Cognitive Enhancement via Neuromodulation and Video Games: Synergistic Effects?

 Open Supplemental Data

Front. Hum. Neurosci., 19 June 2020 |

Marc PalausRaquel Viejo-Sobera*Diego Redolar-Ripoll and Elena M. Marrón

  • Cognitive NeuroLab, Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain

Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique able to modulate cortical excitability. This modulation may influence areas and networks responsible for specific cognitive processes, and the repetition of the induced temporary changes can produce long-lasting effects. TMS effectiveness may be enhanced when used in conjunction with cognitive training focused on specific cognitive functions. Playing video games can be an optimal cognitive training since it involves different cognitive components and high levels of engagement and motivation. The goal of this study is to assess the synergistic effects of TMS and video game training to enhance cognition, specifically, working memory and executive functions. We conducted a randomized 2 × 3 repeated measures (stimulation × time) study, randomly assigning 27 healthy volunteers to an active intermittent theta-burst stimulation or a sham stimulation group. Participants were assessed using a comprehensive neuropsychological battery before, immediately after, and 15 days after finishing the video game+TMS training. The training consisted of 10 sessions where participants played a 3D platform video game for 1.5 h. After each gaming session, TMS was applied over the right dorsolateral prefrontal cortex (DLPFC). All participants improved their video gaming performance, but we did not find a synergistic effect of stimulation and video game training. Neither had we found cognitive improvements related to the stimulation. We explored possible confounding variables such as age, gender, and early video gaming experience through linear regression. The early video gaming experience was related to improvements in working memory and inhibitory control. This result, although exploratory, highlights the influence of individual variables and previous experiences on brain plasticity.


Non-invasive brain stimulation techniques have become a step forward in cognitive neuroscience due to their ability to establish causal links between cognition and its neural substrate. Among these techniques, transcranial magnetic stimulation (TMS) allows modulation of cortical excitability in highly specific target regions, inducing changes in the associated cognitive functions and even enhancing them (e.g., Luber and Lisanby, 2014).

Nevertheless, the specific parameters through which TMS affects cognition are not entirely clear. TMS effectiveness seems to be partially task-dependent (Koch and Rothwell, 2009Johnson et al., 2012Duecker et al., 2013Matsugi et al., 2014) and most effective when used together with cognitive training (Bentwich et al., 2011Schilberg et al., 2012Hopfner et al., 2015Rabey and Dobronevsky, 2016Lee et al., 2017Nguyen et al., 2017). But both, the stimulation and the training must have certain characteristics to achieve the desired near-transfer and far-transfer effects (i.e., translation of benefits to similar or different cognitive domains, respectively).

Regarding the stimulation, its influence can be maximized when it is delivered after skill training. This allows us to take advantage of the state-dependency effects in specific neural populations (Romei et al., 2016), and TMS can interact with their current, imbalanced state (Silvanto et al., 2018). Examples in animal studies, using hypothalamic intracranial self-stimulation have shown that, administering the stimulation immediately after a skill training produce higher retention rates for that skill than administering the stimulation before the training (Redolar-Ripoll et al., 2002).

On the other hand, transfer effects of the training are maximized when different cognitive skills are integrated (Taatgen, 2013), high levels of engagement and motivation are maintained (Maraver et al., 2016), and there is sufficient exposure to the task (Zhao et al., 2020). In recent decades, video games have received a great deal of attention as cognitive training tools, due to some features that make them suitable for cognitive enhancement: they are widely available, integrate several cognitive processes at once, allow adjustment of variable difficulty, and are highly motivating and engaging. Furthermore, they are often used for long enough over a person’s lifetime to have a real impact on cognition. There is a considerable body of literature dedicated to the effects of video gaming on the brain (for a systematic review see Palaus et al., 2017), and the implications of using a particular video game genres are well understood (Dobrowolski et al., 2015).

Given the ability of TMS to induce plastic changes in the brain, and the particular suitability of video games to train cognitive functions, we expect that their combination would produce synergistic effects on cognitive enhancement, but the literature documenting combined use of TMS and video games is still scarce (e.g., Anguera et al., 2013). In particular, we expect to enhance cognition (i.e., processing speed, visuospatial skills, attention, working memory, executive functions, and general intelligence) in a healthy sample by playing a 3D platform video game during 10 sessions and applying TMS over the dorsolateral prefrontal cortex (DLPFC) immediately after playing. We hypothesized that post video game TMS would enhance the positive effects of video game training over cognition.

Direct link to the research

About S. R. Zelenz 119 Articles
S.R. Zelenz has worked in education for 20 years. Working with students from all walks of life, cultures, races, and social diversity, Zelenz’s research in Educational Leadership led to finding a better way to approach learning for students with trauma histories. Many were juvenile offenders, gang members, diagnosed with varying behavioral disorders, or had family histories of violence, murder, or narcissistic parenting. This research could not be effectively accomplished without further understanding: how epigenetic trauma inheritance may be impacting these students; how brain development from trauma may be impacting their behavioral and emotional development; as well as deep understanding of psychology and its varying classifications for behavioral and personality disorders. The goal is to find solutions for changing the conversation and making a real difference for these students. She has also worked with nonprofits of varying focus areas for the last 25 years. Her undergraduate degree in Arts Administration and Music prepared her for managing nonprofits of any size as well as procuring funding so that they can achieve their goals. Pairing her nonprofit background with her education background, she has been able to make a difference for over 200 nonprofits worldwide, written curriculum for schools across the globe, and assisted many arts organizations through performance and management.