How to Rebuild an Attention Span

In the war on distraction, a new long-term study of disrupted attention, multitasking, and aging shows dramatic results in improving working memory for older participants through use of an online game

Begin with a Twist

Let’s start with the twist: A specially-designed video game helped reverse signs of aging in the brains of players in their 60s and 70s. So, even though competing claims on our attention, including from all those devices that bleep and burp and screech, often swamp our ability to focus, evidence from a major study to be published tomorrow indicates that training on a video game improved not only the ability to stay on task but also shored up short-term memory in aging adults.  You may have to read the latter half of that last sentence over again if your email flashed in the background while you skimmed, texts pinged through to your cell phone while you absorbed this new information, and the television erupted with the sound of shelling in Syria while you wondered if you should read on. These are among the wages of rapid-fire disruptions that frequently hobble cognitive functioning in so-called “normal aging.”

Decline in our ability to filter out distraction and focus attention, unfortunately, begins not in middle age but rather in our 20s. Ongoing research on memory over the past five years in the laboratory of Dr. Adam Gazzaley at the University of California-San Francisco identified underlying neural mechanisms that characterize this process of decline. The connections between paying attention, filtering out interference, and remembering are critical because it’s obviously far more difficult to retrieve something never properly imprinted in the first place. Here’s one of the ways we get derailed: Even that casual mention of unfolding catastrophe in Syria in the last paragraph may set off a distracting internal dialogue as other manifestations of external distraction tugged on your attention. In that case, it may be hard to accept the idea that relatively use of an immersive, even fun, video game will help in the war on disruption. Stick with me, here. Maybe you could turn down the volume on a couple of the competing channels? A little more focus, please.

The Results

Here’s the breaking news. In a major, long-term, well-controlled study, published tomorrow on the cover of the prestigious science magazine Nature, researchers in Dr. Gazzaley’s laboratory show that modest exposure to NeuroRacer, the customized video training game, helped participants improve their ability to screen out distraction and stay on task. These are the essential building blocks for successful multitasking. Three linked experiments in the Gazzaley Lab involved 174 subjects grouped evenly along the age continuum, from 20-85-years. Effects of the training were robust, showing notable improvement in the ability of older players to keep on task. Study subjects demonstrated markedly better scores after just 12 sessions in training taken an hour a day and three times a week. A participant aged 79-years old even outscored members of a control group made up of 20-somethings who did not engage in training.

The experiments reported on this week are the latest from the research program of Dr. Gazzaley, a physician and noted brain imager who set out, a decade ago, to create interventions to reverse the tide of aging in the brain. The neuroscientist explains that he’s out to reinforce “top-down modulation” in human cognition, which means strengthening the sense of greater control over cognitive power in aging adults. What’s bound to draw the most attention is the claims that playing the game spilled into a more general shoring up of cognitive abilities.

Most significantly, monitoring through electroencephalography (EEG) showed evidence of markedly increased activity of a particular kind in the prefrontal cortex, part of the brain responsible for cognitive control. Before you speed out to scoop up a raft of commercial video games, though, there’s a caveat from lead author on the study, Joaquin Anguera. “Video games aren't a panacea,” he told me. “PlayingMedal of Honor is not going to solve all your problems. The game we designed, NeuroRacer, was sculpted to target a specific ability.” In other words, the neuroscientists built a game designed specifically to promote “interference-resisting abilities,” and they’d gathered evidence of both targeted and larger gains.

The Controversy Over Brain Training

Findings in the study by Anguera, Gazzaley, and nine other colleagues at UCSF build on the work of others in laboratories around the world on the dynamic neuroscientists call transfer. That’s the contested idea that brain training in a specific area can yield more general benefits in cognitive functioning.  The adds another layer to accumulating eveidenc he that video training and other interventions can, under certain circumstances, shore up not only performance in a narrow channel – doing crossword puzzles, remembering larger blocks of numbers, and so on – but also general thinking capacities.

An earlier study, also published in Nature back in 2010, dumped all over the idea that brain training games yielded anything more than the ability to improve performance on narrow grounds. The publicity the earlier study generated left the impression that transfer was quite rare, perhaps even illusory. In fact, “Game Over for Brain Training” was the headline on a video about the 2010 study of 11,500 participants, still posted on the Website of neuroscientist Adrian Owen. Owen, a noted neuroscientist, oversaw the earlier study which evaluated claims of beneficial effects of other video games.

“The holy grail of brain training is that they will transfer to other brain functions,” he explained on a television show, broadcast by BBC, built around the experiment as it unfolded. “We all know that if you practice something you will get good at it. There’s no question that if you practice on a brain training game you’ll get better at that brain training game. The question we were trying to get at is: Does it lead to any general benefit in other areas of life, in other aspects of cognitive function?” In clarifying the point, Owen added, “If you want to get better at playing the violin, practice the violin. But you’re not going to get any better at playing the trumpet by practicing the violin.”

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The conclusion that brain training had no transfer effect, and the publicity it generated around the world, only fueled rising skepticism about outsize claims of those promoting everything from supplements to quick-fix gimmicks in the multimillion dollar enterprise aimed at the burgeoning population of aging adults concerned about fading memory. In an overall review of those claims, the Stanford Center on Longevity previously warned that an exploitative hard sell for products from computer training to supplements ranged “from reasonable though untested to blatantly false.” There were few provable links between discrete activities and broader benefits, the review concluded.  In other words, taking your vitamins or doing a variety of brain training exercises was unlikely to help you retrieve the name of your boss’s partner, painfully tripping along the tip of your tongue.

In the current report in Nature, however, 11 researchers in Gazzaley’s laboratory presented persuasive evidence of transfer. They ventured one step further, detailing the underlying neural mechanisms at play.   “… (A)ge-related deficits in neural signatures of cognitive control, as measured with electroencephalography were remediated by multitasking training (ie. enhanced midline frontal theta power and frontal-posterior theta coherence),” they write. Use of the specially-designed game, in other words, markedly improved performance of older adults not merely on the game itself but also led to robust increases in activity in those parts of the brain’s prefrontal cortex associated with greater cognitive control.

“We got the whole story this time,” Dr. Gazzaley told me, sounding rather triumphant, when I reached him on the phone in mid-August  as he was going through final edits of the article. “We demonstrated transfer from the training to other types of cognitive abilities and showed that the multitasking improvements on the game were sustainable.” He felt especially chuffed that older adults who participated in a version of the game that required multitasking were also the ones who demonstrated heightened ability in fighting distraction and sustaining their attention.

In an email several days later, he summed up the significance of this breakthrough: “What we have here is a link between neural plasticity and behavioral plasticity, pointing to a neural basis of transfer effects…Transfer has become the holy grail for training studies, but it is not a magic trick. Our data suggest that there must be a common neural mechanism of cognitive control that underlies working memory, sustained attention and multitasking and we put pressure on it with our game.”

This was a point fleshed out by the lead author of the study, Joaquin Anguera. “Many groups have found transfer to other abilities, other groups have shown neural changes following training, but we are the first to show both – and that they are correlated with each other,” he said. “That’s something no other cognitive training study has previously shown, ever – hey, with video game training!” The next step, he said, would be refining NeuroRacer, fleshing out the role of the prefrontal cortex, and devising interventions that even more effectively reverse the “costs” of distraction for older adults. If they can succeed in these goals, the implications for helping people navigate the disruptiveness of modern life would be immense.

Backdrop

The current study builds on earlier research by Gazzaley, a physician and neurologist at the Mission Bay campus of UCSF. He trained originally in an MD/PhD program at Mt. Sinai Medical Center, focussed on the patterns of cognitive decline in aged monkeys. Unlike humans, monkeys suffer from memory loss as they age but don’t contract Alzheimer’s Disease, and that set him on the search for solutions to commonly-experienced cognitive slippage. When he moved to a medical residency in clinical neurology at the University of Pennsylvania, Gazzaley regularly conducted extensive histories on aging patients, exploring the common but often quite troubling lapses in cognition related to so-called “normal aging.” He routinely asked his patients, “Have you noticed any change in your thinking abilities?” and used the responses to shape his research goals.

In a postdoctoral fellowship in the laboratory of Dr. Mark D’Esposito, a renowned expert on working memory at U.C. Berkeley, Gazzaley was perhaps best known as part of the team which identified separate neural markers for focusing attention and filtering out distraction – two functions once thought of as an indivisible thing. “Not two sides of the same coin, but different coins,” the neuroscientist said, in describing this breakthrough. Followup work detailed the connection between paying attention and simultaneously warding off interruptions. The current study builds on this earlier finding, which launched Gazzaley on his quest to identify the underlying neural mechanisms controlling what we remember and how we forget.

Focus in his research on the underlying mechanics of brain systems mechanisms is the aspect of the research program that his one-time mentor, Mark D’Esposito, values most. “To me, too much emphasis is being placed on the mode of training (video games, therapists, traditional cognitive training, etc.),” he wrote me, after reviewing the new study. Instead, the monitoring of brain activity which will allow researchers to use “brain systems (rather than the cognitive symptoms) to develop cognitive interventions” held the greatest promise, according to D’Esposito.  

The Game

NeuroRacer itself is a variant of a driving-while-distracted interactive experience. Back in the spring of 2011, mid-way through the current study, I spent several weeks embedded with researchers and participants because I wanted to follow an experiment – no matter its results – as a major neuroscience effort of this kind unfolded over time. I followed participants through steps of the study, watched as the experiment continued, sat in on evaluation sessions while sketchy results tumbled, and even tried my hand at the game. The game, developed with the help of designers at LucasFilms, seemed visually rich. It provided an immersive experience, certainly more fun than testing programs purposely stripped down to their most basic elements. The colors were appealing and the game had the feel of something dynamic and interesting, even if the action doesn't include rapid fire explosions or the need to throttle or shoot at anybody.

It was this immersive feature of NeuroRacer that most impressed other researchers in the field. “It’s the first real attempt to meaningfully harness the power of games in a dedicated cognitive enhancement tool,” commented C. Shawn Green, a neuroscientist at the University of Wisconsin-Madison and experts on brain training. “Many of the ‘brain trainers’ out there are really nothing more than slightly dressed-up versions of classic psychology paradigms,” Green went on. “You’re simply not going to create a useful paradigm just by labeling something a ‘video game’ (and maybe having a few stars appear when people do well). The game used here is reasonably playable as a real game, but also tractable as a research tool, thus allowed the authors to ask solid questions about the mechanics underlying the behavioral and neural changes.”

For users, the game relies on familiar conventions. When the screen lights up, the road reveals itself. On my first run at NeuroRacer, done sitting behind a computer in a darkened lab, I thought: Piece of cake, what idiot couldn’t master this? Controlling the direction by a modem operated on the right, I managed to hold my sporty auto avatar in its lane for several seconds. Then, unfortunately, the road kept slipping away from me, winding around curves, and unexpectedly rising and falling in elevation. The multitasking version of the game required me to drive and, simultaneously, respond accurately through a button on the left to signs that popped up at random on the screen.

Designers of NeuroRacer used an “adaptive staircase algorithm” to ratchet up the level of difficulty, meaning that each time a participant improved enough to respond accurately at least 80 percent of the time the challenge increases incrementally. This component of the research is the study’s “special sauce,” Gazzaley told me. The adaptation allows participants of different ages and abilities to start at an equivalent level of comfort and provides a basis for valid comparison across age groups.

“It leads to continuous challenge over the training period,” he explained. “Unlike the real world, where you get better at at something, it gets easier – here, as you get better it gets harder.”  In effect, Gazzaley and his co-inventors had produced a more useful training program simply by paying closer attention to the fundamental principles of gaming. The algorithm “adjusts the game to keep you in the zone,” Gazzaley went on. “Game designers call it ‘flow.’”

Trial Runs

My own experience with the game involved few periods of happy flow. My performance stacked up in a series of rather spectacular crashes and disheartening scores on sign identification. In brief, I flunked multitasking in this particular form. Upright, behind the computer in a darkened room, I felt a little like Charlie Chaplin in Modern Times, out of sync with the machinery. In that second stage of the experiment, I also played NeuroRacer while prone inside a tube and being monitored by functional Magnetic Resonance Imaging (fMRI). Prone, in the tube, it was more like a monkey in a cage, flailing around ineffectively and mostly blurting out, “Oh, crap – missed again.”

When I met with him in his office the next day, Gazzaley had excused these awful initial scores as just one piece of mounting evidence about the grand generational mystery: Why even healthy adults suffer progressively high deficits in responding to competing claims on attention. Older adults typically experience more difficulty in switching between tasks, partly because of what Gazzaley called “stickiness of perception.”  This sticky quality of perception as we age, which means that we leave multiple channels of perception and attention cracked open when we switch from doing one thing to another.

A participant in her EEG cap (Gazzaley Lab, UCSF)

“Older adults appear to have a problem in re-engaging, but also in disengaging,” Gazzaley explained. When you switch tasks, you’re basically going from one complex network to another. If that transition is sluggish from disuse or changes in the brain – in the neurochemistry – you’ll feel the consequences.”  Limiting the costs of disengagement, and easing the transition to re-engagement, is the aim of ongoing research in his laboratory. If you bring down costs of distraction, Gazzaley has argued, you could bolster the capacity to sustain attention, stay on task, and increase cognitive performance. This was part of what he’d set out to prove with NeuroRacer.

Next Steps

Next steps in the laboratory center on a series of ongoing experiments intended to flesh out a more complete understanding of the dynamics underlying those transitions – engagement, disengagement, and re-engagement – that end up smoothing, or hampering, the ability to switch tasks.  Through follow-up studies, Gazzaley’s colleagues are already on the hunt for varied ways of shoring up working memory, not only for aging adults but younger people as well. Gazzaley speculates that effective treatments to enhance brainpower will involve turning down the intensity of signaling from the so-called “default network” in the prefrontal cortex in additional to amplifying activation in the midline theta area.

He suggested that the current study also will prove relevant, as well, for those seeking new treatments for disease, including Alzheimer’s, dementia, depression, and ADHD. “All complex systems are susceptible to noise, or interference, and our brains are the most complex system we are aware of. And so, interference through distraction and interruption is a major vulnerability of our brains,” he wrote to me. “If you have something wrong with your brain, then you are likely to have a greater susceptibility to interference compared to healthy individuals.”

In other words, discovery of underlying mechanics that make healthy aging adults feel as though they’re slipping mental gears should translate into methods for shoring up cognitive functioning even in people with diagnosable illnesses. “Those conditions – ADHD, depression and dementia – all involve trouble with interference and general deficiencies in cognitive control,” Gazzaley went on. “And so it’s reasonable to hypothesize that this intervention may also be effective in improving their cognitive control abilities by challenging them with such a high-interference game.”

Relevance to diagnosable illnesses, rather than the common complaints of healthy adults, will have to be tested, of course. Torkel Klingberg, an expert in working memory at the Karolinska Institute, cautioned that independent studies will be required “to confirm the effects, and also investigate the effect in clinical samples (eg. ADHD or dementia).” Klingberg thought the most significant contribution of the current study was its role in providing “a substantial rebuttal of the view that the cognitive capacity of an individual is a fixed trait that cannot be affected by environment or training.” The challenge now would be to design interventions with robust results in improving the daily lives of aging adults.

Other researchers in the field praised the approach and quality of the study. “The distinctive contribution of the current study was that it opened a unique window into the mechanisms underlying multitasking, and more generally, cognitive control,” wrote Bornali Kundu, lead author of an influential recent study on attention and short-term memory in the Journal of Neuroscience. She pointed out that the benefits of current available treatments are limited by the narrow scope of their effects. “So far we treat such disorders with drugs that target one or more neurotransmitters,” Kundu said. “By training the particular set of neurons (and by default also regulating the relevant neurochemistry) we are specifically treating the patient’s ‘problematic’ brain circuit, however complicated that circuit may be.”

Arthur Kramer, director of the Beckmann Institute for Advanced Science and Technology at the University of Illinois, credited the researchers for making considerable strides in demonstrating how training, transfer and retention of information occurs. He felt the study should be replicated with larger numbers of participants with more varied skills, and that there was much more to be learned by fleshing the effects of transfer through more detailed batteries of tests before and after the training. The ultimate test that matters, he added, was whether “the training effects transfer to real-world skills and behaviors, e.g. safely driving an automobile, maintaining independence as we age…”

Four new prototypes based on the NeuroRacer game are under development in the lab, and a souped-up version of NeuroRacer is also being worked on at a company called Akili Interactive Labs, spun off from his laboratory several years ago. Gazzaley figures that some people will raise questions about his role in simultaneously conducting the research while also inventing training programs in a for-profit venture, but he sees only complementary interests. The company, after all, will not produce entertainment versions of the game, but rather will test and market a video game derived from NeuroRacer as an FDA-approved device. “Hey, one of my main goals from the beginning was to see this research leave the lab,” he said. Eventually, “medicine will not be equated with drugs only,” the neuroscientist added. One day NeuroRacer might be remembered “not as a game, but rather asmedicine.” Here was the latest installment in the war on distraction, bound to build to an even greater crescendo as Boomers clamor for more help in beating back the effects of aging on the brain.