Beeps, Blips, and a New Class of Medicine: Video Games

Bret S. Stetka, MD

Disclosures

April 22, 2016

In This Article

Where Video Games Hold Promise

Medscape: So it's this idea of multitasking that in part separates your video game design with, say, crosswords, which have been criticized as of late for only resulting in someone getting more proficient at crosswords, a skill that doesn't necessarily translate into other aspects of cognition.

Dr Gazzaley: Yes. It has to do with brain plasticity. The foundation that interactive experiences change the brain is well-founded in neuroscience. But the devil's in the details. How do you formulate something to apply continuous pressure to the system to change it over time? That's really the challenge for the whole field—developing something at a high enough level to induce these types of meaningful and sustainable changes.

Then we need to very carefully validate them. And validation methods are very complicated. What kind of outcome measures are you picking? What is the dose? Is it long enough to lead to the changes you're looking for? As a field, we're still learning how to do this. At the end of the day, not everything you do is going to be equally beneficial to your brain, just like not everything you eat is going to be equally beneficial to your body.

Medscape: In what conditions has video game therapy been studied so far?

Dr Gazzaley: Our findings published in Nature[1] found that NeuroRacer could induce significant improvement in cognitive tasks and some evidence of long-lasting benefits in older adults. NeuroRacer has at this point sort of left our lab, and the technology behind it has been licensed by a Boston-based company called Akili Interactive Labs Inc., who are developing a much higher level version with better gameplay, graphics, music, and training mechanics. The next generation of game is now in multiple clinical trials, including for depression, autism, traumatic brain injury, Alzheimer disease, and ADHD; that latter of which has been presubmitted to the US Food and Drug Administration.

We hypothesize that these trials will show similar results as we have shown in older adults using NeuroRacer, as they have similar types of attention and cognitive problems to those seen in older adults. But, of course, the data will either confirm or deny this.

Medscape: In reading up on your research, despite your enthusiasm for this line of research, you're very cautious when it comes to premature marketing claims. Is that fair to say?

Dr Gazzaley: Yes, for sure. We're still learning the design principles as well as the validation methods that are most appropriate to both develop and validate these new games as therapeutic tools. So there's a lot of work left to be done, but I remain conservatively optimistic. I would say that the data we've seen so far are enough to get us excited to advance to the next stage to continue to refine our approach. But yes, I'm always concerned when I see marketing claims that are overinflated beyond what the data are actually showing about a particular product.

Medscape: There's another group at Johns Hopkins working on a video game approach to stroke rehabilitation. Have you collaborated with these or other researchers doing similar work?

Dr Gazzaley: Yes, I know that group. They are also trying to develop something that's high quality but validated. We have many colleagues out there pursuing cognitive training approaches, but they're often much less sophisticated in terms of developing the gameplay.

And then there are groups that are building amazing games, but they are not really clinically validated. These are more in the entertainment domain. I think that this combination of high-level game development with high-level validation is fairly rare.

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