Among the non-pharmacological methods under development for maintaining cognitive function across the lifespan is computerized cognitive training (CCT). There has been considerable interest in using CCT to slow or remediate age-related cognitive decline, both normal and pathological. Toward these ends, it would be useful to know how the effects of CCT on cognitive function vary over the course of normal cognitive aging. Are there changes in either 1) the overall efficacy of CCT or 2) which cognitive faculties are affected? To address these two questions, we reanalyzed results from a large online study by Hardy et al. (1) of 4,715 adults between 18 and 80 that examined effects of CCT on both a neuropsychological test battery and self-reported ratings of cognition and affect in daily living. Combined across all participants, Hardy et al. found greater improvement on both types of assessment following 10 weeks of CCT with the commercial program Lumosity, as compared to practice with a control activity involving computerized crossword puzzles. The present study compared the size of these effects on the older (50–80) and younger (18–49) participants. To address the question of overall efficacy, we examined CCT effects (treatment minus control) on overall performance of the test battery and mean rating. No significant difference on either measure was found between the two age cohorts. To address the question of whether the same magnitude of overall effects on both age cohorts was due to equivalent effects on the same set of underlying cognitive functions, we examined the patterns of CCT effects across individual subtests and rated items. These patterns did not differ significantly between the two age cohorts. Our findings suggest that benefits from CCT can occur to a similar degree and in a similar way across an extended part of the adult lifespan. Moreover, the overall effects of CCT delivered over the internet were of the same small to medium size as those typically found in the lab or clinic. Besides improving access and reducing the cost of CCT for older adults, delivery over the internet makes long-term training more practicable, which could potentially yield larger benefits.

Fundamental to the efficacy of cognitive training (CT) is its dose. Here we used the power and breadth afforded by a large dataset to measure precisely dose-response (D-R) functions for CT and to examine the generality of their magnitude and form. The present observational study involved 107,000 users of Lumosity, a commercial program comprising computer games designed to provide CT over the internet. In addition to training with Lumosity games, these users took an online battery of cognitive assessments (NeuroCognitive Performance Test, NCPT) on two or more occasions separated by at least 10 weeks. Changes in performance on the NCPT between the first and second assessments were examined as a function of the amount of intervening gameplay. The resulting D-R functions were obtained both for overall performance on the NCPT and performance on its eight subtests. Also examined were differences between D-R functions from demographic groups defined by age, gender, and education. Monotonically increasing D-R functions, well fit by an exponential approach to an asymptote, were found consistently for overall performance on the NCPT, performance on seven of the eight subtests, and at each level of age, education, and gender. By examining how individual parameters of the D-R functions varied across subtests and groups, it was possible to measure separately changes in the effects on NCPT performance of 1) transfer from CT and 2) direct practice due to repeated testing. The impact of both transfer and direct practice varied across subtests. In contrast, while the effects of direct practice diminished with age, those of transfer remained constant. Besides its implications for CT by older adults, this latter finding suggests that direct practice and transfer do not involve identical learning processes, with transfer being limited to learning processes that remain constant across the adult lifespan.

BackgroundThe 21st Century Cures Act highlights the value of evidence obtained outside of traditional clinical trials (real world evidence, RWE) to enhance trial design and support health care decision making. Increasing use of computers and smartphones has accelerated the generation of RWE and enabled digital therapies including computerized cognitive training (CCT). CCT offers promise for improving cognitive outcomes in MCI and AD, but its effectiveness has not been fully established. Toward this end, we examined RWE on the effectiveness of CCT in MCI/AD using a large online dataset.MethodWe analyzed de‐identified data from a cohort of 82,984 individuals who participated in an online CCT program (Lumosity). Of these, 3514 reported a diagnosis of MCI or AD while the rest served as controls (N = 79,470). Participants completed the NeuroCognitive Performance Test (NCPT), a validated, computerized, online neuropsychological battery. A subset also completed a survey assessing real‐world cognitive functioning (RWC survey). Measures on both instruments were examined at baseline and after varying doses of CCT.ResultAt baseline, the MCI/AD cohort was significantly impaired on all eight NCPT cognitive subtests and the NCPT composite measure of global cognition compared to demographics‐matched controls (p<0.0001, N = 3514 MCI/AD, 79,470 healthy). The MCI/AD cohort was also impaired on the RWC survey (p<0.0001 for the composite score), particularly on items related to concentration or forgetfulness. Engagement with CCT varied among MCI/AD subjects with 2+ assessment timepoints (N = 1934), with an average of 340 CCT games played (SD = 482) over 112 days between assessments (SD = 104). The change from baseline in the NCPT composite measure increased with amount of CCT (p<0.0001, Cohen’s d = 0.31). RWC survey items also improved with training in a subset who completed them at multiple timepoints (p = 0.0530, N = 162).ConclusionThis study provides RWE for the efficacy of CCT in MCI/AD on both objective and patient rated cognitive outcomes. The study also provides insights into dose effects. Such RWE will help optimize CCT interventions to improve cognitive symptoms of MCI and AD.