(Candy) Crushing Dementia? Exploring Cognitive Training as Strategy for Cognitive Health

Abstract

Dementia is an umbrella term for symptoms that are caused by underlying brain disorders that impair everyday functioning, including memory, thinking, and social abilities. Dementia can arise from a combination of genetic, biological, environmental, and lifestyle factors and is most commonly associated with Alzheimer’s disease (AD). Although available treatments may help manage symptoms and improve quality of life, there is currently no cure for most forms of dementia. As the number of dementia cases increases, understanding not only its causes and treatments but also strategies that may reduce disease risk has become increasingly important. In particular, preventative measures may help reduce the risk of developing the disorder. In this manuscript, I discuss current advances in dementia prevention, with a particular focus on cognitive stimulation and its potential role in promoting cognitive resilience, while offering my perspective on how these approaches could contribute to future prevention strategies. This narrative review evaluates evidence linking cognitive stimulation and structured cognitive training to cognitive resilience and considers whether accessible games could be studied as tools for supporting brain health.

Keywords: Dementia, Alzheimer’s Disease, Preventative Care, Treatment, Cognitive Resilience

Introduction

When I was younger, I did not fully understand what Alzheimer’s disease (AD) truly was. I only knew that my grandmother, Vilma, was gradually changing. She had grown up in Italy and spoke limited English. Although she could still remember episodic memories from her childhood with her two sisters back in Italy and with her husband, my grandfather, she increasingly struggled to remember recent events and routine experiences. At first, the symptoms appeared subtle. She would misplace familiar household items (like putting her undergarments in the freezer), and my family dismissed these episodes as a normal part of the aging process. One day, however, my father and I found her walking alongside the road carrying Stop & Shop plastic bags full of her clothes because she believed she was traveling back to Italy. It was at that moment that I recognized something much more serious than normal aging was occurring.

My grandmother lived with AD for more than a decade. At the time of her diagnosis, my grandmother was in her early-seventies, placing her in the age group at the highest risk for developing AD. Although advanced age is the greatest known risk factor, genetics and family history also play an important role in an individual’s susceptibility (Tenchov et al., 2024). Then I learned that several of my grandmother’s relatives had also been diagnosed with Alzheimer’s disease, showing a possible inherited predisposition. While she was never genetically tested, both her age and family history likely contributed to her risk of developing the disease.

AD is by far the most common cause of dementia, representing about 60-80% of all dementia cases. In the United States alone, an estimated 7.4 million adults in 2026 currently living with Alzheimer’s dementia (Eugene et al., 2026). As life expectancy continues to increase around the world, the number of people living with dementia is expected to rise dramatically, making it one of the greatest public health challenges of the twenty-first century. While researchers have made significant progress in understanding the biological mechanisms responsible for dementia, developing treatments capable of stopping the disease has remained an ongoing challenge.

As the disease progressed, her cognitive function continued to deteriorate, as is usually characterized (Tenchov et al., 2024). She gradually lost her memory and eventually became unable to ambulate independently, dress herself, feed herself, or communicate effectively. Her speech became limited to mumbled words and the occasional repetition of familiar names (my name was one of the main ones she would repeat). As her functional decline became more severe, my mother and aunt could no longer provide the level of care she required, leading to her admission into a long-term care facility where she received around-the-clock supervision and support. During the later stages of the disease, she was prescribed Donepezil (Winblad, 2009), an acetylcholinesterase inhibitor commonly used to improve cognitive function and slow symptom progression temporarily (Dooley & Lamb, 2000). Although the medication modestly delayed aspects of her cognitive decline, it could not stop or reverse the underlying neurodegenerative process responsible for AD. More recently, the anti-amyloid antibodies lecanemab (Li et al., 2026) and donanemab (Sims et al., 2023) were approved for selected patients with early Alzheimer’s disease. These treatments can modestly slow clinical decline but do not cure the disease and carry important risks, including brain swelling and bleeding.

To better understand AD, it is important to understand the areas of the brain responsible for the formation of memory. The brain consists of four major lobes (frontal, temporal, parietal, occipital). Within the temporal lobe lies the hippocampus, a structure essential for learning, memory formation, and spatial navigation (Lee, 2023). The hippocampus works closely with the limbic system, which helps control emotions, motivation, and the formation of long-term memories. As AD progresses, neurons within these regions gradually become damaged and die, causing the hippocampus to shrink over time (Rao et al., 2022). This loss of brain tissue contributes to the progressive decline in memory, learning, and other cognitive abilities experienced by patients with dementia (Fogwe et al., 2026). Understanding how these structures change throughout the disease has become a major focus of modern neuroscience and has provided researchers with valuable insight with respect to potential treatment methods (Simpson et al., 2021).

Modern medicine has transformed the treatment of countless diseases through advances in pharmaceuticals, biotechnology, and medical research. In spite of these breakthroughs, AD remains one of the few major neurodegenerative disorders for which there is still no cure. Current medications for Alzheimer’s disease include donepezil (Buck et al., 2024), rivastigmine (Gao et al., 2024), and galantamine (Gao et al., 2024), targeting the cholinergic deficits characteristic of Alzheimer’s disease by inhibiting acetylcholinesterase and increasing the availability of acetylcholine in the brain (Saud et al., 2024). These may briefly improve symptoms or slow cognitive decline, but they cannot prevent the disease from progressing.

Watching my grandmother’s decline and seeing its effects on my family motivated me to ask whether cognitive decline might be delayed before symptoms become severe.

Preventative care

Preventative care is the use of proactive healthcare strategies to lower the likelihood of disease, identify health conditions before symptoms become severe, and reduce the long-term effects of chronic illnesses through methods that promote overall health and well-being (Hensrud, 2000). Preventative care strategies for Alzheimer’s disease include regular cognitive stimulation, physical exercise, proper sleep, and a balanced diet, all of which have been associated with improved brain health and a reduced risk of cognitive decline (Livingston et al., 2024). Among these strategies, cognitive stimulation has emerged as one of the leading promising areas of research (Woods et al., 2023).

Cognitive Training

Cognitive stimulation broadly includes activities that engage memory, attention, language, or reasoning. Cognitive training is more specific: it involves structured, repeated practice designed to improve particular cognitive skills. Reading, writing, puzzles, and games may be mentally stimulating, but they should not automatically be considered validated cognitive-training interventions (Gates et al., 2019). This may include reading, writing, learning a new language, solving puzzles, or even something as simple as playing a cell phone game. By actively using your brain, these activities strengthen the connections between neurons and keep different areas of the brain engaged (Jahan et al., 2026). This is called neuroplasticity (Margetis & Vadakekut, 2026).

To understand neuroplasticity, think of your phone updating. Your phone requires updates every so often to keep up with new improvements and improve your experience while using it. Neuroplasticity works similarly. When your brain learns something new, it creates and strengthens connections to store that information. It allows you to learn new skills and accommodate new situations. In a way, you’re working out your brain. Just as lifting weights strengthens muscles, repeatedly challenging your brain strengthens the pathways between neurons, allowing it to compensate for damage longer before symptoms begin to appear. This introduces another important concept called cognitive reserve.

Cognitive reserve refers to the brain’s skill to adapt, improvise, and find alternative ways to function despite physical damage or age-related changes. You can think of it as mental padding. Individuals with a higher cognitive reserve can withstand more disease-related damage before showing noticeable symptoms of cognitive decline. Although cognitive reserve cannot stop aging or cure AD, it may significantly delay the onset of symptoms, allowing people to maintain their memory, independence, and quality of life for a longer period.

To improve neuroplasticity and cognitive reserve, researchers have shown that reading is one of the most accessible ways (Liu et al., 2024; Perdue et al., 2022; Simfukwe et al., 2025). These studies show that, as you read, your brain is constantly interpreting the words your eyes are following while also connecting them to language, comprehension, attention, and memory (Landi et al., 2013). Instead of relying on just one area of the brain, reading activates several regions at the same time, strengthening communication between neurons; because of this, reading acts as a full workout for the brain rather than exercising only one cognitive skill (Turker et al., 2025). Over time, these repeated mental challenges may help build cognitive reserve and make the brain more resistant to age-related decline.

Writing is another way to activate the brain (Hajikarim-Hamedani et al., 2025). Although it uses many of the same thinking skills as reading, writing requires even more active participation (Tindle & Longstaff, 2015). It forces the brain to arrange thoughts, retrieve memories, choose language, and communicate ideas in a meaningful way. Even something as simple as keeping a journal or writing about your day before bed encourages the brain to recall experiences and put them into words. Rather than allowing memories to pass by, writing requires you to actively process them, giving your brain another opportunity to strengthen its pathways.

The previous two activities may sound like a bore to many, so how about something enjoyable? It has been shown that phone games that involve puzzles and reasoning can also stimulate the brain (Urwyler et al., 2023).

Commercial games such as Candy Crush and Block Blast require visual attention, pattern recognition, planning, and rapid decision-making. However, practicing these games may primarily improve performance on the games themselves. There is currently insufficient evidence that either game improves everyday cognition or reduces dementia risk. Their accessibility and popularity nevertheless make them interesting candidates for controlled research.

Growing research surrounding cognitive training suggests that keeping the brain active throughout life may delay when symptoms begin to appear (Coe et al., 2026). However, cognitive training focuses on strengthening the brain before significant damage develops. This shift from treating dementia to preventing or delaying it has become one of the most encouraging fields of Alzheimer’s research. While scientists continue searching for a cure, something as simple as picking up a book, writing in a journal, or solving a puzzle may help protect the memories that make us who we are.

Limitations

Although research on cognitive training and dementia prevention has produced encouraging results, several limitations still exist. One of the greatest challenges is that AD develops very slowly. Amyloid-beta plaques and tau tangles can begin accumulating in the brain decades before any symptoms appear (Gordon et al., 2018). Because of this, researchers often need to follow participants for many years before determining whether a potential risk-reduction strategytruly reduces the risk of developing dementia. Long-term studies are expensive, time-consuming, and difficult to complete, causing it to be difficult to gather conclusive evidence.

Another limitation is that dementia does not develop the same way in every individual. Genetics, age, cardiovascular health, education level, lifestyle, and environmental elements all influence a person’s risk. Certain individuals may have large amounts of amyloid-beta plaques and tau tangles yet never develop noticeable symptoms because of a high cognitive reserve. In contrast, others experience cognitive decline with much less brain damage. In addition, Alzheimer’s disease is only one cause of dementia. Other conditions, such as vascular dementia, Lewy body dementia, and frontotemporal dementia, involve different biological mechanisms, meaning that a potential risk-reduction strategy effective for one type may not be equally effective for another.

An important limitation is the problem of transfer. A person may improve on a practiced puzzle or game without showing improvement in untrained abilities, everyday functioning, or dementia risk. Observational studies also cannot fully exclude confounding: people who read, write, or solve puzzles regularly may differ in education, health, income, and social engagement from people who do not.

Finally, it is impossible to predict with certainty who will eventually develop dementia. As a result, preventative strategies such as cognitive training, exercise, and healthy lifestyle habits would need to be practiced by everyone rather than only those considered high risk. Even then, keeping these habits over an entire lifetime can be difficult. Although the current evidence strongly suggests that keeping the brain mentally active is beneficial, additional long-term research is needed to determine which activities provide the greatest protection, how often they should be performed, and how to incorporate them into everyday life.

Although researchers have made significant progress in understanding Alzheimer’s disease, there is still a long way to go before a cure is found.. Rather than relying on one medication to treat every patient, many researchers now believe that future treatment will involve a combination of therapies based on each person’s biology, genetics, and stage of the disease. In other words, Alzheimer’s treatment may become much increasingly personalized instead of using the same approach for everyone. While these advances are encouraging, they are still being studied in clinical trials. Until more effective treatments become available, prevention through healthy lifestyle habits and keeping the brain active will continue to be one of the best tools we have for decreasing the risk of dementia.

Conclusion

Watching my grandmother slowly lose the memories that made her who she was showed me that Alzheimer’s disease affects far more than memory itself alone. It changes a person’s independence, relationships, and identity while deeply affecting the families who care for them. My goal is to delay the progression as much as possible for myself and others who are worried they may develop this symptom.

Evidence supports lifelong cognitive engagement as one component of a broader brain-health strategy that also includes physical activity, cardiovascular risk management, sufficient sleep, education, and social connection. These behaviors may support cognitive resilience, but none can guarantee that dementia will be prevented.

Candy Crush should therefore be viewed as a testable example, not a proven intervention. Future randomized, long-term studies should compare accessible commercial games with established cognitive-training programs and determine whether any benefits transfer beyond gameplay to everyday cognition and dementia risk. Even familiar activities may inspire useful scientific questions, but those questions must be tested before conclusions are drawn.

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