Feb 9, 2009
By: Alvaro Fernandez
– “There is much research on the benefits of cognitive rehabilitation strategies among elderly who already experience mild cognitive impairment (MCI) or Alzheimer’s disease, as well as on the positive impact of physical exercise. The researchers, however, wanted to evaluate current research that would focus on the impact of cognitive interventions in the healthy elderly population.”
– “…they concluded that there was no evidence indicating that structured cognitive intervention programs had an impact on the progression of dementia in the healthy elderly population”
Comment: we have not reviewed the analysis yet, so cannot comment in depth. However, just from the press release, we see a few potential problems in how the study was framed, reducing its practical value:
1) Outcomes: I believe it is premature to focus a narrow meta-analysis with “the progression of dementia in the healthy elderly population” as main/ only outcome. There is simply not enough data -which is not surprising, given that computerized cognitive training is a relatively recent phenomenon. What would be more meaningful would be to focus on quality of life (including activities such as driving) and cognitive function outcomes – even if short term. There is a variety of quality studies, including ACTIVE, that show clear benefits beyond placebo – so what we need is a more transparent understanding and taxonomy of what the tools are supposed to accomplish and for whom, and help consumers and professionals make appropriate decisions. It wouldn’t be extremely relevant or enlightening to say that cars don’t work because they don’t fly, which I think is basically what this study is saying. (and yes, this also means we need to educate consumers on what to expect, and what not to expect, from these products, which is what we try to do with resources such as this Checklist).
2) Apparent contradiction: “There is much research on the benefits of cognitive rehabilitation strategies among elderly who already experience mild cognitive impairment (MCI) or Alzheimer’s disease”. Well, what if it is people with cognitive impairments (diagnosed or not) the ones who are using the programs today? (we don’t have hard data to say whether that is the case or not). Until there are more widely available cognitive screenings (which is why we welcomed the Alzheimer’s Foundation of America recent proposal), it is not a surprise that many people and their caregivers make their own decisions – their health providers are basically looking the other way until serious problems are apparent. Implications: 1) we need better information and assessments to identify needs and help guide people towards the tools that may be of help, 2) and, yes, we need to explain to consumers that there are no magic cures or general solutions.
3) Sense of proportion: $80 million in revenues (that was our estimate for 2007 consumer segment revenues) means simply this is an incipient field. For context, the physical fitness market amount to over $20 billion, or 250 times the $80m figure. Don’t have data for the crosswords puzzle or sudoku market sizes handy, but am sure they are many multiple times $80m. I wonder, where are the meta-analyses showing the direct benefits or lack-thereof, based on high-quality trials, of crossword puzzles, sudoku, reading books, classes – those are the most common activities people do in order to “Use It or Lose It”. From a consumer education point of view, I find it slightly misleading to over-analyze one emerging field while ignoring the elephants in the room simply because they happen to be the status quo and we feel comfortable with them. (Btw, are we aware that the average American spends 5 hours in front of a TV, and probably more as we grow older? THAT is the elephant in the room).
4) Finally, based on multiple quality trials in a variety of populations across the lifespan, both “healthy” and “clinical”, as well as brain and neuroplasticity 101, we see a clear theme reinforcing the need for novelty, variety and targeted challenge. We may need to differentiate targeted “mental exercise” from random “mental activity” – this is the hypothesis that would really benefit from a through meta-analysis, which is broader than the very narrow focus the researchers chose. An emerging aspect for people to understand is that, no matter what they do today, their brains would benefit from them doing something different, novel, and cognitively complex. Only a couple of days ago we mentioned an spectacular new study in the paper Science, on how Cognitive Training Changes the Brain More Than We Thought.
In short: the same way that we learned how to best use cars and planes…we’ll need to learn how to best use these emerging tools – please think about cars and planes when they started, and think where they are now.
You can also opt to think about horses: on the one hand, I am sure that when cars started to appear some critics said, “cars don’t work because you cannot take them into horsetrails”. On the other hand, it is true that cars can’t fly.