Multi-tasking, Chronic Fatigue Syndrome and Fibromyalgia
You might call multitasking the cognitive bane of the chronic fatigue syndrome patient’s world. With their reduced information processing slowing them down, and their lowered working memories not allowing them to retain as much, the last cognitive challenge any person with ME/CFS/FM would enjoy engaging in is multitasking; i.e., trying to effectively manage several tasks at once.
Video games seem like just the wrong idea for seniors (and people with ME/CFS/FM) but this study suggests they could provide a boon…
Gudrun Lange, a neuropsychologist who focuses on ME/CFS/FM, simply says don’t multitask – just focus on doing single-tasking better. Johannes Starke’s series of blogs on Health Rising emphasize ways to clear out the mental clutter – leaving room for more organized and calming thought processes. Marco’s blogs about sensory gating and cognitive processes suggest the signal to noise ratio in ME/CFS/FM patients’ minds may just be too low to engage in effective multi-tasking.
People with chronic fatigue syndrome and fibromyalgia, however, are not alone. Seniors, it turns out, display similar types of cognitive issues, and that means that our aging population may end up providing some answers in our search to improve cognition.
One of those answers include, believe it or not, playing video games.
Picture a group of seniors sitting before their computers concentrating on a 3D driving game developed specifically for them by neuroscientists.
What happened next blew more than a few researchers minds and landed this stjudy on the cover of Nature. By the end of the study the worst multitaskers in the world, the seniors, blew the best multitaskers in the world, a bunch of twenty year olds, away. It was no contest.
The Study
First, participants of all ages were given extensive cognitive tests. The researchers found that the ability to multitask declines in a linear fashion as we age (as do, unfortunately, other ‘fluid cognitive’ skills such as reasoning (reasoning!) and working memory.
Then they were asked to play NeuroRacer, a 3D video driving game, that had them speed up, slow down, turn right and left according to signs that appeared. The game, which was years in the making, was specifically designed by neuroscientists to impact the kinds of cognitive deficits they had.
The ‘working memory’ loss seen before the seniors did the video game disappeared after – as they out-gamed a bunch of 20 year olds
A month and 12 hours of gaming later, the seniors returned to the lab. They repeated the game while hooked up to an EEG. Not only were the seniors better at the multitasking skills they’d practiced with the NeuroRacer game, but their working memory capacity (the ability to retain information for a short period of time), and their sustained attention (the ability to focus on one task over a period of time) improved significantly, as well. This kind of carryover where improvement in one cognitive skill carried over to another had not been seen before.
“What’s most novel here is other abilities that were not directly trained, such as sustained attention, which is vigilance, and working memory, their ability to hold on to something for a short period of time, also improved,” Adam Gazzaley – lead researcher
Remarkably, after six months of no gaming the seniors still retained many of their cognitive gains. Then when the seniors and 20 years were tested on the same game, the seniors blew the 20 year olds away; not only were they faster but they were more accurate. The seniors had the advantage of playing the game before, but their ability to beat 20 year olds well acquainted with gaming was astonishing.
The researchers pointed out that these gains were not because the seniors were simply processing information more rapidly (another problem in ME/CFS), but in fact reflected gains in distinct areas of cognition.
The How of It
The question then became what was happening to float these seniors’ cognitive boats, so to speak, all at one time.
The introduction of signs that popped during the driving process requiring the seniors to multitask turned out to be a key to the multidimensional progress made. In effect, it was only by forcing (in a fun way) the seniors to engage in a more complex cognitive challenge that they saw really significant benefits. (The authors noted how different their 3D ‘immersive’ (and fun) video game was from the sparse environments used in the dual task (as opposed to multitask) training studies done before this.
Revving Up Brain Skills – an Introduction to NeuroRacer
An EEG suggested that deactivation of medial prefrontal cortex activity played a critical role in reducing ‘internal distractibility’ and allowing for better task performance.
Medicine for the Mind?
”I think … the careful validation that it actually works in the way you hope it does are essential ingredients in really thinking of this type of interactive media as medicine, which I hope is what we will see happen over this next decade.”
Neural plasticity turned out to the be the key as immersion in an ‘interference-rich’ video game allowed seniors to get back up to speed
One of the strategies seniors adopt to adapt to their declining cognitive powers is slowing down when they need to evaluate information – something that seems to doom them with a video game that requires quick responses. One can imagine seniors (and ME/CFS/FM patients) taking one look at fast moving video game and turning away.
It turned out, though, that the right type of ‘interference-rich’ video was exactly what was needed. They simply had to be exposed to a cognitive challenge that seemed on the face of it a bad idea. Seniors’ brains (and perhaps ME/CFS/FM patients’ brains) still retained enough plasticity to learn how to respond very quickly once again. (By the time the study was over several seniors were upset they had to stop playing the game.)
The Future
“Our motto is better science, better games”
Is NeuroRacer coming to your local doctor’s office or video store soon? The game is not commercially available – yet. The lead researcher, Adam Gazzaley, co-founded a company, Akili Interactive Labs, including neuroscientists and professional gamers, to produce a game called Project Evo for iOS phones and tablets. Currently in clinical trials for cognitive disorders ranging from ADHD to autism spectrum disorder to depression, Gazzaley is hoping Project Evo becomes the first FDA approved video game in a couple of years.
Will seniors (and people with ME/CFS/FM) be playing video games to improve their cognition in the near future?
Despite other commercial labs assertions that their video games improve cognition, NeuroRacer is the first to be tested in a clinical setting, and it’s not clear how effective the other games are. With the NeuroRacer study and its startling findings making the cover of Nature, and then being featured in numerous media outlets, expect more groups to step into the ‘video game as medical device’ arena.
“The sustained multitasking cost reduction over time … provide(s) optimism for the use of an adaptive, interference-rich, video game approach as a therapeutic tool for the diverse populations that suffer from cognitive control deficits (for example, attention deficit hyperactivity disorder (ADHD), depression, dementia).”
The company envisions developing a series of games specifically targeting these disorders.
Comparing the cognitive disfunction of CFS to Aging? I think not …..
Same general dysfunctions….same general deficits. And its not just aging either; if you got to the end of the blog you see there developing video games for people with autism and ADHD…
If it ends up working for them – why not not for ME/CFS? Unless you think the neural plasticity of the ME/CFS brain is tapped out – and I don’t see why it should be…
I’m witnessing the cognitive decline of my husband who will be 67 shortly. He’s assured by the MD that this a normal aging process. This change bears a striking similarity to what I’ve experienced with ME/CFS. He has difficulty with word search, short term memory, and slower thought process, for example. BTW, he’s still working.
He is using an online game, Luminosty, which he has urged me to try. I worry about brain drain, too, but then I remember what Nancy Klimas said when I heard her speak years ago. She affirmed that yes, we have cognitive deficits and maybe brain shrinkage, but the good news is that the brain can form new pathways to overcome these problems. (I am paraphrasing). It seems to me that a game would be a good place to practice.
I’ve had ME/CFS for 20 years now and I can say that just glancing at something like mind craft sends me into a weird mind fog for weeks.
I would be interested in any study done with ME/CFS patients and video games.
My experience is that mental tasks are as energy draining as physical tasks and need to be be carefully paced just like physical tasks. For this reason, I don’t see how we can compare the brain functioning of people with this illness with the ageing population. They do not have the pathological inability to produce energy on demand as we do
Of course they don’t have the energy problems but the brain problems in ME/CFS may not all about ‘energy production’. They may also be about inefficient use of resources..
For instance, research suggests the brains of people with ME/CFS are paying attention to innocuous stimuli instead of disregarding it – that’s a major energy drain that surely interfers with multi-tasking…
It also shows that people with ME/CFS are using more parts of the brain to achieve a task than usual. That’s another energy drain.
These aren’t just problems with energy; they’re problems with brain programming – and that’s what these video games are seeking to change.
It also appears that oxidative stress plays a major role in the aging that occurs in our brains – and high rates of oxidative stress appear to be present in the brains of ME/CFS patients.
So, while yes the energy problems are much greater in ME/CFS, I suspect these training methods may make the brain more efficient in its use of energy…
I recently saw a documentary about physiotherapy for a senior man who had a stroke. He was right-handed naturally, and they measured interesting increase in brain function and coordination after having him perform all his usual right-handed functions with his left hand instead.
I also wonder after watching a documentary done by Suzuki about whether the brain’s ability to utilize insulin could be part of the FM/CHRONIC FATIGUE problem. Wake Forest Medical Centre in Raleigh is having some exciting test results on Alzheimer’s patients who take an insulin dosage under the tongue. This theory stems from the fact that people with type 2 diabetes have a much higher incidence of alzheimers dementia.
My brain fog normally is not as severe as it is in many of the articles I’ve read, but a new symptom showed up in the last month on me. I’ve been an accurate typist for 40 years and a month ago I noticed I’m having a fairly high incidence of dyslexic typing. For example, normally a trained typist starts with the left hand on the keys of asdf and the right hand on the letters jkl; Lately I’ve had to proof-read my typing because I’ve been hitting the corresponding key with the wrong hand; such as typing an L when I wanted an S in the word, or an F when it should have been a J.
My FM was pretty manageable, but after seven years it has added severe chronic fatigue. Also I’ve had to go on thyroid supplement, and I’m going for a second ACTH test in two years because my cortisol has been low the whole time and still decreasing. I’ve been considering trying a Functional Medicine doctor after reading a hormone treatment website. It seems that the ACTH test only tells you if your adrenal and pituitary glands have completely failed and the majority of doctors will not give cortisol supplements to activate these glands unless you are in complete failure, but Dr. Lindner in the following website says physicians trained in Functional Medicine can safely supplement low cortisol levels and lists a site where you can look up Funtional medicine practitioners in your area codes on his site: http://hormonerestoration.com/Cortisol.html
Also if I don’t take magnesium evey day I get nasty Charlie horse cramps in my foot arches, and why I started magnesium it was because I developed a severe Charlie horse in all of my left calf of my leg that never let up at all for three days straight. I hadn’t had any unusual exercise that day and walking it out didn’t work. I couldn’t even put the heel of my foot down to the floor.
Thanks – do you have any more information on the insulin issue. I’ve heard that once before but don’t know where to get more info on that.
There is sort of an inherent conflict of interest when the lead researcher is also the co-founder of a company that will benefit from his research. Hopefully this research will be duplicated by an independent research group. Also I would be curious if you (Cort) read the original study. Your summary as well as the study abstract are extremely vague in terms of statistics with no actual numbers. Saying there is a linear decline with age is pretty meaningless without saying how much it is, 1%, 10%, 20%? Also saying “the seniors blew the 20 year olds away” is an opinion not science. In fact the abstract says “By playing an adaptive version of NeuroRacer in multitasking training mode, older adults (60 to 85 years old)… attaining levels beyond those achieved by untrained 20-year-old participants”. Personally I think that someone of any age who has played a specific game for 12 hours would be significantly better at it than someone of any age who hasn’t, assuming they are both in otherwise good health (which they were in this study).
Though I see your point that training the brain with these games may help reduce mental effort in CFS/ME and result in improvement (which would be great!) I have to agree with the other comments that the CFS/ME brain (and body) is in a whole other class in terms of impairment compared to a senior brain and I can’t see assuming they can be compared.
There is a nice podcast with pro and cons as well as an article on the study free at:
http://www.nature.com/news/gaming-improves-multitasking-skills-1.13674
I read the original study and used it in the blog. The study stated the seniors ‘significantly’ outperformed the twenty year olds. And yes, it’s they had 12 hours of training over a month on it, but the fact that 6–80 year olds were able to beat twenty years who are quite familiar with these kinds of games, was significant I think.
I have to disagree on the last point. The authors of the study are, after all, using the results of the senior study to begin adapting the game for use in people with more severe cognitive impairments; ie autism, ADHD than found in ME/CFS.
That suggests they believe the results of the senior study suggest that this type of ‘mind medicine’ will apply to disorders with cognitive issues. That fact that ME/CFS patients brains are using whatever energy they have inefficiently suggests training methods that help them use that energy more efficiently could be helpful. Who knows if that’s true or not, but it’s a possibility and I would keep open all possibilities. Time will tell; this product will probably make it to market at some point.
Energy, of course, is a more of a central issue in ME/CFS than any other disorder. I wouldn’t imagine that most people with ME/CFS would stay on the game for an hour! Most would start off slowly and see how it goes…
I do believe in neural plasticity ( actually there’s nothing to believe it – it is a fact that the brain fashions work-arounds for brain injuries, and those work-arounds can be optimized by training),
The brain can be trained to respond in a more optimal fashion after it’s injured and I imagine it can be trained to optimize the limited resources available in ME/CFS better as well. (! :))
.
I’m a little perplexed by the problems some seem to have with associating cognitive defects in ME/CFS with those seen in the aging process.
Problems with information processing speed, multitasking, executive function, memory, mood, sleep etc are associated with both ME/CFS and aging.
Perhaps the problem is with the degree of cognitive decline and what we see with normal aging.
I posted an article some time ago that showed a level of cognitive decline (involving time to respond to a dual task – that is multi-tasking) in a sub-set of child ‘CFS’ patients that was in excess of that seen in normal aging and usually seen in dementia.
“their higher nervous system has deteriorated as demented subjects were previously reported to have longer P300 latencies”
http://www.cortjohnson.org/blog/2013/07/28/japanese-sensory-gating-stud-reveals-profound-cognitive-deficits-present-in-chronic-fatigue-syndrome/
Plus the processes that lead to cognitive decline in aging appear to involve the same mechanisms seen in ME/CFS. A breakdown in the normal cellular repair mechanisms appears to lead to aging in the body and the brain resulting in reduced mitochondrial function and raised oxidative stress. Heat shock production (which is the main mechanism for repairing damage caused by oxidative stress) declines as we age. Heat shock production has also be seen to be impaired in ME/CFS patients.
Perhaps a more accurate analogy for ME/CFS patients would be abnormal or accelerated aging as seen in disorders such a dementia but the principal is the same.
As for the use of video games to ‘retrain’ or ‘rehabilitate’ the brain it sounds plausible on the face of it (subject to replication) but I’d be personally inclined to go easy on it.
I gave up what limited gaming i did some time ago as I found it far too over-stimulating and mentally draining and I had better uses for what limited mental energy I had. But it was the type of slower paced but addictive game that kept me at it for hours.
20 mins or so on a regular basis I could probably manage though – might even help with my tendency to be overwhelmed by even a short drive.
Thanks Marco. My understanding, while more general, mirrors yours – that oxidative stress and reduced blood flows are what end up slamming the human brain as it ages…and both of those are present in ME/CFS….
I imagine with seniors and ME/CFS you have two at least somewhat energy depleted brains with the ME/CFS brain usually being hit harder.
I wish I had the energy and well-being to play video games.
I really can’t see how using my very last reserve of energy will give me any more energy; it’s illogical.Driving until my car ran out of petrol wouldn’t increase the distance I could drive!
it does seem paradoxical, doesn’t it.The only way this would work is if playing the game somehow allowed your brain to operate more quickly and efficiently. It seems a bit much to ask of a video game :)…..perhaps with the right kind it would do that.
I want to point out that the study found that the brain wave patterns of the seniors actually shifted; by the end of the game their prefrontal cortex was disengaged – a good sign – and the ‘coherence’ between the front and back portions of their brain was stable (whatever that means..:))
Thanks for posting this Cort. I’m a double winner: ME/CFS and ADD. And, actually, have just started taking Concerta again in the past couple of months. Mostly, because I wanted to use my mind more…for reading, mostly.
I’m not going to debate whether or not this was an unbiased study, I don’t have enough info. I do know, however, the brain is plastic… so long one does not live in a vacuum. I actually worry that lack of ‘normal stimuli’** contributes to the cognitive issues in those extremely isolated with ME/CFS, like myself. The less stimuli the more likelihood of “atrophy” (very heavy quotes here), I fear. And, of course, we need to be careful of any over-stimulation: so a balancing act.
“Phantoms in the Brain”, Vilayanur S. Ramachandran is all about reprogramming, or tricking the brain. An interesting read, which I never finished. (surprise , surprise)
I don’t do “action” games online, but do play Scrabble games. Hopefully that helps a little ! I’d be curious to know what games Marco plays, that are slower paced.
**I think of the Romanian orphanages, where babies/kids get little or no stimulation.
I don’t see how it could be otherwise; the brain is a system of pathways and if pathways don’t get use they crumble; if they get used they get stronger(sometimes to our detriment) – that’s the neural plasticity present in the brain. If you’re isolated or can’t use your brain much – the brain is going to take a hit.
I think mind-training in ME/CFS will probably be like keeping as fit as possible; do what you can in small chunks to keep your mind as fit as possible.
I have seen no evidence (which of course does not mean it doesn’t exist) that the underlying causes of cognitive deficits in ageing and ME are the same.
For seniors, my experience is that the “use it or lose it” maxim applies and using video games to re-establish cognitive pathways makes sense.
For ME, there is evidence of ME-specific brain dysfunction. Given its unique status, I would want evidence before assuming a treatment for a very different group would help me.
The use or lose it maxim in seniors is not what causes their cognitive declines. Their cognitive declines are the result of physiological processes, some of which mimic what happens in ME/CFS…This study found that reduced VO2 max in seniors is associated with cognitive declines! I wish I had looked further into this before I did this darn blog.
I wouldn’t expect you to ‘assume’ it would work in ME/CFS, but I would hope you and other would consider the possibility that it might.
J Gerontol A Biol Sci Med Sci. 2013 Nov 5. [Epub ahead of print]
Cardiorespiratory Fitness and Accelerated Cognitive Decline With Aging.
Wendell CR, Gunstad J, Waldstein SR, Wright JG, Ferrucci L, Zonderman AB.
http://www.ncbi.nlm.nih.gov/pubmed/24192540
BACKGROUND:
The present study examined the prospective association between symptom-limited maximal oxygen consumption (VO2max) and longitudinal performance on a comprehensive neuropsychological battery.
RESULTS:
Analyses revealed significant longitudinal associations between baseline VO2max and trajectory of performance on multiple measures of verbal and visual memory, as well as on a cognitive screening test (all ps < .05). Individuals with lower VO2max demonstrated accelerated trajectories of cognitive decline over time.
CONCLUSIONS:
Baseline cardiorespiratory fitness is related to longitudinal neuropsychological performance, and memory appears to be a particularly vulnerable domain.
—————————
There’s also this review of using non-pharmacological techniques in patients in the milder stages of Alzheimer’s
Expert Rev Neurother. 2013 Nov;13(11):1235-45. doi: 10.1586/14737175.2013.845086. Epub 2013 Oct 17.
Non-pharmacological interventions and neuroplasticity in early stage Alzheimer’s disease.
Herholz SC, Herholz RS, Herholz K.
Non-pharmacological interventions have the potential to reduce cognitive decline and to improve psychosocial aspects in mild cognitive impairment and Alzheimer’s dementia, and the absence of side effects makes them a favorable option also for preventive strategies.
We provide an overview on recent studies involving cognitive training and reminiscence, stimulating and challenging experiences such as visual art and music, physical activities, and electromagnetic stimulation. We review findings on neuroplasticity in the aging brain and their relevance for cognitive improvement in patients with neurodegenerative diseases.
We discuss cognitive reserve and possible mechanisms that drive neuroplasticity and new learning. Finally, we identify promising avenues for future intervention strategies and research, such as combinations of cognitive and pharmaceutical interventions, and individual strategies adapted to the disease stage and tailored to the needs, predispositions and preferences of patients.
I’m definitely getting late to this and everybody’s comments have certainly made me think – a bit late, but better late than never…Here’s another study looking a cardiovascular factors and aging. I think this is important because I really do believe ME/CFS is and will be found to be, at least in part, a cardiovascular disease. Time will tell but I honestly don’t see how it could be otherwise.
Alzheimer Dis Assoc Disord. 2013 Oct 11. [Epub ahead of print]
Vascular Risk Factors and Cognitive Decline in a Population Sample.
Ganguli M, Fu B, Snitz BE, Unverzagt FW, Loewenstein DA, Hughes TF, Chang CC.
We examined several vascular factors in relation to the rates of decline in 5 cognitive domains in a population-based cohort. In an age-stratified random sample (N=1982) aged 65+ years, we assessed at baseline the cognitive domains of attention, executive function, memory, language, and visuospatial function, and also vascular, inflammatory, and metabolic indices.
Several vascular risk factors (history of stroke, diabetes, central obesity, C-reactive protein), although associated with lower baseline cognitive performance, did not predict rate of subsequent decline.
APOE*4 genotype was associated with accelerated decline in language, memory, and executive functions. Homocysteine elevation was associated with faster decline in executive function.
Hypertension (history or systolic blood pressure >140 mm Hg) was associated with slower decline in memory.
Different indices of vascular risk are associated with low performance and with rates of decline in different cognitive domains. Cardiovascular mechanisms explain at least some of the variance in cognitive decline. Selective survival may also play a role.
Continuing the better late than never theme the last blog I did on complex regional pain syndrome implicated activated microglia in CRPS – a condition that like ME/CFS causes significant cognitive problems (and autonomic/cardiovascular) and might be, I suggested, a useful model for ME/CFS.
It appears that cognitive problems in the elderly might have the same root cause :
Review: microglia of the aged brain: primed to be activated and resistant to regulation.
“In this context, microglial activation is amplified and prolonged in the aged brain compared with adults. The cause of this amplified microglial activation may be related to impairments in several key regulatory systems with age that make it more difficult to resolve microglial activation.
The consequences of impaired regulation and microglial hyper-activation following immune challenge are exaggerated neuroinflammation, sickness behaviour, depressive-like behaviour and cognitive deficits. Therefore the purpose of this review is to discuss the current understanding of age-associated microglial priming, consequences of priming and reactivity, and the impairments in regulatory systems that may underlie these age-related deficits.”
http://www.ncbi.nlm.nih.gov/pubmed/23039106
Systemic inflammation (and neuroinflammation) appears to be the common denominator in all these problems.
The microglia again! They are getting so interesting…I’m really learning alot this year. We’ll have a blog out featuring them and the vagus nerve soon. The author believes ongoing microglial activation could be causing ME/CFS. He proposes ME/CFS and FM are microglial disorders…
This — ” The consequences of impaired regulation and microglial hyper-activation following immune challenge are exaggerated neuroinflammation, sickness behaviour, depressive-like behaviour and cognitive deficits.” –
is an amazing sentence!
….That perks my toes up 🙂
Looking forward to that one!
“I wish I had looked further into this before I did this darn blog.” LOL – thanks for the laugh, very refreshing.
In late to this conversation, but fascinated. Worth a shot? Absolutely for me…but with cautious, focused moderation…something thats never been my strong suit until this
illness realigned my iron will.
Moving from PC to Mac was a huge step for my husband and I, 6 years ago. Knowing
full well, for me, with a challenged brain it would be like learning a new language. A bit
like learning a new language. Research from many directions speaks to plasticity of the brain as it adapts to new systems i.e. language..and the benefits.
For me, 64, no children to pull me into gaming, being a recovering Type A business person, I’m open to trying this out. The benefits for the brain is worth the gamble…with moderation…and as someone has said, moderation even in moderation.
I’ve pushed the envelope conventionally and unconventionally to slay this dragon. Lesson learned? Manage the symptoms, and stay open to thinking outside the box.
Much food for thought, again, in comments. Thanks to all.
When I was first diagnosed w/ CFS 14 years ago and was dealing with bad cognitive problems, my CFS doc (Dr. Susan Levine, NYC) recommended playing video games. She actually said that there was some evidence that a particular kind of cognitive therapy was helpful, but would require multiple sessions with a therapist each week, for many months. If I wanted, she would write me a referral. Or, I could play lots of computer games. Guess which I chose 🙂
For whatever reason, my cognitive problems have improved a lot over the years. I have found that I need to change which games I play regularly. I.e., just playing the same ones over and over doesn’t work. I also have not found it to be a major energy sink. Of course, I set it up so I’m leaning back in a recliner while playing, which helps a lot. And it’s not a cure-all. I still have cognitive difficulties, especially when tired. But I think it has really helped.
Thanks Catherine…which games did you try? Will attempt, and keep an open mind.
Adding something to my recliner repertoire would be a plus. “The nest”…with everything at arms lengths limits things.