Pulse
Getting with the Program
Companies are developing products to help aging baby boomers preserve cognitive function. Are they worth the price?
You’ll think faster, focus better, and remember more. Those are some of the claims made by Posit Science, one of a plethora of companies producing software to help aging baby boomers keep their brains as fit as their bodies. From the free online games on the Happy Neuron website to the pricey ($400) Brain Fitness program by Posit Science, they all reflect a popular hypothesis—that cognitive abilities can be maintained or improved by exercising the brain. But do these products work as well as their makers claim?
Mayo Clinic neuropsychologist Glenn Smith, Ph.D., was skeptical when a Posit Science employee asked him what he thought of the company’s Brain Fitness software, which takes people through a series of exercises focused on improving the speed at which they can process auditory information. Posit Science had data showing that people improved their scores on a test taken before and after they did the exercises.
Developing a HABIT Posit
Science’s Brain Fitness program is now used by patients participating in Mayo Clinic’s HABIT (Healthy Activities to Benefit Independence and Thinking) program. HABIT is 10 days of training for people with mild cognitive impairment that helps them develop strategies for coping with daily life.
The centerpiece of the program, which was developed by Mayo neuropsychologist Glenn Smith, Ph.D., and colleagues, is instruction on how to use a special memory compensation aid that involves both calendaring and journaling. The program also helps participants establish a daily exercise routine and introduces them to Brain Fitness software that focuses on improving auditory information processing.
The idea behind HABIT is that participants learn new coping mechanisms. When they go home, their partners can help them maintain those new habits.
To learn more about HABIT go to www.mayo.edu/pmts/mc2800-mc2899/mc2815-06.pdf.
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Smith, who has spent his career conducting research at Mayo Clinic (he’s part of the Alzheimer’s Disease Research Center), immediately saw flaws in Posit Science’s research methodology and told them so. There had been no control group, no randomization. The results might have been caused by the practice effect, a phenomenon whereby people tend to do better on a test the second time they take it simply because they’re familiar with it. “I thought that was the end of it and that they would think I was just a cranky old neuropsychologist,” Smith says. Instead, company officials invited him to their San Francisco headquarters and asked him how he would test whether the exercises really help.
With funding from Posit Science, Smith and a team of investigators from a number of institutions designed a study that was as rigorous as any clinical trial. They developed a placebo—a set of computer-based activities that included watching educational videos and then taking a quiz about them—that would give a control group the idea they were doing something to improve their memory. They also designed a set of tests to assess participants’ processing speed, memory, and performance in their daily lives. And they identified a study population of 70-plus-year-olds, whom they randomly assigned to groups that spent an hour a day, five days a week for two months working with either the real Brain Fitness exercises or the placebo.
Cautious Endorsement
The people who got the placebo, as Smith predicted, did show a little improvement the second time they took the test. Those who worked with the Brain Fitness software, however, improved even more on the memory measures—on the order of about a quarter of a standard deviation, which Smith describes as a “clinically significant change, but not a whopping change.”
Smith thinks Brain Fitness is effective because it targets a fundamental cognitive change that occurs with normal aging—decreased processing speed. And although he hasn’t studied other products, he thinks the ones that focus on cognitive speed and flexibility—the two things that science has shown change most with aging—are more likely than others to be effective as well.
He emphasizes that the study was not designed to show whether the exercises might stave off Alzheimer’s disease and other conditions, and he is cautious about endorsing Brain Fitness. “What I tell people about it is this: If you’re going to spend $400 on something to help your memory anyway, I’d encourage you to use this product because it’s been validated better than most. … But if you don’t have $400 to scrape together for this, you don’t have to have this panic that you’re going to fail cognitively.”
Healthy Advice
Smith believes doctors ought to talk with their patients about keeping their brains fit. He says they first need to establish whether a patient has normal or diminished cognitive abilities. If a patient is aging normally, they should tell him or her to stay active physically. He’d emphasize the research that shows what’s good for the heart is good for brain and that exercise, diet, and keeping cholesterol and blood pressure low can preserve cognitive function. He says doctors also should remind patients that adequate sleep, avoidance of certain medications and alcohol, and both social and cognitive engagement of any type are beneficial.
As far as purchasing products, Smith is higher on software than supplements. “Spending $400 on software is probably money better spent than if you’re going to spend $400 on vitamin E or ginkgo biloba.”—Carmen Peota