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Brain Health Business Grows With Research and Demand

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.

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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:ÂÂ

* 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 increasingly 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. These pro­fes­sion­als will 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 of 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 and 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.

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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

Aging Today

Amer­i­can Soci­ety on Aging

833 Mar­ket St, Suite 511

San Fran­cisco, CA 94103–1824

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