DAVID GREENE, HOST:
In Your Health today - get smart. That's the message from so many video game makers. They say their games can help train your brain. Well, there are plenty of skeptics who say these games just don't work. One skeptic is doing something unexpected, though - putting a game to the ultimate test. Here's reporter April Dembosky, from member station KQED in San Francisco.
APRIL DEMBOSKY, BYLINE: You've probably heard lots of ads for brain games, maybe even passed a store in the mall selling them. This one in downtown San Francisco is just past the cream puff stand and across from Jamba Juice. When you walk in, Dominic Firpo introduces himself.
DOMINIC FIRPO: I'm a brain coach here at Marbles: The Brain Store.
DEMBOSKY: That's right. He said brain coach.
FIRPO: Sounds better than salesperson.
DEMBOSKY: He takes me to the word and memory section of the store and points to one product that says it will improve your focus and reduce stress in just three minutes a day.
FIRPO: We sold out of it within the first month that we got it.
DEMBOSKY: The market for these brain fitness games is worth about $1 billion and is expected to grow to $6 billion in next five years. Game makers appeal to the young and the elderly with this common claim - if you exercise your memory, you'll be able to think faster, be less forgetful, maybe bump up your IQ a few points.
RANDALL ENGLE: That's absurd.
DEMBOSKY: Psychology professor Randall Engle from the Georgia Institute of Technology doesn't buy it. He says intelligence is largely controlled by neurotransmitters.
ENGLE: We're really talking about a biological system.
DEMBOSKY: And you can't really change it with a game.
ENGLE: The idea that you could do some little computer game for half an hour a day for 10 days and change that system is ludicrous on the face of it.
DEMBOSKY: Engle is one of many skeptics who say all these games make you better at is the game itself.
ENGLE: There's very little research that's done right that suggests that these things work.
DEMBOSKY: Engle says the studies are often done by the companies that sell the games. They usually have a really small sample size or there's no real control group. He's done some tests himself to see if the games improve cognitive performance.
ENGLE: Over and over and over again we just don't see any substantial benefit for these games.
DEMBOSKY: Engle is one of 75 scientists who signed a letter addressed to the brain training industry, criticizing companies for exaggerating claims and preying on the anxieties of elderly customers trying to hold off memory decline. Engle says the commercialization of these games has harmed brain research.
ENGLE: Unfortunately, an awful lot of people are more interested in the business of it than in finding the science.
DEMBOSKY: Neuroscientist Adam Gazzaley is interested in both. In his lab at the University of California, San Francisco, he's working on something much more complicated than a brain exercise. It's a fully immersive video game where you guide a horse through the Aztec desert. At the same time, you have to tap green carrots that flash at the top of the screen, but not the yellow carrots or the radishes. Gazzaley thinks this kind of challenge will have an effect.
ADAM GAZZALEY: If we created this - what we call a high interference environment, with multitasking going on and lots of distraction - that if we put pressure in that environment, we would see benefits in other aspects of cognitive control.
DEMBOSKY: Think of it like a racecar. To get around the track, you've got the accelerator, the gearshift and the steering wheel. If one of them's not working right, you'll never win the race. It's like that with the brain. Gazzaley says the networks that control the three classes of cognitive ability - working memory, attention and goal management - all overlap.
GAZZALEY: If you have a problem with any of them, it's going to propagate and you'll have a problem with memory. You have a problem with school or work or relationships or safety in driving.
DEMBOSKY: On the flipside, Gazzaley believes that if you can improve one of these cognitive skills, you might be able to improve all of them. Now, Gazzaley is well aware of the skeptics. Remember that letter from Randall Engle of Georgia Tech and the other critics, the one urging caution around the weak scientific claims of brain games? Adam Gazzaley was one of the people who signed it. And he's the first to admit that his hypothesis needs to be thoroughly tested.
GAZZALEY: I am cautiously optimistic about this.
DEMBOSKY: He decided the best proof he could get would come from taking one of his games through the FDA approval process for medical devices.
GAZZALEY: Can we then go through a very rigorous validation clinical trial, just like people would expect from a drug, to then show how it works how it doesn't work, how it could work better - all those things.
DEMBOSKY: Gazzaley sees great potential to use these games for a range of psychiatric disorders.
GAZZALEY: PTSD, a traumatic brain injury or ADHD, autism, all the different things that cause dementia like Alzheimer's disease.
DEMBOSKY: He's hoping there will be a day when a video game might be prescribed to treat a kid with ADHD instead of a pill.
GAZZALEY: Most of our drugs are pretty blunt instruments.
DEMBOSKY: He says the game, if it works, can be used to target the affected brain networks more precisely, and by monitoring the data of each patient playing the game, they can tailor the treatment on an individual basis.
GAZZALEY: Instead of having a patient come in, receiving a therapeutic - like a pill - going home and having them subjectively monitor the impact and then come back months later and report that, here we have the ability to track in real time what the impact of this therapeutic is.
DEMBOSKY: That is a pretty appealing prospect to psychiatrist Petra Steinbuchel. She works with kids and adolescents with ADHD at the Children's Hospital in Oakland. Parents are always asking her if there's something she can do for their children other than prescribe drugs.
PETRA STEINBUCHEL: Nobody wants to give their child a medication, and many people have a lot of hang-ups about that.
DEMBOSKY: Existing drugs usually wear off before the end of the day. Some kids suffer side effects like low appetite, weight loss or sleep problems.
STEINBUCHEL: If we can avoid that and avoid anything that you put into your body and just make use of something that you're using as a tool to help improve things for the long term - that would be great.
DEMBOSKY: Still, drugs for ADHD are 75 to 90 percent effective. Steinbuchel says until a game matches that standard, it can only ever be one part of her treatment.
STEINBUCHEL: And I think it's part of a bigger picture of looking at sleep, diet, exercise, home environment and school systems, as part of a comprehensive treatment plan.
DEMBOSKY: Adam Gazzaley is betting on his vision of the future. If his first game is approved by the FDA, he has another four in development that he hopes will be next. For NPR News, I'm April Dembosky in San Francisco.
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