The Benefits of Video Games on Brain Cognitive Function: A Systematic Review of Functional Magnetic Resonance Imaging Studies

Abstract

Benefits of video games on cognitive function have been proved by increasing evidence. However, reasons for game-induced changes in cognitive function are still elusive. Therefore, this study conducted a systematic review of brain function activation changes in association with video games. We retrieved publications from three electronic databases (PubMed, Web of Science, and PsycInfo), with publication dates before 8 February 2021. After screening the study with fMRI data, 13 studies were included in this work, including 9 cross-sectional studies and 4 types of research. In this review, we summarized the potential benefits of video games on cognitive function and discussed the effects of different types of video games on cognitive function. In particular, we highlighted the effect of video games on attention ability and visuospatial ability and addressed the functional brain activation changes in frontal and parietal lobes and other related brain regions induced by games. Finally, we pointed out that when discussing the effect of video games on brain function, types of video games should be carefully categorized.

1. Introduction

The video game is a kind of game with audio-visual equipment and is based on a particular plot operation. In video games, individuals interact with video equipment and generate visual and auditory feedback. In general, video game equipment includes pre-programmed programs, input devices (console, mouse, keyboard, etc.), and output devices (screen, audio, etc.). Demographic data about video games show that the average age of video game players has increased in recent decades, and video games have become a common form of entertainment in people’s lives [1].

Cognitive function refers to the ability of the human brain to store and process information. Cognitive function has a great impact on the quality of daily life [2]. The World Health Organization estimates that by 2025 there will be two billion elderly people, 80 percent of whom will live in developing countries [3]. As aging becomes more severe, more and more elderly people suffer from age-related cognitive decline [4,5,6]. Studies have shown that cognitive decline caused by aging reduces the quality of life of the elderly and is closely associated with an increased risk of death. Therefore, maintaining brain health and preventing or delaying cognitive decline has become an urgent problem to be solved in the aging society.

Video games, as a popular form of leisure activity, have attracted people’s attention in recent years. People are now getting to understand the function of video games in maintaining or improving individual cognitive ability under different situations. It is worth noting that, compared with other cognitive training, video game training has its advantages: on the one hand, the unique interest, challenge, and attraction of video games itself motivates individuals to participate in video game training; on the other hand, video game training showed a better effect on skill transferring [7,8,9]. This means that individuals could transfer skills they acquired in video game training to other untrained tasks.

Recent studies also found that video games have a positive effect on cognitive function [10,11,12]. With the development of neuroimaging techniques, more and more studies confirmed that video game training could be beneficial for the brain’s frontal lobe, parietal lobe, temporal lobe, hippocampus, striatum, and other parts of the brain. Video games cause significant changes in the structure and function of the brain area and ascend an individual’s sensory perception, attention, and memory capacity, and enhance the neural basis of individual brain function [13,14,15,16]. In this review, to provide a deeper insight into this field, we provide a detailed discussion of the changes in brain function activation induced by video games.

2. Methods

2.1. Data Sources

The literature search was conducted on 8 February 2021 through three electronic databases (PubMed, Web of Science, and PsycInfo). The language of publication was limited to English. Search terms in title and abstract were combined as follow: [“videogame*” OR video-gam*” OR video-based” OR “action gam*” OR “computer-game*” OR “computer-based” OR “game-based” OR “exergames*” OR “virtual reality game*” OR “Wii” OR “Nintendo” OR “x-box” OR “Kinect”] AND [fMRI OR MRI OR “MR imaging” OR “magnetic resonance imaging” OR “functional MRI” OR “functional magnetic resonance imaging” OR “PET” OR “positron emission tomography” OR “SPECT” OR “single-photon emission computed tomography”] AND [“neuropsychological function” OR “executive function*” OR “executive control” OR “percept*” OR “cognit*” OR “attention*” OR “visual*” OR “vision” OR “inhibition” OR “memory OR “motor” OR “dual-task” OR “switching task” OR “Stroop” OR “object tracking” OR “spatial”]. Furthermore, reference lists of included articles were manually searched for relevant articles captured through the database searches.

2.2. Inclusion Criteria and Study Selection

The screening for relevant studies was conducted adhering to the PICOS principles, which stand for participants (P), intervention (I), comparisons (C), outcomes (O), and study design (S). We included peer-reviewed journal articles published in English when they met the following inclusion criteria: (P) we included healthy people in all age groups; (I) only studies performing video games were considered eligible; (C) studies were designed as a pre/post-intervention experiment, and at least one group was assigned video games. Alternatively, a horizontal study compares video game players (VGP) and non-video game players (NVGP). (O) The relevant studies needed to assess cognition-related brain activation patterns via fMRI, PET, or SPECT (task-based imaging studies or resting-based imaging studies). Additionally, we excluded reward-related tasks because the main aim of this task does not measure cognitive function.

2.3. Data Extraction

Two independent reviewers performed the extraction of the relevant data. The following information was extracted: (1) name of the lead author, (2) number of the participants, (3) age of the participants, (4) imaging modality, (5) game type, (6) intervention time and cognitive task paradigms employed to assess the effects of the intervention, (7) functional brain activation results, and (8) function brain activation results.

fMRI quality measures included experimental design, handedness, gender of participants, explanation for rejected data, details of imaging parameters, software analysis package method, method of motion correction during pre-processing, multiple comparison correction, and detailed description of first and second level analyses. Due to the limited number of studies, the heterogeneity of tasks and contrasts, and most findings reported as a region of interest analyses, voxel-wise whole-brain meta-analyses were not conducted.

3. Results

3.1. Study Characteristics

Figure 1 presents the PRISMA flow chart of the included studies. A total of 800 articles were found in the initial search. To ensure the accuracy of the systematic search process, two reviewers conducted a multi-step search process. We screened the titles, abstracts, and full-length texts to make an initial assessment independently. If the two reviewers had any disagreements, a third reviewer was included. After screening the titles and abstracts, 22 articles were selected to conduct full-text screening.

Furthermore, 12 articles passed the inclusion criteria. Additionally, one manually searched article agreed on by the two reviewers met the inclusion criteria. Finally, 13 articles were selected for the systematic review.

Table 1. Summary of participants’ characteristics.

No.	Study	Number	Age	Imaging Modality	Game Type	During	Task/Stimuli
Horizontal study
1	Gong (2019)	TRVGP: 26 (F: 0) LRVGP: 34 (F: 0	25.35 ± 2.39 24.59 ± 2.13	Resting-state fMRI	Action real-time strategy game	-	-
2	Hou (2019)	VGP: 15 (F: 9) NVGP: 18 (F: 6)	55–74 y 55–78 y	Resting-state fMRI	-	-	-
3	Richlan (2018)	VGP: 14 (F: 7) NVGP: 14 (F: 7)	22.50 ± 2.96 23.57 ± 3.20	Task-state fMRI	First and third person shooters games	-	Visuospatial task and a verbal letter detection task (attentional control)
4	Gorber (2018)	VGP: 10 (F: 10) NVGP: 10 (F: 10)	26.50 ± 7.74 23.90 ± 4.86	Task-state fMRI	First-person shooters games, fighting games, and action-adventure games	-	Visuomotor task (visually-guided responses)
5	Wang (2017)	VGP: 20 (F: 10) NVGP: 20 (F: 6)	65.00 ± 5.97 63.80 ± 6.66	Task-state fMRI	Real-time Strategy games	-	Flanker task (executive function)
6	Kim (2015)	VGP: 16 (F: 0) NVGP: 15 (F: 0)	29.70 ± 4.20 28.30 ± 4.10	Task-state fMRI	Real-time strategy games	-	Texture discrimination task (visual perceptual learning)
7	Gong (2015)	VGP: 27 (F: NVGP: 30 (F:	23.26 ± 0.40 22.30 ± 0.38	Resting-state fMRI	Action games	-	-
8	Bavilier (2012)	VGP: 12 (F: 0) NVGP: 14 (F: 0)	M: 25.50 y	Task-state fMRI	First person shooters action games	-	Visual search task (selective attention)
9	Granek (2010)	VGP: 13 (F: 0) NVGP: 13 (F: 0)	24.00 ± 3.10 26.00 ± 4.60	Task-state fMRI	Video games	-	Visuomotor tasks (visuomotor transformations)
Intervention study
10	Momo (2020)	EG: 25 (F: 9) CG: 15 (F: 6)	24.2 ± 2.60 26.6 ± 3.20	Resting-state fMRI	First-person shooters games	30 h	-
11	Kral (2018)	EG: 34 (F: 14) CG: 40 (F: 13)	12.90 y 12.80 y	Resting-state fMRI	Videogame with empathy training mechanics	-	Empathic accuracy task (empathy)
12	Nikolaidis (2014)	EG: 45 (F: 27)	21.74 ± 2.09	Resting-state fMRI	Videogame with a working memory component	30 h	-
13	Martinez (2013)	EG: 20 (F: 20) CG: 20 (F: 20)	19.60 ± 3.69 18.30 ± 0.48	Resting-state fMRI	Videogame	16 h	-

TRVGP: top-ranking video games player; LRVGP: lower-ranking video games player.

and

Table 2. Summary of brain activation result.

No.	Study	Regions of Significant Differences in Levels of Blood-Oxygen-Level-Dependent (BOLD) Signal
Horizontal study
1	Gong (2019)	Functional connectivity of default mode areas(bilateral posterior cingulate cortex, parahippocampal gyrus right angular gyrus) is enhanced. The functional connectivity of the central executive network (bilateral dorsolateral prefrontal cortex, left superior frontal gyrus Left middle frontal gyrus) is enhanced.
2	Hou (2019)	The amplitude of low-frequency fluctuation value in the left inferior occipital gyrus left cerebellum and left lingual gyrus increased significantly.
3	Richlan (2018)	The activation of the frontoparietal regions(left middle paracingulate cortex, the left superior frontal sulcus, the opercular part of the left inferior frontal gyrus, and the left and right posterior parietal cortex) is increased.
4	Gorber (2018)	The activation of the cuneus, middle occipital gyrus, and cerebellum are decreased.
5	Wang (2017)	Functional connectivity between the left paracentral lobule and right hippocampus left supramarginal gyrus and right dorsolateral prefrontal cortex is enhanced. Functional connectivity between the right precuneus and angular gyrus is decreased.
6	Kim (2015)	White-matter connectivity between the right external capsule and visual cortex and neuronal activity in the right inferior frontal gyrus and anterior cingulate cortex is increased.
7	Bavilier (2012)	The activation of the visual motion-sensitive area is decreased.
8	Gong (2015)	Functional connectivity between anterior and posterior insular subregions and functional integration between the attentional and sensorimotor networks is increased.
9	Granek (2010)	The activation of rostral prefrontal cortex activity(ipsilateral superior frontal gyrus), dorsolateral prefrontal cortex (the middle frontal gyrus and the inferior frontal gyrus), and bilateral ventrolateral prefrontal cortex (the inferior frontal gyrus, the ventro-orbital frontal gyrus, and the rostral lateral sulcus) are increased.
Intervention study
10	Momo (2020)	Functional connectivity between the left thalamus and left parahippocampal gyrus is increased.
11	Kral (2018)	The activation of empathic accuracy-related activation in the right temporoparietal junction is increased. Functional connectivity in empathy-related brain circuits (posterior cingulate–medial prefrontal cortex; medial prefrontal cortex) is increased.
12	Nikolaidis (2014)	The activation of brain regions of working memory(superior parietal lobe, caudate, postcentral gyrus, precuneus, supramarginal gyrus, temporal fusiform cortex, and the insular cortex) is increased.
13	Martinez (2013)	Almost all relevant changes were localized in the left hemisphere. Functional connectivity between parietal, prefrontal, and temporal regions is increased.

lists the detailed information of the 13 studies, which included 9 horizontal studies [1,17,18,19,20,21,22,23,24] (VGP: 153; NVGP:168) and 4 interventional studies [25,26,27,28] (EG:124; CG:75).

3.2. fMRI Quality

Critical criteria for fMRI quality reporting were selected from a set of guidelines for fMRI studies’ standardized reports [29]. All studies reported the overall fMRI design and software package used for analysis. Not a single study met all reporting guidelines, while others lacked at least one reporting guideline, most commonly in clear descriptions of first and second-level contrasts. For specific details, see

Table 3. Summary of fMRI quality.

No.	Study	fMRI Design	Sample Handedness Reported	Sample Gender Reported	Scan Rejection Mentioned	Scan Rejection Reason	Volumes Acquired per Session	Software Package Specified	Method for Motion Correction Described?	Method for Multiple Comparison Correction Described?	Type of Correction Applied	First Level Contrasts Described	Second Level Contrasts Described
Horizontal study
1	Gong (2019)	1	1	1	n	n	1	1	0	1	voxel wise	unclear	unclear
2	Hou (2019)	1	0	1	n	n	0	1	1	1	voxel wise	unclear	unclear
3	Richlan (2018)	1	0	1	1	1	0	1	1	1	voxel wise	1	1
4	Gorber (2018)	1	1	1	0	n	0	1	1	1	voxel wise	1	unclear
5	Wang (2017)	1	0	1	0	0	0	1	1	0	voxel wise	1	1
6	Kim (2015)	1	0	1	0	0	0	1	1	1	voxel wise	unclear	unclear
7	Bavilier (2012)	1	0	1	1	1	1	1	1	1	voxel wise	unclear	unclear
8	Gong (2015)	1	0	1	n	n	1	1	1	0	voxel wise	unclear	unclear
9	Granek (2010)	1	1	1	n	n	1	1	1	1	voxel wise	unclear	unclear
Intervention study
10	Momo (2020)	1	1	1	n	n	1	1	1	1	voxel wise	1	1
11	Kral (2018)	1	0	1	1	1	1	1	1	1	voxel wise	unclear	unclear
12	Nikolaidis (2014)	1	1	1	1	1	1	1	1	0	voxel wise	unclear	unclear
13	Martinez (2013)	1	1	1	0	0	1	1	1	1	voxel wise	1	1

.

4. Discussion

4.1. Effects of Strategy Video Games on Brain Cognitive Function

Strategy video games mainly improve people’s cognitive processing function, executive function, and memory ability. These functions are related to structural changes in the hippocampus and the prefrontal lobe [20,30]. Since strategy video games are not a single format, participants react differently when playing the same genre. As a result, the brain areas involved in logical reasoning and memory are continually receiving new stimuli, and the structure of these areas changes accordingly, leading to functional improvement. Lee et al. (2012) [28] adopted a strategy-based video game to investigate the changes in brain function, using fMRI to scan the brain function before and after the experiment. They found that after training, the strategic subjects in video games caused activation in brain areas, especially the prefrontal cortex, leading to apparent performance improvement. This confirmed the effect of different types of strategy games on brain plasticity. These results implied that video games can act as a useful tool to improve cognitive ability in older adults. Kim et al. (2015) [21] found that strategy gamers may have stronger connections between visual and frontal regions. Additionally, Wang et al. (2017) [20] used a flanking task to investigate executive function in the elderly and found that older VGPs present significantly better behavioral performance than NVGPs. Changes in brain regions in older VGP were more apparent than in NVGP. The related brain region was mainly in frontal-parietal areas, including the right dorsolateral prefrontal cortex, the left supramarginal gyrus, the right angular gyrus, the right precuneus, and the left paracentral lobule.

4.2. Effects of Action Video Games on Cognitive Function of the Brain

Action video games mainly improve visual attention and muscle coordination. Brain regions responsible for these functions include the anterior central gyrus, anterior cingulate gyrus, superior parietal cortex, and cerebellum. However, action video games only involve hand-eye coordination and are often repetitive. As a result, after a long time of training, the brain may respond less to video games and use fewer resources to improve the machining efficiency. Finally, the brain areas are likely to show a local enhancement overall.

Richlan et al. (2018) [18] found that compared with NVGP, the left middle paracingulate cortex, the left superior sulcus, and the opercular part of the left inferior gyrus were observed in the firing VGPs during letter detection. This is because more neurons are needed to be mobilized to participate in this task in VGP to supplement the task brain region’s function and cause the phenomenon of brain region reorganization. Although the study could not confirm the visuospatial advantage of action video game participants, it did demonstrate differences in brain activation patterns between VGP and NVGP during language cognitive tasks. In terms of visual-spatial tasks, only the left extra cortex gyrus was enhanced, which proved that action games had a significant effect on attention and executive function. Gorbet et al. (2018) [19] performed a visual action task on female VGPs in action games. They found that the Cuneus, Middle Occipital Gyrus, and Cerebellum were more active compared with female NVGP players. There was a decrease in inactivation related to the time of training, which may be associated with higher neural efficiency.

Bavelier et al. (2015) [23] also observed decreased activation of brain regions in selective attention of game players, mainly reflected by decreased activation level of frontal and parietal lobes. This was because VGP can allocate attention resources more flexibly. It is worth noting that research has shown that distinct insular subregions are associated with particular neural networks (e.g., Attentional and Sensorimotor networks). Subsequently, Gong et al. (2015) [22] found that functional connectivity between anterior and posterior insular subregions, and central insular sulcus and functional integration between the attentional and sensorimotor networks, was increased. Thus, VGP may enhance the functional integration of insular subregions and the pertinent networks therein. A recent intervention study found that observed behavioral changes might rely on functional changes affecting posterior thalamic structures and their connections with the left parahippocampal gyrus, further confirming the pivotal role—and capacity for fast adaptation in response to training—played by these regions in spatial navigation, orientation, and environment recognition processes [22].

4.3. Effects of Comprehensive Video Games on Brain Cognitive Function

Comprehensive video games include a variety of factors, including strategy, action, and so on, and who is also a director of video game development. The effect of comprehensive video games on the brain is not on a single brain region but is often reflected in multiple brain regions’ joint action. Integrated video games are most likely to produce structural changes in the brain and to show functional changes in the brain. Since integrated video games have the broadest impact on brain plasticity, brain regions’ recombination may be observed in multiple brain regions. Martinez et al. (2013) [28] used fMRI to observe the influence of video games on functional brain networks and found that the temporal lobes, parietal lobes, and prefrontal lobes of the experimental group trained by video games had the most noticeable changes, while other brain functional network areas also showed different degrees of reorganization. This study provides evidence for the reorganization of brain function by video games and contributes to the network’s study that video games affect brain function. Additionally, Gong et al. (2019) [1] found that strategy games enhanced the local functional connectivity in the central executive and default-mode brain regions, which may be related to the high-level strategy and action of the game.

4.4. Effects of Specific Video Games on Brain Cognitive Function

Through personalized and customized games, cognitive function can be improved in a targeted way. Nikolaidis et al. (2014) [27] showed that the functional activation of the superior parietal lobe in the brain area was related to working memory changes after training. Later, behavioral performance improved significantly on the untrained working memory task, which indicated that the plasticity of the parietal lobe induced by complex video game training could help to improve the working memory task skills. The effect depended on the transfer effect of video games. Kral et al. (2018) [26] found that empathy video games can enhance the brain circuits related to empathy and strengthen their functional connections.

5. Conclusions

This study suggests that video games have potential benefits on cognitive function. Different video games have different effects on cognitive function, especially in attention ability and visuospatial ability. The functional brain activation changes in prefrontal, frontal, and parietal lobes induced by games were demonstrated. In future research, different types of video games should be distinguished, and the effects of different types of video training on brain function should be studied separately.