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Your comments on cognitive training, Posit Science, Alzheimer’s Australia, gerontology, games

I have fallen behind on answering a few excellent recent comments -on cognitive training overall, Posit Science and Alzheimer’s Australia, gerontology and the brain, the value of videogames-, so let me address them here:

1) Nicks says (Brain Fitness Programs For Seniors Housing, Healthcare and Insurance Providers: Evaluation Checklist)

“This report is interesting and it addresses many very important questions that cognitive neuropsychologists, such as myself have. I feel that many of the products on the market now make claims which are generally unsubstantiated.

I find it concerning that many of these programmes have been marketed to target older adults in particular without making any specific statement on whether the activities are beneficial and have been supported with empirical research.

i have recently conducted a cognitive intervention study which used a large array of outcome measures which focus on a number of different cognitive functions. The measures investigated both objective and subjective behaviours. The results confirmed that attempting cryptic crosswords for one hour per day increased subjective awareness of older adults own memory. However there was no evidence of a tangible increase in episodic, verbal memory with both recall and recognition. There was also no evidence of increases in metacognition. It is important to note that the intervention period was only six weeks. However this demonstrates that there is a need for products to be clear on what functions the activity will promote and whether it is affected by any confounding variables. For example we found that the beneficial effects were more apparent in individuals with a lower number of years in education. This is important because it is likely that people who purchase such intervention products will tend to have a higher socio-economic status and significantly more developed educational background.

Overall, there is a need in psychology for an overhaul of how we measure cognitive interventions. We also need to ensure that we use the correct methodology (i.e. within subjects designs) and that we used the sorrect sample population. Unfortunatly many of the previous research which the cognitive reserve hypothesis and use-it-or-lose-it theory are based on have not done so.”

My comment: Nick, I mostly agree. I will send you an email to learn more about your research. I find it concerning that people buy things without understanding what they are buying. But I also find concerning the number of people who have already done one million crossword puzzles and think that the single most important thing they can do next for their cognitive health and memory is…one more crossword puzzle. I find it even more concerning that, when I recently asked a group of around 200 assisted living professionals how many of them did offer menntally stimulating activities other than playing bingo and social receptions to their residents, less than a third of them raised their hands.

We only learn by trying things. Clinical trials are a superb way of learning. Initiatives like Alzheimer Australia’s (promoting a particular cognitive training program) can also be very useful, if they use independent measures of cognition and quality of life. We also see many seniors housing facilities conducting pilot studies that will never be published as scientific research but help them find what tools may be helpful in their particular environments.

I could not agree more that a critical part of the puzzle, now largely missing, is the availability of inexpensive and high-quality cognitive assessments. And that will facilitate a more informed use of the growing array of options. Fortunately, we see very interesting signs  that this may change sooner than many people think.

2) David says (Posit Science Program Classic and InSight: Alzheimer’s Australia):

“Alzheimer’s Australia WA enlisted Curtin University Centre for Research on Ageing to conduct a literature and provider review into neuroplasticity and memory enhancement in older people. The result of a two year process of investigation and review by our organisation identified Posit Science as the only provider who had a significant body of clinical trial evidence to support the efficacy of their products.

Alzheimer’s Australia supports the Posit Science programs as one way of staying mentally active (a dementia risk reduction strategy that we clearly support) that also provides proven individual benefit to memory and cognitive function in people experiencing age-related memory loss.

The organisation does not promote these programs to people with dementia, nor on the basis that using them will delay or prevent dementia. Very preliminary pilot study evidence indicates they may have some therapeutic benefit for people with early dementia or MCI, and Alzheimer’s Australia WA is currently engaged with Curtin and Edith Cowan Universities here in Australia to undertake pilot studies to explore this further.

We are also undertaking an 18-month government-funded demonstration project to trial the use of these programs in residential communities, senior’s fitness groups and the workplace, and evaluation of both individual benefit and the sustainability of each group model will be undertaken as part of this process.”

My comment: David, great to read about the research initiatives you mention at the end of your comment. That is exactly what is needed-but my advice would be to compare more than one computer-based cognitive training method. It makes little sense to compare a computer-based training program with watching TV as the control group, for example. You may want to compare Posit science’s 2 programs (which focus on clearly separate and narrow sensory-focused cognitive domains) with wider interventions (such as MindFit and Dakim mPower), and perhaps even with Nintendo Brain Age. From an delay of Alzheimer’s symptoms, and even cognitive decline, point of view, continued and frequent use in the real world are likely to be very important  based on the available evidence, and it is far from clear than the Posit Science programs’ strengths lie there.

People in Australia may find it a bit confusing that something actively endorsed and sold by an Alzheimer’s Association brings the disclaimer “The organisation does not promote these programs to people with dementia, nor on the basis that using them will delay or prevent dementia”. I’d assume that is what people think they are buying from you. Which is why I said in my post that, first, I think it is a great initiative to offer a mentally stimulating activity but, second, given the limited amount of long-term research, it would be a superb opportunity to add an independent cognitive assessment component, to measure the potential impact of one (or several) interventions and to start explaining to people how the brain works, what cognitive functions are, and how different lifestyle factors, such as physical exercise, contribute to cognitive health.

You are endorsing two products by Posit Science, one of which (Classic) has one published study behind, the other one (InSight) with, objectively, no direct clinical validation behind (InSight is a fundamentally new product, launched in March 2008 with 6 exercises: five are brand new, and one had been tested before on a variety of situations with very impressive results. There has been no correlation study done to date, to our knowledge, to validate whether X hours devoted to InSight produces same, better, or worse results as X hours devoted to that one tested exercise). Posit Science Classic program (for auditory processing training) has been used in many more studies (including IMPACT), but those results remain to be published.
Facing a similar situation, Susan Greenfield, Director of the Royal Institution in the UK and Alzheimer’s expert, chose to endorse MindFit last year.  A number of agencies and communities in the US are choosing Dakim’s system. I also hope you are aware of a number of working memory training programs that can be of much value to older adults.

A couple of days ago I published an interview with an executive from Allstate: they are using Posit Science Insight program as a research study first, to measure its effectiveness on improving driving safety of older adults, which makes for a beautiful initiative.

In short: at this point it is a judgment call, informed but not fully determined by the existing evidence, what program may benefit people most, Which is why 1) the most independent cognitive assessments we use to establish baselines and measure progress, the better, 2) informing consumers and professionals about the value and limitations of different approaches may be, in my view, what is really needed. Especially if it comes from an Alzheimer association, and with the kind of disclaimer you offered in your comment, 3) research initiatives like the one you outline are really needed, and I commend your association for taking the lead there.

The easy way out would have been “because research is not perfect, we opt to do nothing or little”. Given what we know, it is good to try-and measure.

3) Dr. Thibeault writes (Brain Training and Cognitive Health: September News)

– “#3 above as it relates to gerontology. Come visit MENTAL GYMNASTIC classes in Oxnard, Camarillo, and Thousand Oaks, Calfornia. With more than 220 “students’ there is widespread interest.”

My comment: I know there is a lot of interest in mental fitness related classes among lifelong learners, in fact I do teach such classes at several San Francisco Bay Area universities…but that was not really the point. The problem we identified was that many gerontology masters programs (this is, the training ground for the gerontologists of tomorrow) didn’t seem to offer any brain/ cognitive-related classes, in a n obvious disconnect with one of the main areas of concern for people over 50. Btw, I hope to visit one your classes soon!

4) Charlie asks (Playing the Blame Game: Video Games Pros and Cons)

“Could you direct me to a link which has the Olson/Kutner study? I’m doing a paper for grad school and would love to include a reference to this work. Thanks for a very helpful and enlightening article. ck “

My comment: Olson & Kutner maintain a good website including research references. See grand theft childhood.

5) Jean writes (same post)

“I am still firmly on the fence and more than a little distressed about the time taken away from reading.
However, I must admit that when we played cowboys and indians or police and thief, the gun (toys, supplied by some adult) played a large part. Our movies were westerns, which by todays standards would have been heavily rated for violence and cultural inappropriateness. Yet most of us turned out okay. So I suppose given the right parenting environment, these children will be okay too.”

My comment: You raise a good point… I appreciate the fact that the first thing that the researchers mentioned in the article did was to immerse themselves in several games, in order to analyze reality, not preconceived notions. I also agree that “most of us turned out okay”!

Enjoy the weekend!

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3 Responses

  1. TJ says:

    I second to your comments in response to the action Alzheimers Australia takes. Despite the public health dilemma you mentioned in the earlier blog, the organization remains accountable in assisting the customers to make informed decision. Going through the website (www.alzheimers.asn.au), specifically on the topic relating to endorsing the Posit Science programs, gave me the feeling that Posit Science products are the world’s best brain fitness programs… Aren’t we jumping to conclusion? Too fast?

  2. Thank you, TJ. The main problem we see is that consumers and healthcare professionals need to better understand that there is no one general solution or magic pill, so using the word “best” can be misleading at this point. Best for what, exactly?

  3. Susan Berg says:

    As an Activities Director of a nursing home, I have seen learning in our residents with dementia. Although I have not done any studies, I have noticed this through clinical observation.

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