Advances in Psychiatry

A new study by researchers from Columbia and Duke University published in the October 27, 2022, issue of NEJM Evidence shows that doing crossword puzzles has an advantage over computer video games for memory functioning in older adults with mild cognitive impairment.

Dr. Devangere Devanand

In a randomized controlled trial led by Devangere P. Devanand, MD, Director of Geriatric Psychiatry at NewYork-Presbyterian/Columbia University Irving Medical Center and Professor of Psychiatry and Neurology at Columbia, with Murali Doraiswamy, MD, Professor of Psychiatry and Medicine at Duke, researchers determined that participants trained in doing web-based crossword puzzles demonstrated greater cognitive improvement than those who were trained on cognitive video games.

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

Crossword puzzles are widely used but have not been studied systematically in mild cognitive impairment, which is associated with high risk for dementia, including Alzheimer’s disease.

“This is the first study to document both short-term and longer-term benefits for home-based crossword puzzles training compared to another intervention.” — Dr. Devangere Devanand

To conduct their study, the researchers randomly assigned 107 participants (average age 71) with mild cognitive impairment (MCI) at the two different sites to either crossword puzzles training or cognitive games training for 12 weeks followed by booster sessions up to 78 weeks. Both interventions were delivered via a computerized platform with weekly compliance monitoring.

The most striking findings of the trial were:

• Crossword puzzles were superior to cognitive games on the primary cognitive outcome measure, ADAS-Cog, at both 12 weeks and 78 weeks.
• Crossword puzzles were superior on FAQ, a measure of daily functioning, at 78 weeks.
• Crossword puzzles were superior for participants at a later disease stage but both forms of training were equally effective in an earlier stage.
• Brain shrinkage measured with MRI was less for crossword puzzles at 78 weeks.

“The benefits were seen not only in cognition but also in daily activities with indications of brain shrinkage on MRI that suggest that the effects are clinically meaningful,” says Dr. Devanand.

The study, which was funded by the National Institute on Aging, also highlights the importance of engagement. Based on remote electronic monitoring of computer use, participants at a later stage of impairment may have better engaged with the more familiar crossword puzzles than with computerized cognitive games.

Two strengths of the trial are the 28 percent participation rate of individuals from racial and ethnic minority groups and the low drop-out rate (15 percent) for such a lengthy home-based trial. While these results are highly encouraging, the authors stress the need for replication in a larger controlled trial with an inactive control group.