Takeaway
Cognitive training works best as part of a multidomain approach that includes physical activity and social engagement. Rather than recommending brain-training apps alone, counsel patients to stay mentally active through enjoyable activities while prioritizing proven interventions like exercise and sleep.
Lifelong learning in clinical excellence | May 19, 2026 | 2 min read
By Mfon Umoh, MD, PhD, Johns Hopkins Medicine
Every week in memory clinic I’m asked a question from concerned care partners: “Should mom or dad play more Sudoku, Wordle, word search, or other brain games?” My answer may not be surprising—I advise people to continue any activities they enjoy that keep their minds engaged. I also recommend both social and physical activities that have the added benefit of promoting cerebrovascular health (blood flow to the brain).
The research
Recently, a couple of studies have come out exploring this. Coe and colleagues published data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, a clinical trial of cognitive training in a large, diverse sample, that started in 1998, with some participants getting booster cognitive training sessions months after their initial trial. This recent work linked the ACTIVE study to Medicare claims (1999 to 2019) to test the long-term effect of cognitive training on the risk of Alzheimer’s disease and related dementias They found a reduced likelihood of dementia diagnoses in participants that received cognitive training with one or more booster sessions. This was the first study to show that cognitive training reduced dementia risk over a 20-year period.
Another large study that included cognitive training was the U.S. POINTER study, a two-year clinical trial that found that structured, multidomain lifestyle interventions, including specific cognitive training, significantly improved or maintained cognitive function in older adults at risk of decline.
The brain-training industry—benefits and concerns
Nevertheless, the benefit of cognitive training is a much-debated area that promotes a roughly 10 billion dollar industry. On the one hand many companies cite sparse evidence and advertise large benefits, claiming immediate and significant improvement in brain health. This often convinces older adults to relinquish lots of money in the hopes of protecting their brains. This plays into ageism—unfair stereotyping of people because of their age—which is prevalent in our society. There’s a lot of media attention on the cognitive challenges that accumulate with aging, and little focus on the strengths that come with aging.
A balanced approach to brain health
What I share with patients and families based on the available data and my clinical experiences is that I believe our brains are beautiful and capable of building new connections throughout life and remaining mentally active can help that. It may look different for different individuals based on each person’s risk and baseline.
What we can do is highlight the value of staying cognitively active and identify ways for patients to engage their mind in enjoyable ways. The U.S. POINTER study recipe included a computer-based brain training program three times a week for 30 minutes and regular engagement in other intellectually challenging and social activities. Also, and most importantly, I recommend that as people engage in cognitive training, they also recognize that there are many brain health habits they should fully engage in to promote brain health.
Here are eight things to recommend to patients:
1. Eat a healthy diet.
2. Practice good sleep hygiene.
3. Optimize sensory abilities to manage hearing and vision loss.
4. Manage chronic conditions like high blood pressure, high cholesterol, diabetes, obesity, and depression.
5. Abstain from tobacco use and minimize alcohol intake.
6. Protect the head – wear a helmet, seatbelt, and prevent falls.
7. Exercise regularly.
8. Maintain healthy social connections.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.