Abstract
Computerised cognitive training, commonly referred to as brain training, has now been shown to be effective in over 100 RCTs across a broad spectrum of brain disorders. Brain training is effective for general cognitive outcomes in healthy elderly and for memory in Mild Cognitive Impairment (MCI). It is unlikely to be effective for cognitive outcomes in established dementia, however, some forms of training may help preserve a sense of self-efficacy and hence quality of life. Clearly, the field needs to move beyond, ‘does it work?’, to more sophisticated questions about how to best implement, understand and maximize effectiveness. For example, we now understand that unsupervised, home-based training is generally ineffective for older adults and that high-frequency dosing subverts efficacy. Furthermore, our group has defined three key clinical phases to brain training: loading dose, peak-plateau dose and maintenance dose. Evidence-based practice will therefore consider each of these when planning an intervention. Interestingly, different brain mechanisms may important at these different phases. On the basis of two RCTs we have shown that sensori-motor cortex plasticity is related to cognitive gains in the early loading dose phase in contrast to strengthening of hippocampus-frontal cortical connectivity in the later peak-plateau phase. Several translational hurdles remain to be overcome. Transfer of cognitive gains to day-to-day function remains challenging for any intervention yet there are emerging positive signals from large studies. Long-term engagement is arguably the greatest challenge -- a rethink of the experience of online brain training is now required. In this respect, social gaming technology and principles have great potential.
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More From: Alzheimer's & Dementia: The Journal of the Alzheimer's Association
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