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Crossword puzzles have an advantage over computerized memory games in improving memory function in older adults with mild cognitive impairment.
A new study by researchers at Columbia University and Duke University published in the journal NEJM Records shows that doing crossword puzzles has an advantage over computer video games for memory functioning in older adults with mild cognitive impairment.
In a randomized controlled trial, led by DP Devanand, MD, professor of psychiatry and neurology at Columbia, with Murali Doraiswamy, MD, professor of psychiatry and medicine at Duke, researchers determined that participants (average age 71 years) were trained to do web-based crossword puzzles showed greater cognitive improvement than those trained in cognitive video games.
“This is the first study to document the short- and long-term benefits of crossword training at home compared to another intervention,” said Dr Devanand, who oversees brain aging and mental health research. in Columbia. “The results are important in light of the difficulty in showing improvement with interventions in mild cognitive impairment.”
Crosswords are widely used but have not been systematically studied in mild cognitive impairment, which is associated with a high risk of dementia, including Alzheimer’s disease.
To conduct their study, Columbia and Duke researchers randomly assigned 107 participants with mild cognitive impairment (MCI) at two different sites to either crossword training or cognitive game training with intensive training for 12 weeks followed by sessions of reinforcement of up to 78 weeks. Both interventions were delivered via an IT platform with weekly compliance monitoring.
The most surprising findings of the trial were:
- Crossword puzzles were superior to cognitive games on the primary cognitive outcome measure, ADAS-Cog, at both 12 weeks and 78 weeks. Crosswords were superior to PMF, a measure of daily functioning, at 78 weeks.
- Crosswords were superior for participants at a later stage of the disease, but both forms of training were equally effective at an earlier stage.
- Brain shrinkage (measured with MRI) was less for crosswords at 78 weeks.
“Benefits were seen not only in cognition but also in daily activities with evidence of brain shrinkage on MRI suggesting that the effects are clinically significant,” Dr. Devanand said.
Crosswords are widely used but have not been systematically studied in mild cognitive impairment, which is associated with a high risk of dementia, including Alzheimer’s disease.
The study also highlights the importance of involvement. Based on remote electronic monitoring of computer use, participants at a later stage of disability may have engaged better with the more familiar crossword puzzles than with the computerized cognitive games.
Two strengths of the trial are the 28% participation rate of individuals from racial and ethnic minority groups and the low dropout rate (15%) for such a long home trial. A limitation of the study was the absence of a control group that did not receive cognitive training.
Although these results are very encouraging, the authors emphasize the need for replication in a larger controlled trial with an inactive control group.
“The trifecta of improving cognition, function and neuroprotection is the Holy Grail for the field,” said Dr. Doraiswamy. “Further research to scale brain training as a digital at-home therapeutic to delay Alzheimer’s should be a priority for the field.”
Original research:
Computerized games versus crossword training in mild cognitive impairment by Murali Doraiswamy et al. NEJM Records
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