Puzzles, brain-training games and hobbies have long been said to stave off cognitive decline. But while some research has shown that intensive brain-training programmes done over several weeks can reduce cognitive impairment, such interventions aren’t very practical in daily life.
So my team and I decided to explore whether doing brief brain-stimulating activities could improve cognitive health. Our large-scale trial found that doing activities such as crossword puzzles, reading, listening to music, brain-training games or learning a new skill can have a significant effect on maintaining cognitive function. And, in some cases, these activities were even shown to reverse cognitive impairment.
To conduct our study, we looked at 11,500 people aged 60 to 85 with mild to severe cognitive impairment. Cognitive impairment was determined using the results of a short computerised cognitive test (the Baddeley Verbal reasoning test, which measures reading comprehension and reasoning). This test was administered at the start of the study.
Reasoning is a key domain of cognitive function that is important for many aspects of daily life – such as managing finances or doing the shopping. Not only is reasoning often used as a predictor of longer-term cognitive decline, it’s also sensitive to cognitive training.
Participants were then split randomly into three groups. Group one (the control group) were asked about any brain-stimulating activities they did daily – such as brain games, puzzles, crosswords, reading, listening to music or playing a musical instrument, social activities (such as being in a choir or seeing friends) and learning a language.
The group’s cognitive function was tested and they were given brief, evidence-based advice about how to protect their cognitive health – including on the importance of physical activity, a healthy diet and doing brain-stimulating activities.
Group two was also asked about their brain health habits and given the same advice on looking after their cognitive health. Alongside these measures, they were given access to a website that our team developed. This website offered automated behavioural support for doing brain exercises and advice for following a healthy lifestyle.
Group three was asked the same questions about brain health and given the same advice as the other two groups. They were also given access to the same website as group two. In addition to these measures, they were offered two brief appointments, phone calls or emails from a facilitator as well – typically a nurse to help ongoing engagement with the website.
A year later, participants in every group took the Baddeley test again.
All of the groups saw cognitive improvements. But we were most surprised by the results of group one – the control group. Our study showed that after 12 months, 28% of people in group one no longer had signs of cognitive impairment. In group two, just under 33% reversed their cognitive decline, while around 32% of those in group three did.
Both groups two and three had small additional improvements in their Baddeley scores compared with the control group. The group that had the extra support (group three) had an 8% reduction in the number of people who had mild cognitive impairment compared to the control group. For those who had cognitive impairment at the start of the study, there was an 18% reduction in the number with severe cognitive impairment compared with the control group.
Since all the study participants had fairly healthy diets and were physically active at the start of and throughout the study, the effect we observed seems to be explained by the participants doing more brain-stimulating activities.
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However, there are a few caveats when it comes to our results.
First, there was no real control group. Although group one acted in some ways as a “control,” it isn’t a classical control group. Typically, control groups in studies do not receive a treatment or intervention. This is so researchers can effectively compare whether a treatment works or not by being able to compare it with a similar group of people who are not receiving that treatment.
But as the control group’s participants were still given advice on their brain health, had their cognition tested, and were asked questions about brain stimulating activities, this led to people changing their behaviour in an effort to improve their cognitive health.
A second caveat is that there has been no formal process analysis yet – meaning the data has not been thoroughly analysed to understand what variables may have predicted the observed changes. A longer-term follow-up will also be needed to know whether brain-training activities have long-term benefits, including on whether dementia develops.
Brain health
Our study is not the first to show that cognitive health can be improved with brain training and lifestyle changes.
But our study is the first large trial to explore the effect that even small, daily activities can have on cognitive health. Our results also show that even simply giving advice and pointing people towards brain-stimulating activities that they can do can have a real impact.
The key message of our study is crucial. It shows that the brain remains malleable and can learn new things well into older age. This means even the small things you do each day can really make a difference in combating cognitive decline.
Paul Little received funding indirectly: funding was given to his University (the University of Southampton) from the UK government funded National Institute of Health Research in order to undertake the study.