Combining brain stimulation and video game to promote long-term transfer of learning and cognitive enhancement

Chung Yen Looi, Mihaela Duta, Anna-Katharine Brem, Stefan Huber, Hans-Christoph Nuerk, Roi Cohen Kadosh, Chung Yen Looi, Mihaela Duta, Anna-Katharine Brem, Stefan Huber, Hans-Christoph Nuerk, Roi Cohen Kadosh

Abstract

Cognitive training offers the potential for individualised learning, prevention of cognitive decline, and rehabilitation. However, key research challenges include ecological validity (training design), transfer of learning and long-term effects. Given that cognitive training and neuromodulation affect neuroplasticity, their combination could promote greater, synergistic effects. We investigated whether combining transcranial direct current stimulation (tDCS) with cognitive training could further enhance cognitive performance compared to training alone, and promote transfer within a short period of time. Healthy adults received real or sham tDCS over their dorsolateral prefrontal cortices during two 30-minute mathematics training sessions involving body movements. To examine the role of training, an active control group received tDCS during a non-mathematical task. Those who received real tDCS performed significantly better in the game than the sham group, and showed transfer effects to working memory, a related but non-numerical cognitive domain. This transfer effect was absent in active and sham control groups. Furthermore, training gains were more pronounced amongst those with lower baseline cognitive abilities, suggesting the potential for reducing cognitive inequalities. All effects associated with real tDCS remained 2 months post-training. Our study demonstrates the potential benefit of this approach for long-term enhancement of human learning and cognition.

Conflict of interest statement

Prof. Cohen Kadosh serves on the scientific advisory boards of Neuroelectrics Inc and The Cognition Matters Foundation (non-profit organisation). His research on brain stimulation was funded by the Wellcome Trust, the British Academy/Leverhulme Trust Small Research Grant, and the James S. McDonnell Foundation. He filed a patent entitled “Apparatus for improving and/or maintaining numerical ability’ (International Application PCT/GB2011/050211), but as the patent was not granted this is unlikely to serve as a conflict of interest. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Coupling brain stimulation with a video game to enhance learning: (a) Sequence of a trial, adaptive game design. Feedback includes both concrete and abstract numerical representations to strengthen fractions understanding (For a magnified view, please see Supplementary Figure S3). (b) Types of fractions attempted. Depending on participants’ performance, the difficulty was systematically adjusted as a function of fraction category (Easy, Medium, Hard), and precision (accepted deviations from the correct target; ±7%, ±6%, ±5%, ±4% of the number line range). This is to challenge participants to map fractions with greater accuracy, at their maximal capacity. (c) Experimental setup included a video game that requires body movements, detected by a motion detector coupled with wireless tDCS. Participants move their bodies side-to-side to locate a spaceship on a virtual number line according to fractions presented on a 1.5 × 1.2 meters screen, 3 meters away from their standing position. (d) Computational simulation of current field intensity map over the right-anodal (blue) and left-cathodal (red) dlPFC produced by Neuroelectrics using the modeling engine of the NIC software. Applied currents are maximally concentrated on the cortical surface directly underneath the stimulating electrodes.
Figure 2. A 3-way interaction between Time,…
Figure 2. A 3-way interaction between Time, Precision and group for Mean RT of maths training on Day 1 and 2.
The source of this interaction was a significant 2-way interaction between Precision and group only for Day 1 (left panel). This interaction was due to a significant difference within the sham group between the hardest precision (4%), and 7% and 5%. Error bars indicate one standard error of mean (SEM).
Figure 3. Double dissociation in stimulation and…
Figure 3. Double dissociation in stimulation and cognitive training outcomes: combined tDCS and cognitive training is more beneficial for low achievers, while cognitive training alone is more beneficial for high achievers.
(a) Pearson and (b) Spearman correlational analyses showing the modulatory effects of baseline mathematics achievement and levels completed at the end of the training. The data on panel A reflects residuals after partialling out the correlation with the performance on the first day of training. One participant from the sham group was excluded for underperforming by 2.5 SD from the mean. Note that some data points on B panel are overlapping and therefore less data points appear.
Figure 4. Transfer of gains from video…
Figure 4. Transfer of gains from video gaming coupled with tDCS.
(a) Only those who received real tDCS showed increased verbal WM capacity immediately after training, and (b) 2 months later. (c) There were no improvements in the visuospatial WM capacity of participants either immediately after training or d) 2 months later. Data are represented as mean ± SEM.

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