Archive for May, 2008
A lot of advertising today touts computer software for brain fitness or brain training activities. Some of the software is (relatively) inexpensive, and some costs a fair amount (for example, about $400 for one program). Several websites offer memberships that give you access to stimulating games and other training activities.
How do you decide what software you should use?
First, I think it’s important to remember that nothing has been shown to stop cognitive aging or to prevent Alzheimer’s disease. Brain fitness, a brain gym, or any other cognitive fitness program may help you maintain your current level of function and may improve some specific skills, such as memory and thinking speed. These are important benefits and make brain fitness programs worth considering.
As for the software, as with many things, it depends. Some software programs have been subjected to more rigorous testing than have others. On the other hand, most brain fitness software programs have similar content. They often include activities that try to help you improve your working memory, your ability to think and react quickly, and your capacity to do several things at once. Some software programs have very original ways to improving your ability to do things. Posit Science’s new offering, Cortext, now includes a software program that helps you improve your visual attention to the world around. This program was developed by Dr. Karlene Ball at the University of Alabama, and has been shown to improve older driver’s skills. It’s called the Useful Field of View, or UFOV.
Some activities built in computer brain training software and often used in brain gyms are pretty much the same whether you’re using an inexpensive handheld trainer. Others, like the UFOV, are only available in a specific package. So whether one program or another is best for you may depend on what kind of memory or other cognitive problems you are having trouble with, and what you want to improve.
A recent article in the International Herald Tribune describes some of the available software programs, and some creative ways that some older adults are figuring out how to maintain their function. The author of the article quotes Dr. Gene Cohen, Director of the Center on Aging at George Washington University, who says that what’s essential is some activity to “challenge your brain.” (Click here to see the article.)
One man, for example, reads books upside down to improve his cognitive flexibility. Another man takes opportunities to memorize numbers he sees around him. The author quotes one of the persons in this article as saying “Smart people find new ways to exercise their brains that don’t involve buying software or taking expensive workshops.”
I would say there are three important issues in deciding whether you use brain fitness software or go to a brain gym.
- The first is whether you want an evaluation of your strengths and weaknesses to help you guide your work in the brain gym. A comprehensive assessment also will give you a baseline to help determine whether any of your abilities change over time.
- The second issue is whether you want to benefit from a specific training activity that is only available in a specific software package. Some people think doing the brain puzzles of Sudoku (a game that asks to do mental arithmetic across several parts of a puzzle) is helpful. You can do that in books you can buy at the grocery store, or you can do it in an inexpensive handheld gaming device such as the Nintendo DS. On the other hand, if you want to work on certain visual or auditory skills, some of the software programs may be a better bet.
- The third issue is whether you want the help, encouragement, and support you can get from the staff in a brain fitness program. Just as many people do well in working out in a gym they have in their home, others find that actually going to a health club helps them stick with their program. This may be especially true if you have a personal trainer or are in a group.
It’s a really “hot” topic, and an often-discussed topic: Can cognitive training on computer software help you improve your memory and stave off Alzheimer’s?
I think the answer to the first question may turn out to be at least a partial yes. I think it’s pretty clear that computer-based training can improve your memory. A lot of research has shown that older people can learn new things, just as younger people do. Sometimes the way older people who are taught may have to change, and sometimes older people need a little more help, but older people can learn new things. My colleague, Dr. Sara Czaja at the Center on Aging here at the University of Miami, has shown that older adults can learn how to do diverse jobs such as entering data on a computer or working with a computer to answer customers’ questions about their insurance policies. Another colleague in the Center, Dr. David Loewenstein, has also shown that even people with memory problems can improve their memory.
A large, multi-center (done at several different locations) trial sponsored by the National Institute on Aging showed that certain kinds of cognitive training had significant effects on reasoning, memory, and psychomotor speed. Perhaps most exciting was the demonstration that some of these training effects were still evident after five years. More recently, several of the companies who sell cognitive or brain fitness software for brain gyms have shown that people who use the software may show improvements in memory and other abilities. I think it’s pretty safe to conclude that older adults can benefit from cognitive training.
Will doing the training keep you from getting Alzheimer’s disease, or from getting memory problems if you don’t already have them? That’s really a good question, but as in many cases, there isn’t a very good answer. Just as cognitive reserve (see my post from April 25 for more about cognitive reserve: click here) may mean it takes longer for someone to have recognizable memory problems, cognitive training may work in much the same way. We know that a lot of the people who participate in cognitive training activities feel that they are helpful.
I think computer-based cognitive training may be very useful in helping participants feel that they understand how their mind works and better able to cope with daily challenges to remember things and solve problems. And as far as we know, there are few or no side effects of computer-based training.
I think that many of us who work in the field of aging and mental abilities sometimes may forget to explain some key terms and phrases to patients. One of the most general and frequently used is the phrase cognitive aging. What does it mean?
Cognitive Aging refers to how our mental capacities change over time. It may seem as though all of our abilities go downhill after age 30 or 40, but research shows that isn’t completely true. The truth is that some abilities decline over time, some stay about the same, and some actually improve as we get older. For example, psychomotor speed is an ability in which most people perform more poorly over time. The precise definition of psychomotor speed varies from study to study, but it’s often assessed by tests that ask you to do some kind of task that requires that you think and to something with your hands as quickly as you can. One task is called a pegboard. A piece of metal attached to a block of wood has rows of holes in it, a little like the kind of pegboard you might put up in your workshop to hold tools. The person being evaluated is asked to put small metal pegs in the board as quickly as he or she can. This is the sort of thing that younger persons in general do much better than older persons do.
Another ability that may decline over time is called working memory. This ability is usually assessed by asking someone to keep a couple of things in their minds and then do something with them. The person being evaluated might be given a series of numbers and then asked to repeat them backwards – he or she has to remember the numbers and then somehow mentally read them backwards. Being asked to do mental arithmetic problems also taps working memory. Here, the person being assessed might have to remember some elements of the problem that are given, might have to access some existing knowledge (like how many quarts are in a gallon), and then do a calculation.
What abilities may actually get better over time? Things that don’t require speed or working memory, but may benefit from life experience. The most common example is vocabulary. Many older adults score better than their younger counterparts on tests of how many words they know. Older adults probably have had more opportunities to learn words, and once a word is in long-term memory, older adults can recall it pretty well. Some people have also suggested that because of the benefits of experience, older adults are better able to discern patterns in events around them. Finally, some research has shown that older adults are better than younger persons at certain kinds of problem solving, especially when it involves social skills or awareness of social issues.
I spend a lot of time teaching medical students, residents, fellows, and other health care professionals. Since I think it’s critical that we base our clinical practice on the best evidence available, I like to talk about what research evidence shows. This means that at least some of the time I have to explain a little bit about how research studies are done, what kind of evidence they produce, and why some studies are generally considered to give us better or stronger evidence than others.
One of the most important issues that comes up in discussions of research in the media and with patients and clinicians has to do with research design. Not all research is done in the same way, and we can draw certain kinds of conclusions from one research design but not others. We often want to decide whether something either causes disease (for example, smoking) or helps prevent it (for example, does vitamin C prevent colds?). Two basic kinds of research studies deal with these issues in different ways, and give us different kinds of information.
The most common type of study that gives us information about factors associated with disease is the observational study. These studies are very common, and usually involve collecting information from a group people at one point in time, and then collecting the information on other occasions. We might, for example, ask a group of people in the community about their memory, diet, exercise, and use of vitamin supplements. Later, we would ask them the same questions again. Perhaps some of the people would say that their memory had gotten worse. We could then find out if their diet, exercise, or use of vitamins was different from the people who said their memory was OK.
The good thing about this kind of study is it’s easy to do and therefore less expensive than many other kinds of research. The weakness is we can’t control all the things that might affect the study’s outcome.
Suppose we found that people who took vitamins were less likely to say their memory got worse. Would that mean that taking vitamin C is good for your memory? No. Although this kind of study is often interpreted this way, it’s not true. We don’t know whether something else is going on that is related to taking vitamin C but also affects memory.
A good example are the results of observational studies that ask people about taking drugs called non-steroidal anti-inflammatory drugs (NSAIDS). These are medications like ibuprofen; there are many brand names. Studies have shown that people who took NSAIDS for arthritis are less likely to develop Alzheimer’s disease. So far, so good. But when controlled clinical trials of NSAIDS in people with memory problems were done, they didn’t show any benefit.
Observational studies are really useful for helping us understand what may cause a disease, but they usually aren’t very good at nailing down exactly how to treat one.
An interesting article appeared in the New York Times over the weekend. The article by Katie Hafner is titled “Exercise Your Brain or Else You’ll . . .Uh . . .” You can find the original article here (registration is required, but is free).
The article recounts several incidents in which people over 50 had troubling memory problems. One man, for example, couldn’t remember his own address when he went to send a package, and a woman who couldn’t locate her cell phone later found it in the refrigerator. Do these kinds of memory lapses mean that these persons have serious memory problems? The answer is, “It depends.” One memory lapse doesn’t mean very much. But a pattern of memory problems over a period to time may mean that someone’s memory isn’t as good as it used to be. Even if that’s true, though, it doesn’t necessarily mean that a person has a serious brain illness such as Alzheimer’s disease. Only a complete evaluation by a well-trained clinician can make that decision.
One issue the article highlights is how people over 50 or so may be more concerned than younger people about memory lapses. Put simply, people over 50 are more likely to worry about brain fitness. I have the pleasure of working with several young people in the Center on Aging. I notice that they may have memory lapses, but they don’t worry about them nearly as much as some of the people who come to our Memory Disorders Clinic for evaluation of their memory. They’re young, and if they forget something they don’t automatically worry about it. For them, it’s just a lapse. For someone over 50, the same kind of lapse is ground for worry. I’m not suggesting that if you’re over 50 and you’re worried (or your spouse and family are worried) about your memory you shouldn’t do something about it. I am suggesting that people over 50 may worry more about their memories. The New York Times article goes on to talk about how worry about cognitive fitness and cognitive decline or memory problems is feeding interest in brain fitness software.
If you’re worried about your memory, the best thing to do is find a qualified clinician who can complete a screening evaluation. Tests of memory and other cognitive abilities can help you find out where you stand in relation to other persons who are similar to you. This can help you decide whether your memory problem needs to be treated. And if you have a memory problem, a knowledgeable clinician may help you find out what’s causing it. Some memory problems are caused by problems such as mood problems, stress, or other treatable conditions. Getting the treatment you need may help.
Latest
- Brain Fitness and The Mind of a Monk
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I saw an interesting blog post yesterday evening on the site of the Huffington Post about the potential benefits of meditation – or at least about what one woman thinks might be the benefits. (more…)
Although many people are excited about the potential for using computers to train their brains, we shouldn’t forget that other techniques have been used to the train the brain for many centuries. I’m thinking about the large number of techniques for meditation. While free computer software still requires an investment in a computer, meditation only asks you to sit or lie quietly and focus your mind.
A recently-published study shows parts of the brain in long-term meditators are larger than the same parts of the brain in people who don’t meditate. The article by Eileen Luders and her colleagues appeared in a recent issue of the journal Neuroimage (Vol. 45, No. 3, pp. 672-678, April 15, 2009). The study showed that portions of the orbitofrontal cortex and the hippocampus were larger in persons who had been regular meditators for 5 or more years. The study is interesting because the parts of the brain that were larger are often thought to be important in helping people keep themselves emotionally balanced.
A number of strategies are likely to be helpful for meditators. There has been a great deal of interest over the last several years in mindfulness meditation. Researchers have studied how it can be used in reducing anxiety and depression. Mindfulness is based on Buddhist meditation (for a brief article, click here) but you don’t have to be a Buddhist to practice meditation. In fact, one of the most important persons who has promoted mindfulness is Jon Kabat-Zinn, a researcher at the University of Massachusetts. You can see a video presentation by him on YouTube by clicking here.