The Brain Exercise Linked to a 25% Lower Dementia Risk

A just-published study finds evidence for one specific brain task in dementia prevention

By Austin Perlmutter, MD

Brain training

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When I talk about dementia prevention, I’m usually focusing on the merits of biological interventions like getting enough exercise, optimizing sleep, managing blood pressure, and better understanding the role of inflammation and metabolic health on brain state. Those factors are foundational and strongly supported by evidence. But there’s another lever that deserves serious attention: we can train the brain itself. A recent study offers some of the longest-term data we have on whether a structured brain training exercise reduces the chances of being diagnosed with dementia decades later. The findings are both encouraging and clarifying. Let’s jump in.

The just-published study, “Impact of cognitive training on claims-based diagnosed dementia over 20 years: evidence from the ACTIVE study,” uses data from one of the biggest randomized controlled trials ever done on the effects of brain training. In this trial, almost 3000 cognitively healthy adults were randomized to one of three brain training groups, or a control group (no training). The three brain training groups were verbal memory training (practice and use of mnemonic tools), reasoning training (practicing how to solve problems with patterns) and speed of processing training (practicing identifying and reacting to visual data).

The participants in the trial received around 10 hours of training over the course of about a month and a half, and then some participants had booster sessions of training after around 1 year and 3 years later. Then, participants were followed for up to 20 years to see if they developed a diagnosis of Alzheimer’s and related dementias. What was found was striking, specifically in one subgroup of the study.

After reviewing the available data, researchers from this trial found that people who did the speed of processing training with the two boosters had a 25% lower rate of diagnosis of Alzheimer’s and related dementias over the 20-year observational window. Importantly, they did not find any statistically significant benefit to the other brain training exercises or in the speed training group that didn’t get the boosters.

Why might this be the case? Speed-of-processing training specifically looks at how quickly and accurately the brain can take in visual information, distribute attention, and make decisions under time pressure. In this study, researchers leveraged a game built by university professors called “Double Decision” that requires a high degree of cognitive demand and may spark rewiring of the brain using neuroplasticity. This mild stress on the brain could contribute to the something called “cognitive reserve” – the brain’s ability to build resilience through learning, a process that may help delay dementia.

So, what should we do with this information? One takeaway I’d echo from other research is that continuously engaging in brain-stimulating activities is a good bet for brain health, but that we need more data on the specific effects of different brain trainings. A number of other studies have demonstrated that people who regularly stretch their brains may be at an advantage (see my full article on that here). However, this study does seem to indicate that there may be a unique value in a certain type of rapid-fire visual focus exercise that Double Decision provides.

Beyond the brain training, the researchers in this study reflect on the importance of research that emphasizes non-pharmaceutical multidomain interventions. As they state, "these lifestyle-change interventions combine various approaches, such as exercise, cardiovascular health monitoring, and cognitive training." This is particularly important in the context of previously published research like the FINGER trial, which showed cognitive improvement in people who performed either a structured or self-guided lifestyle protocol that included exercise, brain training, dietary modification, and a focus on improved social relationships, among other variables.

If you want to use the exact exercise tested in the study, you can check in out on the website BrainHQ.com. I have no affiliation with the site, but I did have the chance to interview its founder, the brilliant professor Michael Merzenich, PhD—one of the world’s leaders in the science of brain plasticity.

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