Video Games as Cognitive Therapy for Early-Stage Dementia

Introduction: Brain Aging and Cognitive Decline

The deterioration of cognitive abilities and brain tissue due to age can have several adverse effects on mental functioning and may even lead to dementia. Researchers are therefore working to discover methods that could help preserve brain function, independence, and cognition among older adults. With age, the white and gray matter of the brain tends to shrink, an effect most pronounced in the prefrontal cortex. Other affected regions include the cerebellum, the lateral prefrontal cortex, and the central temporal lobe structures, including the hippocampus. Notably, the occipital cortex and the entorhinal cortex do not appear to experience significant shrinkage (Ballesteros et al., 2015).

Common symptoms of this age-related shrinkage include reduced memory strength, slower mental processing, irregular recall, and difficulty carrying out routine actions. Speech, general knowledge, and long-term memories, however, typically remain relatively intact. This pattern is observed even in adults with mildly impaired cognitive abilities or early-stage Alzheimer's disease, whose memory stores remain largely preserved while their ability to learn new information is reduced. Remarkably, studies using functional magnetic resonance imaging have revealed altered neural priming patterns among older adults, even when behavioral priming remains intact — possibly as a form of neural compensation (Ballesteros et al., 2013).

Literature Review: Neuroplasticity, Cognitive Training, and Video Games

Several studies support the idea that the quality of life of older adults can be improved. A phenomenon known as neuroplasticity — the brain's ability to adapt in response to environmental changes — has been documented in animals and humans. It is closely tied to cognitive function and neural connectivity. Accordingly, individuals who exist in more stimulating environments tend to show a more active hippocampus, reflecting a richer range of cognitive engagement (Ballesteros et al., 2015).

Experiments carried out on humans indicate that neural plasticity occurs at the level of the neural substrate, and that this phenomenon does not unfold equally in younger and older adults. Even as the brain ages, it retains some degree of neuroplasticity and continues to be shaped by a person's activities (Connor & Shaw, 2016; Friedrich et al., 2014). Cognitive plasticity results from a sustained imbalance between the resources available to an organism and those demanded by its environment, and it determines how capable the brain will be in reorganizing itself based on behavioral tendencies (Bavelier et al., 2012). In line with neuroplasticity principles, several approaches have been developed to slow cognitive deterioration, including reinforcing social interaction skills, exercising cognitive abilities, engaging in physical training, and adopting healthier lifestyle habits (Granic, Lobel, & Engels, 2014).

Cognitive training exercises have proved especially helpful for older adults in the areas of memory, reasoning, attention, multitasking, information processing speed, and working memory (Jak, Seelye, & Jurick, 2013; Anguera et al., 2013; Hampstead et al., 2012).

Merging video games with these training schemes is an approach that has attracted considerable attention, although it has not yet been conclusively proven to enhance the cognitive abilities of older adults. A recent comprehensive study found that when individual skills such as attention, problem-solving, and memory are trained in isolation, significant improvements occur — but those improvements tend to remain confined to the specific skills exercised (Ballesteros et al., 2015). The central question, then, is whether these targeted improvements transfer to untrained skills and produce broader cognitive gains in older populations.

Research on action video games suggests that playing intensive titles can improve a range of perceptual and cognitive skills — including task-switching, short-term visual memory, visuospatial perception, mental rotation, and attentional control — in both younger and older players (Bavelier et al., 2012; Ballesteros et al., 2015). Nevertheless, several other studies found no meaningful improvement in general cognitive ability, or found that any improvements were negligible or skewed toward younger participants rather than older ones (Kuhn et al., 2014; Lampit, Hallock, & Valenzuela, 2014). A notable example is Owen et al. (2010), who conducted training with 11,430 participants over six weeks, using cognitive exercises targeting memory, visuospatial strength, reasoning, planning, and attention. Despite this breadth and rigor, they found no improvement in cognitive abilities beyond the skills directly trained.