Individual differences in response to cognitive training: Using a multi-modal, attentionally demanding game-based intervention for older adults

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Abstract

The effectiveness of a game-based cognitive training intervention on multiple abilities was assessed in a sample of 39 older adults aged 60–77. The intervention task was chosen based on a cognitive task analysis designed to determine the attentional and multi-modal demands of the game. Improvements on a measure of attention were found for the intervention group compared to controls. Furthermore, for the intervention group only, initial ability scores predicted improvements on both tests of attention and spatial orientation. These results suggest cognitive training may be more effective for those initially lower in ability.

Highlights

► We provided a multi-modal game intervention to older adults of varying abilities. ► We examined changes in several abilities compared to a control group. ► Older adults with initially worse abilities appear to benefit more from cognitive training. ► Future investigations should include study of individual differences in training benefit from cognitive training interventions.

Introduction

Age-related cognitive decline is a well-established phenomenon that begins in early adulthood and often accelerates with age, with older adults exhibiting deficits in many areas of cognitive performance, specifically fluid intelligence (Baltes and Mayer, 1998, Salthouse, 2004). Fluid intelligence comprises a number of abilities that allow abstract thinking, reasoning, directing and controlling attention, and learning new information. However, effective cognitive training interventions have the potential to impact many abilities and could result in improved quality of life and longer independence for older adults. Many cognitive training interventions with older adults have shown improvements in ability test scores (Ball et al., 2002, Basak et al., 2008, Bugos et al., 2007, Noice et al., 2004), improvements on subjective tests of well-being (Wolinsky et al., 2006), and activities of daily living (Willis et al., 2006).

There is debate as to whether there are populations of older adults that could most benefit from cognitive interventions. For example, while neural plasticity in response to training has been observed in older adults (Boyke et al., 2008, Erickson et al., 2007), plasticity is generally considered to decline with age (Burke & Barnes, 2006). Therefore, the younger-old and consequently higher-functioning may have more potential for neural reorganization and compensation during an intervention. Indeed, the younger-old have been shown to benefit more from cognitive training in memory than the older-old (Verhaeghen, Marcoen, & Goossens, 1992), although memory training gains may be more reflective of strategy acquisition than ability improvement. It is also possible that lower functioning older adults may be unable to fully participate in a cognitive intervention due to the inherent difficulty of cognitive training and thus, be less likely to benefit.

However, it has also been suggested that cognitive activity may most benefit lower functioning older adults. Studies specifically examining the relationship between baseline ability and training gain found that there were higher benefits from cognitive training for those initially low in ability (Ball, Edwards, & Ross, 2007) and ability and education (Boron, Turiano, & Willis, 2007). Older adults with higher abilities may have already been performing near ceiling, and thus could not show as much improvement. It may also be that there is a threshold for stimulation and activity that results in high ability scores and the high functioning older adults already participate above that threshold as part of their daily lives. Thus, a cognitive intervention adds little beyond the threshold they had already reached. However, adding activities to the lives of lower functioning adults may result in cognitive improvement. Similar findings have occurred in animal models where environmental enrichment during adulthood has been shown to improve behavioral flexibility (Kemperman, Gast, & Gage, 2002).

There is growing interest in the use of video games for training cognitive abilities. Video and computer games can be complex and flexible activities that use multiple cognitive abilities, can offer motivational rewards, and can be played socially. Games have been shown to improve younger adults’ cognitive abilities in areas such as visual attention (Feng et al., 2007, Green and Bavelier, 2003, Green et al., 2010) and mental rotation ability (De Lisi and Cammarano, 1996, Feng et al., 2007, Okagaki and Frensch, 1994, Terlecki et al., 2008). Older adults also appear to benefit from cognitive enhancement via video games. A recent study examined the use of a real-time strategy game called Rise of Nations in a cognitive training program for older adults (Basak et al., 2008). The game required the player to gather resources, research technologies, and build and control large armies all in real time. Participants in the experimental group played the game for 23.5 h and showed significant improvements in task switching, working memory, visual short-term memory and reasoning when compared to the control group (Basak et al., 2008). Thus, any game chosen for an intervention should likely include multi-tasking and switching between multiple cognitive abilities such as memory, spatial manipulations, and reasoning to be effective.

Video games are also promising as a tool for cognitive training because they are designed to be fun to play. Cognitive training appears to be most effective when participants are pushed to the limits of their abilities, which can be frustrating and discouraging if the players feel overwhelmed. While participants may be initially motivated to complete exercises to improve their mental abilities, over time they may lose motivation and fail to invest effort. However, games are designed to be rewarding to play. They usually have extrinsic motivators like sound effects and high score screens that motivate the player to continue in the face of challenges. Using extrinsic motivators like sound effects can dramatically reduce failure rates even in highly difficult tasks like air traffic control (Schneider, 1985).

Comparatively few studies have tested the effectiveness of using video games to improve cognitive abilities in older adults, perhaps because of the perception that older adults are reluctant to adopt new technology or that they may be unwilling to play video or computer games. However, older adults are likely to use technology when they perceive there to be benefits to using it (Melenhorst, Rogers, & Bouwhuis, 2006) and that the technology has relevance to their lives (Selwyn, Gorad, Furlong, & Madden, 2003). Older adults have also exhibited interest in a wide variety of games though they tended to prefer sedentary games to physically active games (Hoppes, Hally, & Sewell, 2000). They have also been shown to be especially interested in games that can be played on varying levels of strategic complexity, such as dominoes (Hoppes et al., 2000). Several elements have been identified as important to older adults’ enjoyment of game playing, including mental fitness, competition and winning, filling their time in a way that provides satisfaction, and a sense of belonging in social games (Hoppes, Wilcox, & Graham, 2001). Video games can be designed to contain all of these elements.

A game that fulfilled the requirements of multi-tasking and switching between multiple cognitive abilities was World of Warcraft (WoW), a massively multiplayer online role playing game created by Blizzard Entertainment. In WoW players complete quests in a persistent virtual world to receive rewards and their characters gain levels, pushing them toward more difficult and complex challenges, many of which require collaboration and social interaction with other human players. Navigating to a novel location within the virtual world, for example, might require players to read a textual description of the goal location, examine a 2D overhead map of the region, decide an optimal path to their goal using the map, translate that path from the 2D overhead view to the 3D game world, and finally navigate through the 3D world to reach their destination. During this process they must also attend to important and constantly changing on-screen indicators within the game world, such as the health of their character in the game, and selectively ignore other on-screen information that might distract them from their task. Due to these characteristics, WoW appeared to be a cognitively demanding game and a formal analysis was performed to identify the cognitive abilities used during play. A cognitive task analysis (CTA), identifying the cognitive skills, or mental demands needed to perform proficiently (Militello & Hutton, 1998), was conducted of both novice and expert performance in the game based on a verbal protocol (Bainbridge & Sanderson, 1990). Two novice players and two expert players, all younger adults, were used for the analysis.

The CTA identified a number of cognitive abilities required by the game during play for novice and expert experience levels. Although the CTA suggested that novice and expert players proceeded through the game in different ways, all players engaged in a number of demanding cognitive processes such as rapidly switching their attention between sub-tasks requiring different cognitive abilities, necessitating effortful attentional control. This confirmed that playing World of Warcraft was a cognitive complex task, both for players experiencing the game for the first time and for those who have been playing for years. We are currently aware of only one other study that utilized task analysis a priori in intervention design (Ackerman, Kanfer, & Calderwood, 2010).

World of Warcraft was predicted to improve the cognitive ability of older adults through the task requirements of using multiple cognitive abilities under attentionally demanding conditions. In particular, it was expected to improve older adults’ spatial orientation ability and attentional control because of the high demands for those abilities during play. Additionally, it was hypothesized that initial ability level would affect improvement such that experimental participants exhibiting lower initial ability would improve more than those exhibiting higher initial ability, due to the intervention targeting ability improvement, which affects performance on multiple tasks, rather than mere skill acquisition for a single task.

Section snippets

Participants

Participants were contacted through a database of older adults who had participated in psychology research and through community newsletters. Control group participants received $50.00 at the end of the study and experimental group participants received $70.00. As a condition of eligibility, all participants in both experimental and control groups had a home computer less than three years of age and a dedicated home internet connection. Demographic information and ability test scores are

Intervention effect

Results were analyzed with a 2 (experimental group) × 2 (pre- vs. post-test session) mixed model ANOVA. For the Stroop Test, a measure of attentional control, there was a significant group by session interaction, F(1, 37) = 4.19, p = .05, η2 = .10, such that participants in the experimental group improved more between pre- and post-test than did participants in the control group. There were no significant interaction effects for the Mental Rotation Test, the Object Perspective Test, the Digit Symbol

Theoretical contributions

The results of this study add to the body of evidence suggesting the efficacy of certain types of video games as cognitive interventions for older adults. World of Warcraft, a game selected because of its demanding attentional characteristics, was found to improve the cognitive ability of older adults. This highlights the usefulness of cognitive task analysis (CTA) as a tool when selecting or designing a cognitive intervention. Past studies showed that surface features of a game may be

Acknowledgement

This research was supported by a grant from the North Carolina State University Faculty Research and Professional Development fund to Dr. Jason Allaire.

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