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The game of chess enhances cognitive abilities in schizophrenia



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Letter to the Editor
The game of chess enhances cognitive abilities
in schizophrenia
Dear Editors,
Chess is a classic board game that relies on simple rules
and complex cognitive strategies. At the same time, there is a
growing body of evidence demonstrating the efciency of
targeted and standardized cognitive interventions for restor-
ing altered cognitive functions in patients with schizophrenia
(McGurk et al., 2007; Demily and Franck, 2008). Originally, it
was tempting to investigate whether chess playing could help
restoring executive functions in patients with schizophrenia.
Twenty-six medicated clinically stable patients meeting
DSM-IV-TR criteria for schizophrenia (APA, 2000)were
enrolled in an open and unblinded study. Exclusion criteria
included evidence of mental retardation or superior cognitive
level, resistance to usual treatment, traumatic brain injury,
presence or history of neurologic or mental illnesses other
than schizophrenia. The assessment of intellectual efciency
(WAIS-III; Wechsler, 2000) showed a mean Total IQthat did
not differ from the normal range value. All patients with
schizophrenia involved in this study completed written
informed consent. They were randomly assigned to one of
two treatment groups: Game of Chess (GC); Treatment As
Usual (TAU). Seven patients of both groups were full-time
hospitalized, the others being in day hospital. Patients were
evaluated by trained physicians (author CD and CC), before
and after treatment on the basis of a comprehensive
neuropsychological test battery (Trail Making Test part A
and B, Wisconsin Card Sorting Test, Stroop and Tower of
London Test).
A randomized 2 groups pre/post-test design was used to
investigate the effect of our experimental factor (Chess factor:
GC Vs. TAU). The procedure lasted 5 weeks. During these
5 weeks, the TAU group did not receive any specic cognitive
rehabilitation (unspecic activities). The GC group practiced
chess 10 times (twice per week; 60 min per session, total
training: 10 h). For the GC group, the treatment began with a
short introduction during which the main rules of the game
were explained (position and displacement of each piece).
The patients started playing one against another under the
supervision of one experienced player (authors CC or MB-M).
Because the criteria of normality and variance homogene-
ity were not met, nonparametric tests were used for statistical
analyses. All patients (n=26) completed the study. The GC
group involved 13 patients (12 males, mean age: 34.7 years,
mean age disease onset: 23.5 years, mean SAPS/SANS total
score: 57/43). The TAU group involved 13 patients (12 males,
mean age: 38.9 years, mean age at disease onset: 20.7 years,
mean SAPS/SANS total score: 53/44). All patients received
atypical antipsychotic medication at the time of the experi-
ment. None of the patients received anticholinergic agent,
sedative treatment, mood stabilizer, antidepressant, or other
Main results are:
Trail Making Test: no signicant difference was observed
between the two groups for intergroup evaluations (all
Wisconsin Sorting Card Test: the GC group made more
perseverative errors than the TAU group in the pre-test
assessment (U=46; Z=2.02; pb.05; +161.54%). This differ-
ence was no longer present in the second assessment
Stroop Test:in the GC group, the number of read items was
increased in the second assessment for the Stroop A
(Colour) and C (Interference) (Z=2.55; pb.05; +12.81% and
Z=2.16; pb.05; +19.79% respectively). By the contrary, no
signicant difference was observed for the TAU group
Schizophrenia Research 107 (2009) 112113
Fig. 1. Mean latency time according to the numberof movements required to
perform the task.
Contents lists available at ScienceDirect
Schizophrenia Research
journal homepage:
0920-9964/$ see front matter © 2008 Elsevier B.V. All rights reserved.
doi:10.1016/j.schres.20 08.09.024
Tower of London Test: latency times in the Tower of
London Task (see Fig. 1) were shorter in the GC group than
in the TAU group for the post-test evaluations for exercises
requiring 2 and 4 movements (U=18; Z=3.41; pb.05;
39.96% and U=27; Z=2.95; pb.05; 40.58% respec-
tively). In the GC group, the rst evaluation did not reveal
any signicant difference in response latencies for the 4
different types of exercises. In the second evaluation,
latency time was found to increase with the number of
required movements (all differences signicant pb.05).
Studies investigating relationships between planning
abilities and chess practice have shown that chess players
are better than naive subjects at solving the Tower of London
task (Unterrainer et al., 2006), corresponding to a higher
degree of frontal lobe involvement (Nichelli et al., 1994).
Task improvements specictotheGCgroupwere
observed for the Stroop test and the Tower of London task.
For the Stroop task, his result can be interpreted as a better
voluntary processing accompanied by a better inhibitory
capacity. The latency time of the ToL was signicantly
normalized after chess-training. This parameter is frequently
called « initial planning time » (Carlin et al., 2000). It is thus
tempting to speculate that chess-training has improved the
planning abilities of patients with schizophrenia.
When considered together,our results suggest that playing
chess for mere 10 h can restore (at least partially) executive
functions of patients with schizophrenia. It may be interesting
to note that chess can be proposed easily at almost no cost
to all psychotic patients. Most of the patients kept playing
chess on their own, after completion of the study.
American Psychiatric Association, 2000. Diagnostic and Statistical Manual of
Mental Disorder, 4th edition Revised. American Psychiatric Association,
Washington DC.
Carlin, D., Bonerba, J., Phipps, M., Alexander, G., Shapiro, M., Grafman, J., 2000.
Planning impairments in frontal lobe dementia and frontal lobe lesion
patients. Neuropsychologia 38, 655665.
Demily, C., Franck, N., 2008. Cognitive remediation: a promising focus for
treatment of schizophrenia. Exp. Rev. Neurother. 8, 10291036.
McGurk, S.R., Twamley, E.W., Sitzer, D.I., McHugo, G.J., Mueser, K.T., 2007. A
meta analysis of cognitive remediation in schizophrenia. Am. J. Psychiatry
164 , 1791 1802.
Nichelli, P., Grafman, J., Pietrini, P., Always, D., Carton, J.C., Miletich, R., 1994.
Brain activity in chess playing. Nature 369, 191.
Unterrainer, J.M., Kaller, C.P., Halsband,U., Rahm, B., 2006. Planningabilities and
chess: a comparison of chess and non-chess. Br. J. Psychol. 97, 299311.
Wechsler, D., 2000. Manuel de léchelle dintelligence pour adultes, WAIS-III
(3e éd.). ECPA, Paris.
Caroline Demily
Michel Desmurget
Valérian Chambon
Nicolas Franck
Center for Cognitive Neuroscience,
UMR 5229 (CNRS & Université Lyon 1), Bron, France
Corresponding author. Center for Cognitive Neuroscience,
67 Boulevard Pinel, 69675 Bron, France.
Tel.: +33 437911223; fax: +33 437911210.
E-mail address: (C. Demily).
Caroline Demily
Centre Hospitalier Saint Jean de Dieu, Lyon, France
Céline Cavézian
EART, TREAT VISION, Fondation Ophtalmologique Rothschild,
Paris, France
Mathieu Berquand-Merle
Nicolas Franck
Centre Hospitalier le Vinatier, Bron, France
16 May 2008
Associated rst authors.
113C. Demily et al. / Schizophrenia Research 107 (2009) 112113
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... Various studies have successfully used chess to strengthen cognitive abilities in schizophrenics (Demily, Cavezian, Desmurget, Berquand-Merle, Chambon & Franck, 2009), and to prevent dementia (Dowd & Davidhizar, 2003). Working memory in general and visual work memory in particular are important parts of the cognitive activities required when playing chess. ...
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... No Ocidente, a analogia entre o jogo de xadrez e o processo clínico no mundo ocidental foi mencionada por Freud (1913Freud ( /1996, ao descrever a relação que se dá entre analista e analisando, não podendo existir um sem o outro. Posteriormente, psicanalistas (Melamed & Berman, 1981), psicólogos cognitivoscomportamentais (Aciego, Garcia & Betancort, 2012;Demily et al., 2009;Saariluoma, 2001) e behavioristas (Mechner, 2010) também citaram o uso do xadrez como instrumento de intervenção psicoterapêutica. Em uma perspectiva desenvolvimental, Sirgirtmac (2016) em estudo quantitativo identificou um aumento positivo no pensamento criativo. ...
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Introduction: One of the most common childhood disorders considered by psychologists and psychiatrists is Attention Deficit/Hyperactivity Disorder, which leads to attention deficit, hyperactivity and impulsivity in affected people. Aim: The purpose of this study was to investigate the impact of Chess training in students with ADHD. Method: The statistical community of the present quasi-experimental study was 76 students with ADHD in Khorramabad city in the academic year of 2019-2020. 32 students were selected by convenience sampling and randomly divided into two groups of 16 controls and experiments based on age, sex and pre-test results. And the experimental group received chess training for 11 consecutive weeks and a weekly session of 60 to 90 minutes. Subjects were evaluated three times (pre-test, post-test, two-week follow-up) with Connors and Swanson questionnaires and data were analyzed by ANOVA and Bonferroni test and Spss 21 software. Results: The results of the study showed a direct and high correlation between the results obtained from both Swanson and Connors measuring instruments and the positive effect of chess training on students with ADHD. (P=0.001, F=20.17). Conclusions: Due to the positive effect of Chess training on the symptoms of ADHD, it is suggested that Chess training be used to reduce the symptoms of ADHD.
Background: Commercial video games are a vastly popular form of recreational activity. Whilst concerns persist regarding possible negative effects of video games, they have been suggested to provide cognitive benefits to users. They are also frequently employed as control interventions in comparisons of more complex cognitive or psychological interventions. If independently effective, video games - being both engaging and relatively inexpensive - could provide a much more cost-effective add-on intervention to standard treatment when compared to costly, cognitive interventions. Objectives: To review the effects of video games (alone or as an additional intervention) compared to standard care alone or other interventions including, but not limited to, cognitive remediation or cognitive behavioural therapy for people with schizophrenia or schizophrenia-like illnesses. Search methods: We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (March 2017, August 2018, August 2019). Selection criteria: Randomised controlled trials focusing on video games for people with schizophrenia or schizophrenia-like illnesses. Data collection and analysis: Review authors extracted data independently. For binary outcomes we calculated risk ratio (RR) with its 95% confidence interval (CI) on an intention-to-treat basis. For continuous data we calculated the mean difference (MD) between groups and its CI. We employed a fixed-effect model for analyses. We assessed risk of bias for the included studies and created a 'Summary of findings' table using GRADE. Main results: This review includes seven trials conducted between 2009 and 2018 (total = 468 participants, range 32 to 121). Study duration varied from six weeks to twelve weeks. All interventions in the included trials were given in addition to standard care, including prescribed medication. In trials video games tend to be the control for testing efficacy of complex, cognitive therapies; only two small trials evaluated commercial video games as the intervention. We categorised video game interventions into 'non-exergame' (played statically) and 'exergame' (the players use bodily movements to control the game). Our main outcomes of interest were clinically important changes in: general functioning, cognitive functioning, social functioning, mental state, quality of life, and physical fitness as well as clinically important adverse effects. We found no clear difference between non-exergames and cognitive remediation in general functioning scores (Strauss Carpenter Outcome Scale) (MD 0.42, 95% CI -0.62 to 1.46; participants = 86; studies = 1, very low-quality evidence) or social functioning scores (Specific Levels of Functioning Scale) (MD -3.13, 95% CI -40.17 to 33.91; participants = 53; studies = 1, very low-quality evidence). There was a clear difference favouring cognitive remediation for cognitive functioning (improved on at least one domain of MATRICS Consensus Cognitive Battery Test) (RR 0.58, 95% CI 0.34 to 0.99; participants = 42; studies = 1, low-quality evidence). For mental state, Positive and Negative Syndrome Scale (PANSS) overall scores showed no clear difference between treatment groups (MD 0.20, 95% CI -3.89 to 4.28; participants = 269; studies = 4, low-quality evidence). Quality of life ratings (Quality of Life Scale) similarly showed no clear intergroup difference (MD 0.01, 95% CI -0.40 to 0.42; participants = 87; studies = 1, very low-quality evidence). Adverse effects were not reported; we chose leaving the study early as a proxy measure. The attrition rate by end of treatment was similar between treatment groups (RR 0.96, 95% CI 0.87 to 1.06; participants = 395; studies = 5, low-quality evidence). One small trial compared exergames with standard care, but few outcomes were reported. No clear difference between interventions was seen for cognitive functioning (measured by MATRICS Consensus Cognitive Battery Test) (MD 2.90, 95% CI -1.27 to 7.07; participants = 33; studies = 1, low-quality evidence), however a benefit in favour of exergames was found for average change in physical fitness (aerobic fitness) (MD 3.82, 95% CI 1.75 to 5.89; participants = 33; studies = 1, low-quality evidence). Adverse effects were not reported; we chose leaving the study early as a proxy measure. The attrition rate by end of treatment was similar between treatment groups (RR 1.06, 95% CI 0.75 to 1.51; participants = 33; studies = 1). Another small trial compared exergames with non-exergames. Only one of our main outcomes was reported - physical fitness, which was measured by average time taken to walk 3 metres. No clear intergroup difference was identified at six-week follow-up (MD -0.50, 95% CI -1.17 to 0.17; participants = 28; studies = 1, very low-quality evidence). No trials reported adverse effects. We chose leaving the study early as a proxy outcome. Authors' conclusions: Our results suggest that non-exergames may have a less beneficial effect on cognitive functioning than cognitive remediation, but have comparable effects for all other outcomes. These data are from a small number of trials, and the evidence is graded as of low or very low quality and is very likely to change with more data. It is difficult to currently establish if the more sophisticated cognitive approaches do any more good - or harm - than 'static' video games for people with schizophrenia. Where players use bodily movements to control the game (exergames), there is very limited evidence suggesting a possible benefit of exergames compared to standard care in terms of cognitive functioning and aerobic fitness. However, this finding must be replicated in trials with a larger sample size and that are conducted over a longer time frame. We cannot draw any firm conclusions regarding the effects of video games until more high-quality evidence is available. There are ongoing studies that may provide helpful data in the near future.
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The chess game comprises different domains of cognitive function, demands great concentration and attention and is present in many cultures as an instrument of literacy, learning and entertainment. Over the years, many effects of the game on the brain have been studied. Seen that, we reviewed the current literature to analyze the influence of chess on cognitive performance, decision-making process, linking to historical neurological and psychiatric disorders as we describe different diseases related to renowned chess players throughout history, discussing the influences of chess on the brain and behavior.
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Chess as a serious leisure activity and its relation to the inhibition of students with and without ADHD Shahar Gindi, Ph.D., Faculty of Education, Beit Berl College, Israel The current study investigated whether chess training relates to inhibitory control in teenagers with and without ADHD, gifted and not gifted. Moreover, the study investigated the possibility that chess training could VI | MIFGASH 48 improve inhibitory control. Participants completed a visual-spatial task designed for the purpose of the study, comprising two conditions. In the “free” condition participants were allowed to test different solutions before choosing the answer and in the "touch move" condition they were asked to choose the answer without any physical attempts, and once chosen, their answer could not be changed. This was in accordance with the touch move rule in chess, whereby a piece touched must be moved or captured. Additionally, participants completed Go/No-Go tasks. The new task was found to be partially effective, as only the touch move condition produced group differences, with chess players performing better than non-chess players, regardless of diagnosis. The No-Go task performance analysis also showed a significant main effect for chess training, and a significant interaction between chess, ADHD, and the use of medicine. Although without establishing causality, these results indicate chess players were less impulsive than non-chess players, regardless of diagnosis. However, it is not yet clear whether this is due to chess training, or a pre-existing difference. Key words: ADHD, inhibitory control, executive function, impulsivity,
Schaken is een van oudsher klassiek bordspel waarbij veel cognitieve vaardigheden nodig zijn, zoals concentratie, planning en inhibitie. Daarom zijn het vaak de slimme kinderen die kiezen voor schaakles of zelfs eerder toegang krijgen tot het volgen van schaakles, binnen en buiten school. Maar zijn het de slimme kinderen die schaaklessen gaan volgen of worden kinderen ook slimmer van schaken? Om slimmer te worden van schaakles zou ‘far transfer’ van leren moeten optreden. Dit is overdracht van vaardigheden tussen minder sterk gerelateerde domeinen, zoals lijkt te gebeuren bij schaken en rekenvaardigheid, omdat beide domeinen kenmerken delen (numerieke en ruimtelijke vaardigheden). Daarnaast zijn er prille aanwijzingen dat schaken een positieve invloed heeft op het executief functioneren van kinderen, zoals cognitieve flexibiliteit, planning en inhibitie. Omdat betere executieve functies zijn gerelateerd aan betere schoolvaardigheden hypothetiseren wij een mediërende rol voor executieve functies in de relatie tussen schaakles en schoolvaardigheden. Schaken kan in dit geval gezien worden als een vorm van executieve functietraining, waarbij de principes van dergelijke trainingen gevolgd kunnen worden om cognitieve functies bij kinderen te verbeteren (zoals het uitdagend maken van de training). Deze training kan onder andere ingezet worden bij achterblijvende schoolprestaties en cognitieve ontwikkeling. Schaken is dus niet alleen voor slimme kinderen. Voor ieder niveau zijn er varianten op het klassieke schaakspel, waardoor iedereen, ook jonge kinderen, op een speelse en ontdekkende manier met schaken in aanraking kunnen komen.
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This study evaluated the effects of cognitive remediation for improving cognitive performance, symptoms, and psychosocial functioning in schizophrenia. A meta-analysis was conducted of 26 randomized, controlled trials of cognitive remediation in schizophrenia including 1,151 patients. Cognitive remediation was associated with significant improvements across all three outcomes, with a medium effect size for cognitive performance (0.41), a slightly lower effect size for psychosocial functioning (0.36), and a small effect size for symptoms (0.28). The effects of cognitive remediation on psychosocial functioning were significantly stronger in studies that provided adjunctive psychiatric rehabilitation than in those that provided cognitive remediation alone. Cognitive remediation produces moderate improvements in cognitive performance and, when combined with psychiatric rehabilitation, also improves functional outcomes.
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Cognitive remediation is a type of treatment added recently to the range of tools available to therapists. It includes a number of miscellaneous methods that aim to correct some of the cognitive impairments observed in schizophrenia. These cover the fields of target attention, memory and executive deficits, as well as impaired social cognition. Cognitive remediation acts as a complement to medication and psychological therapies, which constitute the core methods of treatment for schizophrenia. The present paper reviews the state of the art in cognitive remediation. The principle underlying this innovative therapeutic approach is the enhancement of the cognitive resources of patients with schizophrenia in order to improve their cognitive functions, social skills and in some cases alleviate some of the symptoms of the disease. Several programs developed within the past two decades (e.g., IPT, CRT, NEAR, CET, NET, CRT and CAT) are becoming more widely used. Their efficacy on neurocognition and on functional outcome has been demonstrated, with inconstant continuation of benefit after completion of treatment. The sustainability of the cognitive and functional improvements following completion of these programs has to be further studied. Other programs aimed at acting upon altered social cognition (one of the critical facets of schizophrenia) are still in the experimental stages, but the results obtained so far are encouraging. A preliminary study has also demonstrated the effectiveness of board games in improving cognitive functioning, which seems to be a highly promising therapeutic avenue owing to its ease of use.
Patients with frontal lobe brain damage are reportedly impaired on tasks that require plan development and execution. In this study, we examined the performance of 15 patients diagnosed with frontal lobe dementia and 14 patients with focal frontal lobe lesions on the Tower of London planning task. Patients with frontal lobe dementia committed a significantly higher number of rule violations, made more moves, and demonstrated longer solution time latencies compared to their matched controls. Patients with frontal lobe lesions demonstrated significantly delayed solution times and also made more moves compared to their matched controls. Frontal lobe lesion patient performance suggests an impairment in execution-related processes, while frontal lobe dementia patients appear to be impaired in both plan development and execution. Despite these findings, the identification of a specific cognitive impairment that induces these planning problems remains elusive.
Playing chess requires problem-solving capacities in order to search through the chess problem space in an effective manner. Chess should thus require planning abilities for calculating many moves ahead. Therefore, we asked whether chess players are better problem solvers than non-chess players in a complex planning task. We compared planning performance between chess ( N=25) and non-chess players ( N=25) using a standard psychometric planning task, the Tower of London (ToL) test. We also assessed fluid intelligence (Raven Test), as well as verbal and visuospatial working memory. As expected, chess players showed better planning performance than non-chess players, an effect most strongly expressed in difficult problems. On the other hand, they showed longer planning and movement execution times, especially for incorrectly solved trials. No differences in fluid intelligence and verbal/visuospatial working memory were found between both groups. These findings indicate that better performance in chess players is associated with disproportionally longer solution times, although it remains to be investigated whether motivational or strategic differences account for this result.
Manuel de l'échelle d'intelligence pour adultes, WAIS-III (3e éd
  • D Wechsler
Wechsler, D., 2000. Manuel de l'échelle d'intelligence pour adultes, WAIS-III (3e éd.). ECPA, Paris.
Brain activity in chess playing Planning abilities and chess: a comparison of chess and non-chess
  • P Nichelli
  • J Grafman
  • P Pietrini
  • D Always
  • J C Carton
  • R Miletich
Nichelli, P., Grafman, J., Pietrini, P., Always, D., Carton, J.C., Miletich, R., 1994. Brain activity in chess playing. Nature 369, 191. Unterrainer, J.M., Kaller, C.P., Halsband, U., Rahm, B., 2006. Planning abilities and chess: a comparison of chess and non-chess. Br. J. Psychol. 97, 299–311.
Diagnostic and Statistical Manual of Mental Disorder
American Psychiatric Association, 2000. Diagnostic and Statistical Manual of Mental Disorder, 4th edition Revised. American Psychiatric Association, Washington DC.