According to new research, a certain type of brain training appears to prevent or delay dementia by about 25% in people over 65 years of age.
Surprisingly, it wasn’t the memory or problem-solving tasks that made the difference — it was an interactive computer game that tested the ability to recognize two distinct images in increasingly faster sequences.
The game shows the user one of two vehicles in a desert, urban or rural setting. Then, a Route 66 sign appears briefly on the periphery, surrounded by other road signs that can distract the player.
To perform the training correctly, the player must click on the correct car or tractor and the location of the Route 66 sign. As the player improves, the images disappear faster and faster.
“It’s what we call a divided attention task, where you don’t have a conscious strategy for how to get better,” said study co-author Marilyn Albert, professor of neurology at Johns Hopkins University School of Medicine and director of the Johns Hopkins Alzheimer’s Disease Research Center in Baltimore.
“You’re just trying to do the best you can to figure out how to divide your attention,” she said. “It was also adaptive, in the sense that as people got better, it got harder.”
Unconscious learning
Started in 1998, the ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly) study tested three types of cognitive training in more than 2,800 volunteers with an average age of 74 years.
All were dementia-free at the start of the study and lived independently in six communities across the United States. A fourth group, which received no training, served as a control.
“One of the great strengths of the study is that it was a really representative population — 25% of the participants were minorities,” Albert said. “Therefore, we can state that the findings can be generalized to the entire US population.”
One group focused on memory, learning techniques for memorizing lists of words, texts, and story details. A second group received training focused on reasoning, such as problem solving and identifying patterns that could help in everyday life.
A third group used a speed brain game focusing on divided attention, developed by teachers from Alabama and Kentucky. Sold in 2008 to the owners of BrainHQ, a for-profit brain training company, the updated game is now known as Double Decision. (Other brain training companies have also developed similar speed games.)
Dual attention adaptive games use implicit learning, which is the automatic acquisition of knowledge or skills without awareness of what is being learned. Implicit learning uses different parts of the brain compared to solving problems or understanding the meaning of words, Albert said.
Examples include tying shoelaces, reacting to social cues, and learning to ride a bicycle. “If you haven’t ridden a bike for 10 years, you can get on a bike and ride. We know this type of learning is very long-lasting,” Albert said.
However, there is an important distinction between acquiring a skill and expecting it to have broad benefits in other areas, such as preventing dementia, said Walter Boot, Irving Sherwood Wright Professor of Geriatrics at Weill Cornell Medicine and associate director of its Center for Aging and Behavioral Research in New York City. He did not participate in the study.
“It is possible to learn to ride a bicycle and still remember how to do it 20 years later, just as it is possible to learn the study’s ‘processing speed’ task and continue to perform well on that task many years later,” Boot said in an email. “What remains unclear is how any of these activities would translate into a reduced risk of dementia.”
Need more practice
Initially, the program was intense. Volunteers received in-person training twice a week, with 60- to 75-minute sessions, over five weeks.
At the end of the first year, about half of the participants in each cognitive training group underwent an additional booster session, consisting of four one-hour sessions. Another four hours of training were carried out at the end of the third year of the study, totaling 22.5 hours.
There was no further official training, but when researchers compared the three groups with their Medicare records 20 years later, they found that only the dual-attention speed game contributed to a 25% reduction in dementia diagnoses compared to the control group.
However, this benefit was only seen in a subset of volunteers, according to the study published Monday in the journal Alzheimer’s & Dementia: Translational Research & Clinical Interventions.
“The 25% reduction in dementia risk only occurred in people who did the initial speed game training and then the booster sessions. Those who didn’t do the booster sessions didn’t benefit,” Albert said.
While the information gained from a 20-year study is valuable, the research did not have the data needed to demonstrate a definitive link between computerized training and dementia prevention, said Dr. Susan Kohlhaas, executive director of research and partnerships at Alzheimer’s Research UK, a non-profit research center based in Cambridge. She did not participate in the study.
“Diagnoses were identified through health records rather than specialized clinical testing, so we do not know whether this training changed the underlying diseases that cause dementia or affected specific types of dementia,” she said in a statement.
Although memory and reasoning training did not reduce the risk of dementia, previous publications using data from the ACTIVE study found that both improved memory and executive reasoning, she said.
This training also helps people develop skills that allow them to live independently in their own homes.
Why speed training can help the brain
Why has only fast-paced divided attention cognitive training been shown to be effective against dementia? Most importantly, why would just 22.5 hours of this training seem to have an effect for years? While more research is needed to understand the results, Albert has some educated hypotheses.
“First, the game is quite demanding and not particularly fun,” said Albert. “Playing it for an hour twice a week is hard work. You’re taxing your brain in ways it normally wouldn’t.”
“Therefore, it is possible that speed training activates neurons throughout the brain, creating greater connectivity and increasing plasticity,” she said.
The game was also adaptive in that it became more difficult as people progressed and easier when they failed, said Dr. Richard Isaacson, an Alzheimer’s prevention researcher and director of research at the Florida Institute of Neurodegenerative Diseases.
This interaction “exercises the brain in new ways that may contribute to the cognitive reserve needed to delay dementia,” said Isaacson, who was not involved in the study.
A Cognitive reserve is the brain’s ability to adapt and maintain normal functioning despite the presence of underlying damage, aging or disease.
In Alzheimer’s disease, for example, people with greater cognitive reserve often delay the onset of symptoms, even with the presence of amyloid and tau proteins, two proteins that are the main characteristics of the neurological disease.
There may be another factor involved in the game’s long-term positive impact. An October study found that speed training can preserve acetylcholine, a neurotransmitter that makes the brain more awake, focused and attentive.
“We’re talking about a fundamental physicochemical change that we know is really important as a contributing factor to brain health,” said Dr. Michael Merzenich, professor emeritus at the University of California, San Francisco, in a previous interview with CNN. Merzenich is co-founder and chief scientific officer of Posit Science, owner of BrainHQ.
As researchers search for answers, experts say cognitive training is just one part of the journey to improving brain health.
“Alzheimer’s and other dementias are complex disorders. You can’t just eat a magic blueberry, play a game on your phone or do one thing,” Isaacson said.
“You need the full cocktail: a brain-healthy diet, regular exercise, blood pressure control, quality sleep, stress reduction, and positive relationships—all of these are necessary for brain health.”
date:2026-02-10 20:15:00