The authors have declared that no competing interests exit.
Conceived and designed the experiments: SB FP PA JM. Performed the experiments: JM. Analyzed the data: FP JM. Contributed reagents/materials/analysis tools: JM FP. Wrote the paper: JM SB FP PA. Reviewing literature: JM SB FP PA. Reviewing manuscript: JM SB FP PA.
A major goal of recent research in aging has been to examine cognitive plasticity in older adults and its capacity to counteract cognitive decline. The aim of the present study was to investigate whether older adults could benefit from brain training with video games in a cross-modal oddball task designed to assess distraction and alertness. Twenty-seven healthy older adults participated in the study (15 in the experimental group, 12 in the control group. The experimental group received 20 1-hr video game training sessions using a commercially available brain-training package (
ClinicalTrials.gov
Increasing evidence suggests that playing action video games enhances various aspects of cognition in young adults, including peripheral vision, visual attention, and spatial skills
Identifying factors that may shield individuals from cognitive deterioration in old age is of societal interest given the overall aging of the population observed in western societies and the continuous increase of life expectancy (as marked, for example, by the increasing number of centenarians). Although some cognitive functions, including world knowledge, verbal abilities
Attention is a fundamental building block of cognition and central to many mental functions. Evidence indicates that one important attentional function negatively affected by aging is the capacity to suppress irrelevant information to concentrate on the relevant task
Recent years have seen a surge in attempts to identify ways to reduce and/or counteract the course of cognitive and brain decline. This trend is in good part based on the idea of cognitive and brain plasticity as a way of adaptation by compensatory neural activity
In this study we aimed at examining closer the effect of video game training on attention by measuring alertness and distraction in older adults. For this purpose we used a well specified and documented task, the cross-modal auditory-visual distraction oddball task
Recent work indicates that deviance distraction relates to the involuntary use of the sound by the cognitive system to prepare for action
Using a version of the cross-modal oddball task including a silent block of trials, Andrés, Parmentier and Escera
It remains unknown whether the ability to use sounds to prepare for action (phasic alertness) and to resist distraction by irrelevant oddball auditory distracters can improve in older adults through video game training. The present study investigated this issue using an intervention method. Intervention studies offer a controlled way to evaluate cognitive-enrichment changes because they use a controlled way to assign individuals to treatment conditions
This randomized single blind controlled trial was conducted between January 2013 and July 2013 in Madrid (Spain). Experimenters implemented this trial. Participants were blind to the treatment and control persons that were assigned to each group. The researcher (JM) assigned participants to either of the two groups using the e-Prime software. Written informed consent to participate in the study was obtained from each participant. The protocol of this study and the informed consent were approved by the Ethics Committee of the Universidad Nacional de Educación a Distancia (UNED), Madrid (Spain). The protocols for this study and supporting CONSORT checklist are available as supporting information: See
Sixty healthy adult volunteers aged 57 to 77 years were recruited to participate in this study. Twenty participants declined to participate and the rest (40) were randomly assigned to the experimental and the control groups. The study was completed by 15 of the 20 participants of the experimental group and 12 of the 20 members of the control group (see
Experimental (n = 15) | 68.7 (5.2) | 9/6 | 1.6 (1.2) | 28.9 (1) | 62.1 (9.9) | 11.9 (4.8) |
Control (n = 12) | 68.5 (5.7) | 4/8 | 2.5 (2.9) | 28.8 (1) | 60.1 (7.2) | 13 (3.3) |
All participants were informed of their right to terminate participation at any time, gave their written informed consent before participating in the study and were remunerated 75 € for their participation.
All participants were tested individually prior to and following the intervention phase. The participants assigned to the training group underwent 20 laboratory-based sessions of video game training across a period of 10–12 weeks. Each session lasted approximately 60 min. These participants were trained in groups of three. We describe the video game training program below.
The training sessions were performed in the laboratory. Participants taking part in the training sessions practiced 10 video games selected from the commercial package
TRAINING SESSION (MEAN SCORES) | ||||||||||||||||||||
GAME | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 |
−2,0 | −1,6 | −1,4 | −0,7 | −0,9 | −0,6 | −0,3 | −0,7 | −0,6 | 0,0 | 0,8 | 0,6 | 0,8 | 0,3 | 1,2 | 1,2 | 0,4 | 0,9 | 1,1 | 1,5 | |
−2,2 | −1,7 | −1,0 | −0,8 | −0,7 | −0,4 | −0,2 | 0,2 | −0,4 | −0,3 | −0,7 | 1,2 | 0,5 | 0,6 | 0,6 | 0,4 | 1,1 | 1,7 | 1,5 | 0,6 | |
−1,7 | −1,6 | −1,2 | −1,3 | −1,0 | −0,4 | −0,2 | −0,1 | −0,2 | −0,3 | −0,1 | 0,9 | −0,1 | 0,7 | 1,5 | 1,3 | 0,8 | 0,5 | 0,6 | 1,9 | |
−2,1 | −1,9 | −1,5 | −1,4 | −0,5 | −0,9 | 0,0 | 0,1 | 0,3 | 0,3 | 0,2 | 0,5 | 0,8 | 0,4 | 0,5 | 0,7 | 1,4 | 1,0 | 1,1 | 1,0 | |
−2,9 | −1,9 | −1,1 | −0,7 | −0,6 | −0,3 | −0,2 | 0,1 | 0,3 | 0,7 | 0,4 | 0,6 | 0,8 | 0,3 | 0,6 | 0,6 | 1,0 | 0,2 | 1,6 | 0,6 | |
−2,4 | −2,1 | −1,4 | −0,2 | −0,2 | 0,7 | 0,9 | 1,4 | 0,3 | −0,1 | −0,2 | −0,6 | 1,1 | −0,1 | 1,1 | −0,2 | 0,7 | 0,1 | 1,0 | 0,2 | |
−2,4 | −1,9 | −1,1 | −1,1 | −0,4 | 0,0 | −0,3 | −0,3 | −0,2 | −0,1 | 0,0 | 1,0 | 1,3 | 0,7 | 0,9 | 0,5 | 0,8 | 0,4 | 0,6 | 1,6 | |
−1,8 | −1,6 | −1,4 | −1,4 | −1,0 | −0,7 | −0,4 | −0,5 | 0,1 | 0,4 | 0,1 | 0,5 | 0,6 | 0,8 | 0,8 | 0,9 | 0,9 | 1,2 | 1,1 | 1,5 | |
−1,8 | −1,5 | −1,1 | −1,1 | −1,0 | −0,9 | −0,7 | −0,6 | 0,0 | 0,0 | 0,1 | 0,3 | 0,8 | 0,7 | 0,9 | 0,8 | 1,1 | 1,1 | 1,5 | 1,4 | |
−3,2 | 0,4 | −1,1 | 1,1 | −0,6 | 1,2 | −0,6 | 0,4 | −0,8 | −0,9 | 0,8 | −0,2 | 0,5 | 0,4 | 0,8 | 0,2 | 0,4 | −0,3 | 0,9 | 0,6 | |
3,0 | 2,1 | 1,0 | 0,7 | 0,4 | 0,2 | −0,3 | −0,2 | −0,4 | −0,3 | −0,4 | −0,3 | −0,3 | −0,5 | −0,7 | −0,7 | −0,8 | −1,0 | −0,8 | −0,8 | |
2,5 | 2,5 | 1,3 | 0,7 | 0,4 | 0,1 | −0,1 | −0,1 | −0,4 | −0,2 | −0,1 | −0,5 | −0,6 | −0,6 | −0,7 | −0,7 | −0,9 | −0,8 | −0,9 | −0,8 | |
2,2 | 2,0 | 1,6 | 1,0 | 1,0 | 0,3 | 0,0 | 0,2 | −0,4 | −0,4 | −0,2 | −0,3 | −0,7 | −0,7 | −0,8 | −1,0 | −0,9 | −0,9 | −1,1 | −0,9 | |
3,8 | 1,3 | 0,5 | 0,3 | 0,4 | 0,0 | −0,1 | 0,0 | −0,1 | −0,2 | −0,3 | −0,5 | −0,5 | −0,5 | −0,7 | −0,6 | −0,7 | −0,7 | −0,7 | −0,7 |
Stimulus presentation and data collection were performed using a bespoke program written in E-Prime 2.0 (Psychology Software Tools Inc, Pittsburg, PA, USA). Participants were tested individually in a quiet room.
Participants performed three blocks of 384 trials each (24 practice trials and 360 test trials, as described below). In each trial, participants categorized a visual digit (1–8) as odd or even by pressing response keys (V & B, counterbalanced across participants) with two fingers from their dominant hand. Each trial began with the presentation of a white fixation cross at the centre of the black screen (the cross remained visible throughout the trial except when the digit was presented) as well as a 200 ms sound. The visual digit (in white color) appeared at the center of the screen 100 ms after the sound's offset, and remaining on the screen for 200 ms. The digit's size corresponded to a viewing angle of approximately 2.6 °. A response window of 1200 ms was available from the digit's onset.
Three sound conditions were compared, defined by the content of the sound file played in each trial. In the silent condition, participants performed a whole block of trials in which each trial used a silent sound file. The remaining two blocks contained two types of sounds. The standard sound, used in 576 trials (80%), was a 600 Hz sinewave tone of 200 ms in duration (10 ms of rise/fall times), digitally recorded and low-pass filtered at 10,000 Hz. In the remaining 144 (20%) trials, novel sounds were used. These sounds were taken from a list of 72 novel environmental sounds (e.g., hammer, drill, door, rain, etc.) obtained from Andrés et al.
Participants were instructed to focus on the digit categorization task and ignore any sound presented in order to respond to the digit as accurately and rapidly as possible.
Two independent 2 (group: experimental
In order to determine whether training improved performance on the video games, we first analyzed the effect of training for each of the 10 video games. We then analyzed performance in the oddball task to examine whether the video game training impacted on alertness and distraction.
Comparisons between the first and last sessions were carried out on the performance Z-score. The results showed that training increased performance, both in terms of accuracy as well as in completion times (see
Raindrops | 5.3 | <.001 |
M. Matrix | 5.5 | <.001 |
M.Match | 2.6//4.9 | = .017//<.001 |
Speed match | 6.3//3.7 | <.001// = .002 |
Chalkboard | 3.6 | = .002 |
Moneycomb | 2.4 | = .026 |
Rotation M. | 4.5 | <.001 |
L. Migration | 4.3//10.5 | = .001//<.001 |
M.Faces | 6.3//5.3 | <.001//<.00< |
Space Junk | 3.2 | = .006 |
Accuracy levels in the digit categorization task in both groups were similar [
Response times for correct responses were analyzed after removing outliers (RTs faster than 200 and slower than 1100 ms, representing 3.6% and 3.04% of the trials for pre- and post-training respectively). Standard trials immediately following novel trials were excluded from the analysis, as these have been shown to yield residual distraction
This analysis revealed that the main effect of group was not statistically significant [
Panel A: Mean response times for each group at pre and post-training in the three experimental conditions (silence, standard and novel). Panel B: Mean alertness and distraction effects for trained and controls participants.
A comparison pre- and post-training conditions showed a significant reduction of distraction in the experimental group [
Pre- and post-training comparisons showed a 26 ms increase of alertness in the experimental group [
Finally, although our sample included only 15 participants practicing the video games, we explored the correlations between the improvement on each of the 10 games (computing by the difference between post and pre values) on the one hand, and distraction and alertness on the other hand. We found a marginal negative correlation between distraction and response times on the “memory speed” game (
In the present study, we used a cross-modal oddball paradigm to investigate whether cognitive training with non-action video games would improve older adults' performance in two basic attentional functions: (1) filtering out task-irrelevant information to maintaining the focus of attention on task-relevant information; and (2) alertness (to capitalize on the presentation of a warning cue to prepare for action). The experimental (trained) and control groups performed the oddball task with similar levels of accuracy at the first (pre-test) and the second assessments (post-test). However, response times showed benefits of the video game training, as reflected by the increase in alertness and the reduction of deviance distraction.
Unexpected deviant sounds distract participants away from a focal visual task
Although age is accompanied by cortical deterioration (especially of the prefrontal region
One aspect of our study worth emphasizing is that the video games we used were distinct from the task we used to measure filtering and alertness. That is, the benefits of the training manipulation was not only limited to performance on these games but also transferred to the oddball task. An interesting question is why training with these video games can transfer to these attentional functions. One possibility is that practicing the games improved sustained attention and concentration in general, rather than any specific information processing skill per se. That is, practicing the games might have helped participants to maintain attention and optimize its efficiency (e.g., resisting to deviations of attention in response to task-irrelevant information).
In the present study, we observed this effect using non-violent and non-action video games that may be more appealing to older adults. Practicing video games of this type may offer some protective factor against the effects of aging and may potentially be recommended to older individuals, alongside other interventions found to improve mental functions. These include, for example, a long-term physically active lifestyle (improving executive control and speed of processing,
In summary, research on the benefits of video games has experienced a recent surge among investigators interested in training the cognitive abilities of older adults to prevent cognitive decline, making it an important topic for psychologists, gerontologists and neuroscientists. The results of the present study suggest that training older adults with non-action video games reduces distractibility by improving attention filtering (a function declining with age and largely depending on frontal regions) but also improves alertness. Whether similar changes in alertness and distraction after cognitive training might be observed in younger participants, who are typically regarded to be at the peak of cognitive functioning, is an interesting and open question that would deserve further investigation.
Our study presents some limitations. One is the small sample size. Although we recruited sixty participants at the beginning of the study, only 40 volunteers agreed to participate in this intensive longitudinal study. In the final analyses only twenty-seven participants completed the study and were included in the analysis. A second limitation of the present study is that does not examine whether the impact of video game training may generalize to everyday life tasks. Further research should address whether this improvement would transfer to real world tasks. It is also worth pointing out that the games forming part of the Lumosity suite could be described as tasks similar to some found in intelligence test batteries. Hence another possible avenue for research will be to determine whether the benefits of such games may generalize to video games more similar to those found in the gaming market. Finally, another criterion regarding the importance of the cognitive training results is whether there is evidence of endurance of the training effects. Future research should evaluate the maintenance of training effects.
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The authors thank all the older volunteers who participated in the study. We are grateful to Pilar Toril, Carmen Pita, Antonio Prieto and Laura Ponce for helping with data collection and training.