Lurking beneath the roaring advance of technology and the ever-glitter of the American Dream’s advance into a Roddenberryesque stratosphere are a series of frightening statistics: 4.5 million Americans currently have Alzheimer’s disease, a number that has doubled since 1980 and is projected to reach 11.3-16 million by 2050. One in 10 Americans have a family member that suffers dementia; one in three knows someone who has the disease. It is referred to by medical professionals as “a demographic time bomb” and an escalating epidemic that the American health care infrastructure is not prepared to face. Government funds are pouring into neurological research, and in the meantime doctors are rallying to preach prevention to their patients in the form of rigorous dietary maintenance and exercise – both physical and mental.

The overwhelming success of Nintendo’s Brain Age and Big Brain Academy represents a never-before-seen phenomenon entering game development: consumers purchasing games not out of desire, but out of perceived need. The chill of anxiety that simmers beneath such purchases brings an air of reality to a business formerly concerned only with entertainment. While studies have shown the utility of games in healthcare – and in fact a growing industry conference addresses specifically this – there has long been a lamented gap between commercial software development and the medical community. But that gap, however unsteadily, is beginning to close.

Now joining the fight against cognitive atrophy is one of game design’s brightest, Noah Falstein, whose road to the greater good passed through LucasArts and Dreamworks Interactive, and still continues through what he calls “pure-entertainment” games via his private consulting firm. His recent alliance with Quixit, a shiny new company out to save our minds, represents a unique synthesis of neurological research and game design that combines verified scientific process with the growth and support potential of an online community – and then makes it fun.

Games on the Brain
Falstein has long been involved with the serious games initiative, a branch of game development specifically aimed at applying game development principles and process to real-world challenges.

“I firmly believe that working on pure-entertainment games is a noble calling, too; I don’t want to minimize that. But making games that are designed to entertain while simultaneously achieving another purpose (like brain training) is a very challenging design exercise, and it’s been interesting purely on that level as well.”

For a designer whose work in the field includes such beloved and legendary titles as Secret of Monkey Island, his notions of game development’s potential are concepts to watch. “I really enjoy games that are aimed at pure entertainment, too, and as a freelancer I mix my work with both entertainment-only and serious games. But I do think that the field of serious games is likely to grow faster than other types of games – perhaps even eclipsing entertainment-only titles some day. So I’m committed to working in this area. But if I’ve learned one thing from a career in the game industry, it’s to stay agile and to embrace change, so I hesitate to make blanket predictions about where it is going. It’s one of the new game fields to watch.”

And the science of fun itself – game design – is no stranger to neurological structure and function.

“Understanding how the brain works is very important to game designers. Nearly all the high-level game designers I know are at least interested in the field of brain research, and many know quite a lot about brain function. I’ve found that understanding how different kinds of decision making are done by different parts of the brain has influenced my understanding and designs of entertainment games, pacing them to use a mix of different brain function over time. The great designs of people like Wil Wright, Shigeru Miyamoto and Sid Meier have been exemplifying these principles for years.”

While the idea of playing games to maintain mental health isn’t necessarily new (the Alzheimer’s Association itself recommends the use of games as part of a mental maintenance advisory package, and the effects of Tetris on brain chemistry have had senior citizens tapping away at the puzzle game for years), that idea is just now beginning to gain enough ground as a respected technique to break into medicine – and business. “Brain training” games thus reach into the heart of game design, and what they’re finding pushes the game industry as a whole.

“In one sense, all games are cognitive training tools! But in the specific [sense] of games based on maintaining mental acuity, I see this as a vital, large subset of serious games. I hope that in the future, games like ours will also be increasingly used in research trials to enhance understanding of the brain’s function. That would in turn benefit the game industry in general in many ways.”

A Mental Workout
The intersection of third-party game development and mental exercise gaming is not unprecedented, but mental exercise games face a series of challenges: Either they’re not challenging enough, not varied enough or just plain not fun. Researchers in the past have seen this last as a lesser concern, but as the games-for-health initiative develops, researchers are increasingly realizing that it may be the most important axis.

“I think the key aspect of games that makes them useful – not necessarily superior – is simple fun.”

And “fun” harnesses that most elusive golden fruit coveted by prevention-focused medical professionals: patient motivation. Quixit, which was born when CEO Sheryle Bolton acquired licenses to the France-based Happy Neuron brain game panoply, approaches this challenge bidirectionally: from one angle using Falstein’s design expertise to refine the research-based Happy Neuron games for an entertainment aesthetic, and from another angle creating an online community where hundreds of thousands of potential users can share experiences, engage in friendly competition and, very importantly for primary health practitioners who may only see their patients once or twice a year, track and monitor individual progress. “Quixit is a made-up word that hopefully implies Quiz, Quick and maybe even Quixotic,” Falstein says, and the online service promises a sleek and fun experience already lauded by its visitors.

“My father died of Alzheimer’s-related causes, so I’ve seen first hand how devastating the loss of mental faculties can be. I hope our games will prove to ameliorate, perhaps delay, some of the process of decline for even a few people. If we could achieve that, I think it would have a great impact on a lot of lives.”

And if Quixit can, through methods that doctors agree assist in the prevention of cognitive atrophy, delay the onset of dementia, the Alzheimer’s Association would agree that its contribution to the solution would be major; 50 percent of Alzheimer’s patients, according to its estimates, could avoid the disease entirely if symptoms could be delayed by five years.

But reaching the right demographic can be difficult. “One problem as I understand it is a very human tendency to stay in your comfort zone, and as with physical exercise, it is important in mental exercise to keep trying new things, pushing yourself to excel a bit. Some people love crossword puzzles, and feel that doing them will keep them sharp. As you’d expect, in practice this means they do stay sharp – at doing crossword puzzles. It’s important to cross-train and push different parts of your brain, and making it fun to do so is one way to encourage people to leave that comfort zone.

“We do think the eventual audience is nearly everyone, but for a start we’re focusing on people in the Baby Boom generation. Boomers are largely computer-literate, affluent and increasingly concerned about staying sharp as they age. Well, as we age – this is one of the first times in my career I’ve been creating a game aimed specifically at people my age and older, since when I started I was a 20-something making games that mostly teens played, and as the gaming audience aged and expanded into older markets, I was always a bit ahead of the curve. It’s nice to be back in the target age range again.”

Strain Your Brain
But it ain’t all ginseng and rainbows. Particularly with the rise in popularity of Nintendo’s brain training games, the medical community shows consistent skepticism, verging on disdain, for games that claim to make you smarter. The concept of transference is a major concern in cognitive training: There is no doubt that Brain Age‘s exercises can make your basic math skills improve, but do they really make you smarter? The game’s mechanics are addictive and fun, so the thought that this exercise could actually be good for you gives brain training games a distinct commercial advantage. But how much of that is smoke and mirrors? Is, as some medical professionals have asserted, Nintendo’s Brain Age a fancy crossword puzzle? Can a videogame share an ethical ranking with diet pills?

“I think the biggest unique hurdle is just natural skepticism that our games – or any games – will actually help people sustain mental acuity. It’s a chicken and egg problem: Until you make the game and have large numbers of people using it over time, you can’t prove it’s helping – and some people don’t want to fund you unless they have that proof in hand. Luckily, Brain Age came along while we were in the midst of our initial fundraising, and I think that helped show people that the basic principle is sound for business. Perhaps soon we’ll get some hard scientific evidence from Brain Age and its sequels, which would make the market better for everyone.”

Asked about the medical community’s specific skepticism, Falstein said, “I think it’s understandable – I have a lot of respect for the scientific method. But I don’t think you can make any advance without trying and being willing to risk failure. Luckily, I don’t think anyone is claiming that sorting words or deciphering text is bad for you in any way – and I’m confident time will show it’s very good for you.”

It seems likely that, with time and deliberation, the medical community at large will come around. Brain Age‘s own spokesperson, Dr. Ryuta Kawashima, notably spoke against games as a waste of time prior to his involvement with Nintendo. If such a prominent brain researcher can make the conversion, it speaks well for the inspiration of future scientists.

For Falstein, Brain Age‘s presence on the shelves, and its commercial success, provided market proof, and despite Kawashima’s earlier skepticism, Falstein has hope for Brain Age‘s long term results:

“The more data points out there, the better for all of us.”

Erin Hoffman is a professional game designer, freelance writer, and hobbyist troublemaker. She moderates Gamewatch.org and fights crime on the streets by night.

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