Research Article
No access
Published Online: 8 April 2019

Computer and Videogame Interventions for Older Adults' Cognitive and Everyday Functioning

Publication: Games for Health Journal
Volume 8, Issue Number 2


Objective: This study compared older adults' gains in cognitive and everyday functioning after a 60-session home-based videogame intervention with gains seen under formal cognitive training and usual care/no intervention.
Materials and Methods: Participants were randomized to one of three groups: one group played an off-the-shelf videogame (i.e., Crazy Taxi), the second group engaged in a computerized training program focused on visual attention and processing speed (i.e., PositScience InSight), and the third group received no training. Training in the two intervention conditions consisted of 60 training sessions of 1 hour each, which were completed in 3 months (5 hours a week). Participants received a broad battery of cognitive and everyday functioning assessments immediately before (pretest), after (post-test), and 3 months after (follow-up) training.
Results: Both training conditions improved on direct assessments of trained outcomes. In the InSight-trained group, we found transfer to untrained measures of visual attention and processing speed that were similar to the trained tasks, and these gains endured for up to 3 months. Participants in the videogame condition showed small additional benefits, not emerging until 3 months after intervention completion, on a measure of both attention and mood. No trained groups showed gain on visuospatial skills or memory.
Conclusion: Training effects were highly specific to the target of training. Training effects to visual attention and processing speed were, as expected, larger for InSight-trained participants but were also seen for videogame participants. Given that past research has shown that videogame training leads to greater engagement than cognitive training, videogame interventions may represent a choice for more modest gains in a more engaging context.

Get full access to this article

View all available purchase options and get full access to this article.


1. Hillman CH, Erickson KI, Kramer AF. Be smart, exercise your heart: Exercise effects on brain and cognition. Nat Rev Neurosci 2008; 9:58–65.
2. Willis SL, Tennstedt SL, Marsiske M, et al. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA 2006; 296:2805–2814.
3. Small BJ, Dixon RA, McArdle JJ, Grimm KJ. Do changes in lifestyle engagement moderate cognitive decline in normal aging? Evidence from the Victoria Longitudinal Study. Neuropsychol 2012; 26:144–155.
4. Unverzagt FW, Guey LT, Jones RN. ACTIVE cognitive training and rates of incident dementia. J Int Neuropsychol Soc 2012; 18:669–677.
5. Rebok GW, Ball K, Guey LT, et al. Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults. J Am Geriatr Soc 2014; 62:16–24.
6. Jobe JB, Smith DM, Ball K, et al. ACTIVE: A cognitive intervention trial to promote independence in older adults. Control Clin Trials 2001; 22:453–479.
7. Ball K, Beard BL, Roenker DL, et al. Age and visual search: Expanding the useful field of view. J Opt Soc Am 1988; 5:2210–2219.
8. Ball K, Owsley C, Sloane ME, et al. Visual attention problems as a predictor of vehicle crashes in older drivers. Invest Ophthalmol Vis Sci 1993; 34:3110–3123.
9. Ball K, Berch DB, Helmers KF, et al. Effects of cognitive training interventions with older adults: A randomized controlled trial. JAMA 2002; 288:2271–2281.
10. Edwards JD, Valdés EG, Peronto C, et al. The efficacy of InSight cognitive training to improve useful field of view performance: A brief report. J Gerontol B-Psychol 2013; 70:417–422.
11. Ball K, Edwards JD, Ross LA, McGwin J. Cognitive training decreases motor vehicle collision involvement of older drivers. J Am Geriatr Soc 2010; 58:2107–2113.
12. Edwards JD, Wadley VG, Myers RS, et al. Transfer of a speed of processing intervention to near and far cognitive functions. Gerontology 2002; 48:329–340.
13. Ball K, Edwards JD, Ross LA. The impact of speed of processing training on cognitive and everyday functions. J Gerontol B Psychol 2007; 62(Special Issue 1):19–31.
14. Vance D, Dawson J, Wadley V, et al. The accelerate study: The longitudinal effect of speed of processing training on cognitive performance of older adults. Rehabil Psychol 2007; 52:89–96.
15. Wolinsky FD, Unverzagt FW, Smith DM, et al. The ACTIVE cognitive training trial and health-related quality of life: Protection that lasts for 5 years. J Gerontol A Biol Sci Med Sci 2006; 61:1324–1329.
16. Wolinsky FD, Vander Weg MWV, Martin R, et al. The effect of speed-of-processing training on depressive symptoms in active. J Gerontol A Biol 2009; 64A:468–472.
17. Wolinsky FD, Mahncke H, Vander Weg MW, et al. Speed of processing training protects self-rated health in older adults: Enduring effects observed in the multi-site ACTIVE randomized controlled trial. Int Psychogeriatr 2010; 22:470–478.
18. Green CS, Bavelier D. Learning, attentional control and action video games. Curr Biol 2012; 22:R197–R206.
19. Heuer H. Technologies shape sensorimotor skills and abilities. Trend Neurosci Educ 2016; 5:121–129.
20. Bavelier D, Green CS, Pouget A Schrater P. Brain plasticity through the life span: Learning to learn and action video games. Annu Rev Neurosci 2012; 35:391–416.
21. Przybylski AK, Rigby CS, Ryan RM. A motivational model of video game engagement. Rev Gen Psychol 2010; 14:154.
22. Perron B. The survival horror: The extended body genre. Horror video games: Essays on the fusion of fear and play. Jefferson, NC: McFarland & Co; 2009, pp. 121–143.
23. Sherry JL. Flow and media enjoyment. Commun Theory 2004; 14:328–347.
24. Weber R, Tamborini R, Westcott-Baker A, Kantor B. Theorizing flow and media enjoyment as cognitive synchronization of attentional and reward networks. Commun Theory 2009; 19:397–422.
25. Park DC, Reuter-Lorenz P. The adaptive brain: Aging and neurocognitive scaffolding. Annu Rev Psychol 2009; 60:173–196.
26. Park DC, Lodi-Smith J, Drew L, et al. The impact of sustained engagement on cognitive function in older adults the synapse project. Psychol Sci 2014; 25:103–112.
27. Stine-Morrow EAL, Parisi JM, Morrow DG, et al. An engagement model of cognitive optimization through adulthood. J Gerontol B Psychol 2007; 62(Special Issue 1):62–69.
28. Stine-Morrow EAL, Parisi JM, Morrow DG, Park DC. The effects of an engaged lifestyle on cognitive vitality: A field experiment. Psychol Aging 2008; 23:778–786.
29. Carlson MC, Saczynski JS, Rebok GW, et al. Exploring the Effects of an “Everyday” Activity Program on Executive Function and Memory in Older Adults: Experience Corps®. Gerontologist 2008; 48:793–801.
30. Noice H, Noice T, Staines G. A short-term intervention to enhance cognitive and affective functioning in older adults. J Aging Health 2004; 16:562–585.
31. Green CS, Bavelier D. Effect of action video games on the spatial distribution of visuospatial attention. J Exp Psychol Human 2006; 32:1465.
32. Green CS, Bavelier D. Enumeration versus multiple object tracking: The case of action video game players. Cognition 2006; 101:217–245.
33. Green CS, Bavelier D. Action video game modifies visual selective attention. Nature 2003; 423:534–537.
34. Basak C, Boot WR, Voss MW, Kramer AF. Can training in a real-time strategy video game attenuate cognitive decline in older adults? Psychol Aging 2008; 23:765–777.
35. Fabiani M, Buckley J, Gratton G, et al. The training of complex task performance. Acta Psychol 1989; 71:259–299.
36. Gopher D, Weil M, Siegel D. Practice under changing priorities: An approach to the training of complex skills. Acta Psychol 1989; 71:147–177.
37. Stern Y, Blumen HM, Rich LW, et al. Space Fortress game training and executive control in older adults: A pilot intervention. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2011; 18:653–677.
38. Anguera JA, Boccanfuso J, Rintoul JL, et al. Video game training enhances cognitive control in older adults. Nature 2013: 501:97–101.
39. Baniqued PL, Kranz MB, Voss MW, et al. Cognitive training with casual video games: Points to consider. Front Psychol 2013; 4:1010.
40. Belchior P, Marsiske M, Sisco S, et al. The impact of video game training on selected visual attention in older adults. Comput Hum Behav 2013; 29:1318–1324.
41. Belchior P, Marsiske M, Sisco S, et al. Older adults' engagement with a video game training program. Act Adapt Aging, 2012; 36:269–279.
42. Belchior P, Marsiske M, Leite W, et al. 2016 older adults' engagement during an intervention involving off-the-shelf videogame. Games Health J 2016; 5:151–156.
43. Boot WR, Blakely DP, Simons DJ. Do action video games improve perception and cognition? Front Psych 2011; 2:226.
44. Simons DJ, Boot WR, Charness N, et al. Do “brain-training” programs work? Psychol Sci Public Interest 2016; 17:103–186.
45. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state.” A practical methods for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189–198.
46. Lustig C, Shah P, Seidler R, Reuter-Lorenz PA. Aging, training, and the brain: A review and future directions. Neuropsychol Rev 2009; 19:504–522.
47. Edwards JD, Valdes EG, Peronto C, et al. The efficacy of InSight cognitive training to improve useful field of view performance: A brief report. J Gerontol Psychol Sci Soc Sci 2015; 70:417–422.
48. Delahunt PB, Hardy JL, Brenner DF, et al. (2008). Insight: Scientific principles of a brain-plasticity-based visual training program. [White Paper]. San Fancisco, CA: PositScience Corporation.
49. Blom G. Statistical Estimates and Transformed Beta Variables. New York, NY: John Wiley & Associates; 1958.
50. Thorndike EL, Woodworth RS. The influence of improvement in one mental function upon the efficiency of other functions (I). Psychol Rev 1901; 8:247–261.
51. Owen AM, Hampshire A, Grahn JA. Putting brain training to the test. Nature 2010; 465:775–779.
52. Baltes PB, Willis SL. Plasticity and enhancement of intellectual functioning in old age: Penn State's Adult Development and Enrichment Project (ADEPT). In Craik F.I.M & Trehub S. E. (Eds.), Aging and Cognitive Processes. New York: Plennum Press; 1982, pp. 353–389.
53. Woodworth RS, Thorndike EL. The influence of improvement in one mental function upon the efficiency of other functions. Psychol Rev 1901; 8:247.
54. Thompson TW, Waskom ML, Garel KLA, et al. Failure of working memory training to enhance cognition or intelligence. PLoS One 2013; 8:e63614.
55. Green CS, Pouget A, Bavelier D. Improved probabilistic inference as a general learning mechanism with action video games. Curr Biol 2010; 14:1573–1579.
56. Achtman RL, Green CS, Bavelier D. Video games as a tool to train visual skills. Restor Neurol Neurosci 2008; 26:345–346.
57. Clark K, Fleck MS, Mitroff SR. Enhanced change detection performance reveals improved strategy use in avid action video game players. Acta Psychol 2011; 136:67–72.
58. Unsar S, Sut N. Depression and health status in elderly hospitalized patients with chronic illness. Arch Gerontol Geriatr 2010; 50:6–10.
59. Lin JH, Huang MW, Wang DW, et al. Late-life depression and quality of life in a geriatric evaluation and management unit: An exploratory study. BMC Geriatr 2014; 14:77.
60. Wechsler D. Wechsler Adult Intelligence Scale–Fourth Edition. San Antonio, TX: Pearson; 2008.
61. Benton AL, Varney NR, Hamsher KS. Visuospatial judgment: A clinical test. Arch Neurol 1978; 35:364–367.
62. Shepard RN, Metzler J. Mental rotation of three-dimensional objects. Can J Psychol 1971; 37:367–389.
63. Schaie KW, Hertzog C. Measurement in the Psychology of Adulthood and Aging. In Birren J.E. & Schaie K.W (Eds). Handbook of the Psychology of Aging (2nd ed.). New York: Van Nostrand Reinhold; 1985, pp. 61–94.
64. Owsley C, McGwin G Jr., Sloane ME, et al. Timed instrumental activities of daily living tasks: Relationship to visual function in older adults. Optometry Vision Sci 2001; 78:350–359.
65. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: The PANAS scales. J Pers Soc Psychol 1988; 54:1063–1070.
66. Yesavage J, Sheikh J. Geriatric depression scale (GDS). Clin Gerontol 1986; 5:165–173.
67. Brandt J. The Hopkins verbal learning test: Development of a new memory test with six equivalent forms. Clin Neuropsychol 1991; 5:125.
68. Bediou B, Adams DM, Mayer R, et al. Meta-analysis of action video game impact on perceptual, attentional, and cognitive skills. Psychol Bull 2018; 144:77–110.

Information & Authors


Published In

cover image Games for Health Journal
Games for Health Journal
Volume 8Issue Number 2April 2019
Pages: 129 - 143
PubMed: 30273002


Published online: 8 April 2019
Published in print: April 2019
Published ahead of print: 29 September 2018


Request permissions for this article.




Patrícia Belchior [email protected]
School of Physical and Occupational Therapy, McGill University, Montreal, Canada.
Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal; Geneva, Switzerland.
Anna Yam
Kaiser Permanent Medical Center; Geneva, Switzerland.
Kelsey R. Thomas
VA San Diego Health Care System; Geneva, Switzerland.
Daphne Bavelier
Neuroscience Center; University of Geneva, Geneva, Switzerland.
Karlene K. Ball
Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama.
William C. Mann
North Florida/South Georgia VA Medical Center, Center of Innovation on Disability and Rehabilitation Research, Gainesville, Florida.
Michael Marsiske
Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida.


Address correspondence to: Patrícia Belchior, PhD, School of Physical and Occupational Therapy, McGill University, 3654 Promenade-Sir-William Osler, Montreal H3G 1Y5 Canada [email protected]

Author Disclosure Statement

Karlene Ball owns stock in the Visual Awareness Research Group (formerly Visual Awareness, Inc.), and Posit Science, Inc., the companies that market the Useful Field of View Test and speed of processing training software (which includes the InSight training program). Posit Science acquired Visual Awareness, and Dr. Ball continues to collaborate on the design and testing of these Assessment and Training programs as a member of the Posit Science Scientific Advisory Board.
Additional study support in the form of software licenses was provided by PositScience ( San Francisco, CA. The funding sources had no involvement in research design, data collection, or data analysis. No competing financial interests exist.

Metrics & Citations



Export citation

Select the format you want to export the citations of this publication.

View Options

Get Access

Access content

To read the fulltext, please use one of the options below to sign in or purchase access.

Society Access

If you are a member of a society that has access to this content please log in via your society website and then return to this publication.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

View options


View PDF/ePub

Full Text

View Full Text







Copy the content Link

Share on social media

Back to Top