Crosswords Puzzles: The Key to Delaying Dementia in Older Adults?

The findings of a new study indicate that computer-based crossword puzzles are superior to computer games at improving cognition in patients with mild cognitive impairment (MCI), which is known to augment the risk of dementia, particularly Alzheimer’s disease. The results were reported in NEJM Evidence.

Past studies have demonstrated that computerized games have demonstrated positive results in improving cognition in patients with MCI. Therefore, the researchers of this study postulated that games would show superior efficacy to crossword puzzles in cognitive and functional outcomes. Suffice it to say, their hypothesis was surprisingly proven wrong.

In this double-site, single-blinded, 78-week trial, 107 study subjects with MCI with were stratified by age (≤70 and >70 years), and severity of MCI (early/late), then randomly assigned to receive 12 weeks of either home-based computerized training with web-based cognitive games or web-based crossword puzzles. The primary outcome of interest was change in baseline in Alzheimer’s Disease Scale-Cognitive (ADAS-Cog) score, which is a 70 point scale in higher scores at 78 weeks suggest greater cognitive impairment.

The secondary endpoints were defined as change from baseline in neuropsychological composite score, University of California San Diego Performance-Based Skills Assessment (functional outcome) score, and Functional Activities Questionnaire (a measure of of functional outcome) score at 78 weeks. The researchers also assessed for changes in brain volume and thickness using MRI.

Crossword Puzzles Beat Out Computer Games

According to the results, among patients with early MCI, ADAS-Cog score worsened among subjects playing computer games and improved for those playing crossword puzzles at week 78. These results were similar among patients with late MCI (LS means difference, −2.45; SE, 0.89; 95% CI, −4.21 to −0.70).

The researchers also observed favorable results in crossword puzzle with the respect to one of the secondary endpoints, with worse Functional Activities Questionnaire scoring for games compared with with crosswords at week 78 (LS means difference, −1.08; 95% CI, −1.97 to −0.18). Moreover, the researchers found a greater decrease in hippocampal volume and cortical thickness  for games than for crosswords. “The benefits were seen not only in cognition but also in daily activities with indications of brain shrinkage on MRI that suggests that the effects are clinically meaningful,” said led investigator D.P. Devanand, MD, professor of psychiatry and neurology at Columbia via a press release.

“This is the first study to document both short-term and longer-term benefits for home-based crossword puzzles training compared to another intervention,” continued Dr. Devanand. “The results are important in light of difficulty in showing improvement with interventions in mild cognitive impairment.”

“The trifecta of improving cognition, function and neuroprotection is the Holy Grail for the field,” added Dr. Doraiswamy. “Further research to scale brain training as a home-based digital therapeutic for delaying Alzheimer’s should be a priority for the field.”