Augmenting Cognition

Preparing Society for the Cognitive Age

- By Alvaro Fernandez

Groundbreaking cognitive neuroscience research has occurred over the last 20 years – without parallel growth of consumer awareness and appropriate professional dissemination. “Cognition” remains an elusive concept with unclear implications outside the research community.

Earlier this year, I presented a talk to health care professionals at the New York Academy of Medicine, titled “Brain Fitness Software: Helping Consumers Separate Hope from Hype”. I explained what computerized cognitive assessment and training tools can do (assess/enhance specific cognitive functions), what they cannot do (reduce one’s “brain age”) and the current uncertainties about what they can do (i.e., delay Alzheimer’s symptoms). At the same symposium, Dr. Gary Kennedy, Director of Geriatric Psychiatry at Montefiore Medical Center, provided guidance on why and how to screen for executive function deficits in the context of dementia.

I could perceive two emerging trends at the event: 1) “Augmenting Cognition” research is most commonly framed as a healthcare, often pharmacological topic, with the traditional cognitive bias in medicine of focusing on detection and treatment of disease, 2) In addition, there is a growing interest in non-invasive enhancement options and overall lifestyle issues. Research findings in Augmenting Cognition are only just beginning to reach the mainstream marketplace, mostly through healthcare channels. The opportunity is immense, but we will need to ensure the marketplace matures in a rational and sustainable manner, both through healthcare and non-healthcare channels.

In January 2009, we polled the 21,000 subscribers of SharpBrains’ market research eNewsletter to identify attitudes and behaviors towards the “brain fitness” field (a term we chose in 2006 based on a number of consumer surveys and focus groups to connect with a wider audience). Over 2,000 decision-makers and early adopters responded to the survey.

One of the key questions we asked was, “What is the most important problem you see in the brain fitness field and how do you think it can be solved?”. Some examples of the survey free text answers are quoted here, together with my suggestions.

Most important problems in the brain fitness field

• Public awareness (39%): “To get people to understand that heredity alone does not decide brain functioning”. We need to ramp up efforts to build public awareness and enthusiasm about brain research, including establishing clear links to daily living. We can collaborate with initiatives such as the Dana Foundation’s Brain Awareness Week and use the recent “Neuroscience Core Concepts” materials developed by the Society for Neuroscience to give talks at schools, libraries and workplaces.

• Claims (21%): “The lack of standards and clear definitions is very confusing, and makes a lot of people sceptical”. We need an easy-to understand taxonomy to help consumers and professionals evaluate claims focusing on cognitive functions, not on mental health diagnoses. The classifications should be grounded on a standardized research taxonomy. However, over time we may have to develop a “labeling system” based on the targeted cognitive domain and level of validation. Press releases often only add more confusion. We should blog study results in depth, become trusted resources to trusted reporters and differentiate new findings from previous ones.

• Research (15%): “Determining what activities are most beneficial to the user with the minimum level of effort or most overlap of already existing effort”. A high priority would be to ensure widely-accepted output standards (either commercial or following consensus processes such as the schizophrenia MATRICS Cognitive Battery) with a transparent architecture of outcomes and relationships covering the impact (brain-based, cognitive, behavioral performance) by age groups and by healthy vs. specific disorders.

• Culture (14%): “Integration within existing healthcare infrastructure will require research, education and cultural change. If brain fitness remains a niche alternative approach for the well-healed, we will have failed”. We need to improve the partnership with clinicians and their professional associations.

• Assessment (6%): “Development of standardized and easily accessible assessments of cognitive status that could be used by individuals and organizations to test the efficacy of cognitive improvement methods”. Perhaps the single most effective way to bring cognitive research into the mainstream conversation would be if people took an “annual brain check-up” serving as a cognitive baseline (as objective, functional information to track changes and to inform about interventions and diagnoses). Computerized assessments are already being used in a variety of contexts, from sports neuropsychology to military Traumatic Brain Injury (TBI) detection. A recent report by the Alzheimer’s Foundation of America advocating for widespread cognitive screenings after the age of 75 or even 65 may open up a very interesting public policy debate.

• Exposure (5%): “Get information and products out to all the people, perhaps a drive to get them into public libraries”. We have a major opportunity now to help prepare society to thrive in this cognitive age. We need to improve research and focus on public awareness and standards for this opportunity to come to fruition.

Dr. Bill Reichman, CEO of Baycrest, puts it this way, “We have an opportunity to make major progress in Brain Health in the 21st century, similar to what happened with Cardiovascular Health in the 20th, and technology will play a crucial role”. For that prediction to come true, research on augmenting cognition will need to become mainstream. Neuroscientist Torkel Klingberg is optimistic, “In the future we may be as aware of cognitive function as we now are obsessed with calories, diets, glycemic index and cardiovascular training”.

The process in under way.

– Alvaro Fernandez is the Chief Executive Officer of SharpBrains (www.sharpbrains.com), a market research and educational firm that covers applications of cognitive neuroscience. Alvaro is a member of the World Economic Forum’s Council on The Future of the Aging Society, and teaches at UC-Berkeley Lifelong Learning Institute. He has an M.B.A. and an M.A. in Education from Stanford University.

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SharpBrains offers two publications to better understand emerging cognitive health research, technology and trends, and prepare for them:

- Book: The SharpBrains Guide to Brain Fitness ($24.95 book, $9.99 Kindle version)

- Industry report: The State of the Brain Fitness Software Market 2009 ($1,295, includes executive webinar and access to Network for Brain Fitness Innovation)

]]> http://www.sharpbrains.com/blog/2009/08/07/preparing-society-for-the-cognitive-age-frontiers-in-neuroscience-article/feed/ 0 http://www.sharpbrains.com/blog/2009/06/12/can-you-outsmart-your-genes-an-interview-with-author-richard-nisbett/ http://www.sharpbrains.com/blog/2009/06/12/can-you-outsmart-your-genes-an-interview-with-author-richard-nisbett/#comments Fri, 12 Jun 2009 11:10:36 +0000 David DiSalvo http://www.sharpbrains.com/blog/2009/06/12/can-you-outsmart-your-genes-an-interview-with-author-richard-nisbett/ (Editor’s Note: interviewing Richard Nisbett, author of the excellent recent book Intelligence and How to Get It: Why Schools and Cultures Count, was in my To Do list. I then found that fellow blogger David DiSalvo was faster than I was and did a great job, so here we bring you David’s interview and take).

While the debate over intelligence rages on many fronts, the battle over the importance of heredity rages loudest. It’s easy to see why. If the camp that argues intelligence is 75 to 85 percent genetically determined is correct, then we’re faced with some tough questions about the role of education. If intelligence is improved very little by schools, and if the IQ of the majority of the population will remain relatively unchanged no matter how well schools perform, then should school reform really be a priority?

More to the point, if our genes largely determine our IQ, which in turn underlies our performance throughout our lives, then what is the role of school? For some in this debate the answer to that question is simply, “to be the best you can be.” But that seems little comfort for those who aspire to “be” more than what their IQ category predicts they will.

Those on the other side of this debate question whether heredity plays as big a role as the strong hereditarians claim. And for the role it does play, they question whether hereditability implies immutability. Heredity of height, for example, is about 90 percent, and yet average height in several populations around the world has been steadily increasing due to non-genetic influences, like nutrition. If such a strong hereditary trait can be radically altered by environmental factors–and height is but one example of this–then why is intelligence different?

It is not, argues the camp that might best be described as intelligence optimists. For them, the pessimism that colors the strong hereditarian position isn’t only discouraging, it’s dangerous. Too much is hanging in the balance for pessimism about the potential of our children to prevail.

Richard Nisbett is a champion of the intelligence optimist camp, and with his latest book, Intelligence and How to Get It: Why Schools and Cultures Count , he has emerged as the most persuasive voice marshalling evidence to disprove the heredity-is-destiny argument. Intellectual advancement, Nisbett argues, is not the result of hardwired genetic codes, but the province of controllable factors like schools and social environments–and as such, improving these factors is crucially important. In the thick of controversy, he was gracious enough to spend a few minutes discussing his book with Neuronarrative.

In Intelligence and How to Get It: Why Schools and Cultures Count , you counter the arguments of strong intelligence hereditarianism, but in a sense you’re countering heritability dogma overall. What led you to take on this challenge?

My only complaint was with the heritability of intelligence per se. I just had the strong intuition that intelligence, and certainly IQ scores, were heavily influenced by the environment and by gene-environment interactions. My research indicates that in fact heritability, especially for adult IQ, is substantially less than frequently assumed.

One of the topics you discuss in the book is that drawing inferences based on correlations often produces misleading results. What’s an example of this in the case of intelligence?

The correlation between identical twins reared apart gives an overestimate of heritability because the environments of identical twins reared apart are often highly similar. But the main contradiction of heritability estimates lies in the fact that adoption produces a huge effect on IQ – much bigger than could be explained if you believed the conclusion of heritability estimates based on sibling correlations.

You discuss the importance of early childhood education and provide some compelling statistics on the IQ-boosting effects of preschool. Why in a nutshell is early education so essential?

This is speculative at this point, but here goes. It is beginning to look like the IQ deficits of poor minority kids begin extremely early and have to do with rearing techniques. Parents of such kids don’t talk to them much and don’t do things that would stimulate intelligence. At any rate, we know of several socialization practices that correlate substantially with IQ, and for all those practices parents of poor minority kids are on the low side.

If a child doesn’t receive quality early education, will he or she still be able to bridge the gap later on?

We do know that interventions as late as early adulthood can have a big effect on IQ and academic achievement. College reduces the IQ gap between blacks and whites from one standard deviation (SD) to .4 SD. Just telling junior high school kids that their intelligence is under their control can produce a gain in GPA. You can put a great deal of educational effort in at middle school and junior high ages and produce marked IQ and academic achievement gains.

You mention that children with greater self-control tend to have higher intelligence. How are these linked, and is it reasonable to conclude that increasing self-control raises intelligence?

This is speculative. We know there is a correlation between self-control and intelligence, especially between self-control and both ACT achievement and SAT scores. What we don’t know is whether this relationship is causal. I don’t doubt that it is, but I can’t prove it.

We now know that the brain isn’t a static entity, but rather possesses remarkable plasticity – even, to a degree, well into adulthood. In light of this, and your own research, is it possible for adults to still boost their IQs?

We know that you can increase fluid intelligence even in adults by some kinds of computer-game-like programs. But that work is in its infancy. We know also that the hippocampi of London taxi drivers is 25 percent larger than normal – due to an increase in the spatial relations requirements of the job.

I took away the sense from reading the book that you’re a hopeful realist. If we could begin making changes to our educational system today, what do you think are the most important things we can do to create a brighter future for our kids?

Really effective intervention with parents of low socioeconomic status infants to help them with socialization practices, really good pre-K, KIPP-type elementary and middle school.

I am hopeful, for sure. In principle you could have all these things for the bottom third of socioeconomic status families for less per year than the bailout of AIG. But I hasten to say that we don’t really know how well any of the programs shown to be effective in demonstration projects would scale up.

The book: Intelligence and How to Get It: Why Schools and Cultures Count

– David DiSalvo, a freelance writer and research wonk who has written and lectured on topics involving public health, air and water quality, branding, education, energy efficiency, healthcare and social marketing. More info here. You can follow him on Twitter

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Related reading

- Training Attention and Emotional Self-Regulation – Interview with Michael Posner

- Can Intelligence Be Trained? Martin Buschkuehl shows how

- Richard Dawkins and Alfred Nobel: beyond nature and nurture

Recently there has been growing controversy about the effectiveness of computer-based cognitive training programs. As a co-founder of Posit Science, Inc. Dr. Michael Merzenich is a staunch defender of the methods his company uses to validate the programs that they have developed. But for the purposes of this essay, I want to share some of the key ideas we discussed during his recent interview on the Brain Science Podcast.

First of all, I asked him to discuss some of the highlights of his long career. Since he was one of the first neuroscientists to embrace the concepts of neuroplasticity I was curious about how this came about. While he did have some exposure to the animal evidence as a graduate student, it was actually his experience with the invention of the cochlear implant that convinced Dr. Merzenich of the real-world, practical implications of brain plasticity. The quality of the signal provided by a cochlear implant is rather poor compared to that produced in normal hearing, but over a period of months implant recipients are able to progress to the point of being able to discern speech that sounds “almost normal.” This is a practical example of brain plasticity.

You can learn more about this if you listen to the interview, but I mention it here because it provides an important point of continuity between Dr. Merzenich’s early work with monkeys and the work he went on to do with both Scientific Learning, Inc. and Posit Science. Realizing that monkeys’ ability to understand speech was plastic lead to much of Dr. Merzenich’s later work. If you have been to the Posit Science website you know that their first program for older people is based on hearing. While I am sure the debate will continue about the effectiveness of this program, the science is interesting. We tend to be obsessed with memory, and how it seems to be less efficient as we get older. So you might wonder where hearing fits in. Dr. Merzenich’s research indicates that as people get older their ability to comprehend rapid speech goes down. The key idea is that if you can improve hearing comprehension, memory improves. This is because of the well-known fact that richer signals leave stronger memories.

A similar phenomenon has been observed with vision. As people get older they tend to spend more time focused directly in front of themselves and less time sampling their surroundings. Not only does this mean that they literally see less of what is going on around them, it means their memories are impoverished. Thus, Posit Science’s new Insight program is based on training people to regain the habit of frequently scanning the periphery that comes naturally when one is young.

I would hope that in addition to examining these programs for efficacy, more researchers will build on the basic concepts to develop other programs.

While it is important to develop effective programs for cognitive fitness and improvement, Dr. Merzenich and I both think it is equally important that people embrace lifestyles that will utilize the brain plasticity that everyone has. When I asked him for advice he emphasized the importance of physical activity and the importance of “remaining engaged in life.” If you want your brain to stay “sharp” you have to keep challenging it. Avoid the temptation to take the easy way out by intentionally trying things you aren’t already good at. “I am too old to learn …” is no longer a valid excuse!

Links:

- Brain Science Podcast #54: show notes to Episode 54 of the Brain Science Podcast with Dr. Michael Merzenich.

- Link to Audio  File of Dr. Merzenich’s Interview

Ginger Campbell, MD graduated from the University of Alabama School of Medicine. She also has a Master’s Degree in Biomedical Engineering and spent several years teaching at the University of Alabama in Birmingham. Dr. Campbell has been practicing emergency medicine since 1992. She started the Brain Science Podcast in 2006. Her goal is to help general audiences understand how recent discoveries in neuroscience are unraveling the mysteries of how our brains make us who we are.

Previous posts by Dr. Ginger Campbell, highlighting selected podcasts:

On Being Certain: Believing You Are Right Even When You’re Not.

Brain Science: “Brain Rules” Podcast.

“Our government is proud to support Baycrest and its invaluable work, which is already leading to the discovery of important new tools and approaches to treating brain diseases associated with aging,” said Minister of Research and Innovation, John Wilkinson.

We have Baycrest’s CEO with us today, to explore why Ontario and Baycrest chose to become pioneers in this area, and discuss some of the main opportunities, and challenges. Dr. William E. Reichman is President and CEO of Baycrest. Dr. Reichman, an internationally-known expert in geriatric mental health and dementia, is also Professor of Psychiatry on the Faculty of Medicine at the University of Toronto.

Alvaro Fernandez: Bill, thank you for your time. Let me start by asking, given that you just spoke at the recent Consumer Electronic Show, what do you make of the growing brain fitness field?

Bill Reichman: it looks like a classic example of a very promising but still early stage field – a lot of opportunity and enthusiasm, but also a lot of product claims that are not backed by solid research. Think about the physical fitness analogy: even today, after decades of progress, you still see people buying research-based products such as treadmills but also all types of random machines they see on TV and have not been subject to any validation. Similarly, consumers today do not know what to make of growing brain fitness claims. As another speaker pointed out, for the industry to fulfill its promise, it will need to be careful with research and claims, not to end up like the nutraceuticals category.

By the way, let me recognize that the work you are doing with SharpBrains reports and your website is very important to offer quality information.

Thank you. Let’s step back for a moment. Taking a, say, 10 years view, what is the main opportunity that technology-based brain fitness can offer to society?

First of all, let me say that I think we have an opportunity to make major progress in Brain Health in the XXI century, similar to what happened with Cardiovascular Health in the XX, and technology will play a crucial role.

Given the rapid advances we are witnessing today in the research and technology arenas, I feel confident in saying that in less than 10 years we will have both valid and reliable assessments of cognitive functions, that will be used both by consumers at home and in a variety of health settings, and a better knowledge of what specific cognitive rehabilitative interventions may help specific groups of patients.

Quality and widely available assessments are a critical part of the puzzle. Consumers and professionals need easy-to-use, low cost, assessments to measure both their needs and the impact of different interventions. Baycrest is going to take a leadership role in this area—we believe that the development of a tool equivalent to the blood pressure cuff will have great impact on brain health in the areas of prevention and treatment.

 

Another important component will need to be professional development and training of health professionals. What is Baycrest doing in that direction?

We are very active in knowledge exchange using modalities such as telehealth. For example, we run a Behavioral Neuroscience Rounds virtual series to share best practices with hospitals in Canada, the Middle East, and probably soon the USA too.

Tell us both about the Centre for Brain Fitness launched last year, and the Women’s Brain Health Initiative you have just announced.

As you know, the government of Ontario and local donors invested $20m in a new center here, housed in the Rotman Research Institute, to develop and commercialize brain fitness technologies. Baycrest has traditionally been more focused on the research than the development side, so this is new and exciting step for us. We are now looking to hire the inaugural Director for the Centre of Brain Fitness, so let us know if you have any suggestions. We are looking for a globally recognized leader in neuroplasticity research and cognitive neurorehabilitation. As an adjunct to the Centre, we are in the process of creating a spin-off that will help identify and prioritize commercial applications of our research. You have discussed this with Veronika Litinski from MaRS Venture group who is partnering with us.

Our traditional research strengths have been cognitive assessments and cognitive rehabilitation, so it is a natural extension for us to expand our focus to include healthy aging and the needs of an aging workforce , and to investigate new platforms such as PDAs to enable people to function at the highest possible level.

The Women’s brain health initiative was spearhead by friends of Baycrest, active women of the baby boomer generation. They are interested in research to identify strategies and methods to prevent Alzheimer’s Disease, which affects women disproportionally given their longer life expectancy and frequent status as caregivers, and also in specific gender related topics such as the impact of female hormones on brain development and function. They are raising funds to support new initiatives in women’s brain health and aging at Baycrest and supporting women neuroscientists and enabling their research to be relevant and sensitive to women’s brain health concerns.

A quick clarification – you mention your traditional focus on cognitive rehabilitation. Neuropsychologists have been using computerized cognitive training programs for years to support post-stroke and post-traumatic brain injury recovery, two problems that affect millions of people yet don’t seem to attract enough attention given the current media theme on baby boomers and healthy aging. What is your center doing in that area?

Two of our researchers, Drs. Donald Stuss and Gordon Winocur, in collaboration with Ian Robertson of Trinity College, Dublin, recently released the main textbook in that area, titled Cognitive Neurorehabilitation, published by Cambridge University Press. You should ask them more specific questions about the present state of the field.

I will. Finally, what is the main obstacle you see today for the development of a sustainable brain fitness market that can fulfill its promise?

I’d say the lack of widely accepted standards for outcome measures. There are myriad ways to measure the impact of cognitive exercise and other lifestyle options – we can talk psychometrics, assessments of daily living, neuroimaging findings. But, there is not a consensus yet on what to measure and how. Dr. Gary Small and I were talking recently about the need to step up in this area, figuring out how to engage a variety of serious stakeholders in solving this important issue.

I agree with that sentiment. We have already run over the time for this interview, but we need to follow-up on that. Thank you for your time!

My pleasure.

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Resources mentioned in the interview:

 - Centre for Brain Fitness at Baycrest

 - Cognitive Neurorehabilitation textbook 

Related articles and resources

- Neuroscience Interview Series

- 10-Question Program Evaluation Checklist

- Top 10 Brain Fitness Books

1) Basak C, et al “Can training in a real-time strategy video game attenuate cognitive decline in older adults?” Psychol Aging 2008; DOI: 10.1037/a0013494.

2) Boot, W. R., Kramer, A. F., Simons, D. J., Fabiani, M. & Gratton, G. (2008) The effects of video game playing on attention, memory, and executive control. Acta Psychologica, 129, 387-398.

Let’s first review the first study, a significant experiment in that it showed wide cognitive benefits in adults over 60 years old who played a strategy videogame (Rise of Nations) for 23 hours.

Playing computer games improves brain power of older adults, claim scientists (Telegraph)

- The team at the University of Illinois recruited 40 adults over 60 years old, half of whom were asked to play a computer game called Rise of Nations, a role-playing game in which you have to build your own empire.

- Game players have to build cities, feed and employ their people, maintain an adequate military and expand their territory.

- Both groups were assessed before, during and after the video game training on a variety of tests.

- As a group, the “gamers” became significantly better – and faster – at switching between tasks as compared to the comparison group. Their working memory, as reflected in the tests, was also significantly improved and their reasoning ability was enhanced.

Really remarkable results.

The second study, in contrast, found no comparable cognitive benefits for college students in their early 20s who played the same game for the same number of hours, regardless of whether they play videogames often or don’t.
How come this contrast?

In order to better understand this, we contacted Arthur Kramer and asked him to elaborate on what he told us in our first interview. Let’s first review what we discussed in June:

Question (me): Tell us more about your work with cognitive training for older adults.

Answer (Prof Kramer): 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.

Full interview: here

And below are his answers to my new questions last week, after both studies were published.

What may, in your view, explain the different effect of Rise of Nations on non-gamers, contrasting both studies?
Certainly one of the most notable between our two studies was the age of the study participants – with young adults serving as subjects in the Acta Psychologica paper and older adults serving as subjects in the Psychology & Aging study. We observed training benefits for the older but not for the younger adults. There are several reasons why this might have been the case. First, older adults perform more poorly on the target abilities that we were trying to train – that is executive control processes – than younger adults. So it might be the case that video game training benefits are more readily observed for cognitive processes that are somewhat degraded. Second, while it is quite easy to find older adults who have never played video games (and especially strategy-based games like Rise Of Nations) it is very difficult to find completely naïve younger adults (although the younger adults subjects in our study did play video games less than 1 hour per week). So it is conceivable that video game training based gains might be more readily observed the less experience that someone has with video games. These seem to be the most likely reasons for the different effects in the two studies.

What is the main implication from both studies combined/ what do we know today that we didn’t know 3 months ago?
First, I think that our results suggest promise with regard to video game playing and older adults cognition. However, given, to my knowledge, this is the first attempt to improve executive control abilities of older adults via strategy-based video game playing certainly additional studies should be conducted to further explore this relationship, particularly with real-world tasks as transfer tasks. Second, the results of our study with younger adults suggest that caution is in order with regard to assuming that video game training will enhancing, perceptual, attentional and cognitive abilities of young people. Clearly, there are important boundary conditions of such relationships that we don’t yet know.

Dr. Newberg, thank you for being with us today. Can you please explain the source of your interests at the intersection of brain research and spirituality?

Since I was a kid, I had a keen interest in spiritual practice. I always wondered how spirituality and religion affect us, and over time I came to appreciate how science can help us explore and understand the world around us, including why we humans care about spiritual practices. This, of course, led me to be particularly interested in brain research.

During medical school I was particularly attracted by the problem of consciousness. I was fortunate to meet researcher Dr. Eugene D’Aquili in the early 1990s, who had been doing much research on religious practices effect on brain since the 1970s. Through him I came to see that brain imaging can provide a fascinating window into the brain.

Can we define religion and spirituality -which sound to me as very different brain processes-, and why learning about them may be helpful from a purely secular, scientific point of view?

Good point, definitions matter, since different people may be searching for God in different ways. I view being religious as participating in organized rituals and shared beliefs, such as going to church. Being spiritual, on the other hand, is more of an individual practice, whether we call it meditation, or relaxation, or prayer, aimed at expanding the self, developing a sense of oneness with the universe.

What is happening is that specific practices that have traditionally been associated with religious and spiritual contexts may also be very useful from a mainstream, secular, health point of view, beyond those contexts. Scientists are researching, for example, what elements of meditation may help manage stress and improve memory. How breathing and meditation techniques can contribute to health and wellness. For example, my lab is now conducting a study where 15 older adults with memory problems are practicing Kirtan Kriya meditation during 8 weeks, and we have found very promising preliminary outcomes in terms of the impact on brain function. This work is being funded by the Alzheimer’s Research and Prevention Foundation, but we have submitted a grant request to the National Institute of Health as well.

Can you give an overview of the benefits of meditation, including Richard Davidson’s studies on mindfulness meditation?

There are many types of meditation – and we each are researching different practices. Which of course share some common elements, but are different in nature. Dr. Davidson has access to the Dalai Lama and many Buddhist practitioners, so much of his research centers on mindfulness meditation. We have easier access to Franciscan monks and to practitioners of Kirtan Kriya meditation.

At its core, meditation is an active process that requires alertness and attention, which explains why we often find increased brain activity in frontal lobes during practice. Usually you need to focus on something – a mantra, a visual or verbal prompt- while you monitor breathing.

A variety of studies have already shown the stress management benefits of meditation, resulting in what is often called Mindfulness Based Stress Reduction. What we are researching now is what are the cognitive – attention, memory- benefits? It is clear that memory depends on attention and the ability to screen out distractions – so we want to measure the effect of meditation on the brain, both structurally and functionally.

To measure the brain activation patterns we have been using SPECT imaging, which involves injecting small amounts of radioactive tracers in volunteers, and helps us get a more view of what happens during practice (fMRI is much more noisy).

To measure functional benefits we use the typical batteries of neuropsychology testing.

If there is a growing body of evidence behind the health and cognitive benefits of meditation – what is preventing a more widespread adoption of the practice, perhaps in ways similar to yoga, which is now pretty much a mainstream activity?

Well, the reality is that meditation requires practice and dedication. It is not an easy fix. And some of the best-researched meditation techniques, such as mindfulness meditation, are very intensive. You need a trained facilitator. You need to stick to the practice.

In fact, that’s why our ongoing research focused on a much easier to teach and practice technique. We want to see if people can practice on their own, at home, a few minutes a day for a few weeks.

The other problem is that this is not a standardized practice, so there is a lot of confusion: many different meditation techniques, with different sets of priorities and styles.

My advice for interested people would be to look for something simple, easy to try first, ensuring the practice is compatible with one’s beliefs and goals. You need to match practice with need: understand the specific goals you have in mind, your schedule and lifestyle, and find something practical. Otherwise, you will not stick to it (similar to people who never show up at the health club despite paying fees).

New York Times columnist David Brooks recently wrote two very thought-provoking articles, one on the Cognitive Age we are living in, another on the Neural Buddhists, where he quotes your work. What is the big picture, the main implications for society from your research?

I believe Philosophy complements Science, and all of us human beings would benefit from spiritual practices to achieve higher state of being, develop compassion, increase awareness, in ways compatible with any religious or secular beliefs. This is the main theme of my upcoming book, How God Changes Brain (to be published on March 2009): how we develop a shared knowledge of our common biology, and celebrate the differences which are based on our specific contexts. We are spiritual and social beings.

From an education point of view, I believe schools will need to recognize that rote learning is not enough, and add to the mix practices to improve cognition, and manage stress and relationships.

That spiritual angle may prove controversial in a number of scientific quarters. What would, for example, say to biologist Richard Dawkins?

I’d tell him that we all view the world through the lens of our brains, reflecting our cultural, social, and personal background. His view is based on his lens. Same as mine. All of us have a belief system. His is not particularly more accurate than everybody else’s.

We shouldn’t throw out the baby with bathwater. I don’t think religion is a black & white matter: yes, fundamentalism is a problem, as is rejecting data and ignoring scientific findings. But there are also good elements: the motivation to care about human beings, to develop compassion, to perfect ourselves and our world.

Dr. Newberg, thank you for your time today.

My pleasure.

——

You may enjoy more interviews with leading scientists by checking out our Neuroscience Interview Series.

Dr. Posner, many thanks for your time today. I really enjoyed the James Arthur Lecture monograph on Evolution and Development of Self-Regulation that you delivered last year. Could you provide a summary of the research you presented?

I would emphasize that we human beings can regulate our thoughts, emotions, and actions to a greater degree than other primates. For example, we can choose to pass up an immediate reward for a larger, delayed reward.

We can plan ahead, resist distractions, be goal-oriented. These human characteristics appear to depend upon what we often call “self-regulation.” What is exciting these days is that progress in neuroimaging and in genetics make it possible to think about self-regulation in terms of specific brain-based networks.

Can you explain what self-regulation is?

All parents have seen this in their kids. Parents can see the remarkable transformation as their children develop the ability to regulate emotions and to persist with goals in the face of distractions. That ability is usually labeled ‘‘self-regulation.’’

The other main area of your research is attention. Can you explain the brain-basis for what we usually call “attention”?

I have been interested in how the attention system develops in infancy and early childhood.

One of our major findings, thanks to neuroimaging, is that there is not one single “attention”, but three separate functions of attention with three separate underlying brain networks: alerting, orienting, and executive attention.
1) Alerting: helps us maintain an Alert State.

2) Orienting: focuses our senses on the information we want. For example, you are now listening to my voice.

3) Executive Attention: regulates a variety of networks, such as emotional responses and sensory information. This is critical for most other skills, and clearly correlated with academic performance. It is distributed in frontal lobes and the cingulate gyrus.

The development of executive attention can be easily observed both by questionnaire and cognitive tasks after about age 3–4, when parents can identify the ability of their children to regulate their emotions and control their behavior in accord with social demands.

“Executive attention” sounds similar to executive functions.

Executive functions are goal-oriented. Executive attention is just the ability to manage attention towards those goals, towards planning.

Both are clearly correlated. Executive attention is important for decision-making (how to accomplish an external goal) and with working memory (the temporary storage of information). For example, given that you said earlier that you liked my monograph,  I have been thinking of the subheadings and sections there as I provide you my answers, using my working memory capacity.

You said that each of the three functions of attention are supported by separate neural networks.

Neuroimaging allows us to identify sets of distributed areas that operate together. Different techniques allow us to see different things. For example, fMRI lets us see the activation of areas of grey matter. A more recent technique, diffusion tensor, is focused instead on the white matter. It detects connectivity among neurons, it helps us see a map of networks.

How many networks have been identified so far?

So far, a number of networks have been identified. For an illustration, you can see the wonderful interactive Brain Map by the University of Texas, San Antonio (Note: http://www.brainmap.org/).

Let me mention another fascinating area of research. There is a type of neuron, named the Von Economo neuron, which is found only in the anterior cingulate and a related area of the anterior insula, very common in humans, less in other primates, and completely absent in most non-primates.  These neurons have long axons, connecting to the anterior cingulate and anterior insula, which we think is part of the reason why we have Executive Attention. Diffusion tensor allows us to identify this white matter, these connections across separate brain structures, in the live brain. From a practical point of view, we can think that neural networks like this are what enable specific human traits such as effortful control.

What is effortful control?

It is a higher-order temperament factor consisting of attention, focus shifting, and inhibitory control – both for children and adults. A common example is how often you may make plans that you do not follow through with. A test often used to measure executive attention is the Stroop Test (you can try it here). Effortful control has been shown to correlate with the scores on executive attention at several ages during childhood, and imaging studies have linked it to brain areas involved in self-regulation.

Good parenting has been shown to build good effortful control, so there are clear implications from this research.

Tell us now about your recent research on attention training

Several training programs have been successful in improving attention in normal adults and in patients suffering from different pathologies. With normal adults, training with video games produced better performance on a range of visual attention tasks. Training has also led to specific improvements in executive attention in patients with specific brain injury. Working-memory training can improve attention with ADHD children.

In one recent study we developed and tested a 5-day training intervention using computerized exercises. We tested the effect of training during the period of major development of executive attention, which takes place between 4 and 7 years of age.

We found that executive attention was trainable, and also a significantly greater improvement in intelligence in the trained group compared to the control children. This finding suggested that training effects had generalized to a measure of cognitive processing that is far removed from the training exercises.

A collaborator of our lab, Dr. Yiyuan Tang, studied the impact of mindfulness meditation with undergrads to improve exec attention, finding significant improvements as well. We hope that training method like this will be further evaluated, along with other methods, both as possible means of improving attention prior to school and for children and adults with specific needs.

Can you explain the potential implications of this emerging research on Education and Health?

It is clear that executive attention and effortful control are critical for success in school. Will they one day be trained in pre-schools? It sounds reasonable to believe so, to make sure all kids are ready to learn. Of course, additional studies are needed to determine exactly how and when attention training can best be accomplished and its lasting importance.

In terms of health, many deficits and clinical problems have a component of serious deficits in executive attention network. For example, when we talk about attention deficits, we can expect that in the future there will be remediation methods, such as working memory training, to help alleviate those deficits.

Let me add that we have found no ceiling for abilities such as attention, including among adults. The more training, even with normal people, the higher the results.

Let me ask your take on that eternal question, the roles of nature and nurture.

There is a growing number of studies that show the importance of interaction between our genes and each of our environments. Epigenetics is going to help us understand that question better, but let me share a very interesting piece of research from my lab where we found an unusual interaction between genetics and parenting.

Good parenting, as measured by different research-based scales, has been shown to build good effortful control which, as we saw earlier, is so important. Now, what we found is that some specific genes reduced, even eliminated, the influence of the quality of parenting. In other words, some children’s development really depends on how their parents bring them up, whereas others do not – or do to a much smaller extent.

Too bad that we do not have time now to explore all the potential ethical implications from emerging research like that…let me ask a few final questions. First, given that we have been talking both about formal training programs (computer-based, meditation) and also informal ones (parenting), do we know how formal and informal learning interact? what type can be most effective when, and for whom?

Great question. We don’t know at this point. A research institute in Seattle, funded by the National Science Foundation, is trying to address that question. One practical issue they address is the influence of bilingual education on cognition.

How can SharpBrains readers access the computer-based attention training program you talked about earlier?

Researchers and parents can download the program, which is aimed at kids aged 4 to 6. The computerized exercises are available on www.teach-the-brain.org. Click on learning tools and follow attention.
Finally, what can we expect from your lab in the next years?

We will hear soon if we obtain the NIH proposal to train children at age 5 and then follow-up over the years, compared to a control group. The program I mentioned earlier showed good short-term results, but we would like to track those kids over time and see what happens. For example, we will examine whether or not an early intervention might translate into a “snowball effect” of higher levels of cognitive and school performance.

References:

- Tang, Y., Ma, Y., Wang, J., Fan, Y., Feng, S., Lu, Q., et al. (2007). Short-term meditation training improves attention and self-regulation. Proceedings of the National Academy of Sciences, 104(43), 17152-17156.

-Rueda, M.R., Rothbart, M.K.. & Saccamanno, L. & Posner, M.I. (2005) Training,maturation and genetic influences on the development of executive attention. Proc.U.S Nat’l Acad of Sciences 102, 14931-14936.

- Rueda, M.R., Posner, M.I., & Rothbart,M.K. (2005) The development of executive attention: contributions to the emergence of self regulation. Developmental Neuropsychology 28, 573-594.

This is the same reporter who suffered a severe traumatic brain injury when a roadside bomb detonated next to his vehicle in January 29th 2006 as he was covering news developments in Iraq.

Today we are fortunate to interview Lee Woodruff, Bob’s wife and pillar throughout his recovery. Lee and Bob co-wrote the fantastic book In an Instant: A Family’s Journey of Love and Healing.

Alvaro Fernandez: Lee, many thanks for your time. I was amazed reading your book, where you share your journey, and then watching Bob interview John Edwards, the best display I can imagine of his recovery. Can you please summarize for us what Bob -and you- went through since January 2006?

Lee Woodruff: As you know, Bob suffered a life-threatening traumatic brain injury in Iraq. He was promptly taken under military care and underwent a series of surgeries for head injuries, with a joint Army & Air Force neurosurgical team in Iraq, in a US Army Medical Command hospital in Germany, and at Bethesda Naval Hospital, back here in the US.

During this time, spanning around 4 months, he spent 37 days in coma, and his skull had to be surgically rebuilt. The cognitive rehabilitation process started then, at a medical facility closer home.

Can you please explain what kind of cognitive rehab Bob has gone though-both in a formal way, with a therapist, and informally, on his own?

The first thing I’d like to say is that rehab is a long process. Doctors told me that Bob, despite the severity of his injuries, had better chances to recover than other victims, because of the reserve of neurons and connections he had built thanks to an intellectually stimulating and diverse life, including living in China for several years and traveling to dozens of countries, having worked as a lawyer and as a journalist, and his overall curiosity and desire to learn. It seems that more and more research shows how people who are mentally active throughout their lives, either through their jobs, or doing puzzles, sudokus…are, of course up to a point, better prepared to deal with problems such as TBI.

Still, recovery is a long process. Bob had six months of structured cognitive therapy focused on speech and languages areas, because that was the part of his brain that had been most damaged. The therapist identified the main tasks for him to work on in a challenging, yet familiar way, usually asking Bob, for example, to read the New York Times, then try to remember what he had read, and write a short essay on his thoughts and impressions.

Since then he has, in a sense, used his work in the documentary To Iraq and Back and other projects at ABC as his informal, but very effective, way to keep improving. I am amazed to watch in real time how, even today, how he gets better and better. To give you an example of his motivation to recover: he recently took on Chinese lessons to see if working on that also helped him.

In the book, Bob says that, if he had to say in one word what he was experiencing during much of the recovery, he would use the word “slower”. His brain was slower at processing new information, at remembering words. What progress has he experienced?

A lot. He is not exactly at the same level he was before the injury, but he is again an amazing reporter, father, and husband. And I see progress every month, so we have hope that he will continue getting better and better.

Sometimes Bob tells me he is not the person I married. And then, as I mention in the book, I laugh and reply “I am not either. I’m older, wiser and more wrinkled.”
I have learned to trust him. Especially in the beginning, it wasn’t always easy to fully accept and follow his judgment, but I have seen how little by little he grew perfectly able to recreate his role as a husband and as a father, and to recreate our respective roles in the family. It has been wonderful to see that happen. It has been a miracle.

Bob has been a very fortunate survivor of traumatic brain injury. There are over a million cases every year of TBI. Many of them are military-related (a recent RAND study estimates that over 300,000 US service members have sustained TBI during assignments in Iraq or Afghanistan), but also happen in civilian life, mainly due to traffic accidents or sports concussions. What do we know today about how to prevent and treat TBI?

The Iraq War is literally re-writing the book, the way researchers and doctors see and tackle the problem. Most of the progress is happening in the military, but I hope that transfers into benefits for civilians, too. From a preventive point of view, the military has been stepping up to improve the body armor of soldiers, and I can now see why wearing seat belts as we drive and helmets as we bike can make a big difference.

From the recovery point of view, there is much more optimism and hope today than only a few years ago about how many TBI patients can improve, if given the opportunity to, through a supportive environment and physical and cognitive therapy. The military has recognized the problem of the so-called “Walking Wounded’, and is devoting significant resources to analyzing best options and treating them. As we chatted earlier, the Army recently announced that from now on soldiers will get a cognitive screening before they get deployed to the field, so that in case there are problems that screening can serve as a good baseline to compare functions to.

But the improvement in the area is only starting. We need to see much progress.

Can you now tell us more about the Bob Woodruff Foundation for Traumatic Brain Injury? What are your main priorities?

Bob and I are devoting much time to raising awareness of the problem and the need to find and implement good solutions for cognitive care. Our foundation supports community, grass-roots approaches to helping TBI survivors and their families. Given the huge scale of the problem among the military, and the fact that Bob survived thanks to the excellent care he received from the military along the way, we are focusing first on helping military victims.

For example, we recently funded four scholarships for TBI-related research, and also bought 300 mattresses for a small non-profit that helps patients and their spouses rebuild their lives once they have to leave Army bases-many of whom cannot afford to move all their belongings, including beds and mattresses, out of the bases.

And there are many more things to do. For example, while many more soldiers are  getting better care, that is not always the case with National Guard reservists who, despite having a dedicated branch of the armed forces oversee their progress, are often at more at risk of living with undetected TBI since they don’t have to report at bases once they are back.

It is also not clear that the military (as well as insurance companies) are always willing to pay for the long-term costs of care.

What are some specific ways people can support the work of your foundation?

They can visit our new website, Bob Woodruff Foundation (http://remind.org/), to learn about the problems and to donate funds, no matter how big or small. We are also holding a fundraising event in NYC in November to raise awareness.

But probably the most important thing every one can do is to recognize the sacrifices the soldiers have made, and find active ways to look for them and help them in their own communities. Soldiers and their families often have grown in a culture of self-reliance, of not asking for help, so here we all need to take the initiative to figure out how we can help. Ask yourself, how can I help the TBI survivors in my neighborhood? Perhaps by giving them a job, or offering them help or training, so they can secure one? How can I help their spouses and families maintain healthy and happy environments? Perhaps by offering them free movie tickets? A massage?

Lee, many thanks for those suggestions. I do have friends at a local Veteran Affairs hospital, and will follow-up on those great ideas. I hope our readers can also think of ways they can help (and exercise their brains along the way). Is there something else you would like to add, that you would know everyone to be aware of?

I’d say never give up. We have seen how Bob has recovered, which I think is a miracle. Let’s simply try our best to help everyone out there.

For further information:

- Book: In an Instant: A Family’s Journey of Love and Healing
- Foundation: Bob Woodruff Foundation.

Related interviews:

- Build Your Cognitive Reserve – Dr. Yaakov Stern

- Dr. Elkhonon Goldberg on Cognitive Training

- Cognitive Simulations: Interview with Prof. Daniel Gopher

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