Recent studies have dug a little deeper into whether brain training apps really build cognitive skills, and to what extent.

Unsurprisingly, the answer is complicated! Overall, few independent studies have found far transfer and long-term effects. The majority of independent results found only near transfer. The short answer is that brain training tasks help improve performance—but only on those same tasks.

Below, we discuss what cognitive functions are targeted by brain training apps and activities—and which aren’t.

Building Cognitive Skills: How Brain Training Works

Cognitive training tools make use of a number of different terms when discussing the development and transference of cognitive skills, including:

• Working memory: How short-term memory helps us function in the world. Working memory refers to the short-term recall required in decision making and executive function.
• N-back: A popular brain training task that measures working memory, similar to card matching games like Concentration.
• Dual n-back: A complex version of the n-back. Instead of being asked to focus on one stimulus, patients are asked to focus on two at the same time, in different formats, e.g., one visual and one auditory.
• Complex span task: A short-term memory task interwoven with another processing task, like judging symmetry. Functions similarly to Spatial Span.

The Science Behind Brain Training

In one study published in the Journal of Cognitive Enhancement, participants were trained on two tasks: a complex span task and a dual n-back task. Participants were then tested on related memory tasks and given a test of overall fluid intelligence; their brain activity was also measured by EEG.

This study showed that cognitive training did help with some memory tasks—as long as those memory tasks were similar to the ones being regularly practiced. This is known as “near transfer”—when practicing a skill makes a person better at that skill.

While near-transfer skills are important to develop, whether this can reasonably be called “brain training” is another matter. Better to call it “practice”! Think about physical health activities like calf raises: they aren’t full-body workouts, but exercises targeting a particular area. Brain training tasks offer similar targeted benefits to improving at the specific task.

One 2016 meta-analysis of brain training agreed that “far transfer” skill development—that is, improvement in cognitive skills across dissimilar contexts—is not evidenced in cognitive training that targets working memory. Another study in the Journal of Experimental Psychology even found no performance improvement on cognitive function tests between those engaged in regular “brain training” activities and those who were not.

Overall, the research shows good near transfer and some intermediate transfer reflected in brain training programs. However, far transfer—skill development with high transferability to other cognitive domains—is not currently supported by brain training.

How Patients Can Improve Brain Fitness

Ideally, brain training would provide holistic skill improvement across all cognitive areas. But all is not lost! We know that brain training has some impact on brain activity; what we don’t know is how, exactly, it works. As research on cognitive training improves, we’re learning that dynamic, complex, and variable challenges are the best way to build cognitive skills across domains.

In other words, brain training apps may still be good options for patients looking to build cognitive skills—provided a number of different skills are being tested. Dual n-back testing is particularly helpful for measuring working memory.

Potential Use Cases: Who Can Brain Training Help?

Brain training is often recommended to anyone looking to improve their cognitive abilities, from patients with mild cognitive impairment (MCI) to people looking to increase their IQ. But who can brain training really help? More research is needed to validate any of the claims made by brain games apps. Below, we break down the research supporting—or not supporting—cognitive training as an intervention for various groups below.

1. Slowing Cognitive Decline in the Elderly

In one 2015 study of older Finnish adults considered at risk for cognitive decline, participants partaking in regular brain training—among other interventions—showed slowing of cognitive decline in some cases and better cognitive function test performance in others.

This makes a certain degree of sense—we know regularly solving sudoku and crossword puzzles can factor into improved cognitive performance testing. But, while these findings are promising, the importance isn’t necessarily in cognitive training by itself.

A multi-pronged intervention against cognitive decline is more important than brain training alone. Diet, exercise, social habits, and monitoring of comorbidities were also closely measured as part of the study, and were crucial contributors to the positive results.

Further reading:How to Talk About Cognitive Health Care with Patients

2. ADHD Management

Science on the effect of brain training on ADHD symptoms is conflicting. One 2015 study suggested—with caveats—that brain training may help to develop attention skills, but has little effect on impulsivity. A 2020 review of ADHD–brain training studies, meanwhile, noted that 13 out of 18 assessed studies identified an improvement in executive functioning among children with ADHD, while 5 did not.

This said, the science is quickly evolving, with new areas of research always emerging. One 2021 study was able to track the emergence of P3 brain waves—which are linked to informational integration in the brain—following cognitive training interventions.

As with elderly populations, cognitive training is likely a helpful intervention in the sense that any intervention has results when compared against control populations. Put another way, if individuals with ADHD are given an intervention and compared to healthy controls without ADHD, that may not be grounds to conclude an effect.

There’s no clear reason not to recommend cognitive training as one possible way to help with ADHD management—especially recommended among other interventions in a multi-pronged approach.

3. Sports / Brain Injury Recovery

Support is strong for the usefulness of brain training in recovering from traumatic brain injury (TBI)—in certain areas. Studies in 2019 and 2020 showed that cognitive training helped to increase cognitive functions on certain markers (like executive function) among recovery groups, while showing little or no improvement in other areas (such as information processing).

Yet these studies, again, target demographics for intervention and compare them against control groups without intervention. As noted by the authors themselves, these studies don’t necessarily measure the degree of effectiveness of brain training. Nor do they accurately account for other neuroplastic effects such as spontaneous recovery and maturation. They also do not account for the benefits of physical therapy or other rehabilitation efforts in addition to brain training.

As one possible intervention, cognitive training may have positive effects among TBI recovery patients. But—as with other examples—it shouldn’t be considered a magic bullet, and other interventions may aid with recovery alongside.

4. Daily Skills & Preventative Care

While brain training can be a helpful factor in improving or maintaining cognitive health, there is a difference between whether brain training itself enhances cognitive skills holistically—and whether it simply improves cognitive performance on par with other interventions.

This said, recommending cognitive maintenance as a part of routine healthcare has numerous benefits. The puzzles and activities involved in brain training may be recommended to patients as one aspect of cognitive care planning—as long as it’s not the sole point of intervention!

Why Benefits and Results May Vary

The truth about brain training is that it’s not always clear how effective it really is. Brain science is a rapidly evolving field, with new measures and methodologies emerging all the time.

Brain science is also quite an opaque field—something app developers may use to their advantage. Below, we discuss a few reasons why the potential benefits of cognitive training aren't always clear-cut—and how to separate the emerging science from spurious claims.

All Brains Are Different

As healthcare moves toward a more individualized approach to patient care, assessing patients on their own terms has become an increasingly key aspect of care provision.

We know that intelligence is an emergent property of anatomically distinct cognitive systems, each of which has its own capacity. In other words, intelligence skills are dependent on numerous factors, including genetics, environment, lifestyle, and others. The same factors can affect cognitive improvement and decline.

In other words, while brain training may be an effective intervention for some people, it may not produce significant improvement in others—even within the same group. There is no bulletproof, one-size-fits-all patient treatment: as true in cognitive care as in any other area of patient care.

“Brain Training” Definitions Vary

How one study, app, or product defines “brain training” may be completely different from the next. Methodologies, measurements, and studied areas of performance vary widely.

Because of these various or unclear definitions, there’s no guarantee that a brain training product actually does what it claims. An app that claims to provide cognitive training may provide nothing more than simple matching puzzles—a fun diversion, but not really training your brain.

Brain Training Might Not Always Be Scientifically Validated

Many brain training activities are linked to scientifically validated measures, but the variability of brain training platforms means that it can be hard to discern which are and which aren’t. While some exercises measure performance in relation to working memory, for example, others may not consider working memory relevant to their findings.

Finding out which cognitive training activities are actually based on scientific measures can be a task in itself, which can pose an obstacle when recommending brain training to patients. It may not be enough to recommend cognitive training generally—the activities’ effectiveness may depend on whether they’re scientifically backed.

Improving Brain Health and Fitness

We’ve discussed that brain training can form one part of a cognitive care plan. But while brain training can be good for the brain in the sense of improving individual skills, we know it’s best used as one part of a multi-pronged approach, and not guaranteed to improve cognitive performance on its own.

This said, being committed to building mental fitness is one example of a good habit that can contribute to brain health. Like intelligence, brain health is built on a foundation of numerous different factors, including:

• Forming good habits. This can include making a habit out of brain training, or just solving puzzles, such as crossword puzzles. But it can mean a lot more! Regularly reading a book is an example of a habit that creates all kinds of positive relations in the brain.
• Learning and practicing complex skills. This is one of the best ways to work the transferrable mental skills brain training claims to improve. Choose a skill with:
  • Challenge. Problem-solving is one of the most important skills in cognition and an especially great way to build working memory!
  • Complexity. Complexity is the key factor in why n-back testing and complex span tasks are thought to be good methods of cognitive development.
  • Lots to practice. As you learn a new skill, you develop strategies and efficiencies that develop mastery. This is what brain training and skill-building have in common: brain training allows you to perfect the skill of brain training games. Practicing a wider array of skills means a wider array of cognitive benefits.
• Physical activity. It’s well known that exercise and daily physical activity is shown to help with mental health, but it can also help improve performance in nearly every domain of cognition.
• Social interactions. Strengthening cognitive skills can be as easy as hanging out, catching up, or even striking up a conversation while walking the dog.
• Sleep. Many studies have shown that getting enough sleep is crucial for supporting health brain functions. What "enough sleep" means varies person to person, but approximately 7 hours is a common recommendation.
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Measuring Cognitive Performance

As you integrate and interrogate cognitive care in your patient care workflows, you or your patients may be on the hunt for a dynamic, variable, scientifically backed tool for measuring cognitive performance. Creyos Health offers just that, allowing clinicians to administer 12 core tasks of cognitive function, including standard questionnaires such as the Patient Health Questionnaire (PHQ-9).

My patients really appreciate the feedback they get from completing the Creyos assessments. And they find completing them fun! It's like a little game. But we get so much information out of it, that even when we administer a longer assessment, it's worth it!

— Gabrielle Thompson, Founder and FNP-C, GT Healthcare

With Creyos’ support, clinicians can monitor patients’ cognitive performance, track cognitive changes, and measure the positive results and effectiveness of treatment. Administering these cognitive tasks comes with a user experience as engaging as brain games, but with the backing of decades of scientific research.

These cognitive maintenance healthcare tools allow clinicians to generate easy-to-understand reports to improve communication with patients, family members, and caregivers, and enhance practice offerings in cognitive care.

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Final Thoughts: The Brain Can Change

Though brain training isn’t the magic bullet for cognitive health it claims to be, there’s plenty of good news when it comes to enhancing cognitive skills. A multi-pronged approach—including a complex and varied lifestyle—and scientifically backed tools can go a long way toward getting a picture of cognitive performance and implementing strong patient care when it comes to cognitive health.