Reportage on the use of virtual reality in cognitive therapy, at the EHPAD retirement home in Laval, France. Ride in EHPAD is a virtual reality app that offers a recreational bike ride in various environments. The app is designed for elderly people and Alzheimers sufferers. The patients relax, get some exercise, and stimulate cognitive functions through simple games (with no failure). (Photo by: BSIP/UIG via Getty Images)

Not so long ago, people kept ageing brains active through reading and writing, talking with friends and family, and perhaps playing cards or doing puzzles. Now a rapidly growing number are taking a high-tech approach to cognitive maintenance, through computer programs designed to stimulate the brain.

The brain training and cognitive assessment sector is one of the fastest growing parts of the tech market. Sales are increasing at a compound rate of 20 to 25 per cent a year, passing $1.3bn worldwide in 2013 and forecast to exceed $6bn by 2020, according to Alvaro Fernandez, chief executive of the specialist market research company SharpBrains.

More than half of revenues come from people aged 50 or more. “The field is moving very fast, both in the science and in the delivery mechanisms for brain training,” Mr Fernandez said.

Two factors lie behind this rapid growth. One is the improving hardware and software, particularly graphics, that make brain-training programs appealing to elderly users who are not comfortable with computers or smartphones.

The first wave of programs were downloaded on to home computers, the second is played online through the internet and a third, now emerging, is tailored to smartphone and mobile devices. Some companies are also selling biosensors that monitor the user’s brainwaves through EEG (electroencephalogram) technology as they train.

The other factor expanding the sector is accumulating scientific evidence about the brain’s “plasticity”, the fact that neurons can grow or adapt to new tasks at any age, given the right stimulus.

While it is obvious that practising a particular skill makes you better at it, at least in the short term, some neuroscientists have questioned whether specific brain training programs lead to a broader improvement in cognitive abilities and, if so, how long this lasts.

Such doubts are disappearing now that longer term studies are publishing positive results. A powerful example is the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial, funded by the US National Institutes of Health and involving 2,800 healthy volunteers in their 70s and 80s. It reported earlier this year that brain training to improve reasoning and speed of mental processing left significant benefits a decade later.

Richard Hodes, director of the National Institute on Ageing, said the results “suggest that we should continue to pursue cognitive training as an intervention that might help maintain the mental abilities of older people so that they may remain independent and in the community.”

A former doubter, Professor Clive Ballard of King’s College London who was until recently research director of the Alzheimer’s Society, said data from a large UK trial – not yet published – showed well-targeted brain training increased the reasoning ability of elderly volunteers. “Playing ordinary computer games probably won’t help but some studies are showing benefits from challenging memory games, where you have to hold several iterations in your memory while completing certain tasks,” he added.

Not everyone is convinced, however. Last week 69 neuroscientists and psychologists from around the world said in an open letter: "We object to the claim that brain games offer consumers a scientifically grounded avenue to reduce or reverse cognitive decline when there is no compelling scientific evidence to date that they do.

“The promise of a magic bullet detracts from the best evidence to date, which is that cognitive health in old age reflects the long-term effects of healthy, engaged lifestyles."

Yet some brain training companies are making their own contributions to research. Lumosity (based in California, the heartland of the brain training industry) has built a research platform, the grandly named Human Cognition Project. This provides performance data from 60m people, who have played the company’s games a total of 2bn times, for analysis by university scientists.

Most brain training companies do not publish financial figures, but the biggest name in the online consumer and mobile sector appears to be Lumosity, which has received $65m in venture capital funding since 2007. Other leading brain training and assessment businesses include Brain Resource, CogState, Cogmed, NeuroSky, Cogniciti, Emotiv Insights and Brain+.

One of the few top-quality, scientifically validated brain tests available free on the internet comes from Cogniciti, a spin-out from the University of Toronto’s Baycrest Health Sciences centre. Its 20-minute test, designed for people aged 50 to 79, assesses functions such as memory and attention and tells people how they have performed compared to others of their age.

Brain centres, where people go for neural exercise and training outside the home, have been less successful, according to Mr Fernandez. “They make much logical sense but issues over costs and privacy have held them back,” he said. “Many early pioneers are struggling, some have closed.”

However one brain centre pioneer, clinical neuroscientist Majid Fotuhi, has ambitious expansion plans for NeurExpand, the group of three centres he founded recently in the Washington DC area, which offer a three-month brain fitness programme.

“We plan to open 50 centres across the US over the next three years,” Dr Fotuhi said. “Our first three centres were filled as soon as we opened them, so we are confident that the demand is there.”

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