Brain fitness: Casual gaming or preventative medicine?

Brains fitness: an introduction
Brains fitness: Just a game?

Games are a very powerful medium for health, education and social impact. The phenomenon was well captured at the Games for Health conference. Alvaro Fernandez, CEO of SharpBrains, created the Cognitive Health Track for the conference, where he covered convergence of the scientific, technological and demographic trends that led to creation of a new market: software and online applications that can help people of all ages assess and train cognitive abilities.

Below, I talk with him about the difference between casual gaming and evidence-based brain fitness tools.

I see a whole range of games, especially on the mobile platform now. But they’re just casual games, not fitting into this brain fitness category.  The missing link is the evidence that these types of interventions are effective.  Where is the consensus view that this training leads to transferable results, so they really improve something in the every day lives of people?

Let me first talk about all those casual games that you mentioned appear in many mobile platforms and then I will talk about the research and the transfer.  What I think is important to recognize is that consumers are not stupid.  We talk to consumers all the time and we do many market surveys.  Many times they buy all those games and they don’t really expect any medical intervention, instead they seek just entertainment. Why do people do crossword puzzles to start with? They find it engaging, challenging so they are doing it because they find it intrinsically rewarding.  Not because they are expecting any kind of medical intervention. I think we need to improve the kind of information provided to consumers so they can distinguish what is entertainment versus the kinds of claims that some developers make.

One cannot reduce our brain age and most people understand that all those mobile casual games are just entertainment.  As more companies begin to make science-based claims, some of them go too far in the claims they make.  They may have some good clinical evidence that specific groups of people get specific benefits, but this does not mean that everyone will see the same benefit.  But again, this is a new field so we trust consumers, in time, will become better informed.  We are talking now to associations who want to distribute better information to their members so we can partner and evolve that way.  Different products will be available at different price points in different platforms with different levels of clinical validation.  Right now, it is like the Wild West, where people have no idea what to expect.  It will become clear as the field evolves.

In terms of the other question, let me start by mentioning a couple of interesting studies that happened last year that we talk about in the book: Arthur Kramer, a very respected scientist from Illinois conducted two separate studies where two different groups of people used the same video game, Rise of Nations. It is one of these strategy video games in which you have to manage an empire, manage the shipping, make complex decisions, run the city and empire.  Both studies were controlled, published last year, engaged two different groups of people: one was a group in their 60’s and 70’s, another group was people in their 20s.  What he found was pretty fascinating and I think very revealing.  For older adults there was a transfer to a wide variety of non-trained executive functions and analytical abilities.  This transfer did not happen at all in people in their 20s.  It was exactly the same game and it was exactly the same amount of time spent. Two important points here: different people have different needs so from the point of view of someone in her 60s or 70s, perhaps is retired, perhaps needs more help to maintain executive functions that someone in his or her 20s who is already exposed to a more mentally stimulating environment. They are learning new jobs, they are starting their careers, so it’s a different starting point.  And second, the novelty of the game itself is different in that for older adults, who are not exposed to interactive media like that game, that was very novel, very challenging.  From the point of view of younger kids, who have probably been playing video games for their whole life, the marginal benefit of using the same was completely negligible.  It was not statistically significant.  So back to your original question, what I think is important to realize, although in a new field there is never a perfect consensus, but it is evident that specific programs can help impact specific brain regions and that the effects are visible by brain imaging, and qualitative benefits are measurable.

In terms of how that transfer includes real-life benefits, people need to understand what tool is good for their specific goals.  There is a variety of studies where we see how some of these programs, again, not all of them, can help for example, kids or adults who have Attention Deficit Disorder to improve attention and reduce their inattention symptoms. It can also be very helpful in clinical environments for patients with stroke or Traumatic Brain Injury.  It can also be helpful for people with Mild Cognitive Impairment and Alzheimer’s.  It can also have some effect on older adults who are healthy.  The problem now and where consumers are puzzled is when claims that are extremely broad and manufacturers seem to imply that research has wide benefits for a wide population, which is not the case.  Consumers need to understand that there are different programs.  First of all they have to understand their own objectives, have realistic expectations and find a program that from a science point of view has published relevant science for their peer group, for their priority. But again, it is very different from saying that everyone in the universe can reduce their brain age by 10 or 20 years.

You are bringing up an interesting point: how a company can afford to fund a large enough study to provide the evidence sought by the medical community and at the same time make the product affordable for consumers?

This is a new field, there are many questions, and answers will be appearing.  For example, at the Boston conference, we had people from AllState and other insurance companies. The insurance companies are starting to realize the value of assessment, screening or training products.  So we cover both assessments and training because we think both of them are extremely important. No program is ever going to be a magic solution for everything.  What we see happening is better assessments, maybe administered by doctors, or perhaps from the preventive point of view, maybe better qualitative assessments where people get a better sense of their strengths and weaknesses to better determine what are their intervention priorities.  Maybe physical exercise, or stress management, or an auditory processing training , or a working memory training.  But I think there are many gaps that exist in the market right now and with our book we wanted to explain what is cognition, how the brain works.  We felt that most books prior to ours were either too scientific or not accessible to an average reader or they were too self-help, and they were not very loyal to the published research.  We try to be close to research but make it accessible for people.  We wanted to demystify cognition so that many healthcare professionals will be able to make better decisions and choose appropriate interventions.

The priority for the whole field is to improve the level of education of both consumers and healthcare professionals dealing with cognitive health issues. We also need clearer standards for research taxonomy and what claims manufacturers can make so that consumers can understand and navigate those claims better. And that was one takeaway from the conference in Boston. We propose a cognitive-based taxonomy of claims and a process to encourage developers to follow the taxonomy so that claims are more transparent to consumers.  I do think what Baycrest is doing with the Centre for Brain Fitness is going to be very important as well, given the quality of research and consequences for the healthcare system.
The beauty of it is that first of all, it is a non-invasive intervention, so there are no side effects, other than wasting time and money.  But it’s a different type of intervention than having a more serious drug intervention that may have contraindications with other drugs.  This is a safer approach, it is scalable because it’s technology-based, but it is still early. Consumers are confused and we need better systems and standards in place to bring transparency to the field and, in a sense, civilize the Wild West.

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Did you miss the first post in this interview series? Be sure to catch “Games for health with SharpBrains CEO, Alvaro Fernandez“.

Stay tuned for the final installment in this interview series, coming next week. Get the blog emailed to your inbox so you don’t miss it!