Ask the Expert Interview: Adam Gazzaley, MD, PhD, on gaming, neuroscience, and cognitive health

Dr. Adam Gazzaley is a neuroscientist, neurologist, author, and entrepreneur. Over the course of his career, he has merged his scientific research with the possibilities of technology, exploring video games as an innovative treatment option for attention and memory. In this interview, Dr. Gazzaley explains how his interests and research have developed, and the next directions for the field.

How do you define "gaming" in your research and what led you to intersect your research as a neuroscientist with game development?

The goal to build a video game was not my initial inspiration. I wanted to find a novel approach to improve attention in older adults. This was in response to my research revealing that memory abilities in older adults were impaired by them being more distractible. I came up with the idea to challenge older individuals with a task that would selectively activate neural networks involved in attention. The hypothesis was that this would harness their brain’s natural plasticity to optimize attention abilities over time. I decided to build a task as a video game because I felt that the fun and immersive nature of play would lead to deeper engagement in the moment and better adherence to this as a treatment over time, which in turn would result in better outcomes.

What is cognitive control and how can gaming help to improve cognitive control outside of the game domain? How long do cognitive improvements last?

Cognitive control defines a set of abilities that allow us to engage in the world in a goal-directed manner. It includes attention, working memory (holding information in mind for short periods of time), and cognitive flexibility (multitasking and task switching). Neuroscientists have learned over the years that although these aspects of cognitive control are distinct in many ways, they use common neural networks that involve the prefrontal cortex. Because of this, I hypothesized that if an individual engaged in a game that challenged cognitive control at a very high-level, and was adaptive such that it kept pushing them to the edge of their ability, we would see a transfer of benefits to cognitive control abilities outside the domain of the game. And that is what we have found in almost a dozen studies. How long it lasts is still an open question, although we have shown benefits in some of our studies 6 months to a year later. I suspect that for long-lasting improvements we will need to offer booster doses of the game over time.

How can gaming prevent normal cognitive decline associated with aging or treat memory disorders like dementia?

In our studies on healthy older adults, we have shown the benefits of different types of custom-built video games on both attention and memory abilities. These games work by challenging our research participants in a “closed-loop” system, which means the games use algorithms that allow them to challenge and reward the players at an appropriate level based upon their own data. We are now advancing our efforts to study if our games have benefits in older adults who have mild cognitive impairment and the earliest stages of dementia.

Video games have recently been FDA cleared as a prescription treatment for children with ADHD. How far is this new frontier of "playing your medicine" from the cognitive aging space?

Yes, after a decade of effort by hundreds of people at Neuroscape and Akili, as well as external scientific research teams, evidence has been generated that resulted in FDA clearance of EndeavorRx as a prescription treatment for inattention in children with ADHD. This marks the first FDA-cleared digital treatment for ADHD, and the first prescription treatment for any clinical condition delivered as a video game. EndeavorRx was reviewed through FDA’s de novo pathway and so its clearance creates a new regulatory classification of therapeutics. The goal now is to advance this research and regulatory approval to other populations that would benefit from improved inattention abilities. Personally, I am very motivated to create solutions for cognitive challenges in older adults; that is where this all began for me.

For more insights from Dr. Gazzeley, join our Live Better Longer webinar, “Gaming and Your Brain”, with Prevention on Tuesday, March 30, 2021, 4-5 pm ET. Learn more and RSVP here.