When Computer Games May Keep The Brain Nimble
本 月發表的一項研究顯示﹐玩“三思而行”(Double Decision)能夠減緩甚至扭轉人們隨著年齡增長而腦功能下降的趨勢﹐而填字遊戲卻做不到這一點。該研究由政府資助﹐其結果來源於早先一次大規模的試 驗﹐該試驗表明：玩過多種認知遊戲的老年人具有更好的健康狀況和駕駛記錄﹔做飯等日常事務也表現得更出色。
美 國俄亥俄州克利夫蘭醫院(Cleveland Clinic)老年醫學中心主任芭芭拉•梅新傑•拉波特(Barbara Messinger-Rapport)說：“他們所做的無非是通過電腦程序來使得老人在認知測試上有較好的表現﹐但這並不意味著你在現實生活中也具有同樣 的認知能力﹐比如開車或者管理藥物。”
本次項目的首席研究員﹐來自愛荷華大學公共衛生 學院(College of Public Health at the University of Iowa)的教授弗雷德里克•沃林斯基(Fredric Wolinsky)表示﹐之前的研究已經證明：玩一些電腦遊戲的確對實際生活有幫助﹐例如減輕抑鬱症狀。作為美國政府多年資助項目ACTIVE的一部分﹐ 一項於2011年發佈的研究表明﹐經過六年認知訓練的老人在安全駕駛方面的表現明顯改善﹐造成交通事故的幾率下降50%。沃林斯基並沒有參與該項研究。該 研究發表在《美國老年醫學會期刊(Journal of the American Geriatrics Society)》上。
最近 一項刊登在《公共科學圖書館期刊(PLoS One)》上﹐名為《愛荷華州積極健康思想研究》(Iowa Healthy and Active Minds Study)的項目對681個健康人士進行了隨機對照測試。參與者被分成兩個組﹐分別是年齡50歲至64歲和65歲以上。每個組的成員要麼進行“公路旅行 (Road Tour)”遊戲（之後改名為“三思而行”(Double Decision)）﹐要麼進行填字遊戲﹔一些成員選擇在實驗室訓練﹐其他的則在家裡完成。
在進行研究前﹐該研究機構已經對參與者的認知能力進行了測試﹐其中很多都包含了注意力測試、腦力勞動轉換測試等“執行功能(executive function tasks)”測試。測試結果與每位參與者所在組別的平均表現相關。
同 樣的測試在一年後再次進行。沃林斯基表示﹐那些被安排進行填字遊戲的參與者表現出典型的的認知能力下降。而進行電腦遊戲的參與者﹐相比一般隨年齡增長而導 致認知能力下降的人群﹐卻有較大的改善。根據“執行能力”測試項目的不同﹐認知能力衰退程度放緩了2到7年。訓練場所（家或實驗室）對結果也並無太大影 響。
邁 克爾•梅策尼希(Michael Merzenich)說﹐開發了“三思而行”(Double Decision)以及其他智力遊戲的Posit Science公司希望儘快開展認知遊戲對減緩或防止老年痴呆症(Alzheimer)的研究。Posit Science公司總部位於舊金山﹐梅策尼希是其首席科學官﹐同時也是加州大學舊金山分校(University of California, San Francisco)的名譽教授。
沃林斯基透露﹐他希望下一個研究可以使用功能性核磁共振成像(functional MRI imaging)來測量認知遊戲參與者大腦的變化。
穆 拉利•雷斯瓦米(Murali Doraiswamy)是北卡羅來納州達勒姆(Durham)市杜克大學(Duke University)醫學中心的精神病學教授﹐他認為愛荷華研究項目是所有展示老年大腦訓練成效研究當中最好﹐以及最嚴謹的。但對於大腦訓練遊戲﹐他覺 得仍有一個問題存在：長期下來人們會對此覺得枯燥﹐而不再堅持進行訓練。他說﹐“這是一個有前景的領域﹐我認為我們要做的就是使遊戲變得趣味橫生。”
The computer game's concept is relatively simple. Find the matching motor vehicle and road sign amid a series of increasing distractions. Succeed and the challenge gets quicker and harder.
Cognitive-training games like this one, Double Decision, are designed to improve brain functions and are at the center of a growing body of research looking at their effectiveness as scientists strive to find ways to ward off the cognitive declines that usually come with age.
A government-funded study published this month found that playing Double Decision can slow and even reverse declines in brain function associated with aging, while playing crossword puzzles cannot. The study builds on an earlier large trial which found that older people who played various cognitive games had better health-related outcomes, driving records and performed better at everyday tasks such as preparing a meal.
Such research has led groups like AARP, the big seniors group, to jump on board and offer discounts for certain games that have shown proven benefits.
Doctors who work with the elderly say they get many questions about so-called brain games and exercises. Despite promising study results, some doctors say there still isn't enough evidence to prove such exercises will help people in everyday life.
'What they do is they train you with a computer program to do better on a test' of cognitive function, said Barbara Messinger-Rapport, director of the Center for Geriatric Medicine at the Cleveland Clinic in Ohio. 'But does that mean you do better on real-life activities that utilize those skills such as driving . . .or managing your medications?'
Fredric Wolinsky, lead researcher for the latest study and a professor at the College of Public Health at the University of Iowa, said previous studies have demonstrated there are real-world benefits to playing certain computer games, including a reduction in depression symptoms. A study published in 2011 as part of a multi-year, government-funded trial, known as ACTIVE, showed that participants followed for six years had a 50% lower rate of motor-vehicle accidents following cognitive training, said Dr. Wolinsky, who didn't participate in that research. The study appeared in the Journal of the American Geriatrics Society.
The latest study, called the Iowa Healthy and Active Minds Study, published this month in the online journal PLOS ONE, was a randomized controlled trial involving 681 healthy people. Participants were divided into two age groups -- from 50 to 64, and 65 and over. People in each group were assigned either to play Road Tour, which has since been renamed Double Decision, or to do computerized crossword puzzles; some did the exercises in the lab and others at home.
Double Decision briefly displays an image of a vehicle and a particular road sign. As the screen continually shifts, and assorted vehicles and road signs come and go, players must watch out for and identify the particular vehicle and sign that appeared at the game's start. The game becomes more challenging as players advance levels, forcing them to quicken their mental speed as distractions multiply and images become harder to distinguish. The study, which was funded by the National Institutes of Health, involved playing the game a minimum of 10 hours over a five-to-eight-week time period. One group played for an additional four hours after 11 months.
Before beginning the study, participants were given standard cognitive tests, many involving executive-function tasks such as concentration and shifting from one mental task to another. The results were ranked relative to the average performance on those tests for the participants' age group.
The same tests were administered a year later. People assigned to do crossword puzzles showed typical cognitive one-year declines, Dr. Wolinsky said. But the groups who played the computer game showed a clear improvement compared with the normal loss of cognitive function as people age. The amount of improvement ranged from two to seven years, depending on which executive function was being tested. People who worked at home improved at the same rate as those who were in the lab.
Improvements in the younger group matched those among the older participants. 'That's really important,' said Dr. Wolinsky. It suggests 'we are able to start the recovery process sooner, rather than waiting until the cognitive decline has become so large.'
The study followed similar research -- the ACTIVE trial -- also sponsored by the NIH. In that trial, about 2,800 elderly participants showed improved memory, reasoning and visual processing speed after playing an earlier version of the Double Decision game, said Dr. Wolinsky, who also worked on that earlier research.
The ACTIVE study also tested the time it took to do daily activities, like preparing a meal, and performance tests, such as reading price tables to pick the best telephone provider, Dr. Wolinsky said. Participants showed improved performance compared with those who didn't get such cognitive training.
In the latest study, Dr. Wolinsky said he chose to use the updated Double Decision game in part because it is available for home users. In comparing computer-game use with another activity, he said he chose crosswords because many older people enjoy the puzzles and the general perception is that they keep the brain and mind active and engaged.
San Francisco-based Posit Science Corp., the company that makes Double Decision and other brain games, expects soon to participate in multisite studies looking at the impact such games could have in delaying or possibly preventing the onset of Alzheimer's disease, said Michael Merzenich, a professor emeritus at the University of California, San Francisco and chief scientific officer of Posit Science.
AARP recently began offering its members discounts on several Posit Science games, said Deborah Abernathy, director of AARP Brain Health. 'Their exercises, specifically, we found were very helpful. They're fun, they're short and they're easy to do and they're online,' she said.
Dr. Wolinsky said he doesn't currently have a financial relationship with Posit Science. He did consulting work with the company for a total of 15 days from 2007 to 2009 as part of the analysis of the earlier ACTIVE study, he said.
Dr. Wolinsky said the next study he expects to pursue will use functional MRI imaging to measure changes in the brain in people participating in cognitive-training exercises, he said.
P. Murali Doraiswamy, a professor of psychiatry at Duke University Medical Center in Durham, N.C., said the Iowa study was one of the best and most rigorous to show the benefits of brain training in older age. But a problem with brain-training games is that people often get bored and don't continue with them. 'It's a very promising area,' he said. 'I think what we have to do is we have to make the games fun.'