A Northeastern game finds cognitive care does not fit one mold

A tiny astronaut named Lerner watches colored, glowing gems flash across a computer screen. Then the player steers him over a rocky alien landscape, reaches a platform and fires a pink laser at the gems in the exact order they appeared. Northeastern University researchers gave this bespoke video game to 50 participants across the United States to test working memory in older adults living with HIV.

The point was not entertainment. It was to see whether the same cognitive exercise works the same way for everyone. The Brain Game Center for Mental Fitness and Wellbeing designed the game as part of remotely administered tests examining how vulnerable groups respond to personalized interventions. Director Aaron Seitz said the research challenges the idea that one solution can serve every person with cognitive decline.

The results separated the HIV group from earlier findings in older adults without HIV. In the non-HIV group, people with lower inhibitory control—more difficulty focusing, showing self-control and ignoring distractions—tended to perform worse with the game and later preferred a non-gamified version using simple flashcards. Among older participants living with HIV, that relationship flipped: some people with lower inhibitory control still benefited from the game.

The researchers also found three distinct cognitive profiles among participants with HIV. People sharing the same broad HAND classification—HIV-associated neurocognitive disorders—could still show different combinations of strengths and difficulties in inhibitory control, working memory and general cognitive ability. HAND ranges from impairments that may go unnoticed in daily life to HIV-associated dementia, and affects working memory, processing speed, executive function or attention in about 30% to 50% of people living with HIV.

So what, concretely? A cognitive label may not tell clinicians which training format will help a particular person. A game could become one way to identify those differences and adapt an intervention, especially for older adults living with HIV, who may face more difficulty managing medication, following conversations or handling finances independently. The evidence here remains experimental: the study shows differing response patterns, not a validated treatment, and the researchers argue that more HIV-specific cognitive research is needed.