The recent dis­cov­ery that expe­ri­ence can change brain struc­ture and func­tion at any age has sparked numer­ous health, edu­ca­tion, and pro­duc­tiv­ity appli­ca­tions whose value and lim­i­ta­tions we are only start­ing to grasp.

Brain fit­ness has quickly become a main­stream aspi­ra­tion among baby boomers and elders, pri­mar­ily in North Amer­ica. It has fueled a grow­ing inter­est in brain fit­ness classes, brain fit­ness cen­ters, and brain fit­ness pro­grams, along with atten­dant oppor­tu­ni­ties and chal­lenges. An increas­ing num­ber of adults want use­ful tools to pro­tect cog­ni­tive health and performance—not nec­es­sar­ily to reverse aging—and what they are find­ing is an expand­ing and noisy mar­ket­place where they (and also pro­fes­sion­als) need to care­fully eval­u­ate their own needs and the avail­able options (Fer­nan­dez and Gold­berg, 2009). Read the rest of this entry »

Wel­come to a new edi­tion of Grand Rounds blog car­ni­val, the weekly edi­tion of what’s best in the health and med­ical blo­gos­phere. This week, twenty four blog­gers share data, insights, ques­tions, reflec­tions and more. Enjoy! Read the rest of this entry »

The AAA Foun­da­tion for Traf­fic Safety just started to rec­om­mend a new dri­ver safety pro­gram called Dri­ve­Sharp (see AAA and Posit Release Pro­gram to Improve Dri­vers’ Minds), devel­oped by Posit Sci­ence. Dri­ve­Sharp is a com­put­er­ized cog­ni­tive assess­ment and train­ing tool based on Kar­lene Ball’s research on older adults’ cog­ni­tive fit­ness and driving.

In the press release for the agree­ment, Peter Kissinger, dri­ver safety research and pol­icy vet­eran and CEO of the AAA Foun­da­tion, says that “Part of mak­ing our nation’s roads safer is help­ing mature dri­vers who wish to stay active — a quickly grow­ing pop­u­la­tion — main­tain or improve their dri­ving safety.”

We have Peter Kissinger with us to dis­cuss the con­text for this inno­v­a­tive initiative.

Peter, I appre­ci­ate your time. In order to set the con­text, would you intro­duce the role and pri­or­i­ties of the AAA Foundation?

Sure. All your read­ers will know that AAA is the main dri­ver asso­ci­a­tion in North Amer­ica, with over 50 mil­lion mem­bers. The AAA Foun­da­tion is focused on the research and pol­icy required to improve dri­ver safety and has 4 strate­gic pri­or­i­ties:
– Intro­duce a cul­ture of traf­fic safety. It is an out­rage that there is a driving-related death every 13 min­utes in the US, and yet, we seem to accept this as sta­tus quo
– Improve road safety, espe­cially on rural roads, where almost 60% of the deaths occur,
– Improve safety among teens, one of the high­est risk groups
– Improve safety among seniors, another high-risk group.

In terms of driver-centered inter­ven­tions, are your pri­or­i­ties are teenage and older drivers?

Yes. You have prob­a­bly seen the U-shaped risk curve (Edi­tor note: see fig­ure at left) that shows how acci­dent risks are very high among teenagers, then decrease and remain sta­ble until our 60s, and then increase again.

We have pro­moted ini­tia­tives such as Dri­verZED (see www.driverzed.org) to help teenagers bet­ter iden­tify and man­age the typ­i­cal sources of risk, so they advance faster through the learn­ing curve. For older dri­vers we focus on how to bal­ance the priv­i­lege of dri­ving with the right of mobil­ity — we know that los­ing dri­ving inde­pen­dence can bring a vari­ety of neg­a­tive con­se­quences for the individual.

Given aging pop­u­la­tion trends, it is clear we need to intro­duce bet­ter sys­tems to bal­ance those two goals you just out­lined –safety and mobil­ity. Do you think as a soci­ety we are prepared?

I don’t think we are, and I am pes­simistic that we will be in the short term. This is a very impor­tant prob­lem: offi­cial esti­mates say that the pro­por­tion of all dri­vers who are over 65 years of age will grow from 15% today to 25% in 2025.

Let me give you some back­ground: two years ago we put together a work­shop to iden­tify the state of the research and the state of the prac­tice of dri­ver safety among Read the rest of this entry »

The San Fran­cisco Chron­i­cle brings two great pieces today — includ­ing an excel­lent review of our new Book!

Is Your Brain A Couch Potato? (online book review)

“At 165 pages, we’re talk­ing 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.”

Soft­ware designed to make older dri­vers sharper (arti­cle in print ver­sion)

- “All­state is exper­i­ment­ing with the soft­ware because it wants its cus­tomers who are over 50 to become bet­ter dri­vers so they have fewer acci­dents and can drive longer, per­haps in return for lower pre­mi­ums, said Tom War­den, an assis­tant vice pres­i­dent in Allstate’s research and plan­ning center.”

- “All­state found Posit after the insur­ance company’s own sci­en­tists, who were work­ing on the phys­i­ol­ogy and psy­chol­ogy of good dri­vers, dis­cov­ered research done by Visual Aware­ness, a com­pany in Alabama that has worked with State Farm and var­i­ous state motor vehi­cle depart­ments on expand­ing dri­vers’ fields of view. Posit acquired Visual Aware­ness last year.”

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?

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-Monteore): 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  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-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.

Round-up of recent news with a vari­ety of angles, from the effects of gam­ing to cog­ni­tive train­ing for dri­ving skills and brain fit­ness classes.

Seniors use brain train­ing soft­ware to sharpen their minds (Dal­las Morn­ing News)

- “All­state Insur­ance has invited some pol­i­cy­hold­ers and other older dri­vers to try InSight so researchers can eval­u­ate whether the soft­ware reduces accidents.”

- “Depend­ing on the results, the auto insurer says it may expand the pilot project and offer pre­mium dis­counts to dri­vers who take the brain training.”

- “Today, only one in seven licensed dri­vers is 65 or older. But by 2030, when the last of the boomers turn 65, the pro­por­tion will be one in four. ”

Brain games (Palo Alto Weekly)

- “There is research that jus­ti­fies the belief that games can aid the brain’s health, accord­ing to Dr. Wal­ter Bortz II, a Stan­ford Uni­ver­sity School of Med­i­cine asso­ciate pro­fes­sor and expert on longevity and robust aging. Stud­ies show that stim­u­lat­ing the brain by learn­ing new tasks increases blood fac­tors in the brain that act like steroids, mak­ing it pos­si­ble for the brain to grow even in old age

- “Called “brain plas­tic­ity,” such growth is the foun­da­tion of brain-fitness soft­ware research.”

Brain Fit­ness Classes Keep Seniors Men­tally And Socially Active (Wash­ing­ton Post)

- “More options for exer­cis­ing the brain are on the way. Last year, the Ontario gov­ern­ment pledged about $8 mil­lion to develop a brain fit­ness cen­ter in Toronto. In San Fran­cisco, Jan Zivic, a for­mer exec­u­tive search con­sul­tant, opened a cen­ter, vibrant­Brains, that offers mem­ory improve­ment classes and work­shops. Zivic was inspired by help she got from brain fit­ness games she played after being injured in an auto­mo­bile accident.”

The 15 Clear­est Ben­e­fits of Gam­ing (Edge Magazine)

-“But Fer­nan­dez warns that the gamer gen­er­a­tion isn’t auto­mat­i­cally guar­an­teed to have bet­ter cog­ni­tive health than their grand­par­ents. Cog­ni­tive fit­ness (hav­ing the men­tal abil­i­ties required to thrive in cog­ni­tively more com­plex envi­ron­ments) seems to depend on four major pil­lars: nutri­tion, phys­i­cal exer­cise, stress man­age­ment and men­tal exer­cise. All these fac­tors have phys­i­cal effects on our brains (for exam­ple, phys­i­cal exer­cise con­tributes to the cre­ation of new neu­rons, while stress and anx­i­ety pre­vents and/or reduces the cre­ation of new neu­rons). The bad news is that we have grow­ing obe­sity rates and anx­i­ety among young peo­ple. So, games are great for men­tal exer­cise, but we shouldn’t for­get the other ingre­di­ents for cog­ni­tive fitness.

- “Fer­nan­dez muses, Indeed fun can be seen as a goal in itself . The prob­lem is that we con­fuse gam­ing as a vehi­cle with gam­ing as con­tent. Gam­ing as vehi­cle is arguably great it allows for inter­ac­tiv­ity, engage­ment. Gam­ing as con­tent, well, it depends. It is not the same to play a bloody shooter game as it is to Tetris or Rise of Nations, so the field should do a bet­ter job at explain­ing to main­stream soci­ety the diver­sity of games and dis­pel some myths.

More Brain Fit­ness and Cog­ni­tive Health News

Good arti­cle in the New York Times today:
An Epi­demic of Crashes Among the Aging? Unlikely, Study Says

- “The (Insur­ance Insti­tute for High­way Dri­ving) insur­ance insti­tute is con­duct­ing fur­ther research to deter­mine why the risks appear to be going down for older dri­vers. It may be that today’s older dri­vers are sim­ply in bet­ter phys­i­cal and men­tal shape than their coun­ter­parts a decade ago, so they are not only less likely to make a dri­ving mis­take, but also less frail and bet­ter able to sur­vive injuries.”

There is no doubt that, as a group, older per­sons of any given age are in bet­ter phys­i­cal and men­tal shape today than their coun­ter­parts years ago. For con­text, world­wide life expectancy has increased more than 20 years in less than 6o years — so you can imag­ine how a per­son in his or her early 70s today is in bet­ter shape than some­one in his or her mid-60s a few decades back.

Still, as the num­ber of peo­ple over the age of 60 starts to grow expo­nen­tially given the influx of baby boomers, soci­ety at large will prob­a­bly ben­e­fit from start­ing to think through 1) what are the types of pro­grams, whether intro­duced and man­aged by the AARP, DMV or car insur­ance com­pa­nies, that can help older adults drive safely for as long as they want and need, 2) what are the mech­a­nisms to pre­vent hav­ing dri­vers in our roads who don’t pos­sess the min­i­mum per­cep­tual and cog­ni­tive abil­i­ties required to drive “safely” (and what “safely” really means).

And, yes, we should prob­a­bly have a sim­i­lar con­ver­sa­tion regard­ing teenage dri­ving.
For related read­ing, you may enjoy these 2 articles:

- All­state: Can we improve Dri­ver Safety using Posit Sci­ence InSight?

- Improv­ing Dri­ving Skills and Brain Func­tion­ing– Inter­view with ACTIVE’s Jerri Edwards

With three years still left until pub­li­ca­tion, the fights over the new ver­sion of the psy­chi­atric diag­nos­tic man­ual, the DSM-V, are hot­ting up and The New York Times has a con­cise arti­cle that cov­ers most of the main point of contention.

- “What you have in the end,  Mr. Shorter said, “is this process of sort­ing the deck of symp­toms into syn­dromes, and the out­come all depends on how the cards fall.

- Psy­chi­a­trists involved in prepar­ing the new man­ual con­tend that it is too early to say for sure which cards will be added and which dropped.

Although I doubt the DSM com­mit­tee are using that exact metaphor, it cer­tainly illus­trates the point that the process requires a cer­tain degree of value-judgement.

It’s inter­est­ing, how­ever, that the pub­lic debate is cur­rently focused on whether cer­tain diag­noses should be included or not, rather than whether diag­no­sis itself is use­ful for psychiatry.

We’ve had psy­cho­met­rics for a good 100 years that allow us to mea­sure dimen­sions of human expe­ri­ence and per­for­mance with a much greater degree of accu­racy than Read the rest of this entry »

“If Dr. Rob can inter­view Santa, why can’t I inter­view a select group of health & med­ical blog­gers? They will have some good ideas to share”.

So did President-elect Obama came to real­ize a few days ago. After his peo­ple kindly con­tacted our peo­ple, we felt com­pelled to grant him open access to our col­lec­tive wis­dom. With­out fur­ther ado, below you have Grand Rounds 5:12 — a Q&A ses­sion led by the incom­ing Pres­i­dent on how to reform (for the bet­ter, we hope) healthcare.

On Health Insurance

Q:  How does the blo­gos­phere per­ceive the prob­lem of hav­ing a sig­nif­i­cant group of peo­ple uninsured?

Health Insur­ance Col­orado: a grow­ing eco­nomic bur­den, which may lead to emer­gency rooms turn­ing peo­ple away if they are unable to pro­vide proof of health insurance.

Dr Rich: well, a recent arti­cle in the Jour­nal of the Amer­i­can Med­ical Asso­ci­a­tion showed how over­crowd­ing in Amer­i­can emer­gency rooms is NOT due to the unin­sured. Rather, it is due to insured Amer­i­cans who can­not get in to see their pri­mary care physi­cians. We may need improved care both for the insured and unin­sured groups.

Insure­Blog: I’d sec­ond that. Lack of health insur­ance is a major prob­lem but is it really our Biggest Problem?

It’s All about Attitude

Q: You may have heard my cam­paign mantra, “Yes We Can”. Can I count on your support?

ButY­ouDont­Look­Sick: Yes. If Leslie Hunt can talk so openly about her chronic ill­ness (Lupus) yet ful­fill her Amer­i­can Idol dreams, we can ful­fill our dreams too.

Notes of an Anes­the­sioboist: you are talk­ing to the group of pro­fes­sion­als will­ing to self-experiment with our own body for the ben­e­fit of sci­ence and our patients.

Med­views: My wife, son, and I signed up to work as med­ical vol­un­teers for your upcom­ing inauguration.

Emergi­Blog: I am on board too. But, please, remem­ber that car­ing is the essence of nurs­ing. And that is why my patients will always be my patients and never my  clients.

Neu­roan­thro­pol­ogy: Mr. President-elect, it seems to me that, despite all our good inten­tions, bal­anc­ing the bud­get and mul­ti­ple com­pet­ing pri­or­i­ties will be a chal­lenge. May I sug­gest you start prac­tic­ing some capoeira for equi­lib­rium training?

Shrink Rap: Happy to help. Now, we will need to pro­tect some time for qual­ity sleep time.

Train­ing

Q: I am encour­aged by your words. How can my team and I bet­ter sup­port you in your daily activities?

Aequa­nim­i­tas: we need more role mod­els for us to “learn to think, observe, and com­pare” and that the patient is our “first, last, and only teacher”.

Mud­phud­der: Couldn’t agree more. We need Read the rest of this entry »

(Please note that this is my per­sonal take at the dis­cus­sions that took place in Dubai as part of the Global Agenda Coun­cil on the Chal­lenges of Geron­tol­ogy put together by the World Eco­nomic Forum, and builds on the work of my col­leagues, but it does not rep­re­sent a for­mal doc­u­ment or state­ment of posi­tion. Sim­ply put, we would like to engage your brain in defin­ing the chal­lenges and outlining/ exe­cut­ing the solutions).

Con­text: The Chal­lenges of the Aging Society

The world is aging. This is occur­ring in two ways: through shifts in the age struc­ture that will even­tu­ally lead to many more peo­ple reach­ing older ages than ever before, and through con­tin­ued suc­cess in extend­ing life. Less than 100 years ago, life expectancy was between 30 to 40 years. Today, close to 800 mil­lion cit­i­zens are 60 and over.

And aging in health­ier ways. Aging has incor­rectly been asso­ci­ated with decline and decay, when in fact many peo­ple live healthy into older ages. There has been a syn­chro­nous exten­sion in life expectancy and qual­ity of life — the aver­age 65-year-old today is much health­ier, phys­i­cally and men­tally, than the aver­age 50-year-old of 100–150 years ago — when most exist­ing insti­tu­tions were envi­sioned and created.

Healthy life can be fur­ther extended with exist­ing knowl­edge. The fact is the onset and pro­gres­sion of fatal and dis­abling dis­eases, dis­or­ders, and dis­abil­ity can be post­poned using well-researched basic mea­sures of pub­lic health, envi­ron­men­tal and behav­ioural changes, and med­ical tech­nol­ogy inter­ven­tions. The same meth­ods may be used to improve or main­tain men­tal and phys­i­cal functioning.

Our health­care and retire­ment sys­tems are on bank­ruptcy track — their premises are out­dated. Exist­ing insti­tu­tions, poli­cies and atti­tudes do not reflect the points out­lined above, hav­ing been devel­oped for a soci­ety that no longer exists. We need to get on the right track: Read the rest of this entry »