(Editor’s Note: given the grow­ing media atten­tion to three appar­ently sep­a­rate worlds –cog­ni­tive enhance­ment via drugs, brain fit­ness train­ing soft­ware, com­put­er­ized neu­rocog­ni­tive assessments-, I found it refresh­ing to see our co-founder Elkhonon Gold­berg intro­duce the topic of cog­notropic drugs with an inte­gra­tive per­spec­tive in the much updated new edi­tion of his clas­sic book, now titled The New Exec­u­tive Brain: Frontal Lobes In A Com­plex World. Below goes an excerpt).

For many neu­ropsy­chol­o­gists, like myself, sci­ence is a labor of love, but see­ing patients is bread and but­ter. Tra­di­tion­ally, the clin­i­cal con­tri­bu­tion of neu­ropsy­chol­ogy has been mostly diag­nos­tic, with pre­cious lit­tle to offer patients by way of treat­ment. Neu­ropsy­chol­ogy is not the only clin­i­cal dis­ci­pline for years con­signed to help­less voyeurism. Every dis­ci­pline con­cerned with cog­ni­tion shares this hum­bling predica­ment. A psy­chi­a­trist treat­ing a schiz­o­phrenic patient or a depressed patient finds him– or her­self in a sim­i­lar posi­tion. There are ample phar­ma­co­log­i­cal tools to treat the patient’s psy­chosis or mood, but very few to treat the patient’s cog­ni­tion. Even though psy­chi­a­trists increas­ingly rec­og­nize that cog­ni­tive impair­ment is often more debil­i­tat­ing in their patients than psy­chosis or mood dis­or­der, tra­di­tion­ally, very lit­tle direct effort has been aimed at improv­ing cognition.

A neu­rol­o­gist treat­ing a patient recov­er­ing from the effects of head injury does not fare much bet­ter. There are ade­quate means to con­trol the patient’s seizures but not his or her cog­ni­tive changes, despite the fact that cog­ni­tive impair­ment is usu­ally far more debil­i­tat­ing than an occa­sional seizure. Soci­ety has been so pre­oc­cu­pied with sav­ing lives, treat­ing hal­lu­ci­na­tions, con­trol­ling seizures, and lift­ing depres­sion that cog­ni­tion (mem­ory, atten­tion, plan­ning, prob­lem solv­ing) has been largely ignored. Granted, var­i­ous neu­rolep­tics, anti­con­vul­sants, anti­de­pres­sants, seda­tives, and stim­u­lants do have an effect on cog­ni­tion, but it is an ancil­lary effect of a drug designed to treat some­thing else.

Alzheimer’s dis­ease and other demen­tias have been society’s wake-up call. Here, in the most afflu­ent coun­try in the most afflu­ent of times, human minds were suc­cumb­ing to decay before human bod­ies, a sharp chal­lenge to the tacit pop­u­lar belief that the “body is frail but soul is for­ever.” This pro­vided an impe­tus for the devel­op­ment of an entirely new class of drugs, which can be termed famil­ially as “cog­notropic.” Their pri­mary and explicit pur­pose is to improve cognition.

Since med­ical and pub­lic pre­oc­cu­pa­tion with demen­tia focuses on mem­ory, most of the phar­ma­co­log­i­cal efforts have been directed at improv­ing mem­ory. At the time of this writ­ing, a hand­ful of drugs known as “Alzheimer’s drugs” or “mem­ory enhancers” have been approved by the U.S. Food and Drug Admin­is­tra­tion (FDA). In real­ity, both des­ig­na­tions are some­what mis­lead­ing. The drugs in ques­tion are Read the rest of this entry »

In a recently pub­lished sci­en­tific study (see Hall C, et al “Cog­ni­tive activ­i­ties delay onset of mem­ory decline in per­sons who develop demen­tia” Neu­rol­ogy 2009; 73: 356–361), Hall and col­leagues exam­ined how edu­ca­tion and stim­u­lat­ing activ­i­ties may inter­act to con­tribute to cog­ni­tive reserve. The study involved 488 ini­tially healthy peo­ple, aver­age age 79, who enrolled in the Bronx Aging Study between 1980 and 1983. These indi­vid­u­als were fol­lowed for 5 years with assess­ments every 12 to 18 months (start­ing in 1980). At the start of the study, all par­tic­i­pants were asked how many cog­ni­tive activ­i­ties (read­ing, writ­ing, cross­word puz­zles, board or card games, group dis­cus­sions, or play­ing music) they par­tic­i­pated in and for how many days a week. Researchers were able to eval­u­ate the impact of self-reported par­tic­i­pa­tion these activ­i­ties on the onset of accel­er­ated mem­ory decline in 101 indi­vid­u­als who devel­oped demen­tia dur­ing the study.

Results showed that for every “activ­ity day” (par­tic­i­pa­tion in one activ­ity for one day a week) the sub­jects engaged in, they delayed for about two months the onset of rapid mem­ory loss asso­ci­ated with demen­tia. Inter­est­ingly, the pos­i­tive effect of brain-stimulating activ­i­ties in this study appeared to be inde­pen­dent of a person’s level of education.

This is great news as it sug­gests that it is never too late to try to build up brain reserve. The more brain stim­u­lat­ing activ­i­ties one does and the more often, the bet­ter for a stronger cog­ni­tive reserve.

The cog­ni­tive reserve hypoth­e­sis sug­gests that indi­vid­u­als with more cog­ni­tive reserve can expe­ri­ence more Alzheimer’s dis­ease pathol­ogy in the brain (more plaques and tan­gles) with­out devel­op­ing Alzheimer’s dis­ease symptoms.

How does that work? Sci­en­tists are not sure but two pos­si­bil­i­ties are con­sid­ered.
1. One is that more cog­ni­tive reserve means more brain reserve, that is more neu­rons and con­nec­tions between neu­rons.
2. Another pos­si­bil­ity is that more cog­ni­tive reserve means more com­pen­satory processes (see my pre­vi­ous post “Edu­ca­tion builds Cog­ni­tive Reserve for Alzheimers Dis­ease Pro­tec­tion” for more details.)

Now, one may won­der about the dif­fer­ence types of men­tal stim­u­la­tion avail­able, includ­ing not only puz­zles and such, but struc­tured activ­i­ties such as brain fit­ness soft­ware and med­i­ta­tion. Do we exer­cise our brain every time we think about some­thing? What can one do to exer­cise one’s brain in ways that enhance capac­ity? Does aer­o­bic fit­ness train­ing also exer­cise one’s brain? What types of method­olo­gies and prod­ucts are avail­able? Do they “work”? Are all the same?

Those are the types of ques­tions we wanted to address in the book The Sharp­Brains Guide To Brain Fit­ness (avail­able via Amazon.com). We are proud of the recog­ni­tion the book has started to obtain, includ­ing endorse­ments by lead­ing scientists:

“The Sharp­Brains Guide to Brain Fit­ness is the only book that I know of that seam­lessly inte­grates lat­est infor­ma­tion about cog­ni­tive health across the lifes­pan, with inter­views with active researchers exam­in­ing cog­ni­tive main­te­nance and enhance­ment, along with reviews of com­mer­cial prod­ucts tar­geted to cog­ni­tive enhance­ment. The book should be very use­ful to any­one inter­ested in brain care, both health care pro­fes­sion­als and the pub­lic at large”.
— Arthur Kramer, Pro­fes­sor of Psy­chol­ogy at Uni­ver­sity of Illinois

“This Sharp­Brains book pro­vides a very valu­able ser­vice to a wide com­mu­nity inter­ested in learn­ing and brain top­ics. I found it inter­est­ing and help­ful“
- Michael Pos­ner, Emer­i­tus Pro­fes­sor of Neu­ro­science at the Uni­ver­sity of Ore­gon, and first recip­i­ent of the Dogan Prize

– Pas­cale Mich­e­lon, Ph. D., is Sharp­Brains’ Research Man­ager for Edu­ca­tional Projects. Dr. Mich­e­lon has a Ph.D. in Cog­ni­tive Psy­chol­ogy and has worked as a Research Sci­en­tist at Wash­ing­ton Uni­ver­sity in Saint Louis, in the Psy­chol­ogy Depart­ment. She con­ducted sev­eral research projects to under­stand how the brain makes use of visual infor­ma­tion and mem­o­rizes facts. She is now an Adjunct Fac­ulty at Wash­ing­ton University.

Ref­er­ences:

- Study: Hall C, et al “Cog­ni­tive activ­i­ties delay onset of mem­ory decline in per­sons who develop demen­tia” Neu­rol­ogy 2009; 73: 356–361

- Book: The Sharp­Brains Guide To Brain Fit­ness: 18 Inter­views with Sci­en­tists, Prac­ti­cal Advice, and Prod­uct Reviews, to Keep Your Brain Sharp

The Longevity Div­i­dend is a the­ory that says we hope to inter­vene sci­en­tif­i­cally to slow the aging process, which will also delay the onset of age-related dis­eases. Delay­ing aging just seven years would slash rates of con­di­tions like can­cer, dia­betes, Alzheimer’s dis­ease and heart dis­ease in half. That’s the longevity part.

The div­i­dend comes from the social, eco­nomic, and health bonuses that would then be avail­able to spend on schools, energy, jobs, infra­struc­ture tril­lions of dol­lars that today we spend on health­care ser­vices. In fact, at the rate we’re going, by the year 2020 one out of every $5 spent in this coun­try will be spent on health­care. Obvi­ously, some­thing has to change.

Enter the Longevity Div­i­dend. The Longevity Div­i­dend doesn’t sug­gest that we live longer; instead, it calls for liv­ing bet­ter. The idea is that if we use sci­ence to increase healthspan, not lifes­pan. In other words, tomor­rows 50-year-old would have the health pro­file of a 43-year-old.

It might sound like sci­ence fic­tion, but, in fact, it’s quite pos­si­ble. We’re already doing it in some ani­mal mod­els using genetic and dietary inter­ven­tions, tech­niques related to what sci­en­tists call “the biol­ogy of aging.”

Get­ting there in humans, how­ever, means embrac­ing an entirely new approach to our think­ing about dis­ease and aging, and how we con­duct sci­en­tific research into the two.

Get­ting Sci­en­tists’ Attention

A group of emi­nent researchers first pro­posed the Longevity Div­i­dend in a 2006 arti­cle pub­lished in The Sci­en­tist. The authors, S. Jay Olshan­sky, PhD, pro­fes­sor of epi­demi­ol­ogy and bio­sta­t­ics at the Uni­ver­sity of Illi­nois in Chicago, Daniel P. Perry, exec­u­tive direc­tor of the Alliance for Aging Research in Wash­ing­ton, DC, Richard A. Miller, MD, PhD, pro­fes­sor of pathol­ogy at the Uni­ver­sity of Michi­gan in Ann Arbor, and Robert N. But­ler, MD, pres­i­dent and CEO of the Inter­na­tional Longevity Cen­ter in New York, intended their essay to be a “gen­eral state­ment to sci­en­tists about the need for a par­a­digm shift in the way we think about aging and disease.

The researchers also met with U.S. sen­a­tors who served on the Sen­ate com­mit­tee that over­saw the bud­get for the National Insti­tutes of Health (NIH). “We told them we believed Read the rest of this entry »

In April 2008, Bay­crest, a lead­ing research insti­tute focused on aging and brain func­tion, received $10-million from the Ontario Gov­ern­ment to cre­ate a ground­break­ing Cen­tre for Brain Fit­ness. Its stated goal was to “develop and com­mer­cial­ize a range of prod­ucts designed to improve the brain health of aging Ontar­i­ans and oth­ers around the world”.

“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 Read the rest of this entry »

Wel­come to the 8th edi­tion of Hour­glass, the blog car­ni­val devoted to biogeron­tol­ogy. Enjoy!

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Use It or Lose It

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Cog­ni­tive Enhance­ment, Health and Assessments

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The Ben­e­fits of Caloric Restric­tion Read the rest of this entry »

Wel­come to the 61st edi­tion of Encephalon, the blog car­ni­val that offers some of the best neu­ro­science and psy­chol­ogy blog posts every other week.

We do have an excel­lent set of arti­cles today. cov­er­ing much ground. Enjoy the reading:

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Neu­ro­science and Society

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Alzheimer’s Dis­ease and Neu­rocog­ni­tive Health Read the rest of this entry »

After about age 50, most peo­ple begin to expe­ri­ence a decline in mem­ory capa­bil­ity. Why is that? One obvi­ous answer is that the small arter­ies of the brain begin to clog up, often as a result of a life­time of eat­ing the wrong things and a lack of exer­cise. If that life­time has been stress­ful, many neu­rons may have been killed by stress hor­mones. Given the most recent sci­en­tific lit­er­a­ture, reviewed in my book Thank You, Brain, For All You Remem­ber. What You For­got Was My Fault, dead neu­rons can’t be replaced, except in the hip­pocam­pus, which is for­tu­nate for mem­ory because the hip­pocam­pus is essen­tial for mak­ing cer­tain kinds of mem­o­ries per­ma­nent. Another cause is incip­i­ent Alzheimer’s dis­ease; autop­sies show that many peo­ple have the lesions of the dis­ease but have never shown symp­toms, pre­sum­ably because a life­time of excep­tional men­tal activ­ity has built up a “cog­ni­tive reserve.

So is there any­thing you can do about it besides exer­cise like crazy, eat healthy foods that you don’t like all that much, pop your statin pills, and take up yoga?

Yes. In short: focus, focus, focus.

Chang­ing think­ing styles can help. Research shows that Read the rest of this entry »

You know your weight. And your phys­i­cal fit­ness. And a vari­ety of health-related metrics.

What about your brain fitness?

Two recent announce­ments bring out how the assess­ment of cog­ni­tive abil­i­ties, or brain func­tions, is increas­ingly being done thanks to new com­put­er­ized options:

1) Last week, OptumHealth announced an exclu­sive 3-year agree­ment (esti­mated at $18m) with the Aus­tralian com­pany Brain Resource. OptumHealth will be embed­ding the Brain Resource plat­form into their over­all Behav­ioral Solu­tions program.

- OptumHealth Behav­ioral Solu­tions will work with Brain Resource to pro­vide clin­i­cians with a Web-based assess­ment that mea­sures gen­eral cog­ni­tion (how peo­ple process infor­ma­tion) and social cog­ni­tion (how peo­ple man­age their emo­tions). This 40-minute assess­ment is based on well-known and val­i­dated tests of mem­ory, atten­tion, exec­u­tive func­tion, and response speed, and mood, social skills and emo­tional resilience.

Read the rest of this entry »

Have you heard of or read John Ratey’s book “Spark: The Rev­o­lu­tion­ary New Sci­ence of Exer­cise and The Brain”? Accord­ing to Har­vard Psy­chi­a­try Pro­fes­sor John Ratey noth­ing beats exer­cise for pro­mot­ing brain heath.

I am sure you have also heard that exer­cis­ing your mind pro­motes brain health.

What is the con­nec­tion between phys­i­cal and men­tal exer­cises? Do they have addi­tive effects on brain health? Are they redundant?

Read the rest of this entry »

A few col­leagues referred me over the week­end to a very nice arti­cle at busi­ness pub­li­ca­tion Port­fo­lio.

While the arti­cle does an excel­lent job at intro­duc­ing the reader to the con­cept and promise of com­put­er­ized cog­ni­tive assess­ments, it also con­tributes to the mythol­ogy of “Brain Age”.

Let’s first take a look at the arti­cle How Smart Are You: The busi­ness of assess­ing cog­ni­tion and mem­ory is mov­ing from test­ing brain-impaired patients to assess­ing healthy peo­ples’ brains online.

A cou­ple of quotes:

- “Cog­ni­tive Drug Research is one a hand­ful of busi­nesses, most of them out­side of the U.S., that work with phar­ma­ceu­ti­cal com­pa­nies to test how new drugs for every­thing from nico­tine addic­tion to Alzheimer’s dis­ease affect the mind’s abil­ity to remem­ber things, make deci­sions, and ana­lyze information.”

- “Cog­ni­tive tests have been around for a cen­tury as exam­i­na­tions taken with paper and pen­cil. In the 1970s and ‘80s the tests shifted to com­put­ers, Cog­ni­tive Drug Research founder Keith Wesnes says.

So far, so good. In fact, one of the key high­lights from the mar­ket report we released in March was that “Large-scale, fully-automated cog­ni­tive assess­ments are being used in a grow­ing num­ber of clin­i­cal tri­als. This opens the way for the devel­op­ment of inex­pen­sive consumer-facing, base­line cog­ni­tive assess­ments.” And we pro­filed a few lead­ing com­pa­nies in the space: Brain Resource Com­pany, Cog­ni­tive Drug Research, CNS Vital Signs and CogState.

Now, the arti­cle is accom­pa­nied by a 5–7 minute quick test that promises to give us our “Brain Age”. And this doesn’t come from Nin­tendo, but from Cog­ni­tive Drug Research, a respected science-based company.

You can check it out Read the rest of this entry »