Marketplace of Memory

What the Brain Fitness Technology Industry Says About Us and How We Can Do Better

Daniel R. George, PhD, MSc; Peter J. Whitehouse, MD, PhD

Disclosures

Gerontologist. 2011;51(5):590-596. 

In This Article

Problems in the Marketplace

At present, the brain fitness technology industry is being met with increasing scientific, if not cultural, scrutiny (Fernandez, 2010). Despite a few modestly positive studies in older adults (Ball et al., 2002; Belleville et al., 2006; Klingberg, 2010; Papp, Walsh, & Snyder, 2009; Smith et al., 2009; Spector et al., 2003), empirical support for the efficacy of brain fitness training programs in meaningfully improving cognition is generally insufficient. Relatively few products have been rigorously evaluated using scientific methods or reported in peer reviewed journals, and most existing studies generally evaluate low-intensity interventions in which community-dwelling adults may engage in the intervention for 3 or fewer hours per week. When they have been evaluated, task performance is relatively easy to demonstrate, some cognitive generalizability is sometimes reported, but measuring improvement in daily life has rarely even been attempted. A recent study in Nature (Owen et al., 2010) evaluated 11,430 participants in a six-week program, finding no transfer effects from the training tasks of brain fitness games to more general tests of cognition (i.e., reasoning, memory, planning, visuospatial skills, and attention). Other meta-analyses have found no evidence that structured cognitive intervention programs actually delay or slow progression to AD in healthy elderly (Papp et al., 2009). Consumers of digital brain fitness games and training programs may marginally improve at the games themselves, but it can fairly be asked whether any real-world value exists if such benefits are not extended to everyday tasks or quality of life? Moreover, it is reasonable to ask whether we should expect a profound transfer to activities of daily living when most interventions occur across such short time intervals at such low "doses."

In fact, it is not surprising that a human being who practices performance in any task will improve over time. The crucial question, which investigators have explored for several decades, is whether the increments generalize to other domains of thinking and whether they improve activities of daily living (Ball, Wadley, & Edwards, 2002; Detterman & Sternberg, 1982). If one performs a visual recognition task, for instance, will it generalize to auditory recognition or to memory improvements? And even if there is some evidence that past specific activities improved performance and other related but different tasks, how does performance in rarefied lab environments translate into functioning in the context of one's daily life, which occurs in many diverse environments full of potential confounders? Furthermore, studies must accept the reality that peoples' self-ratings of their own function are often inaccurate and subject to many influences that may bias the conclusions. Reported self-improvement in studies may reflect a personal justification for having spent as much time working on the particular brain fitness game. Furthermore, it is seldom discussed what should constitute sufficient proof in brain fitness studies. Are pre- and post-comparison of performance all that is needed? Is a well-conducted randomized control trial (RCT) required or not? And perhaps most importantly, what do we compare in our efficacy studies? What is the equivalent of the placebo in studies that use computer programs or video games? Ultimately, investigation into the efficacy of brain fitness technology is still relatively young, and adequate supporting data have not yet been published (Fernandez, 2010; Klingberg, 2010). Future research on brain fitness products most certainly merits continued investment—particularly studies that might address the dosing issues by embedding brain fitness activities in regular life activities. However, as long as evidence remains lacking, the industry's claims represent the hype of marketing departments rather than a genuine hope earned through thorough scientific inquiry.

Another major hurdle for brain fitness technology is that the industry is predicated on the fallacy that consumption of single commercial products can forestall the complex, heterogeneous multifactorial processes of brain aging that occur across the life course. This reductionist mentality, which has hitherto driven the development of pharmaceuticals and "smart drugs", is now being projected onto a new breed of technological product. However, the consequence of reductionism is that it disregards the myriad factors that influence brain health across the life span (e.g., diet, exercise, exposure to neurotoxins, psychosocial stress, learning opportunities, access to health care, head injuries, etc; Stein et al., 2008; Whitehouse & George, 2008). In the world of brain fitness, neuro-stimulation is king, and the products one might use to accomplish this task are the sine qua non of cognitive well-being. But humans are not merely de-contextualized brains; in fact, brains are embedded among many other vital organs in the bodies of individual persons who are interdependent members of families, neighborhoods, local communities, national constituencies, and natural ecosystems. Manifold forces at each of these levels impact neurodegenerative processes from womb to tomb, with "cognitive health" being the collective property that emerges from the interaction of these inputs across our lives. To ignore the complex etiology of "neurodegeneration" and thus to fail to frame brain aging as a public health and broader social issue, is a conceit fostered by a neoliberal-capitalist approach to brain fitness.

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