• Posted November 2, 2022

What's Better for Your Brain, Crossword Puzzles or Computer Games?

Older adults looking to slow down memory loss might find some help in a classic brain-teaser: the crossword puzzle.

That's the suggestion of a small study that followed older adults with mild cognitive impairment -- problems with memory and thinking that may progress to dementia over time. Researchers found that those randomly assigned to do crossword puzzles for 18 months showed a small improvement in tests of memory and other mental skills.

That was in contrast to study participants who were assigned to a more modern brain exercise: computer games designed to engage various mental abilities. On average, their test scores declined slightly over time.

Experts cautioned that the study was small and had other limitations. For one thing, it lacked a "control group" of participants who did not perform brain exercises. So it's not clear whether doing crossword puzzles or playing games is significantly better than doing nothing.

"This is not definitive," said lead researcher Dr. Davangere Devanand, a professor of psychiatry and neurology at Columbia University in New York City.

He said that larger studies, including a control group, are still needed.

As it is, the current results were unexpected, according to Devanand. Going into the trial, the researchers suspected that computer games would reign superior. Past studies have found that such games can help older adults with no cognitive impairments sharpen their mental acuity.

It's not clear why crosswords were the winner in this trial. But, Devanand said, there was evidence that the puzzles were specifically more effective for people in the "late" stage of mild cognitive impairment -- which may suggest that crosswords were easier for them to manage.

The findings were published online recently in the journal NEJM Evidence.

Mild cognitive impairment is common with age, and does not always progress to dementia. But in many cases it does. It's estimated that among adults age 65 and older who have such impairments, 10% to 20% develop dementia over a one-year period, according to the U.S. National Institute on Aging.

Researchers want to find ways to delay or prevent that progression to dementia, and mentally stimulating activities are one avenue under study.

Some research has found that brain games may help people with mild cognitive impairment boost their memory and thinking skills -- though studies have found a lot of variation in the types of improvements seen.

And one question, according to Devanand, is whether any particular types of brain exercises are better than others.

So his team set out to compare the effects of web-based computer games and web-based crossword puzzles.

The researchers recruited 107 older adults with mild cognitive impairment and randomly assigned them to either type of brain exercise. All participants received lessons on how to log on and use the games or puzzles.

Even though the crossword puzzles were online, Devanand noted, they were otherwise the same as old-fashioned paper-and-pencil ones. They were moderately difficult -- at the level of a New York Times puzzle on a Thursday.

After 18 months, the investigators found, the crossword group had improved by about 1 point, on average, on a standard scale assessing cognitive decline -- focused mainly on memory and language skills.

In contrast, people in the games group declined by a half-point, on average.

Individuals did vary, however. About one-quarter of the games group, for instance, improved their scores by at least 2 points.

And when the researchers looked closer, the difference between the two brain exercises was specifically seen among people in the later stages of mild cognitive impairment.

It's possible, Devanand said, that for older people with more substantial impairments, crossword puzzles were easier to manage.

An expert not involved in the study said that "limited conclusions" can be drawn from the findings -- in part because there was no control group.

"However, the results open the door to follow-up trials to directly examine the possibility of benefit from computerized crossword puzzles," said Claire Sexton, senior director of scientific programs and outreach for the Alzheimer's Association.

She stressed, though, that it's unlikely any single measure -- crosswords or otherwise -- will make a big difference in the progression toward a complex disease like dementia.

Instead, Sexton said, the greatest potential may be in "multidomain interventions that simultaneously target many risk factors."

Sexton noted that the Alzheimer's Association is funding a trial, called U.S. Pointer, that is testing that possibility. It's looking at whether a combination of tactics -- including physical activity, brain exercises and better control of high blood pressure and diabetes -- can benefit older people at increased risk of cognitive decline.

For now, there is at least little risk to picking up a crossword puzzle habit.

"We have a saying in this field about the brain," Devanand said. "Use it or lose it."

More information

The Alzheimer's Association has advice on protecting brain health.

SOURCES: Davangere P. Devanand, MD, professor, psychiatry and neurology, Columbia University Medical Center, New York City; Claire Sexton, DPhil, senior director, scientific programs and outreach, Alzheimer's Association, Chicago; NEJM Evidence, Oct. 27, 2022, online