Try eating food with one chop stick. 

It is possible, for certain types of food. But probably not the best approach.

Let's now talk brain health.

Dr. Larry McCleary is a former acting Chief of Pediatric Neurosurgery at Denver Children's Hospital, and author of the The Brain Trust Program (Perigee Trade, 2007). He agreed to help us answer an important, yet often neglected, question: Given That We Are Our Brains, How do We Nourish Them?

Alvaro: Dr. McCleary, Why did a former neurosurgeon such as yourself develop an interest in brain health public education?

Dr. McCleary: For two reasons ... I am a Boomer and am trying to maximize my own brain health. Also, there is much exciting research documenting how we can be proactive in this regard. This information needs to be disseminated and I would like to help in this process.

And what is the single most important brain-related idea or concept that you would like every person in the planet to fully understand?

The most important take home message about brain health is that we now know that no matter what your brain status or age, there is much you can do to significantly improve brain function and slow brain aging. Based on emerging information, what is especially nice is the fact that unlike many things in life our brain health is largely under own control.

What are the most important elements to nourish our brains as we age?

I approach this question much like an athlete prepares for competition. They utilize a holistic approach. This is also what a healthy brain requires. It should not be surprising that "what is good for the body is good for the brain." That is how our bodies and brains evolved.

Hence what I believe are valuable components of a well-rounded approach to brain health involve:

A) Appropriate nutrition.

The major fuel the brain consumes is glucose. The earliest sign of impending dementia and Alzheimer disease (AD) is a decrement in the ability of the brain to use glucose efficiently. Based on this observation, some neuroscientists are referring to AD as Type 3 diabetes because of the inability to appropriately use glucose in that disorder. This makes sense because people with diabetes have a four-fold increase in AD.

The brain is a fatty organ. The most important fats are those in the nerve cell membranes whose presence keeps them flexible. These are the long chain omega 3 fatty acid molecules found in fatty, cold-water fish and arachidonic acid (a long chain omega 6 fatty acid). These are both delicate fats and as such can oxidize easily (meaning they can become rancid).

Thus, we should include additional dietary components that provide free radical fighting activity to protect them against oxidation. Based on these observations, I recommend a diet containing fatty fish, veggies and salads, non-starchy fruits (like berries) - that are high in free radical fighting compounds - and nuts. Addition of specific nutritional supplements may be helpful for the elderly, those under chronic stress, in the context of medications that lower critical nutrient levels in the body, or when dietary quality varies.

B) Stimulating brain activity

To increase neuroplasticity (the continual ability of the brain to "rewire" itself) and neurogenesis (the formation of new nerve cells), brain stimulation is vital. All types count including school work, occupational endeavors, leisure activities and formal brain training. The key in any activity is to include novelty (to encourage thinking outside the box), challenge and variety.

C) Physical activity

Exercise delivers additional blood and oxygen to the brain. Yet, it does so much more. It actually causes alterations in the nerve cells. They produce more neurotrophins, which are compounds that increase the formation of new nerve cells and enhance their connectivity. They also make the neurons we have more resistant to the aging process. Cross train your brain by starting with a good aerobic program and mix in resistance (weight training) exercise and speed and agility components such as jumping rope, playing ping-pong, gymnastics and various balance drills.

D) Stress reduction

Chronic, unremitting stress kills neurons. This is especially detrimental to memory function. So include a component of stress reduction in your approach to optimal brain health and make sure to get plenty of sleep.

E) Be Aware of Side effects of medications

There are medications that lower the level of important brain nutrients in the body such as B vitamins and coenzyme Q10. Check with your doctor to screen for these. There are also many common medicines (many OTC) that have anti-cholinergic activities. These can impair the function of one of the most important memory neurotransmitters in the brain -acetylcholine.

Finally, what brain health-related information or practices would you suggest other doctors and health professionals pay more attention to, both for themselves and the patients they see?

They should counsel their patients on tips for brain health such as those listed above in much the same way they discuss cardiac risk factors and how to address them. I would like to see physicians encourage their patients to avoid high-fructose corn syrup because it has recently been shown to be associated with increased brain atrophy.

Dr. McCleary, many thanks for your great insights.

My pleasure!

-------------- 

For more information

- The Brain Trust Program (Perigee Trade, 2007).

- Evolution and Brain Health, an article by Dr. McCleary.

Enjoy the weekend...always a good time to nourish our brains.

I am honored to interview him today.

Dr. Kramer, thank you for your time. Let’s start by trying to clarify some existing misconceptions and controversies. Based on what we know today, and your recent Nature piece (Note: referenced below), what are the 2-3 key lifestyle habits would you suggest to a person who wants to delay Alzheimer’s symptoms and improve overall brain health?

First, Be Active. Do physical exercise. Aerobic exercise, 30 to 60 minutes per day 3 days per week, has been shown to have an impact in a variety of experiments. And you don’t need to do something strenuous: even walking has shown that effect. There are many open questions in terms of specific types of exercise, duration, magnitude of effect…but, as we wrote in our recent Nature Reviews Neuroscience article, there is little doubt that leading a sedentary life is bad for our cognitive health. Cardiovascular exercise seems to have a positive effect.

Second, Maintain Lifelong Intellectual Engagement. There is abundant prospective observational research showing that doing more mentally stimulating activities reduces the risk of developing Alzheimer’s symptoms.

Let me add, given all media hype, that no “brain game” in particular has been shown to have a long-term impact on Alzheimer’s or the maintenance of cognition across extended periods of time. It is too early for that-and consumers should be aware of that fact. It is true that some companies are being more science-based than others but, in my view, the consumer-oriented field is growing faster than the research is.

Ideally, combine both physical and mental stimulation along with social interactions. Why not take a good walk with friends to discuss a book? We lead very busy lives, so the more integrated and interesting activities are, the more likely we will do them.

Great concept: a walking book club! Now, part of the confusion we observe is due to the search of “magic solutions” that work for everyone and everything. We prefer to talk about several pillars of brain health, and different priorities for different individuals. Can you elaborate on what interventions seem to have a positive effect on specific cognitive abilities and individuals?

Perhaps one day we will be able to recommend specific interventions for individuals based on genetic testing, for example, but we don’t have a clue today. We are only beginning to understand how the environment interacts with our genome.

But I agree on the premise that there probably won’t be a general solution that solves all cognitive problems, but we need a multitude of approaches. And we can’t forget, for example, the cognitive benefits from smoking cessation, sleep, pharmacological interventions, nutrition, social engagement.

Physical exercise tends to have rather broad effects on different forms of perception and cognition, as seen in the Colcombe and Kramer, 2003, meta-analysis published in Psychological Science (Note: referenced below).

Cognitive training also works for a multitude of perceptual and cognitive domains – but has shown little transfer beyond trained tasks.

No single type of intervention is sufficient. Today there is no clear research on how those different lifestyle factors may interact. The National Institute on Aging is starting to sponsor research to address precisely that.

Earlier you said that no brain software in particular has been shown to maintain cognition across extended periods of time. Now, didn’t the ACTIVE trial (Note: referenced below) 5-year results show how cognitive training (computerized or not) can result in pretty durable results? For context, are there comparable controlled studies to ACTIVE where 10 or so hours of physical exercise today can result in measurable (yet, incomplete) cognitive benefits 5 years from now?

The ACTIVE study showed a good deal of 5-year retention of the tasks that were trained for 10 hours each, but limited transfer of training was found for other untrained tasks. It seems unlikely that significant transfer may ocurring with the relatively little training (e.g. 10 hours in the ACTIVE study) and focused tasks that have been provided in training studies thus far.

On whether there are controlled studies similar to ACTIVE that have measured the long-term cognitive benefits of physical exercise, not that I know of.

To wrap up this part of the conversation, what's in your mind the best way to explain the relative benefits of physical vs. cognitive exercise? From a fundamental point of view, it seems clear that physical exercise can help enhance neurogenesis (Note: the creation of new neurons), yet learning/ cognitive exercise contributes to the survival of those neurons by strengthening synapses, so I see more how those two "pillars" are complimentary than "one or the other".

I agree. Given what we know today I would recommend both intellectual engagement and physical exercise. However, we do know, from a multitude of animal studies, that physical exercise has a multitude of effects on brains beyond neurogenesis, including increases in various neurotransmitters, nerve grown factors, and angiogenesis (the formation of new blood vessels).

Tell us more about your work with cognitive training for older adults.

We have now a study in press where we evaluate the effect of a commercially available strategy videogame on older adults’ cognition.

Let me first give some context. It seems clear that, as we age, our so-called crystallized abilities remain pretty stable, whereas the so-called fluid abilities decline. One particular set of fluid abilities are called executive functions, which deal with executive control, planning, dealing with ambiguity, prioritizing, multi-tasking. These skills are crucial to maintain independent living.

In this study, we examined whether playing strategy-based video game can train those executive functions and improve them. We showed that playing a strategy-based videogame (Rise of Nations Gold Edition) can result in not only becoming a better videogame player but it transferred to untrained executive functions. We saw a significant improvement in task switching, working memory, visual short-term memory, and mental rotation. And some, but more limited, benefits in inhibition and reasoning.

I can share a few details on the study: the average age was 69 years, and the experiment required around 23 hours of training time. We only included individuals who had played videogames 0 hours/ week for the last 2 years.

That last criteria is interesting. We typically say that good “brain exercise” requires novelty, variety and challenge. So, if you take adults who are 69-years-old and haven’t played a videogame in 2 years, how do you know if the benefit comes from the particular videogame they played vs. just the value of dealing with a new and complex task?

That’s a great question. The reality is that we don’t know, since we had a “waiting list” control group. In the future perhaps we should compare different videogames or other mentally stimulating activities against each other and see what method is the most efficient. Perhaps the National Institutes on Health may be interested in funding such research.

In any case, your study reinforces an important point: older brains can, and do, learn new skills.

Yes. The rate of learning by older adults may be slower, and they may benefit from more explicit instruction and technology training, but, as a society, it is a massive waste of talent not to ensure older adults remain active and productive.

Another recent study we conducted, this one still under review, is titled Experience-Based Mitigation of Age-Related Performance Declines: Evidence from Air Traffic Control. It deals with the question: “Can Age Itself Be an Obstacle for someone to perform as an Air Controller? And the Answer is: age itself, within the age range that we studied, is not an obstacle. Our results suggest that, given substantial accumulated experience, older adults can be quite capable of performing at high levels of proficiency on fast-paced demanding real-world tasks.

Now, the field of computerized cognitive training has potential in a variety of applications beyond “healthy aging”. You are obviously familiar with Daniel Gopher’s work training military pilots using Space Fortress. Is your lab doing something in that cognitive enhancement direction?

Yes, I have been involved in that area of work since the late 70s, when I helped design the protocols for Space Fortress. Which provides indeed a very interesting example of real-life transfer: pilots do seem to fly better as measured by real-life instruments.

Our lab is now embarking on a 5-year study for the Navy to explore ways to capitalize emerging research on brain plasticity to enhance training and performance. MIT and my lab will analyze the best training procedures to increase the efficiency and efficacy of training of individual and team performance skills, particularly those skills requiring high levels of flexibility. The results from this study will be in the public domain, so I hope they contribute to the maturity of the field at large.

That’s an important point. What does the field of cognitive fitness at large need to mature and become more mainstream?

We need more research. But not any kind of research. What we need is a kind of independent “Seal of Approval” based on independent clinical trials. Most published research of cognitive training interventions is sponsored and/ or conducted by the companies themselves. We need independent, objective and clear standards of excellence.

The Department of Education maintains a What Works Clearinghouse to review existing evidence behind programs that make education-related claims. Perhaps we need a similar approach for programs making cognitive claims with adults. We also see a need for more solid and widely-available cognitive assessments, to have better baselines and independent measures of cognitive abilities.

Good news there: the NIH is preparing an “NIH Toolbox” to provide valid, reliable instruments to researchers and clinicians, to solve the problem that exists today, namely, the lack of uniformity among many measures used. The initiative was launched in 2006, and it is a 5-year effort, so we’ll need to wait to see results.

Dr. Kramer, many thanks for your time and work. My apologies for having you stay by your desk during this interview. Next time I am in Illinois, I will invite you to a walking interview.

Excellent idea! The pleasure has been mine. Let me thank you as well, for the very important work you are doing.

(Note: on 6/30, I clarified some remarks by Dr. Kramer regarding the ACTIVE trials, with his approval.)

References

Willis SL, Tennstedt SL, Marsiske M, et al. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA. 2006;296:2805-14.

Stanley Colcombe, Arthur F. Kramer (2003). Fitness effects on the cognitive function of older adults: A Meta-Analytic study. Psychological Science 14 (2) , 125–130.

Charles H. Hillman, Kirk I. Erickson & Arthur F. Kramer Be smart, exercise your heart: exercise effects on brain and cognition. Nature Reviews Neuroscience 9, 58-65.

Related Interviews

- Cognitive Simulations for Peak Performance- with Dr. Daniel Gopher

- Improving Driving Skills, and the ACTIVE trials- with Dr. Jerri Edwards

- Build Your Cognitive Reserve- with Dr. Yaakov Stern

Reference: Jaeggi, S. M., Buschkuehl, M., Jonides, J., & Perrig, W. J. (2008). Improving Fluid Intelligence With Training on Working Memory. Proceedings of the National Academy of Sciences of the United States of America, 105(19), 6829-6833 (You can read it here, with subscription).

Before you keep reading, let me clarify a couple of terms:

- "Working Memory" is the ability to hold several units of information in our minds and manipulate them in real time. For example, imagine I ask you to remember, and then say backwards, the 7 digits of my phone number.

- "Fluid intelligence" can be described as the ability to deal with new challenges and new problems, those that we encounter for the first time.

Dr. Buschkuehl, nice to talk to you. Can you first provide us with some context on your research?

My collaborator Susanne Jaeggi and I started our training work four years ago in the Lab of Prof. Walter Perrig at the University of Bern, Switzerland. Now we are both Post Docs in Prof. John Joindes’ Lab at the University of Michigan. We developed a complex computerized task and have tried it in a number of studies. We reported our results in two unpublished dissertations, but this is the first time it has been published in a peer-reviewed journal.

Could you please explain the training involved in this particular study?

We recruited 70 students aged around 26 years and set half of them on a challenging computer-based cognitive training regimen, based on the so-called "n-back task." This is a very complex working memory task that involves the simultaneous presentation of visual and auditory stimuli. The experimental group watched a series of screens on their computers, where a blue square appeared in various positions on a black background. Each screen appeared for half a second, with a 2.5 second gap before the next one appeared. While this happened, the trainees also heard a series of letters that were read out at the same rate.

At first, students had to say if either the screen or the letter matched those that popped up two cycles ago. The number of cycles increased or decreased depending on how well the students performed the task. The students sat through about twenty-five minutes of training per day for either 8, 12, 17 or 19 days, and were tested on their fluid intelligence before and after the regimen using the Bochumer-Matrizen Test (this is a problem-solving task based on the same principle as the very well known Raven’s Advanced Progressive Matrices. However, it is more difficult and therefore especially suited for academic samples).

What were the results?

Participants in the experimental group did significantly better on the fluid intelligence test (which was not directly trained) than participants in the control group. Those in the control group hadn’t gone through any training. The control group did improve slightly, but real “trainees” outperformed them (see Figure Xa). Furthermore, we found that the improvement was dose-dependent: the more they trained, the larger the gain on fluid intelligence.

Images: PNAS.

We just published a market report to cover the growing brain fitness software market. A common question we get is, “How are computerized programs like the one you used fundamentally different from, say, simply doing many crossword puzzles?”

First, thank you for sending the report along. Fascinating to see what is starting to happen in this field.

In terms of why our program worked, I could say that the program has some inherent properties that are at least in this combination unique to our training approach. Our program is:
- Fully adaptive in real-time: The person using the program is truly pushed to his or her peak level all the time, thereby "stretching" the targeted ability.
- Complex: We present a very complex task, mixing different forms of stimuli (auditory, visual) under time pressure.
- Designed for Transferability: The tasks can be designed in a way that do not allow for the development of task-specific "strategies" to beat the game. One needs to truly expand capacity, and this helps ensure the transfer of to non-trained tasks.

This is very different from enhancing task-specific capacities, such as memorizing lists of 100 numbers, which have been shown not to necessarily transfer to related domains.

Can you give an example of the lack of transferability of other training methods?

In Ericsson’s classic paper (Ericsson, K. A., & Delaney, P. F. (1998). Working memory and expert performance. In R. H. Logie & K. J. Gilhooly (Eds.), Working Memory and Thinking (pp. 93-114). Hillsdale, NJ: Erlbaum), people who could memorize 100 numbers, using a variety of mnemotecnic techniques, could not get even close to 100 letters. Remembering numbers didn’t translate into remembering other things, so it wasn’t a general memory capacity that had been improved.

What are the particular aspects of the University of Michigan study that surprised you the most?

First, the clear transfer into fluid intelligence, that many researchers and psychologists take as fixed.

Second, I was surprised to see that the more training the better the outcome. The improvements did not seem to peak early.

Third, that all trained groups improved, no matter their respective starting points. In fact, students with lowest fluid intelligence seemed to improve the most. But that was not the main focus of our study, so we can not say much more about it.

How did participants describe the experience, and their benefits?

Many liked the training. They saw the challenge, and tried hard to push themselves through the training to see how far they could go.

We did not analyze how the fluid intelligence gains transferred into real life. But from an anecdotal point of view, many participants have shared stories of how they perceive a major benefit. Now they can follow lectures more easily, understand math better etc…

There is a degree of artificial controversy these days in the media and the scientific community on the respective benefits of physical or mental exercise. Your thoughts?

We obviously need both. Physical exercise keeps the body in a good shape but especially in older people also leads to cognitive benefits. Mental exercise, like the one we used, can enhance important abilities and is most likely the most efficient way to improve a specific cognitive process but also generalizes to a broader range of skills, as we showed.

Research will need to help clarify who needs what type of exercise more. Some people may get enough mental exercise through very complex jobs and what they need is physical exercise. For others, it may be the opposite.

What are your plans now?

First, to conduct follow-up research to analyze the neural basis of the improvement via neuroimaging studies and try to measure benefits in real life.

But our main hope is to be able to investigate and develop applications for people who need it most: children with development problems, stroke/ TBI rehab, and older adults.

Also, let me note that there is a cross-platform application available (Note: Here), that allows to train with the dual n-back task and several other training tasks that we developed for other studies. Although the application is available in English, the Manual and the BrainTwister Website are not at the moment. We are about to release an English version, but unfortunately I cannot give you a release date right now. If the training program is used for research (i.e. a training study), it is provided free of charge.

Martin, many thanks for sharing your time and insights with us. Please keep us informed of new developments.

My pleasure. We will.

----------------------------

Reference: Jaeggi, S. M., Buschkuehl, M., Jonides, J., & Perrig, W. J. (2008). Improving Fluid Intelligence With Training on Working Memory. Proceedings of the National Academy of Sciences of the United States of America, 105(19), 6829-6833 (You can read it here, with subscription). 

For related interviews on working memory training, see

Memory training and attention deficits: interview with Notre Dame's Bradley Gibson

Working Memory Training: Interview with Dr. Torkel Klingberg

Working Memory Training from a pediatrician perspective 

And, if you want to try the task yourself before the official website mentioned above is ready (and we'll keep you updated), you can do so Here.

Main focus of research

Alvaro Fernandez: Please explain to our readers your main research areas

Jerri Edwards: I am particularly interested in how cognitive interventions may help older adults to avoid or at least delay functional difficulties and thereby maintain their independence longer. Much of my work has focused on the functional ability of driving including assessing driving fitness among older adults and remediation of cognitive decline that results in driving difficulties.

Some research questions that interest me include, how can we maintain healthier lives longer? How can training improve cognitive abilities, both to improve those abilities and also to slow-down, or delay, cognitive decline? The specific cognitive ability that I have studied the most is processing speed, which is one of the cognitive skills that decline early on as we age.

ACTIVE results

Can you explain what cognitive processing speed is, and why it is relevant to our daily lives?

Processing speed is mental quickness. Just like a computer with a 486 processor can do a lot of the same things as a computer with a Pentium 4 processor, but it takes much longer, our minds tend to slow down with age as compared to when we were younger. We can do the same tasks, but it takes more time. Quick speed of processing is important for quick decision making in our daily lives. When you are driving, if something unexpected happens, how quickly can you notice the situation and decide how to react?

Please describe how the ACTIVE trial used the cognitive training program, and what the results were found to be when they were published in the Journal of the American Medical Association in December 2006?

I was a co-investigator of the ACTIVE study, a multi-site, controlled study, with thousands of adults over sixty-five, to evaluate the effectiveness of three different cognitive training methods with three different groups:

- The first group used a memory training program including a variety of traditional memory techniques such as mnemonics and the method of loci.

- The second group was trained in learn inductive reasoning skills.

- The third group was exposed to computer-based programs to train processing speed.

All 3 groups spent the same amount of time in their respective training programs, around 2 hours a week for 5 weeks, going through exercises of increasing difficulty. The ACTIVE study was designed to track participants' performance over a number of years, so, after this initial 5-week intervention, some groups received training booster sessions, after 1 year and again after 3 years.

Willis and colleagues published the 5-year results in JAMA last December and the results were very positive. All 3 types of cognitive programs were shown to have an effect immediately after the program, after 3 years, and after 5. But, the results of the group that used a computer-based program to train processing speed showed clear short-term and long-term results. Individuals who experienced improved speed of processing also showed better performance on tasks of instrumental activities of daily living such as quickly finding an item on a crowded pantry shelf and reading medication bottles. They also reacted to road signs more quickly. We found this transfer of training in our prior studies using the training protocol as well.

In short, significant percentages of the participants improved their memory, reasoning and information-processing speed across all three methods. The most impressive result was that, when tested five years later, the participants in the computer-based program had less of a decline in the skill they were trained in than did a control group that received no cognitive training.

Clarifying confusion

The results of the ACTIVE study were quite impressive and contributed in large part to the amount of media coverage about brain fitness last year. However, as you have probably seen, there is a good deal of confusion about brain fitness among the media and the public at large. Can you help our readers understand two common questions: 1) Why are new programs better than, say, doing crosswords puzzles?, and 2) Can one really say that these programs can reverse age-related decline?

To answer the first question, I would say that a crossword puzzle is not a form of cognitive training. It can be stimulating, but it is not a form of structured mental exercise that has been shown to improve specific cognitive skills - other than the skill of doing crossword puzzles, of course.

In terms of the second question, it is too early to say whether we can really reverse decline in a permanent way. There are many skills involved and the studies are not long enough to really compare different trajectories. What we can say is that by doing some exercises, one can improve cognitive speed of processing by 146-250%, and that a significant portion of that improvement stays even after 5 years. We cannot say more definitively.

But I think it is noteworthy to be able to say that, in all of the programs tested, the payoff from cognitive training, or what we can call "mental exercise", seemed far greater than we are accustomed to getting from physical exercise. Just imagine if you could say that 10 hours of workouts at the gym every day this month was enough to help keep you fit five years from now.

Now, the program used is not fully automated, correct? It required the intervention of a trained person to calibrate the program at the right level of difficulty.

That is correct.

Driving-related performance

Another fascinating study that you published as a co-author in Human Factors (2003), applied the same computer-based program to improving the driving-related mental skills of older adults. Can you explain that study?

Sure. Our goal was to train what is called the "useful field of view." The useful field of view is a measure of processing speed and visual attention that is critical for driving performance, and one of the areas that declines with age. It has previously been shown that this skill can be improved with training, so we wanted to see what effect it would have on the driving performance of older adults, and whether the training would be more or less effective than a traditional driving simulation course.

For the study, we divided forty-eight adults over fifty-five years old into two intervention groups of twenty-four people each. Each group received twenty hours of training. One group was exposed to a traditional driving simulator, where they learned specific driving behaviours. The other one went through the cognitive training program.

Both groups' driving performance improved right after their respective programs, but most benefits of the driving simulator disappeared by month eighteen.

The speed-of-processing intervention helped participants not only improve "useful field of view," the skill that was directly trained, but it also transferred into real-life driving, and the results were sustained after 18 months. And, by the way, the evaluation was as real as one can imagine: a 14-mile open road evaluation.

Faster speed-of-processing seemed to enable adults to react better to unexpected events that require a fast response and to reduce by 40% the number of dangerous manoeuvres on real roads (defined as those that required the training instructor to intervene during the evaluation).

The Future

Research like this seems to present major opportunities for society. For example, wouldn't insurance companies, or the AARP, want to sponsor more research and evaluate whether to offer this type of training to their members? Won't major employers see opportunities to improve the performance of older employees by identifying the cognitive skills that may need the most improvement and offering tailored training? We could speculate that a person with faster processing abilities will also be able to make faster decisions and learn faster...

That makes sense, based on what we know. Cognitive abilities evolve in different ways as we age, and some typically start to decline in our thirties. Cognitive interventions may help train and improve those abilities, and there is already research that strongly indicates where and how training can be useful. More research is still required to deliver more precise and tailored interventions in a variety of environments. I suspect we will see the field grow significantly - and not just for aging-related priorities. Cognitive training may become useful for a variety of health conditions, such as Parkinson's and Alzheimer's patients, for example. More research will help researchers refine assessments and training programs.

References

- Edwards, J.D., Ross, L.A., Clay, O.C., Wadley, V.G., Crowe, M., Roenker, D.L. & Ball, K.K. (2006). The Useful Field of View test: Normative data. Archives of Clinical Neuropsychology, 21: 275-286

- Ball, K.K., Roenker, D., Wadley, V.G., Edwards, J.D., Roth, D.L., McGwin, G. M., Raleigh, R., Joyce, J., & Cissell, G.M. & Dube, T. (2006). Can high-risk older drivers be identified through performance-based measures in a department of motor vehicles setting? Journal of the American Geriatrics Society, 54: 77-84.

- Roenker, D., Cissell, G., Ball, K., Wadley, V., & Edwards, J. (2003). Speed of processing and driving simulator training result in improved driving performance. Human Factors, 45: 218-233.

- Jobe, J.B., Smith, D.M., Ball, K., Tennstedt, S. L., Marsiske, M., Willis, S.L., Rebok, G.W., Morris, J.N., Helmers, K.F., Leveck, M.D., Kleinman, K. ACTIVE: A cognitive intervention trail to promote independence in older adults. Control Clinical Trials, 2001, 22(4): 453-479.

- Edwards, J., Wadley, V., Myers, R., Ball, K., Roenker, D., & Cissell, G. (2002). Transfer of a speed of processing intervention to near and far cognitive functions. Gerontology, 48: 329-340.

- Edwards, J.D., Wadley, V.G., Vance, D.E., Wood, K.M., Roenker, D.L., & Ball, K.K. (2005). The impact of speed of processing training on cognitive and everyday performance. Aging & Mental Health, 9: 262-271.

Credit for pic: Dennis Keim dk-studio

 

I am honored to interview him today.

Alvaro Fernandez: Let's start with that eternal source of debate. What do we know about the respective roles of genes and our environment in brain development?

Robert Sylwester: Genetic and environmental factors both contribute to brain maturation. Genetics probably play a stronger role in the early years, and the environment plays a stronger role in later years. Still the mother's (environmental) use of drugs during the pregnancy could affect the genetics of fetal brain development, and some adult illnesses, such as Huntington's Disease, are genetically triggered.

Nature and nurture both require the significant contributions of the other in most developmental and maintenance functions. We typically think of environmental factors as things that happen to us, over which we have little control.

Can't our own decisions have an effect in our own brain development? For example, what if I choose a career in investment banking, vs. one in journalism or teaching?

We make our own career decisions in life, and most of us make a combination of good and bad decisions, which influence our brain's maturation.

My father was very unusual in his career trajectory in that he worked at one place throughout his entire adult life, and died three months after he retired at 91. I've always thought that it's a good idea to make a change every ten years or so and do something different – either within the same organization or to move to another one.

It's just as good for organizations to have some staff turnover as it is for staff to move to new challenges. The time to leave one position for another is while you and your employer are still happy with what you're doing. You'll take what you learned in your prior job to your new job, and you'll add competencies from your new job that you otherwise wouldn't have developed.

I find that, in an emerging field like cognitive science, we need to start by clarifying the language we use. Can you define some words such as Learning, Education, Brain Development and Cognition.

Sure.

LEARNING: Most organisms begin life with most or all of the processing systems and information that they need to survive. Humans are a notable exception in that an adult-size brain is significantly larger than a mother's birth canal, so we're born with an immature one pound brain that develops additional mass and capabilities during its 20 year post-birth developmental trajectory. Parenting, mentoring, teaching, and mass media are examples of the cultural systems that humans have developed to help young people master the knowledge and skills they need to survive and thrive in complex environments. Learning is one the main activities we do, even if we often are not aware of it.

EDUCATION: Education, like the culture it subsumes, is a conservative phenomenon. Science and technology move rapidly, but education doesn't. So if schools often resemble the schools of 50 years ago, that should not be surprising. Parents remember their school experiences, and since they survived them, they are typically leery about educators experimenting with their children. This explains in part why schools have not incorporated many of the recent developments in neuroscience and cognitive psychology.

BRAIN DEVELOPMENT: Childhood brain development is focused on systems that allow children to recognize and remember the dynamics of environmental challenges – challenges that protective adults will solve for them. Adolescent brain development is more focused on frontal lobe development, the systems that allow us to respond appropriately and autonomously to the challenges we confront.

COGNITION: Every experience will alter our brain's organization at some level, so our brain's processing networks continually change throughout our life. This process is called brain plasticity. For example, since my brain has adapted to my switch from a typewriter to a computer, it would now be difficult (but not impossible) for me to write again on a typewriter. Now, cognition is linked to other concepts: emotion is the processing system that tells us how important something is; attention focuses us on the important and away from the unimportant things; problem-solving determines how to respond, partly on the basis of our memory of prior related experiences; and behavior carries out the decision. The general term cognition encompasses these various processes.

You recently published a book titled The Adolescent Brain: Reaching for Autonomy (2007. Corwin Press). What advice would you give to parents and educators of adolescents?

Biological phenomena always operate within ranges. For example, leaves fall from trees in the autumn, but typically not all at once. Developmental changes similarly do not occur at the same time and at the same rate in all child and adolescent brains. And just as it's possible for wind or temperature to alter the time when a leaf might fall, unexpected events can alter the time when an adolescent has to confront and respond to given environmental challenges.

The important thing for adults to do is to carefully observe an adolescent's interests and abilities, and insert challenges that move maturation forward at a reasonable level. If you push too fast, you end up with a stressed out adolescent. If you do not challenge sufficiently, you end up with a bored adolescent. No magic formula exists for getting this just right. This means, for example, that we celebrate the skills of artists and athletes who function beyond typical human capacity, and we create judicial sanctions for those whose behavior does not reach culturally acceptable levels. Most human behavior is personally chosen and executed within wide ranges. We can easily observe this wide range in such phenomena as political discourse and religious belief or practice. Adolescents strive towards autonomous adulthood as they gradually discover their interests and capabilities, and what is biologically possible and culturally appropriate. They adapt their life to wherever they're most comfortable within the marvelous sets of possible and appropriate ranges that exist.

Adolescents take risks, no doubt about that. If you want to eventually function within any range, you have to locate its outer positive and negative limits. Speed limits and other regulations provide direction, but adolescents (and adults) still tend to move towards the limits – and maybe just a smidgen beyond. Bad things can then occur. Part of learning, that each person needs to learn to self-regulate.

In short, parents and educators need to pay attention to observe where adolescent's interests and abilities lie, and engage them with experiences that will enable them to move forward. Theorists, such as Howard Gardner, Robert Sternberg, and David Perkins have proposed that intelligence involves multiple components, and can't be reduced to a single point on a numerical scale, as I.Q. attempts to do.

Education is still a field with many competing, fragmented, approaches. A typical tension is between movements that advocate focusing on intellectual strengths, vs. those that advocate training and shoring up weaknesses, or bottlenecks. What is your take?

The answer is probably both-- but do let me know when you've figured out the correct balance in that issue, and I'll contact the folks in Stockholm who give out the Nobel Prizes.

I take good note of that offer...what are the most exciting areas of brain research, and what are some resources for educators to learn about brain and refine teaching? Websites, books?

The cognitive neurosciences are currently so dynamic. It seems that an exciting new development occurs every day, and many of these new developments are reported in the mass media.

I write a monthly non-technical column on educationally significant developments in the cognitive neurosciences for the Internet journal Brain Connection. All 90 of my earlier columns are archived within the following link, so many questions of readers have probably been explored in previous columns: here.

Sharpbrains.com is another great resource. Both websites will link folks to other useful websites.

In terms of books, I always think an author’s most recent book is the best one to read, since it incorporates new developments that have occurred since earlier books were published. For example, I'm now reading Steven Pinker's intriguing new book, The Stuff of Thought: Language as a Window into Human Nature (2007, Viking). It's the fifth in 14 years in his series of books for general readers, and I've benefitted from each, and from their cumulative effect. As indicated above, my most recent book is The Adolescent Brain: Reaching for Autonomy. I'm currently working on a companion book, A Child's Brain: The Need for Nurture, which Corwin Press will publish in 2009.

One nice thing about committing to write a book is that I now have to stay alive or at least lucid for another year or so.

And you will be both. Robert, many thanks for your time, and see you in San Francisco next month.

Same. Always a pleasure to talk.

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Announcements: both Robert Sylwester and Alvaro Fernandez will be presenting at the upcoming Learning & The Brain Conference. You can learn more about the conference, and the special discount for SharpBrains' readers, clicking here.

You may enjoy some of our previous interviews in our Neuroscience Interview Series:

- James Zull on the Art of Changing The Brain.

- Elkhonon Goldberg on Cognitive Training.

- Yaakov Stern on Lifelong Learning and building a Cognitive Reserve.

Finally, a reminder that we just released a Whitepaper titled 10 Brain Fitness Myths Debunked, based on the interview series: here.

- “With the nation’s 78 million baby boomers approaching the age of those dreaded “where did I leave my keys?” moments, it’s no wonder the market for computer-based brain training has shot up from essentially zero in 2005 to $80 million this year, according to the consulting firm SharpBrains.”

- “Now comes the largest and most rigorous study of a commercially-available training program, and it shows that there is hope for aging brains. This morning, at the meeting of the Gerontological Society of America, scientists are presenting data showing that after eight weeks of daily one-hour sessions with Brain Fitness 2.0 from Posit Science, elderly volunteers got measurably better in their brain’s speed and accuracy of processing. “

We recently had the chance to interview Dr. Elizabeth Zelinski of the University of Southern California Andrus Gerontology Center, who led the IMPACT (Improvement in Memory with Plasticity-based Adaptive Cognitive Training) Study Sharon Begley refers to in the quote above. 

First, some context on this study, which is by far the largest high-quality study of its kind. The study was prospective, randomized, controlled, and used a double blind trial. 524 healthy adults 65-year-old and over were divided into two groups. One received an hour a day of training for eight to ten weeks, and the other spent the same amount of time watching educational DVDs. The IMPACT study, funded by Posit Science corporation, was performed in multiple locations, including the Mayo Clinic, USCF, and San Francisco Veteran Affairs Medical Center.

The discussion centers at his point on the initial results that were presented Gerontological Society of America (the study hasn't been published yet).

Alvaro Fernandez: Dr. Zelinski. Thank you for being with us. Could you start by setting the context and providing an overview of how human cognitive abilities typically evolve as we age – based on insights from your Long Beach Longitudinal Study?

Elizabeth Zelinski: Of course. The first concept to understand is that different cognitive skills evolve over the lifespan in different ways. Some that rely on experience, such as vocabulary, actually improve as we age. Some tend to decline gradually, starting in our late 20s. This happens, for example, with processing speed (how long it takes us to process and respond to information), memory, and reasoning. We could summarize this phenomenon by saying that as we age we get better at dealing with the familiar, but worse at dealing with the new. We can always learn, but at a slower pace.

Are there any specific tipping or inflection points in this trend, any age when the rate of decline is more pronounced?

We don’t have a clear answer to that. It depends a lot on the individual. In general it is a gradual, cumulative process, so that by age 70 we statistically see clear age declines. Which, for example, is a strong factor determining why older adults struggle to adapt to new technologies, but why trying to learn them provides needed mental stimulation. Now we know that genes only account for a portion of this decline. Much of it depends on our environment, lifestyle and actions.

Can you summarize what a healthy individual can do to slow down this process of decline, and help stay healthy and productive as long as possible?

One general recommendation is to do everything we can to prevent or delay disease processes, such as diabetes or high-blood pressure, that have a negative effect on our brains. For example, it is a tragedy in our society that we usually reduce our levels of physical exercise drastically after we leave school.

Let me then ask: what are the relative virtues of physical vs. mental exercise?

Great question! That in fact leads into my second recommendation. Aerobic exercise has been shown to be a great contributor to overall cognitive health. But it has not shown any significant effect on improved memory. This is an important point to remember: there have been dozens of studies on the impact of physical exercise on cognition and they have found many impacts, but none in the area of memory. In contrast, directed cognitive training, or “mental exercise”, has been shown to improve specific cognitive abilities, including memory.

Now, there is no magic bullet: both are important components. And I would add a third element: it is also important to maintain emotional connections. Not only with ourselves, to have self-confidence and self-esteem, but with our family our friends.

Let’s talk now about the IMPACT study initial results. What results surprised you the most?

Probably the most surprising outcome was a clear transfer of the training, which is critical so that the cognitive improvements have an impact on everyday life. The program we used, Brain Fitness 2.0, trains auditory processing. The people in the experimental group improved very significantly, which was not that surprising. What was very surprising was that there was also a clear benefit in auditory memory, which wasn’t directly trained. In other words, people who were 75-years-old performed auditory memory tasks as well as average 65-year-olds, so we can say they reversed 10 years of aging for that cognitive ability.

Another area where people in the experimental group showed significant improvement was in self-reported perception of their abilities in a variety of daily life tasks, such as remembering names and phone numbers, where they had left their keys, as well as communication abilities and feelings of self-confidence.

Those results, even if initial, are impressive and have very significant implications. Let’s now speculate a bit about the future. We have said that different cognitive abilities evolve in different ways, and we have talked about just a few of them. We have discussed how physical exercise can be useful. And how directed cognitive training may help improve specific cognitive skills, like the Brain Fitness 2.0 program developed by Dr. Michael Merzenich. Other examples include working memory training, shown by Dr. Torkel Klingberg, and attentional control, by Dr. Daniel Gopher. In the future, will we have access to better assessments and tools to identify and train the cognitive abilities we need to work on the most, in the same way that we can go to a gym today and find the combination of machines that provide the most effective personalized workout?

The physical fitness analogy is a good one, in that cognitive enhancement requires the engagement in a variety of activities, those activities must be novel, adaptive and challenging-which is why computer-based programs can be helpful. But even at a more basic level, what matters is being engaged with life, continually exposed to stimulating activities, always trying to get out of our comfort zones, doing our best at whatever we are doing. A major typical misconception is that there is only one general intelligence to care about. In reality, we have many different cognitive abilities, such as attention, memory, language, reasoning, and more, so it makes sense to have different programs designed to train and improve each of them. Before embarking on this study I was skeptic about what we would find. Now I believe cognitive training is a very promising area that deserves more scientific and policy attention.

Dr. Zelinski, thank you for your time. When do you expect your paper will be published, so we can analyze it in more detail?

You are welcome. I think the paper will be submitted for publication in the next couple of months.  We won't know where until it's been peer reviewed and accepted.  Will let you know as soon as I do.

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More reading

- see Poster results presented at GSA

- read more interviews in our Neuroscience and Psychology Interview Series

- Brain Fitness: November Monthly Digest: a collection of articles and links including news, resources, brain teasers, and more.

Prof. Robert Emmons studies gratitude for a living as Professor of Psychology at UC Davis and is Editor-In-Chief of the Journal of Positive Psychology. He has just published Thanks: How the New Science of Gratitude Can Make You Happier, an interdisciplinary book that provides a research-based synthesis of the topic as well as practical suggestions.

Alvaro Fernandez: Welcome. Prof. Emmons, could you please provide us an overview of the Positive Psychology field so we understand the context for your research?

Robert Emmons: Sure. Martin Seligman and colleagues launched what was called “positive psychology” in the late 90s as an antidote to the traditional nearly exclusive emphasis of “negative psychology” focused on fixing problems like trauma, addiction, and stress. We want to balance our focus and be able to help everyone, including high-functioning individuals. A number of researchers were investigating the field since the late 80s, but Seligman provided a new umbrella, a new category, with credibility, organized networks and funding opportunities for the whole field.

And where does your own research fit into this overall picture?

I have been researching gratitude for almost 10 years. Gratitude is a positive emotion that has traditionally been the realm of humanists and philosophers, and only recently the subject of a more scientific approach. We study gratitude not as a merely academic discipline, but as a practical framework to better functioning in life by taking control of happiness levels and practicing the skill of emotional self-regulation.

What are the 3 key messages that you would like readers to take away from your book?

First, the practice of gratitude can increase happiness levels by around 25%. Second, this is not hard to achieve - a few hours writing a gratitude journal over 3 weeks can create an effect that lasts 6 months if not more. Third, that cultivating gratitude brings other health effects, such as longer and better quality sleep time.

What are some ways to practice gratitude, and what benefits could we expect? Please refer to your 2003 paper in the Journal of Personality and Social Psychology, where I found fascinating quotes such as that “The ability to notice, appreciate, and savior the elements of one’s life has been viewed as a crucial element of well-being.”

The most common method we use in our research is to ask people to keep a “Gratitude Journal” where you write something you feel grateful for. Doing so 4 times a week, for as little as 3 weeks, is often enough to create a meaningful difference in one’s level of happiness. Another exercise is to write a “Gratitude Letter” to a person who has exerted a positive influence on one’s life but whom we have not properly thanked in the past, and then to meet that person and read the letter to them face to face.

The benefits seem to be very similar using both methods in terms of enhanced happiness, health and wellbeing. Most of the outcomes are self-reported, but there is an increasing emphasis on measuring objective data such as cortisol and stress levels, heart rate variability, and even brain activation patterns. The work of Richard Davidson is exemplary in that respect, showing how mindfulness practice can rewire some activation patterns in the frontal lobes.

Now, let me give an overview of the paper you mention, titled Counting Blessings versus Burdens: An Experimental Investigation of Gratitude and Subjective Well-Being in Daily Life (note: reference below). The paper includes 3 separate studies, so I will just be able to provide a quick glimpse. More than a hundred adults were all asked to keep a journal, and were randomly assigned to 3 different groups. Group A had to write about things they felt grateful about. Group B about things they found annoying, irritating. Group C about things that had had a major impact on them. 2 out of the 3 different experiments were relatively intense and short term (keeping a daily journal for 2-3 weeks), while one required a weekly entry during 10 weeks.

Across the 3 different studies we found that people in the gratitude group generally evidenced higher-levels of well-being than those in the comparison conditions, especially when compared to Group B (the one journaling about hassles), but also compared to the “neutral” group.

In the longer study, which ran for 10 weeks, we also saw a positive effect on hours of sleep and on time spent exercising, on more optimistic expectations for the coming week, and fewer reported physical symptoms, such as pain. Additionally, we observed an increase in reported connectedness to other people and in likelihood of helping another person deal with a personal problem.

We could then say that we can train ourselves to develop a more grateful attitude and optimistic outlook in life, resulting in well-being and health improvements, and even in becoming better-not just happier- citizens. And probably one can expect few negative side effects from keeping a gratitude journal. What do you think prevents more people from benefiting from these research findings?

Great question, I reflect often on that. My sense is that some people feel uncomfortable talking about these topics, since they may sound too spiritual, or religious. Others simply don’t want to feel obligated to the person who helped them, and never come to realize the boost in energy, enthusiasm, and social benefits that come from a more grateful, connected life.

Judith Beck talked to us recently (interview notes here) about her work helping dieters learn important mental skills through cognitive therapy techniques. You talk about gratitude. Other positive psychologists focus on Forgiveness. How can we know which of these techniques may be helpful for us?

The key is to reflect on one’s goal and current situation. For example, the practice of forgiveness can be most appropriate for people who have high levels of anger and resentment. Cognitive therapy has been shown to be very effective against depression. In a sense both groups