Computers in Human Behavior 28 (2012) 1091–1096

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Computers in Human Behavior

journal homepage: www.elsevier.com/locate/comphumbeh

Individual differences in response to cognitive training: Using a multi-modal,

attentionally demanding game-based intervention for older adults
Laura A. Whitlock, Anne Collins McLaughlin ⇑, Jason C. Allaire
Department of Psychology at North Carolina State University, USA

a r t i c l e i n f o a b s t r a c t

Article history: The effectiveness of a game-based cognitive training intervention on multiple abilities was assessed in a
Available online 17 February 2012 sample of 39 older adults aged 60–77. The intervention task was chosen based on a cognitive task anal-
ysis designed to determine the attentional and multi-modal demands of the game. Improvements on a
Keywords: measure of attention were found for the intervention group compared to controls. Furthermore, for
Older adults the intervention group only, initial ability scores predicted improvements on both tests of attention
Cognitive ability and spatial orientation. These results suggest cognitive training may be more effective for those initially
Intervention
lower in ability.
Video games
Individual differences
Ó 2012 Elsevier Ltd. All rights reserved.

1. Introduction nitive training in memory than the older-old (Verhaeghen, Marcoen,

Age-related cognitive decline is a well-established phenomenon
that begins in early adulthood and often accelerates with age, with
older adults exhibiting deficits in many areas of cognitive perfor-
mance, specifically fluid intelligence (Baltes & Mayer, 1998;
Salthouse, 2004). Fluid intelligence comprises a number of abilities
that allow abstract thinking, reasoning, directing and controlling
attention, and learning new information. However, effective cogni-
tive training interventions have the potential to impact many
abilities and could result in improved quality of life and longer
independence for older adults. Many cognitive training interven-
tions with older adults have shown improvements in ability test
scores (Ball et al., 2002; Basak, Boot, Voss, & Kramer, 2008; Bugos,
Perlstein, McCrae, Brophy, & Bedenbaugh, 2007; Noice, Noice, &
Staines, 2004), improvements on subjective tests of well-being
(Wolinsky et al., 2006), and activities of daily living (Willis et al.,
2006).
There is debate as to whether there are populations of older
adults that could most benefit from cognitive interventions. For
example, while neural plasticity in response to training has been ob-
served in older adults (Boyke, Driemeyer, Gaser, Buchel, & May,
2008; Erickson et al., 2007), plasticity is generally considered to de-
cline with age (Burke & Barnes, 2006). Therefore, the younger-old
and consequently higher-functioning may have more potential for
neural reorganization and compensation during an intervention.
Indeed, the younger-old have been shown to benefit more from cog-
⇑ Corresponding author. Address: Department of Psychology, Box 2650, North
Carolina State University, Raleigh, NC 27695, USA.
E-mail address: Anne_mcLaughlin@ncsu.edu (A.C. McLaughlin).
& Goossens, 1992), although memory training gains may be more
reflective of strategy acquisition than ability improvement. It is also
possible that lower functioning older adults may be unable to fully
participate in a cognitive intervention due to the inherent difficulty
of cognitive training and thus, be less likely to benefit.
However, it has also been suggested that cognitive activity may
most benefit lower functioning older adults. Studies specifically
examining the relationship between baseline ability and training
gain found that there were higher benefits from cognitive training
for those initially low in ability (Ball, Edwards, & Ross, 2007) and
ability and education (Boron, Turiano, & Willis, 2007). Older adults
with higher abilities may have already been performing near ceil-
ing, and thus could not show as much improvement. It may also be
that there is a threshold for stimulation and activity that results in
high ability scores and the high functioning older adults already
participate above that threshold as part of their daily lives. Thus,
a cognitive intervention adds little beyond the threshold they
had already reached. However, adding activities to the lives of low-
er functioning adults may result in cognitive improvement. Similar
findings have occurred in animal models where environmental
enrichment during adulthood has been shown to improve behav-
ioral flexibility (Kemperman, Gast, & Gage, 2002).
1.1. Games as tools for cognitive training
There is growing interest in the use of video games for training
cognitive abilities. Video and computer games can be complex and
flexible activities that use multiple cognitive abilities, can offer
motivational rewards, and can be played socially. Games have been
shown to improve younger adults’ cognitive abilities in areas such

0747-5632/$ - see front matter Ó 2012 Elsevier Ltd. All rights reserved.
doi:10.1016/j.chb.2012.01.012
1092 L.A. Whitlock et al. / Computers in Human Behavior 28 (2012) 1091–1096
as visual attention (Feng, Spence, & Pratt, 2007; Green & Bavelier,
2003; Green, Li, & Bavelier, 2010) and mental rotation ability
(De Lisi & Cammarano, 1996; Feng et al., 2007; Okagaki & Frensch,
1994; Terlecki, Newcombe, & Little, 2008). Older adults also appear
to benefit from cognitive enhancement via video games. A recent
study examined the use of a real-time strategy game called Rise
of Nations in a cognitive training program for older adults (Basak
et al., 2008). The game required the player to gather resources,
research technologies, and build and control large armies all in real
time. Participants in the experimental group played the game for
23.5 h and showed significant improvements in task switching,
working memory, visual short-term memory and reasoning when
compared to the control group (Basak et al., 2008). Thus, any game
chosen for an intervention should likely include multi-tasking and
switching between multiple cognitive abilities such as memory,
spatial manipulations, and reasoning to be effective.
1.2. Motivation
Video games are also promising as a tool for cognitive training
because they are designed to be fun to play. Cognitive training
appears to be most effective when participants are pushed to the
limits of their abilities, which can be frustrating and discouraging
if the players feel overwhelmed. While participants may be
initially motivated to complete exercises to improve their mental
abilities, over time they may lose motivation and fail to invest
effort. However, games are designed to be rewarding to play. They
usually have extrinsic motivators like sound effects and high score
screens that motivate the player to continue in the face of
challenges. Using extrinsic motivators like sound effects can
dramatically reduce failure rates even in highly difficult tasks like
air traffic control (Schneider, 1985).
Comparatively few studies have tested the effectiveness of
using video games to improve cognitive abilities in older adults,
perhaps because of the perception that older adults are reluctant
to adopt new technology or that they may be unwilling to play vi-
deo or computer games. However, older adults are likely to use
technology when they perceive there to be benefits to using it
(Melenhorst, Rogers, & Bouwhuis, 2006) and that the technology
has relevance to their lives (Selwyn, Gorad, Furlong, & Madden,
2003). Older adults have also exhibited interest in a wide variety
of games though they tended to prefer sedentary games to physi-
cally active games (Hoppes, Hally, & Sewell, 2000). They have also
been shown to be especially interested in games that can be played
on varying levels of strategic complexity, such as dominoes
(Hoppes et al., 2000). Several elements have been identified as
important to older adults’ enjoyment of game playing, including
mental fitness, competition and winning, filling their time in a
way that provides satisfaction, and a sense of belonging in social
games (Hoppes, Wilcox, & Graham, 2001). Video games can be
designed to contain all of these elements.
1.3. Overview of the intervention game
A game that fulfilled the requirements of multi-tasking and
switching between multiple cognitive abilities was World of
Warcraft (WoW), a massively multiplayer online role playing game
created by Blizzard Entertainment. In WoW players complete
quests in a persistent virtual world to receive rewards and their
characters gain levels, pushing them toward more difficult and
complex challenges, many of which require collaboration and
social interaction with other human players. Navigating to a novel
location within the virtual world, for example, might require
players to read a textual description of the goal location, examine
a 2D overhead map of the region, decide an optimal path to their
goal using the map, translate that path from the 2D overhead view
to the 3D game world, and finally navigate through the 3D world to
reach their destination. During this process they must also attend
to important and constantly changing on-screen indicators within
the game world, such as the health of their character in the game,
and selectively ignore other on-screen information that might
distract them from their task. Due to these characteristics, WoW
appeared to be a cognitively demanding game and a formal analy-
sis was performed to identify the cognitive abilities used during
play. A cognitive task analysis (CTA), identifying the cognitive
skills, or mental demands needed to perform proficiently (Militello
& Hutton, 1998), was conducted of both novice and expert perfor-
mance in the game based on a verbal protocol (Bainbridge &
Sanderson, 1990). Two novice players and two expert players, all
younger adults, were used for the analysis.
The CTA identified a number of cognitive abilities required by
the game during play for novice and expert experience levels.
Although the CTA suggested that novice and expert players pro-
ceeded through the game in different ways, all players engaged
in a number of demanding cognitive processes such as rapidly
switching their attention between sub-tasks requiring different
cognitive abilities, necessitating effortful attentional control. This
confirmed that playing World of Warcraft was a cognitive complex
task, both for players experiencing the game for the first time and
for those who have been playing for years. We are currently aware
of only one other study that utilized task analysis a priori in inter-
vention design (Ackerman, Kanfer, & Calderwood, 2010).
1.4. Hypotheses
World of Warcraft was predicted to improve the cognitive ability
of older adults through the task requirements of using multiple cog-
nitive abilities under attentionally demanding conditions. In partic-
ular, it was expected to improve older adults’ spatial orientation
ability and attentional control because of the high demands for
those abilities during play. Additionally, it was hypothesized that
initial ability level would affect improvement such that experimen-
tal participants exhibiting lower initial ability would improve more
than those exhibiting higher initial ability, due to the intervention
targeting ability improvement, which affects performance on mul-
tiple tasks, rather than mere skill acquisition for a single task.
2. Method
2.1. Participants
Participants were contacted through a database of older adults
who had participated in psychology research and through commu-
nity newsletters. Control group participants received $50.00 at the
end of the study and experimental group participants received
$70.00. As a condition of eligibility, all participants in both exper-
imental and control groups had a home computer less than three
years of age and a dedicated home internet connection. Demo-
graphic information and ability test scores are reported in Table 1.
2.2. Materials
Participants completed a series of ability tests during the pre-
and post-test sessions to measure initial ability and change over
the experimental period. These included tests of spatial ability,
executive function, and memory.
2.2.1. Mental Rotation Test (MRT)
The MRT was a measure of mental rotation ability and consisted
of a version of the test made from the Vandenberg & Kuse images
(Peters et al., 1995; Vandenberg & Kuse, 1978). Participants
 L.A. Whitlock et al. / Computers in Human Behavior 28 (2012) 1091–1096 1093

Table 1 2.2.5. Stroop Test

Demographics and Pre-Test Ability Scores by Group. The Stroop Test (Stroop, 1935) was used to measure attentional
n = 20 n = 19 control. Participants were given a list of color names printed in dif-
Control Experimental ferent colors of ink. They were asked to read aloud the name of the
Gender colors in which the words are printed, not the text of the words
Female n = 11 n=9 themselves. Scores consisted of time to read aloud 100 color names
Male n=9 n = 10 where lower times indicated better performance.
M (SD) M (SD) F
Age 66.80 (4.93) 68.58 (4.38) 1.44 2.2.6. Progressive matrices
Frequency of computer use1 5.94 (1.26) 5.37 (1.16) 2.09
The test used to measure reasoning ability was a progressive
Education2 5.21 (1.51) 4.47 (1.47) 2.32
Health3 3.84 (1.01) 4.16 (0.83) 1.1 matrices test (Newton & Bristoll, 2011), similar to Raven’s Progres-
sive Matrices (Raven, Raven, & Court, 2003). Participants identified
Pre-Test Ability Scores
Shipley Vocabulary4 35 34 0.83 the pattern in a series of images and an image that would best
Stroop5 131.18 (29.87) 132.83 (26.09) 0.03 complete the series or selected an image that did not belong in
Object Perspective6 56.47 (27.47) 46.97 (39.08) 0.78 the group. A higher score indicated better performance.
Digit Symbol Substitution7 48.20 (12.23) 47.47 (9.92) 0.04
Mental Rotation8 62.50% (16.04) 58.10% (17.55) 0.68
Progressive Matrices9 5.10 (2.27) 5.53 (2.37) 0.33
2.2.7. Everyday Cognition Battery: Memory test (ECB Memory)
ECB Memory10 25.80 (2.59) 24.74 (3.33) 1.25 ECB Memory (Allaire & Marsiske, 1999) tested cued recall mem-
ory. The test consisted of information, such as a medicine/nutrition
There were no significant differences between experimental and control groups on
these demographic and pre-test measures.
label, followed by multiple-choice questions. Participants were
1
Higher scores indicated more frequent computer use, on a 7-point scale ranging given 1 min to study the information then turned to the next page
from ‘‘once every few months’’ to ‘‘daily, most of the day.’’ and were given 1 min to answer the questions. Higher scores
2
Higher scores indicated more education, on an 8-point scale ranging from ‘‘less indicated better performance.
than high school graduate’’ to ‘‘MD, JD, PhD, or other advanced degree.’’
3
Higher scores indicated better self-reported health, on a 5-point scale ranging
from ‘‘poor’’ to ‘‘excellent’’. 2.2.8. Shipley Institute of Living Scale: Vocabulary
4
Measure of vocabulary; administered only at pre-test. The Shipley Vocabulary test (Shipley, 1946) is a 40-question
5
Attentional control, lower scores indicated better performance. multiple choice test of synonym vocabulary. For each question par-
6
Spatial orientation, lower scores indicated better performance. ticipants are shown an initial word and asked to select from four
7
Perceptual speed.
8
Spatial rotation.
possible answers which word means the same thing, or most
9
Measure of reasoning ability. nearly the same thing, as the initial word. Higher scores indicate
10
Everyday cognition. better performance.

indicated which two of four images represented rotated versions of
a larger image and a higher score indicated better performance.
2.2.2. Object Perspective Test
The Object Perspective Test (Kozhevnikov & Hegarty, 2001)
measured spatial orientation, defined as the ability to imagine
how a stimulus appeared from another perspective. It consisted
of an array of seven objects with a circle drawn below. Participants
were told to imagine being at the position of one object while
facing another object and then asked to draw on the circle the
direction of a third object in relation to their current orientation.
Score on this test was the summed degree errors, and therefore a
higher score indicated worse performance.
2.2.3. Paper Folding Test
The Paper Folding Test (Ekstrom, French, Harman, & Dermen,
1976) was a measure of spatial visualization, defined as the ability
to manipulate complex spatial information when several stages are
required to produce the solution (Voyer, Voyer, & Bryden, 1995).
Participants imagined folding paper based on an illustration with
the last picture in each series showing a hole punched in the paper.
Participants then mentally unfolded the paper and indicated which
of five choices represented the correct location of holes in the pa-
per. Scores were the number of items answered correctly, and
higher scores indicated better performance.
2.2.4. Digit Symbol Substitution Test
The Digit Symbol Substitution Test (Wechsler, 1981) was a
measure of perceptual speed. The test consisted of a key of nine
digits, one through nine, each paired with a simple symbol. Partic-
ipants were given 90 s to draw the symbols in boxes below the
digits and a higher score indicated better performance on the task.
2.3. Equipment
The intervention took place using participants’ home computers
and hardware specifications varied. However, all computers met
the game’s minimum system requirements: Windows XP or Win-
dows Vista, Intel Pentium 4 1.3 GHz, 512 MB RAM, and GeForce 2
class graphics cards.
2.4. Design and procedure
The study used a pretest–postest, control group design. Partici-
pants were assigned to either the WoW (experimental) group or
control group prior to coming in for the study. At pretest partici-
pants completed the series of ability tests and questionnaires
either in singly or as part of a group depending on participant
availability. Participants’ corrected near vision was assessed with
a Snellen eye chart during the pre-test session to screen for partic-
ipants whose vision might interfere with their ability to perform
on the cognitive tests. No participants were excluded on the basis
of their vision results. The Stroop and near vision tests were
administered individually. The participants in the experimental
group were scheduled to return for a training session. The 2-h
pre-training session consisted of lecture and demonstration (1 h)
followed hands-on practice with playing WoW (1 h). They were
given training materials to assist them, including a locally-
developed illustrated game manual created for the study as well
as the official game manual. All participants reached a criterion
of performance by the end of this training session where they
could navigate the virtual world and perform simple in-game tasks
using the WoW interface.
Experimental participants returned home and played the game
at home for approximately 14 h over a 2 week period, or about an
hour a day. They were instructed to try their best to complete a
series of tasks and take on increasingly difficult challenges within
1094 L.A. Whitlock et al. / Computers in Human Behavior 28 (2012) 1091–1096
the game, and were given a list of suggested tasks of increasing dif-
ficulty. ‘‘Hints’’ were given for earlier tasks as scaffolding. During
the 2 weeks they were encouraged to contact the experimenters
with any questions, either by phone, email, or within the game
itself. After approximately 2 weeks both groups returned for the
posttest where they completed the ability tests and questionnaires.
Experimental group participants additionally completed a ques-
tionnaire about their experience with the game.
3. Results
3.1. Intervention effect
Results were analyzed with a 2 (experimental group)  2 (pre-
vs. post-test session) mixed model ANOVA. For the Stroop Test, a
measure of attentional control, there was a significant group by
session interaction, F(1, 37) = 4.19, p = .05, g2 = .10, such that
participants in the experimental group improved more between
pre- and post-test than did participants in the control group. There
were no significant interaction effects for the Mental Rotation Test,
the Object Perspective Test, the Digit Symbol Substitution Test,
Progressive Matrices Test, or the ECB: Memory. The Paper Folding
test was administered only at post-test; a one-way ANOVA of
Paper Folding post-test scores found no significant difference
between the experimental and control groups.
3.2. Individual differences
Two-block hierarchical regression analyses were used to exam-
ine the relationship between the predictors of initial pre-test per-
formance and group on change scores for all ability tests except the
Paper Folding Test, which was performed only at post-test. For all
regression analyses the first block consisted of the predictors of
group and pre-test scores, and the second block tested for an inter-
action effect by adding the interaction term of pre-test score and
group.
3.2.1. Attentional control – Stroop Test
Because a lower Stroop score indicated better performance, the
change score was calculated by subtracting the post-test score
from the pre-test score, such that more positive change scores indi-
cate more improvement. The first block, consisting of the predic-
tors of group and pre-test scores, accounted for 22.7% of the
variance in change scores. Both group (b = 0.31, p = .04) and pre-
test score (b = 0.35, p = .02) predicted change scores such that both
experimental participants and participants who started with high-
er Stroop scores (indicating worse performance) tended to improve
more.
The second block, which added the interaction term, accounted
for 36% of the variability in change scores. There was a significant
interaction between group and pre-test score (b = 0.51). As can be
seen in Figure 1, participants in the experimental condition who
had higher pre-test scores (indicating worse performance) tended
to have higher change scores (b = .48, p = .01). For participants in
the control condition no relationship existed between initial
performance and change. These findings indicated that the exper-
imental group, but not the control group, improved differentially
on a measure of attentional control based on initial performance.
Experimental participants who performed more poorly on the
Stroop pre-test (as indicated by higher scores) improved more than
participants who performed initially well (Fig. 1).
3.2.2. Spatial orientation – Object Perspective Test
Because a lower score indicated better performance, the change
score was calculated by subtracting the post-test score from the
pre-test score such that more positive change scores indicated
more improvement. In the first block, pre-test scores significantly
predicted change scores (b = .38, p = .04).
The second block, which added the interaction term, signifi-
cantly accounted for 29.5% of the variance in change scores. The
interaction term consisting of the two variables was significant
(b = .73, p < .01). The experimental group, but not the control
group, improved differentially on a measure of spatial orientation,
such that participants in the experimental condition with poorer
pre-test performance tended to have higher change scores (Fig. 1).
3.2.3. Mental rotation, recognition memory, reasoning, perceptual
speed, spatial visualization
Multiple regression analyses were also conducted on the other
ability test measures. There was a significant main effect of pre-
test score for the Mental Rotation Test (b = .50, p = .02), ECB
Memory (b = .72, p < .01), and Reasoning (b = .69, p < .01) such
that participants who performed more poorly at the pre-test
tended to improve more, but no significant interactions of pre-test
score and group on change scores were found. There were no sig-
nificant main effects or interaction effect for the Digit Symbol Sub-
stitution Test. No regression analysis was performed for the Paper
Folding Test because it was administered only at post-test.
4. Discussion
4.1. Theoretical contributions
The results of this study add to the body of evidence suggesting
the efficacy of certain types of video games as cognitive interven-
tions for older adults. World of Warcraft, a game selected because
of its demanding attentional characteristics, was found to improve
the cognitive ability of older adults. This highlights the usefulness
of cognitive task analysis (CTA) as a tool when selecting or design-
ing a cognitive intervention. Past studies showed that surface
features of a game may be misleading when considering their
potential to improve cognitive ability, e.g., one 3-D puzzle game
demonstrated improvement of mental rotation ability (De Lisi &
Cammarano, 1996) and a different 3-D puzzle game showed no
effect (Feng et al., 2007). CTA can help identify underlying qualities
that may be most conducive to ability improvement, such as
requiring the use of multiple types of cognitive abilities and atten-
tional control.
No relationship was found between age and cognitive change.
This is contrary to expectations of greater change in younger par-
ticipants due to an increased capacity for neural plasticity. How-
ever, the participants in this study consisted of a relatively young
sample of older adults. The range of ages for participants in this
study may have simply been too limited to determine a relation-
ship between age and potential benefit from a cognitive interven-
tion of this type.
The relationship found between initial ability level and ability
change in the intervention group suggests that lower-ability older
adults may stand to benefit more from cognitive training. It is
important to note, however, that this study involved a relatively
high-functioning sample of older adults. It is possible that among
high-functioning older adults, the ‘‘lower-high’’ can benefit more
than the ‘‘higher-high.’’ It may be that there is an ideal range for
benefit from cognitive interventions – initial ability low enough
to benefit, but young enough to have higher plasticity (and thus,
likely to have higher abilities). Given that our sample was all rela-
tively young, the lower-ability participants in our study may have
differed from the higher-ability participants in the cognitive de-
mand required by their daily activities, and that the intervention
served as a cognitive equalizer for the training group. Future
 L.A. Whitlock et al. / Computers in Human Behavior 28 (2012) 1091–1096
Fig. 1. Scatterplots illustrating the relationship between pre-test scores on the Stroop and Object Perspective Tests and change scores for each experimental group.
studies should include more measures of individual differences,
including daily activities, to further investigate this possibility.
One limitation of our study was a lack of random assignment
because of the difficulty encountered recruiting participants who
met all computer requirements. Participants were assigned to
groups in a non-random convenience assignment based on their
availability for the testing sessions. However, pre-test performance
in both groups revealed no significant differences, nor were there
significant differences in demographics between the two groups,
which suggested there were no systematic differences between
groups.
Last, ideally intervention studies should feature a control condi-
tion that contains a placebo intervention to reduce any effects due
to simply taking part in an intervention (Green et al., 2010; Lied &
Karzandjian, 1998). Our study utilized a control group but no
‘‘intervention-like’’ group to compare to our target intervention.
Future studies of the use of video games as a cognitive intervention
for older adults should incorporate a control condition utilizing a
video game not expected to lead to improvement (Feng et al.,
2007; Green & Bavelier, 2003).
4.2. Conclusion
The population of the world is aging at an unprecedented rate,
and number of older adults worldwide is expected to triple to two
billion by 2050 (United Nations, 2009). Cognitive training under
certain circumstances and for certain individuals has the potential
to improve abilities and possibly daily life. The current study con-
tributes to knowledge about individual differences in benefit and
how to predict a priori the intervention tasks most likely to have
an effect. Future work can build upon these findings by studying
individual differences in the capacity to benefit from multi-modal
cognitive training interventions, as well as the potential for such
improvements to transfer to the daily lives of older adults.
Acknowledgement
This research was supported by a grant from the North Carolina
State University Faculty Research and Professional Development
fund to Dr. Jason Allaire.
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