SharpBrains

Think about this: How can anyone take care of his or her brain when every week brings a new barrage of articles and studies which seem to contradict each other?

Do supplements improve memory? Do you need both physical and mental exercise –or is one of them enough? Which brain training approach, if any, is worth one's time and money?

We tried to address these questions, and many others, in our recent book, The SharpBrains Guide to Brain Fitness (182 pages, $24.95), that we presented at Games for Health Conference last week. The book is the result of over two years of extensive research including more than a hundred interviews with scientists, professionals and consumers, and a deep review of the scientific literature, led by neuropsychologist Elkhonon Goldberg and myself with the help of cognitive scientist Pascale Michelon. As we wrote in the Introduction, what we wanted to do first of all was to debunks these 10 myths on brain health and brain training:

Myth 1. Genes determine the fate of our brains.
Facts: Lifelong neuroplasticity allows our lifestyles and actions to play a meaningful role in how our brains physically evolve, especially given longer life expectancy.

Myth 2. Aging means automatic decline.
Facts: There is nothing inherently fixed in the precise trajectory of how brain functions evolve as we age.

Myth 3. Medication is the main hope for cognitive enhancement.
Facts: Non-invasive interventions can have comparable and more durable effects, side effect-free.

Myth 4. We will soon have a Magic Pill or General Solution to solve all our cognitive challenges.
Facts: A multi-pronged approach is recommended, centered around nutrition, stress management, and both physical and mental exercise.

Myth 5. There is only one “it” in “Use It or Lose it”.
Facts: The brain is composed of a number of specialized units. Our life and productivity depend on a variety of brain functions, not just one.

Myth 6. All brain activities or exercises are equal.
Facts: Varied and targeted exercises are the necessary ingredients in brain training so that a wide range of brain functions can be stimulated.

Myth 7. There is only one way to train your brain.
Facts: Brain functions can be impacted in a number of ways: through meditation, cognitive therapy, cognitive training.

Myth 8. We all have something called “Brain Age”.
Facts: Brain age is a fiction. No two individuals have the same brain or expression of brain functions.

Myth 9. That “brain age” can be reversed by 10, 20, 30 years.
Facts: Brain training can improve specific brain functions, but, with research available today, cannot be said to roll back one’s “brain age” by a number of years.

Myth 10. All human brains need the same brain training.
Facts: As in physical fitness, users must ask themselves: What functions do I need to improve on? In what timeframe? What is my budget?

Do you have other myths in mind you would like  us to address?

We have started to receive great feedback from the healthcare community, such as this email from a neurosurgeon in Texas:

"I really like the book, it is comprehensive without being too technical. I have recommended it to several patients. There are some other books that I expected would be greeted with enthusiasm, but were too complex for most of my patients. I think this book is right in the sweet spot".

And this great book review by an Internist Physician and Robert Wood Johnson Foundation Fellow, titled Is Your Brain A Couch Potato?:

“…a short, sweet, entertaining read of a complex topic, with timely (written in 1/09) reviews of 21 top technology products, as well as informed and expert predictions of where this burgeoning brain-fitness field is headed. More importantly, after you read it, you'll have a good, detailed sense of where you, personally, can act to improve your own couch-potato brain - and how to keep it fit and flexible your whole life. The SharpBrains Guide To Brain Fitness reminds of us all why books (and not just googling a topic) can be well worth your time and money. Two Stethoscopes Up - check it out. life."

—Doc Gurley, book review for SFGate.com (06/08/09)

The book:  The SharpBrains Guide to Brain Fitness (available via Amazon.com Here, review copies available upon request).

Description: While most of us have heard the phrase “use it or lose it,” very few understand what “it” means, or how to properly “use it” in order to maintain brain function and fitness. The SharpBrains Guide to Brain Fitness is an invaluable guide that helps readers navigate growing brain research and identify the lifestyle factors and products that contribute to brain health and fitness. By gathering insights from eighteen of the world’s top scientists and offering tools and detailed descriptions of over twenty products, this book is an essential guide to the field of brain fitness, neuroplasticity and cognitive health. An accessible and thought-provoking read, The SharpBrains Guide to Brain Fitness educates lifelong learners and professionals in healthcare, education, business, etc., on emerging trends and forecasts of what the future will hold.

Products Reviewed (we reviewed scientific studies published before January 2009, when the manuscript text was closed):

- Overall brain maintenance: Brain Age series (Nintendo), BrainWare Safari (Learning Enhancement Corporation), FitBrains.com (Vivity Labs), Happy-Neuron.com (Scientific Brain Training), Lumosity.com (Lumos Labs), MindFit (CogniFit), (m)Power (Dakim)

- Targeted brain workout: Classic and InSight (Posit Science), Working Memory Training JM and RM (Cogmed), DriveFit (CogniFit), Earobics (Houghton Mifflin), Fast ForWord (Scientific Learning), IntelliGym (Applied Cognitive Engineering), Vision Restpration Therapy (NovaVision)

- Emotional self-regulation: emWave PC and Personal Stress Reliever (HeartMath), Journey to the Wild Divine (Wild Divine), RESPeRATE (InterCure), StressEraser (Helicor)

Given the whole distracting "controversy" of whether Nintendo Brain Age "works" or not, I have started to use the following "brain teasers" in my talks in order to help the audience gain a more useful perspective of what is going on. They worked great both in the Medicare Readmissions Summit in DC a few weeks ago, and at the Games for Heath Conference last week.

Q: How many soldiers in the US Army have gone through computerized cognitive testing before being deployed, and why?
A: Over 150,000, in order to establish an objective starting baseline and identify potential PTSD and TBI problems upon their return

Q: How big is the ongoing investment by OptumHealth, a division of UnitedHealth Group (UNH), in developing computerized cognitive assessments to inform clinical decision-making?
A: over $6m

Q: How many Allstate policy-holders over the age of 50 are now using a computerized cognitive training program to measure the potential improvements in driving safety derived from the training?
A: Over 8,000, in the state of Pennsylvania

Q: How many residential communities are offering computerized cognitive training programs to their residents?
A: Over 700, in the US alone, covering independent and assisted living

Q: How much money has the Government of Ontario invested in setting up a new Centre for Brain Fitness as part of Baycrest research center in order to develop and commercialize technologies to assess and enhance cognitive functions?
A: $10m, matched with another 10m from local investors

For more on our Cognitive Health Track at Games for Health Conference last week, see this USA Today article:

More doctor's prescriptions may include brain games to improve mental acuity

(pretty good overall, but please note that SharpBrains didn't organize the whole conference, "only" the cognitive health track, which was a lot of stimulating fun. Ben Sawyer and team did overall conference).

This is a press release that went through the wire earlier today. If you are interested, in attending the conference, you can learn more and register Here

Note that below you can find 5 out of the 12 sessions - we will announce the full track tomorrow. To get a 15% off registration fees, you can use discount code: sharp09, when you register.

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The Games for Health Project, organizers of the 5th Annual Games for Health Conference, today announced its first Cognitive Health Track powered by SharpBrains, a leading market research company focused on the brain fitness and the cognitive health market.

The Cognitive Health track builds upon previous year's sampling of sessions looking at cognitive health and fitness, expanding to a full two-day track at The Games for Health Conference, June 11-12, Boston, MA. The Conference features the largest gathering of organizations interested in the intersection between videogames, health and healthcare.

"There is already a very active cognitive health videogames industry and field of research," said Ben Sawyer, co-founder of the Games for Health Conference. "We partnered with SharpBrains to bring their expertise in this field our conference planning. Together we have for the first time created a powerful set of sessions and a much needed conversation with researchers, thought-leaders and industry pioneers who will attend the event in June."

The track features a dozen sessions covering research findings and partnerships, implementation in insurance, consumer and clinical settings, and special sessions looking at innovative areas such as driver safety, healthy aging, attention deficits, stroke/traumatic brain injury, schizophrenia and multiple sclerosis.

"The convergence of interactive media such as videogames with cognitive science opens the door to innovative and scalable approaches to Continue Reading »

Working memory is our ability to store and manipulate information for a brief time. It is typically measured by dual-tasks, where the individual has to remember an item while simultaneously processing a sometimes unrelated piece of information. A widely used working memory task is the reading span task where the individual reads a sentence, verifies it, and then recalls the final word. Individual differences in working memory performance are closely related to a range of academic skills such as reading, spelling, comprehension, and mathematics. Crucially, there is emerging research that working memory predicts learning outcomes independently of IQ. One explanation for the importance of working memory in academic attainment is that because it appears to be relatively unaffected by environmental influences, such as parental educational level and financial background, it measures a student’s capacity to acquire knowledge rather than what they have already learned.

However little is known about the consequences of low working memory capacity per se, independent of other associated learning difficulties. In particular, it is not known either what proportion of students with low working memory capacities has significant learning difficulties or what their behavioral characteristics are. The aim of a recent study published in Child Development (reference below) was to provide the first systematic large-scale examination of the cognitive and behavioral characteristics of school-aged students who have been identified solely on the basis of very low working memory scores.

In screening of over 3000 school-aged students in mainstream schools, 1 in 10 was identified as having working memory difficulties. There were several key findings regarding their cognitive skills. The first is that the majority of them performed below age-expected levels in reading and mathematics. This suggests that Continue Reading »

After many many months of mental stimulation, physical exercise and the certain need for stress management... we have just announced the release of the The State of the Brain Fitness Software Market 2009 report, our second annual comprehensive market analysis of the US market for computerized cognitive assessment and training tools. In this report we estimate the size of the US brain fitness software market at $265M in 2008, up from $225M in 2007 (18% annual growth), and from $100m in 2005. Two segments fuelled the market growth from 2007 to 2008: consumers (grew from $80m to $95m) and healthcare & insurance providers (grew from $65m to $80m).

The 150-page report finds promising research and initiatives to drive significant growth, combined with increased consumer confusion given aggressive marketing claims and lack of education and standards. The report includes:
- The complete results of an exclusive January 2009 Survey with 2,000+ respondents
- A proprietary Market & Research Momentum Matrix to categorize 21 key vendors into four categories
- 10 Research Executive Briefs written by leading scientists at prominent research labs
- An analysis of the level of clinical validation per product and cognitive domain

Top 10 Highlights from the report:

1) Consumers, seniors’ communities and insurance providers drove year on year sustained growth, from $225m in 2007 to $265m in 2008. Revenues may reach between $1 billion to $5 billion by 2015, depending on how important problems (Public Awareness, Navigating Claims, Research, Health Culture, Lack of Assessment) are addressed.

2) Increased interest and confusion: 61% of respondents Strongly Agree with the statement “Addressing cognitive and brain health should be a healthcare priority.” But, 65% Agree/Strongly Agree “I don't really know what to expect from products making brain claims.”

3) Investment in R&D seeds future growth: Landmark investments by insurance providers and government-funded research institutes testing new brain fitness applications planted new seeds for future growth.

4) Becoming standard in residential facilities: Over 700 residential facilities – mostly Independent and Assisted Living facilities and CCRCs – have installed computerized cognitive training programs.

5) Customer satisfaction: Consumers seem more satisfied with computer-based products than paper-based options. But, satisfaction differs by product. When asked “I got real value for my money”, results were as follows: Lumosity.com (65% Agree), Puzzle Books (60%), Posit Science (52%), Nintendo (51%) agreed. Posit Science (53% Agree) and Lumosity.com (51%) do better than Puzzle Books (39%) and Nintendo (38%) at “I have seen the results I wanted.”

6) Assessments: Increasing adoption of computer-based cognitive assessments to baseline and track cognitive functions over time in military, sports, and clinical contexts. The Alzheimer’s Foundation of America now advocates for widespread cognitive screenings after 65-75.

7) Specific computerized cognitive training and videogames have been shown to improve brain functions, but the key questions are, “Which ones”, and “Who needs what when?”

8) Aggressive marketing claims are creating confusion and skepticism, resulting in a distracting controversy between two misleading extremes: (a) “buying product XYZ can rejuvenate your brain Y years” or (b) “those products don’t work; just do one more crossword puzzle.” The upcoming book The SharpBrains Guide to Brain Fitness aims to help consumers navigate these claims.

9) Developers can be classified into four groups, based on a proprietary Market and Research Momentum Matrix: SharpBrains finds 4 Leaders, 8 High Potentials, 3 Crosswords 2.0, and 6 Wait & See companies.

10) Increased differentiation: Leading companies are better defining their value proposition and distribution channels to reach specific segments such as retirement communities, schools, or healthcare providers.

Leading researchers prepared 10 Research Executive Briefs:
- Dr. Joshua Steinerman (Einstein-Montefiore): Neuroprotection via cognitive activities
- Dr. Jerri Edwards (South Florida): Assessments of driving fitness
- Dr. Susanne Jaeggi and Dr. Martin Buschkuehl (Bern, Michigan): Working memory training and fluid intelligence
- Dr. Torkel Klingberg (Karolinska): Working memory training, dopamine, and math
- Dr. Liz Zelinski (UC Davis): Auditory processing training
- Dr. David Vance (UAB): Speed-of-processing training
- Dr. Jerri Edwards (South Florida): Cognitive training for healthy aging
- Dr. Daphne Bavelier & Dr. Shawn Green (Rochester): Action videogames and attentional skills
- Dr. Arthur Kramer (Illinois): Strategy videogames and executive functions
- Dr. Yaakov Stern (Columbia): The cognitive reserve and neuroimaging
- Dr. David Rabiner (Duke): Objective assessments for ADHD

Table of Contents

Editorial
Executive Summary
Chapter 1. Bird’s-Eye View of the Growing Field
Chapter 2. Market Survey on Beliefs, Attitudes, Purchase Habits
Chapter 3. The Emerging Competitive Landscape
Chapter 4. The Science for Brain Fitness and Cognitive Health
Chapter 5. Consumers – Adopting Crosswords 2.0?
Chapter 6: Healthcare and Insurance Providers - A Culture of Cognitive Health
Chapter 7: K12 School Systems- Ready for Change?
Chapter 8: Military, Sports Teams, Companies – Brain-Performance Link
Chapter 9: Future Directions – Projections and Bottlenecks

Companies profiled include: Advanced Brain Technologies, Applied Cognitive Engineering, Brain Center America, Brain Resource, CNS Vital Signs, Cogmed, Cogstate, CogniFit, Cognitive Drug Research, Dakim, Houghton Mifflin, Learning Enhancement Corporation, LearningRx, Lumos Labs, Marbles: The Brain Store, Nintendo, NovaVision, Posit Science, Scientific Brain Training, Scientific Learning, TransAnalytics, vibrantBrains, Vigorous Mind, Vivity Labs.

More on the report by clicking on The State of the Brain Fitness Software Market 2009.

"Whatever you struggle with in a sense as it stems from your neurology, the inherent plasticity of the brain gives you a basis for improvement. This is a way underutilized and under-appreciated resource that well all have." Dr. Michael Merzenich on the Brain Science Podcast #54, 2/13/09.

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 Continue Reading »

The growing field of cognitive training (one of the tools for brain fitness) can appear very confusing as the media keeps reporting contradictory claims. These claims are often based on press releases, without a deeper evaluation of the scientific evidence.

Let’s take a couple of recent examples, in successive days:

“It doesn’t work!” type of headline:
Reuters (Feb. 10, 2009) — Formal brain exercise won't help healthy seniors: research
“Healthy older people shouldn't bother spending money on computer games and websites promising to ward off mental decline, the author of a review of scientific evidence for the benefits of these "brain exercise" programs says”.

“It works!” type of headline:
ScienceDaily (Feb. 11, 2009) — Computer Exercises Improve Memory And Attention, Study Suggests
“According to the researchers, participants who used the Brain Fitness Program also scored as well as those ten years younger, on average, on memory and attention tests for which they did not train.”

So… does structured brain exercise / cognitive training work or not?

The problem may in fact reside in asking this very question in the first place, as Alvaro pointed out a while ago in his article “Alzheimer's Disease: too serious to play with headlines“.

We need a more nuanced set of questions.

Why? Because:
1. Cognition is made of several different abilities (working memory, attention, executive functions such as decision-making, etc)
2. Available training programs do not all train the same abilities
3. Users of training programs do not all have the same needs or goals
4. We need to differentiate between enhancing cognitive functions and delaying the onset of cognitive deficits such as Alzheimer’s.

Let’s illustrate these points, by Continue Reading »

I wanted to alert you to a very interesting finding published in a recent issue of Science, one of the world's leading scientific journals.

The study was led by Dr. Torkel Klingberg and his colleagues from the Karolinska Institute in Sweden. The goal was to learn whether Working Memory Training is associated with changes in brain biochemistry, thus suggesting a mechanism by which training may lead to enhanced working memory capacity and a reduction in attention problems. Thus, although Working Memory Training has previously shown promising results as a treatment for working memory and attention difficulties, this was a basic science study rather than a treatment study.

The major finding was that increased working memory capacity following training was associated with changes in brain biochemistry. Specifically, the researchers found changes in the density and binding potential of cortical D1 dopamine receptors in brain regions that are activated during working memory tasks.

Results from this study suggest a biological basis for the improvement in working memory capacity and reductions i Continue Reading »

The IMPACT study which we reported on in December 2007, funded by Posit Science, conducted  by the Mayo Clinic and USC Davis, has just announced publication at the Journal of the American Geriatrics Society. Reference:

- Smith et al. A Cognitive Training Program Designed Based on Principles of Brain Plasticity: Results from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training Study. Journal of the American Geriatrics Society, April 2009.

Computer Exercises Improve Memory And Attention, Study Suggests (Science Daily)

- "The Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) study was funded by the Posit Science Corporation, which owns the rights to the Brain Fitness Program, tested in the study."

- "Of the 487 healthy adults over the age of 65 who participated in a randomized controlled trial, half used the Brain Fitness Program for 40 hours over the course of eight weeks. The Brain Fitness Program consists of six audio exercises done on a computer, and is intended to "retrain the brain to discriminate fine distinctions in sound, and do it in a way that keeps the user engaged," Zelinski explained." The other half of participants spent an equal amount of time learning from educational DVDs followed by quizzes.

Comment: this is a very interesting study, in that it shows both that cognitive training works, and that it doesn't work.

What do I mean? Continue Reading »

Study Questions Effectiveness Of $80 Million Per Year 'Brain Exercise Products Industry for Elderly (Science Daily)

- "There is much research on the benefits of cognitive rehabilitation strategies among elderly who already experience mild cognitive impairment (MCI) or Alzheimer's disease, as well as on the positive impact of physical exercise. The researchers, however, wanted to evaluate current research that would focus on the impact of cognitive interventions in the healthy elderly population."

- "...they concluded that there was no evidence indicating that structured cognitive intervention programs had an impact on the progression of dementia in the healthy elderly population"

Comment:  we have not reviewed the analysis yet, so cannot comment in depth. However, just from the press release, we see a few potential problems in how the study was framed, reducing its practical value: Continue Reading »