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Does Video Gaming Have Impacts on the Brain: Evidence from a Systematic Review

Denilson brilliant t..

1 Department of Biomedicine, Indonesia International Institute for Life Sciences (i3L), East Jakarta 13210, Indonesia

2 Smart Ageing Research Center (SARC), Tohoku University, Sendai 980-8575, Japan; pj.ca.ukohot@iur (R.N.); pj.ca.ukohot@atuyr (R.K.)

3 Department of Cognitive Health Science, Institute of Development, Aging and Cancer (IDAC), Tohoku University, Sendai 980-8575, Japan

Ryuta Kawashima

4 Department of Functional Brain Imaging, Institute of Development, Aging and Cancer (IDAC), Tohoku University, Sendai 980-8575, Japan

Video gaming, the experience of playing electronic games, has shown several benefits for human health. Recently, numerous video gaming studies showed beneficial effects on cognition and the brain. A systematic review of video gaming has been published. However, the previous systematic review has several differences to this systematic review. This systematic review evaluates the beneficial effects of video gaming on neuroplasticity specifically on intervention studies. Literature research was conducted from randomized controlled trials in PubMed and Google Scholar published after 2000. A systematic review was written instead of a meta-analytic review because of variations among participants, video games, and outcomes. Nine scientific articles were eligible for the review. Overall, the eligible articles showed fair quality according to Delphi Criteria. Video gaming affects the brain structure and function depending on how the game is played. The game genres examined were 3D adventure, first-person shooting (FPS), puzzle, rhythm dance, and strategy. The total training durations were 16–90 h. Results of this systematic review demonstrated that video gaming can be beneficial to the brain. However, the beneficial effects vary among video game types.

1. Introduction

Video gaming refers to the experience of playing electronic games, which vary from action to passive games, presenting a player with physical and mental challenges. The motivation to play video games might derive from the experience of autonomy or competing with others, which can explain why video gaming is pleasurable and addictive [ 1 ].

Video games can act as “teachers” depending on the game purpose [ 2 ]. Video gaming has varying effects depending on the game genre. For instance, an active video game can improve physical fitness [ 3 , 4 , 5 , 6 ], whereas social video games can improve social behavior [ 7 , 8 , 9 ]. The most interesting results show that playing video games can change cognition and the brain [ 10 , 11 , 12 , 13 ].

Earlier studies have demonstrated that playing video games can benefit cognition. Cross-sectional and longitudinal studies have demonstrated that the experience of video gaming is associated with better cognitive function, specifically in terms of visual attention and short-term memory [ 14 ], reaction time [ 15 ], and working memory [ 16 ]. Additionally, some randomized controlled studies show positive effects of video gaming interventions on cognition [ 17 , 18 ]. Recent meta-analytical studies have also supported the positive effects of video gaming on cognition [ 10 , 11 , 12 , 13 ]. These studies demonstrate that playing video games does provide cognitive benefits.

The effects of video gaming intervention are ever more widely discussed among scientists [ 13 ]. A review of the results and methodological quality of recently published intervention studies must be done. One systematic review of video gaming and neural correlates has been reported [ 19 ]. However, the technique of neuroimaging of the reviewed studies was not specific. This systematic review reviewed only magnetic resonance imaging (MRI) studies in contrast to the previous systematic review to focus on neuroplasticity effect. Neuroplasticity is capability of the brain that accommodates adaptation for learning, memorizing, and recovery purposes [ 19 ]. In normal adaptation, the brain is adapting to learn, remember, forget, and repair itself. Recent studies using MRI for brain imaging techniques have demonstrated neuroplasticity effects after an intervention, which include cognitive, exercise, and music training on the grey matter [ 20 , 21 , 22 , 23 , 24 ] and white matter [ 25 , 26 , 27 , 28 , 29 ]. However, the molecular mechanisms of the grey and white matter change remain inconclusive. The proposed mechanisms for the grey matter change are neurogenesis, gliogenesis, synaptogenesis, and angiogenesis, whereas those for white matter change are myelin modeling and formation, fiber organization, and angiogenesis [ 30 ]. Recent studies using MRI technique for brain imaging have demonstrated video gaming effects on neuroplasticity. Earlier imaging studies using cross-sectional and longitudinal methods have shown that playing video games affects the brain structure by changing the grey matter [ 31 , 32 , 33 ], white matter [ 34 , 35 ], and functional connectivity [ 36 , 37 , 38 , 39 ]. Additionally, a few intervention studies have demonstrated that playing video games changed brain structure and functions [ 40 , 41 , 42 , 43 ].

The earlier review also found a link between neural correlates of video gaming and cognitive function [ 19 ]. However, that review used both experimental and correlational studies and included non-healthy participants, which contrasts to this review. The differences between this and the previous review are presented in Table 1 . This review assesses only experimental studies conducted of healthy participants. Additionally, the cross-sectional and longitudinal studies merely showed an association between video gaming experiences and the brain, showing direct effects of playing video games in the brain is difficult. Therefore, this systematic review specifically examined intervention studies. This review is more specific as it reviews intervention and MRI studies on healthy participants. The purposes of this systematic review are therefore to evaluate the beneficial effects of video gaming and to assess the methodological quality of recent video gaming intervention studies.

Differences between previous review and current review.

CT, computed tomography; fMRI, functional magnetic resonance imaging; MEG, magnetoencephalography MRI, magnetic resonance imaging; PET, positron emission tomography; SPECT, single photon emission computed tomography; tDCS, transcranial direct current stimulation; EEG, electroencephalography; NIRS, near-infrared spectroscopy.

2. Materials and Methods

2.1. search strategy.

This systematic review was designed in accordance with the PRISMA checklist [ 44 ] shown in Appendix Table A1 . A literature search was conducted using PubMed and Google Scholar to identify relevant studies. The keywords used for the literature search were combinations of “video game”, “video gaming”, “game”, “action video game”, “video game training”, “training”, “play”, “playing”, “MRI”, “cognitive”, “cognition”, “executive function”, and “randomized control trial”.

2.2. Inclusion and Exclusion Criteria

The primary inclusion criteria were randomized controlled trial study, video game interaction, and MRI/fMRI analysis. Studies that qualified with only one or two primary inclusions were not included. Review papers and experimental protocols were also not included. The secondary inclusion criteria were publishing after 2000 and published in English. Excluded were duration of less than 4 weeks or unspecified length intervention or combination intervention. Also excluded were studies of cognition-based games, and studies of participants with psychiatric, cognitive, neurological, and medical disorders.

2.3. Quality Assessment

Each of the quality studies was assessed using Delphi criteria [ 45 ] with several additional elements [ 46 ]: details of allocation methods, adequate descriptions of control and training groups, statistical comparisons between control and training groups, and dropout reports. The respective total scores (max = 12) are shown in Table 3. The quality assessment also includes assessment for risk of bias, which is shown in criteria numbers 1, 2, 5, 6, 7, 9, and 12.

2.4. Statistical Analysis

Instead of a meta-analysis study, a systematic review of the video game training/video gaming and the effects was conducted because of the variation in ranges of participant age, video game genre, control type, MRI and statistical analysis, and training outcomes. Therefore, the quality, inclusion and exclusion, control, treatment, game title, participants, training period, and MRI analysis and specification of the studies were recorded for the respective games.

The literature search made of the databases yielded 140 scientific articles. All scientific articles were screened based on inclusion and exclusion criteria. Of those 140 scientific articles, nine were eligible for the review [ 40 , 41 , 42 , 43 , 47 , 48 , 49 , 50 , 51 ]. Video gaming effects are listed in Table 2 .

Summary of beneficial effect of video gaming.

Duration was converted into weeks (1 month = 4 weeks); DLPFC, dorsolateral prefrontal cortex; GM, grey matter; FPS, first person shooting. * Participants were categorized based on how they played during the video gaming intervention.

We excluded 121 articles: 46 were not MRI studies, 16 were not controlled studies, 38 were not intervention studies, 13 were review articles, and eight were miscellaneous, including study protocols, non-video gaming studies, and non-brain studies. Of 18 included scientific articles, nine were excluded. Of those nine excluded articles, two were cognitive-based game studies, three were shorter than 4 weeks in duration or were without a specified length intervention, two studies used a non-healthy participant treatment, and one was a combination intervention study. A screening flowchart is portrayed in Figure 1 .

Flowchart of literature search.

3.1. Quality Assessment

The assessment methodology based on Delphi criteria [ 45 ] for the quality of eligible studies is presented in Table 3 . The quality scores assigned to the studies were 3–9 (mean = 6.10; S.D. = 1.69). Overall, the studies showed fair methodological quality according to the Delphi criteria. The highest quality score of the nine eligible articles was assigned to “Playing Super Mario 64 increases hippocampal grey matter in older adult” published by West et al. in 2017, which scored 9 of 12. The scores assigned for criteria 6 (blinded care provider) and 7 (blinded patient) were lowest because of unspecified information related to blinding for those criteria. Additionally, criteria 2 (concealed allocation) and 5 (blinding assessor) were low because only two articles specified that information. All articles met criteria 3 and 4 adequately.

Methodological quality of eligible studies.

Q1, Random allocation; Q2, Concealed allocation; Q3, Similar baselines among groups; Q4, Eligibility specified; Q5, Blinded assessor outcome; Q6, Blinded care provider; Q7, Blinded patient; Q8, Intention-to-treat analysis; Q9, Detail of allocation method; Q10, Adequate description of each group; Q11, Statistical comparison between groups; Q12, Dropout report (1, specified; 0, unspecified).

3.2. Inclusion and Exclusion

Most studies included participants with little or no experience with gaming and excluded participants with psychiatric/mental, neurological, and medical illness. Four studies specified handedness of the participants and excluded participants with game training experience. The inclusion and exclusion criteria are presented in Table 4 .

Inclusion and exclusion criteria for eligible studies.

i1, Little/no experience in video gaming; i2, Right-handed; i3, Sex-specific; e1, Psychiatric/mental illness; e2, Neurological illness; e3, Medical illness; e4, MRI contraindication; e5, experience in game training.

3.3. Control Group

Nine eligible studies were categorized as three types based on the control type. Two studies used active control, five studies used passive control, and two studies used both active and passive control. A summary of the control group is presented in Table 5 .

Control group examined eligible studies.

3.4. Game Title and Genre

Of the nine eligible studies, four used the same 3D adventure game with different game platforms, which were “Super Mario 64” original and the DS version. One study used first-person shooting (FPS) shooting games with many different game titles: “Call of Duty” is one title. Two studies used puzzle games: “Tetris” and “Professor Layton and The Pandora’s Box.” One study used a rhythm dance game: Dance Revolution. One study used a strategy game: “Space Fortress.” Game genres are presented in Table 6 .

Genres and game titles of video gaming intervention.

* West et al. used multiple games; other games are Call of Duty 2, 3, Black Ops, and World at War, Killzone 2 and 3, Battlefield 2, 3, and 4, Resistance 2 and Fall of Man, and Medal of Honor.

3.5. Participants and Sample Size

Among the nine studies, one study examined teenage participants, six studies included young adult participants, and two studies assessed older adult participants. Participant information is shown in Table 7 . Numbers of participants were 20–75 participants (mean = 43.67; S.D. = 15.63). Three studies examined female-only participants, whereas six others used male and female participants. Six studies with female and male participants had more female than male participants.

Participant details of eligible studies.

3.6. Training Period and Intensity

The training period was 4–24 weeks (mean = 11.49; S.D. = 6.88). One study by Lee et al. had two length periods and total hours because the study examined video game training of two types. The total training hours were 16–90 h (mean = 40.63; S.D. = 26.22), whereas the training intensity was 1.5–10.68 h/week (mean = 4.96; S.D. = 3.00). One study did not specify total training hours. Two studies did not specify the training intensity. The training periods and intensities are in Table 8 .

Periods and intensities of video gaming intervention.

The training length was converted into weeks (1 month = 4 weeks). ns, not specified; n/a, not available; * exact length is not available.

3.7. MRI Analysis and Specifications

Of nine eligible studies, one study used resting-state MRI analysis, three studies (excluding that by Haier et al. [ 40 ]) used structural MRI analysis, and five studies used task-based MRI analysis. A study by Haier et al. used MRI analyses of two types [ 40 ]. A summary of MRI analyses is presented in Table 9 . The related resting-state, structural, and task-based MRI specifications are presented in Table 10 , Table 11 and Table 12 respectively.

MRI analysis details of eligible studies.

* Haier et al. conducted structural and task analyses. + Compared pre-training and post-training between groups without using contrast. TFCE, Threshold Free Cluster Enhancement; FEW, familywise error rate; FDR, false discovery rate.

Resting-State MRI specifications of eligible studies.

Structural MRI specifications of eligible studies.

Task-Based MRI specifications of eligible studies.

All analyses used 3 Tesla magnetic force; TR = repetition time; TE = echo time, ns = not specified.

4. Discussion

This literature review evaluated the effect of noncognitive-based video game intervention on the cognitive function of healthy people. Comparison of studies is difficult because of the heterogeneities of participant ages, beneficial effects, and durations. Comparisons are limited to studies sharing factors.

4.1. Participant Age

Video gaming intervention affects all age categories except for the children category. The exception derives from a lack of intervention studies using children as participants. The underlying reason for this exception is that the brain is still developing until age 10–12 [ 52 , 53 ]. Among the eligible studies were a study investigating adolescents [ 40 ], six studies investigating young adults [ 41 , 42 , 43 , 47 , 49 , 51 ] and two studies investigating older adults [ 48 , 50 ].

Differences among study purposes underlie the differences in participant age categories. The study by Haier et al. was intended to study adolescents because the category shows the most potential brain changes. The human brain is more sensitive to synaptic reorganization during the adolescent period [ 54 ]. Generally, grey matter decreases whereas white matter increases during the adolescent period [ 55 , 56 ]. By contrast, the cortical surface of the brain increases despite reduction of grey matter [ 55 , 57 ]. Six studies were investigating young adults with the intention of studying brain changes after the brain reaches maturity. The human brain reaches maturity during the young adult period [ 58 ]. Two studies were investigating older adults with the intention of combating difficulties caused by aging. The human brain shrinks as age increases [ 56 , 59 ], which almost invariably leads to declining cognitive function [ 59 , 60 ].

4.2. Beneficial Effects

Three beneficial outcomes were observed using MRI method: grey matter change [ 40 , 42 , 50 ], brain activity change [ 40 , 43 , 47 , 48 , 49 ], and functional connectivity change [ 41 ]. The affected brain area corresponds to how the respective games were played.

Four studies of 3D video gaming showed effects on the structure of hippocampus, dorsolateral prefrontal cortex (DLPFC), cerebellum [ 42 , 43 , 50 ], and DLPFC [ 43 ] and ventral striatum activity [ 49 ]. In this case, the hippocampus is used for memory [ 61 ] and scene recognition [ 62 ], whereas the DLPFC and cerebellum are used for working memory function for information manipulation and problem-solving processes [ 63 ]. The grey matter of the corresponding brain region has been shown to increase during training [ 20 , 64 ]. The increased grey matter of the hippocampus, DLPFC, and cerebellum are associated with better performance in reference and working memory [ 64 , 65 ].

The reduced activity of DLPFC found in the study by Gleich et al. corresponds to studies that showed reduced brain activity associated with brain training [ 66 , 67 , 68 , 69 ]. Decreased activity of the DLPFC after training is associated with efficiency in divergent thinking [ 70 ]. 3D video gaming also preserved reward systems by protecting the activity of the ventral striatum [ 71 ].

Two studies of puzzle gaming showed effects on the structure of the visual–spatial processing area, activity of the frontal area, and functional connectivity change. The increased grey matter of the visual–spatial area and decreased activity of the frontal area are similar to training-associated grey matter increase [ 20 , 64 ] and activity decrease [ 66 , 67 , 68 , 69 ]. In this case, visual–spatial processing and frontal area are used constantly for spatial prediction and problem-solving of Tetris. Functional connectivity of the multimodal integration and the higher-order executive system in the puzzle solving-based gaming of Professor Layton game corresponds to studies which demonstrated training-associated functional connectivity change [ 72 , 73 ]. Good functional connectivity implies better performance [ 73 ].

Strategy gaming affects the DLPFC activity, whereas rhythm gaming affects the activity of visuospatial working memory, emotional, and attention area. FPS gaming affects the structure of the hippocampus and amygdala. Decreased DLPFC activity is similar to training-associated activity decrease [ 66 , 67 , 68 , 69 ]. A study by Roush demonstrated increased activity of visuospatial working memory, emotion, and attention area, which might occur because of exercise and gaming in the Dance Revolution game. Results suggest that positive activations indicate altered functional areas by complex exercise [ 48 ]. The increased grey matter of the hippocampus and amygdala are similar to the training-associated grey matter increase [ 20 , 64 ]. The hippocampus is used for 3D navigation purposes in the FPS world [ 61 ], whereas the amygdala is used to stay alert during gaming [ 74 ].

4.3. Duration

Change of the brain structure and function was observed after 16 h of video gaming. The total durations of video gaming were 16–90 h. However, the gaming intensity must be noted because the gaming intensity varied: 1.5–10.68 h per week. The different intensities might affect the change of cognitive function. Cognitive intervention studies demonstrated intensity effects on the cortical thickness of the brain [ 75 , 76 ]. A similar effect might be observed in video gaming studies. More studies must be conducted to resolve how the intensity can be expected to affect cognitive function.

4.4. Criteria

Almost all studies used inclusion criteria “little/no experience with video games.” The criterion was used to reduce the factor of gaming-related experience on the effects of video gaming. Some of the studies also used specific handedness and specific sex of participants to reduce the variation of brain effects. Expertise and sex are shown to affect brain activity and structure [ 77 , 78 , 79 , 80 ]. The exclusion criterion of “MRI contraindication” is used for participant safety for the MRI protocol, whereas exclusion criteria of “psychiatric/mental illness”, “neurological illness”, and “medical illness” are used to standardize the participants.

4.5. Limitations and Recommendations

Some concern might be raised about the quality of methodology, assessed using Delphi criteria [ 45 ]. The quality was 3–9 (mean = 6.10; S.D. = 1.69). Low quality in most papers resulted from unspecified information corresponding to the criteria. Quality improvements for the studies must be performed related to the low quality of methodology. Allocation concealment, assessor blinding, care provider blinding, participant blinding, intention-to-treat analysis, and allocation method details must be improved in future studies.

Another concern is blinding and control. This type of study differs from medical studies in which patients can be blinded easily. In studies of these types, the participants were tasked to do either training as an active control group or to do nothing as a passive control group. The participants can expect something from the task. The expectation might affect the outcomes of the studies [ 81 , 82 , 83 ]. Additionally, the waiting-list control group might overestimate the outcome of training [ 84 ].

Considering the sample size, which was 20–75 (mean = 43.67; S.D. = 15.63), the studies must be upscaled to emphasize video gaming effects. There are four phases of clinical trials that start from the early stage and small-scale phase 1 to late stage and large-scale phase 3 and end in post-marketing observation phase 4. These four phases are used for drug clinical trials, according to the food and drug administration (FDA) [ 85 ]. Phase 1 has the purpose of revealing the safety of treatment with around 20–100 participants. Phase 2 has the purpose of elucidating the efficacy of the treatment with up to several hundred participants. Phase 3 has the purpose of revealing both efficacy and safety among 300–3000 participants. The final phase 4 has the purpose of finding unprecedented adverse effects of treatment after marketing. However, because medical studies and video gaming intervention studies differ in terms of experimental methods, slight modifications can be done for adaptation to video gaming studies.

Several unresolved issues persist in relation to video gaming intervention. First, no studies assessed chronic/long-term video gaming. The participants might lose their motivation to play the same game over a long time, which might affect the study outcomes [ 86 ]. Second, meta-analyses could not be done because the game genres are heterogeneous. To ensure homogeneity of the study, stricter criteria must be set. However, this step would engender a third limitation. Third, randomized controlled trial video gaming studies that use MRI analysis are few. More studies must be conducted to assess the effects of video gaming. Fourth, the eligible studies lacked cognitive tests to validate the cognitive change effects for training. Studies of video gaming intervention should also include a cognitive test to ascertain the relation between cognitive function and brain change.

5. Conclusions

The systematic review has several conclusions related to beneficial effects of noncognitive-based video games. First, noncognitive-based video gaming can be used in all age categories as a means to improve the brain. However, effects on children remain unclear. Second, noncognitive-based video gaming affects both structural and functional aspects of the brain. Third, video gaming effects were observed after a minimum of 16 h of training. Fourth, some methodology criteria must be improved for better methodological quality. In conclusion, acute video gaming of a minimum of 16 h is beneficial for brain function and structure. However, video gaming effects on the brain area vary depending on the video game type.

Acknowledgments

We would like to thank all our other colleagues in IDAC, Tohoku University for their support.

PRISMA Checklist of the literature review.

For more information, visit: www.prisma-statement.org .

Author Contributions

D.B.T., R.N., and R.K. designed the systematic review. D.B.T. and R.N. searched and selected the papers. D.B.T. and R.N. wrote the manuscript with R.K. All authors read and approved the final manuscript. D.B.T. and R.N. contributed equally to this work.

Study is supported by JSPS KAKENHI Grant Number 17H06046 (Grant-in-Aid for Scientific Research on Innovative Areas) and 16KT0002 (Grant-in-Aid for Scientific Research (B)).

Conflicts of Interest

None of the other authors has any conflict of interest to declare. Funding sources are not involved in the study design, collection, analysis, interpretation of data, or writing of the study report.

The Cognition-Impairing Effect of Video Games in Adolescents

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The playing brain. the impact of video games on cognition and behavior in pediatric age at the time of lockdown: a systematic review.

1. Introduction

3.1. effect of video games on cognitive functions, 3.2. video games effect on attention and addictive behaviors, 3.3. video games effect and prosocial and aggressive behaviors, 4. discussion, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Smirni, D.; Garufo, E.; Di Falco, L.; Lavanco, G. The Playing Brain. The Impact of Video Games on Cognition and Behavior in Pediatric Age at the Time of Lockdown: A Systematic Review. Pediatr. Rep. 2021 , 13 , 401-415. https://doi.org/10.3390/pediatric13030047

Smirni D, Garufo E, Di Falco L, Lavanco G. The Playing Brain. The Impact of Video Games on Cognition and Behavior in Pediatric Age at the Time of Lockdown: A Systematic Review. Pediatric Reports . 2021; 13(3):401-415. https://doi.org/10.3390/pediatric13030047

Smirni, Daniela, Elide Garufo, Luca Di Falco, and Gioacchino Lavanco. 2021. "The Playing Brain. The Impact of Video Games on Cognition and Behavior in Pediatric Age at the Time of Lockdown: A Systematic Review" Pediatric Reports 13, no. 3: 401-415. https://doi.org/10.3390/pediatric13030047

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