May 20, 2008
By: Alvaro Fernandez
I wrote this article for the March/ April edition of the publication Aging Today, published by the American Society on Aging, and received permission to reproduce it here.
In recent years, most professionals in aging have become aware of the growing scientific evidence showing that human brains retain the ability to generate neurons and change over a lifetime, discoveries that have broken the scientific paradigm prevalent during the 20th century. Furthermore, neuroimaging and cognitive training studies are showing how well-directed exercise presents people major opportunities for healthy brain aging.
How can people use emerging technologies to keep their brains healthy and productive as long as possible? An emerging market for brain health– $225 million market in 2007, in the United States alone, of which consumers account for $80 million–is trying to address that question in a way that complements other important more traditional pillars (and multi-billion industries) of brain health, such as physical exercise, balanced diet, stress management (stress has been shown to actually kill neurons and reduce the rate of creation of new ones) and overall mental stimulation and lifelong learning.
2007 AN ACTIVE YEAR
A series of important events took place in 2007, a seminal year for the brain health field, beginning in January when many mainstream media publications, such as Time Magazine and CBS News, started to publish major stories on neuroplasticity and brain exercise. This media coverage followed the publication of the long-awaited results from national clinical trials showing that significant percentages of the participants age 65 and older who trained for five weeks improved their memory, reasoning and information-processing speed. Findings from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Study appeared in the Journal of the American Medical Association (Dec. 20, 2006) and revealed that even after five years, participants in the ACTIVE computer-based program showed less of a decline in information-processing skills than those in a control group that received no cognitive training.
Also, in June last year, the Journals of Gerontology published a special summer issue devoted to cognitive training research studies; actress Nicole Kidman became the mass-market face of “brain training,” highlighting the commercial success of the Nintendo Brain Age software, and the Centers for Disease Control and Prevention, along with the Alzheimer Association released a cognitive health roadmap to guide growing amount of research and improve public health education.
At the annual scientific meeting of the Gerontology Society of America in November, researcher Elizabeth Zelinski of the University of Southern California’s Andrus Gerontology Center, reported very positive initial (not yet published) results from the IMPACT (Improvement in Memory with Plasticity-based Adaptive Cognitive Training) study based on the program that trains auditory processing created by Posit Science, based in San Francisco. In December, PBS broadcast The Brain Fitness Program, featuring Michael Merzenich of Posit Science and the University of California, San Francisco, and his colleagues discussing neuroplasticity, the ability of the brain to change and adapt–even rewire itself.
In addition in November, The Brain Resource Company, an Australian firm specializing in developing cognitive assessments for clinical trials, signed a multimillion dollar contract with an insurance company to develop more sensitive diagnostic brain markers and assessments to enable wider adoption of cognitive assessments.
CLEARING UP CONFUSION
These and other developments are signs of an incipient market still in an immature stage–and that has resulted in much misinformation and confusion. So let me address some typical questions:
Do these programs cure Alzheimer’s? No program can claim that it specifically delays or prevents Alzheimer’s disease beyond general statements, such as that mental stimulation together with other lifestyle factors (nutrition, physical exercise and stress management) can contribute toward building a cognitive reserve that may reduce the probability of Alzheimer’s-related symptoms.
What can brain-health training do? Human cognitive abilities evolve in a variety of ways with aging. Some improve, such as pattern recognition and emotional self-regulation; some decline, for example, speed of processing, working memory and novel problem-solving. Certain mental abilities have proved to be trainable, though, and this provides the opportunity to improve brain performance and quality of life, potentially prolonging one’s independence and autonomy.
How do I evaluate whether any program is good for me and my clients, patients or residents? Ask what cognitive skills you want trained. Some programs present the benefits in such a nebulous way that it is impossible to tell whether or not they will yield any results. The general wording “Brain training” itself is of limited benefit because such activities as gardening or learning a new language “train” the brain, too. One must ask whether an improvement experienced in a brain training program will transfer to real life, and usually that happens when a person trains the cognitive skill or skills that are specifically relevant-there are no general solutions to all problems. Assessments are needed that are distinct from the exercises. Last year, SharpBrains. released a 10-question checklist to help people evaluate the growing number of programs making brain-related claims. You can download a complimentary copy at http://www.sharpbrains.com/press-room/ (Note: you can download it Here).
Growing research is showing that training can improve brain function and people must learn to navigate an emerging number of tools. How does this development affect retirement communities, nursing homes, and the aging health professionals in general? Is this just a fad that will soon vanish, or a first wave of many? I believe technology is emerging as a welcome tool for evaluating and training specific brain functions, and this will enable the increasingly rapid growth of a cognitive fitness field that can parallel physical fitness.
In exercising my brain about this, I’ve anticipated 10 trends that I think are likely to emerge during the next three to five years. These include:Ã‚Â
*Ã‚Â Emphasis on brain maintenance will increase. The health and aging field will shift from trying to increase longevity to maintaining quality of life throughout late life. Brain health, so neglected until now, will become a major focus.
* Fitness and exercise will gain new meaning applied to cognitive ability. This new focus on numerous brain functions will become obvious in retirement communities and nursing homes. The brain is part of the body and, not surprisingly, many similar principles apply. Much brain exercise will happen in the same installations as physical exercise is done today. Perhaps research will show how best to integrate both types of exercise, such as by training one’s working memory while jogging, or improving one’s attention while biking.
* Makers of public policy will launch government-led efforts to bring cognitive fitness into the mainstream. This will parallel President John F. Kennedy’s initiative to popularize physical fitness by establishing the White House Committee on Health and Fitness during the early 1960s. The increasing number of lifelong learning centers will be important allies in this process.
* Better assessment tools will be developed. These new tools will include personalized assessments, both in the form of neuroimaging and cognitive batteries of tests. These tools will allow anyone to identify areas to strengthen, establish a baseline to analyze performance over time and measure the effectiveness of brain fitness workouts and other cognitive interventions. Today’s assessments are cumbersome, expensive to administer and geared toward clinical populations. Tomorrow’s may become as common as devices for checking blood pressure or glucose levels.
* There will be more and better computer-based training programs. These will allow everyone to exercise cognitive skills as needed, both improving strengths and widening bottlenecks that prevent overall progress. Different programs will flex different mental muscles much as different machines at a gym build different muscle groups. The rudimentary, research-limited tools of today will give way to programs defining not only what they do but also who should use them.
* Noncomputer-based programs will also prove to be effective tools. Research increasinglyÃ‚Â is affirming the value of such methods as meditation to train attention and regulate emotions, using cognitive therapy to build self-motivation and other abilities, and keeping a gratitude journal to affirm positives in one’s life and improve self-reported happiness.
* Certified brain coaches will guide, support and tailor programs. Coaches will help those hone their cognitive skills and build their brain reserves. Watch for practitioners from various professional backgrounds-perhaps psychologists, therapists or trainers-filling this role.
* Doctors and pharmacists will play a central role in brain health.Ã‚Â These professionals willÃ‚Â continue to be regarded as trusted advisors and points of information about the body, including the brain.
* Insurance Plans will offer incentives for the use of cognitive assessments and training programs. These tools will become part ofÃ‚Â initiatives for preventive medicine.
* Corporations will add a brain component to their wellness initiatives. Companies will contribute to keeping older employees as healthy and productive as possible, a trend that will be critical given predicted labor shortages in many fields andÃ‚Â the growing number of perfectly healthy individuals won’t want to retire at 60 or 65.
We live fascinating times. Neuroscientist Ramon y Cajal said, at the turn of the 20th century, “Every man can, if he so desires, become the sculptor of his own brain.” Today we are starting to develop refined sculpting tools to do just that.
Alvaro Fernandez is the CEO and cofounder of SharpBrains.com, a cognitive fitness website and consulting firm.
In Focus is a regular feature of Aging Today, the bimonthly newspaper of the American Society on Aging. Articles may be reproduced by obtaining written permission from ASA. Contact:
Paul Kleyman, Editor
American Society on Aging
833 Market St, Suite 511
San Francisco, CA 94103–1824