Crossword Puzzles and Training the Brain

Authors: Bart D. Brigidi, PhD & Renee H. Raynor, PhD

Can we train our brains to think faster? More efficiently? To remember better? Will doing crossword puzzles keep dementia or Alzheimer’s at bay?  Questions like these have kept neuroscientists and the popular media busy for decades.  At the heart of the “brain-train” movement is a huge debate, which is especially relevant to individuals with brain injury from cancer and its treatment. Some researchers say that there is no reason to believe that mental exercises would have any meaningful and lasting effects on our abilities to think and learn. Other researchers say that you can train the brain by routinely using challenging puzzles, number logic problems, and computer software.

At The Preston Robert Tisch Brain Tumor Center at Duke (PRT-BTC), we have been studying whether these methods are worthwhile for brain cancer patients.

Because of innovative treatments, survival is being extended for brain cancer patients. As brain cancer continues to be transformed into a more chronic illness, quality of life issues, like preserving cognitive abilities, increasingly will be pushed to the forefront of clinical care initiatives.  Cognitive dysfunction negatively impacts quality of life for brain tumor patients and their caregivers. Over the course of their disease, nearly all individuals with brain tumors will experience changes in their cognitive abilities. This may range from subtle, nuisance forgetfulness (e.g., misplacing common household items) to more debilitating cognitive disturbances (e.g., inability to communicate with others or severe memory problems).  The term “chemo brain” has been offered to be a syndrome associated with systemic therapies and described as resulting in cognitive slowing, a mental “fogginess,” or being more distractible and forgetful.  Unfortunately, there are only a handful of medications that are FDA approved to treat cognitive dysfunction and often their efficacy appears to be limited or complicated by interactions with adjuvant therapies.

We were interested to know if brain tumor patients would be interested in trying non-medication methods to treat their cognitive dysfunction.  Since there were no existing published studies on non-medication methods or cognitive training (CT) to treat cognitive dysfunction in adult brain tumor patients, we collected surveys from 92 adult brain tumor patients and their caregivers regarding their beliefs, attitudes, and interest in CT using computer software.  Results showed that 100% of the sample endorsed having a computer with Internet access and being comfortable with using a computer to do CT. Seventy percent of the sample indicated having used either medication or non-medication methods of cognitive improvement in the past, with 62% currently taking a psychostimulant and 37% taking donepezil. Of those taking medications for cognitive enhancement, 45% were unsure that they had noticed benefit from the medications, and 39% had discontinued use of a cognitive enhancing medication or supplement in the past. Ninety percent would prefer doing CT at their home versus a clinic setting. Seventy-five percent endorsed being able to sit down at a computer for at least 30 minutes daily and 68% endorsed that the minimal time for CT to be effective would likely be at least 30 minutes per day on at least 5 days a week. Interestingly, ninety percent would have liked to have learned about CT at the time of their neuropsychological feedback session at the PRT-BTC. Overall, results demonstrated that CT appeared needed and was highly desired by adults with brain tumors and their caregivers. 

Our next step, which is where we are currently, is to develop a comprehensive home-based CT program for brain tumor patients with mild to moderate cognitive dysfunction.  In a pilot study, we continue to pilot test one component of a larger cognitive rehabilitation program.  We have administered CT using computerized cognitive tasks of attention, speed of processing, working memory, and reasoning using Captain’s Log®, computerized software designed to train mental abilities.Participants have been asked to complete CT at least one hour per day on 4 out 7 days per week.  Primary outcome measures included standardized measures of verbal attention speed of processing, verbal memory, psychomotor speed, executive functioning, verbal fluency, and perceived cognitive ability.  In addition to the computer training, we are also asking participants to complete ½ hour sessions of training every other week in how to deal or cope with making mistakes due to cognitive dysfunction.  Results have shown that regardless of change in neurocognitive outcomes, which were modest, for those survivors who were administered additional training in coping skills, ratings of acceptance (i.e., willingness to experience making mistakes in everyday life) improved over time.  These results revealed the possibility that adult survivors of brain cancer may benefit more from CT with a structured, coping skills component than traditional CT, in which case individuals are required to simply sit down at a computer and complete training.

Results of the acceptance-based cognitive training program are promising, but are still preliminary.  More rigorous testing of this method to treat cognitive dysfunction is needed.  If this method were successful, this would expand options for brain tumor patients to deal with cognitive dysfunction and should be further studied in combination with medication approaches.

Source: The Preston Robert Tisch Mrain Tumor Center at Duke