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Improving Brain Health Outcomes with Tech, Incentives and Comparative Effectiveness Research

Mal­prac­tice Method­ol­ogy (New York Times OpEd by Peter Orszag)

Right now, health care is more evidence-free than you might think. And even where evidence-based clin­i­cal guide­lines exist, research sug­gests that doc­tors fol­low them only about half of the time. One esti­mate sug­gests that it takes 17 years on aver­age to incor­po­rate new research find­ings into wide­spread prac­tice. As a result, any clin­i­cal guide­lines that exist often have lim­ited impact. How might we encour­age doc­tors to adopt new evi­dence more quickly?

If this is the case with health care over­all, despite much progress over the last 30–40 years, imag­ine how worse it may be when we talk about brain health, when neu­ro­science and cog­ni­tive neu­ro­science are rel­a­tively more recent disciplines.

This is a key insight to keep in mind as we debate the value and lim­i­ta­tions of inno­v­a­tive brain health solu­tions, espe­cially those that are non-invasive and have no neg­a­tive side effects:  what mat­ters most to actual human beings liv­ing today is how those tools and solu­tions seem to per­form, based on best evi­dence, com­pared to alter­na­tives avail­able today — not com­pared to Pla­tonic ideals about research and prac­tice which may exist in our minds but not in the real, empir­i­cal world. Of course we then need to guide research so that we have bet­ter evi­dence in the future, but progress must occur in par­al­lel and rein­force each other: progress in prac­tice and in research.

The OpEd author then pro­ceeds to defend mal­prac­tice reform as the pri­mary way to do so. This may well be so with health­care as a whole, but when we are talk­ing about brain care I believe his next 2 pro­pos­als are more directly rel­e­vant: Read the rest of this entry »

The Future of Cognitive Enhancement and Mental Health: Meet the Experts

Since 2006, as part of the research sup­port­ing The Sharp­Brains Guide to Brain Fit­ness and Sharp­Brains’ mar­ket reports, we have inter­viewed dozens of leading-edge sci­en­tists and experts. Below are some of our favorite quotes and inter­views — you can read the full inter­view notes by click­ing on the links:

Con­ver­sa­tions in 2010

“…putting good evi­dence to work in prac­tice requires more than pub­lish­ing good research. I’d say that sci­en­tific evi­dence is directly rel­e­vant to per­haps 15% of clin­i­cal deci­sions…we require tech­nolo­gies that trans­late emer­gent knowl­edge into prac­tice.” - Dr. John Docherty, Adjunct Pro­fes­sor of Psy­chi­a­try at Weill Med­ical Col­lege, and for­mer Branch Chief at NIMH.
Full Inter­view Notes.
“We should be think­ing about the brain through its whole life­time…We need to break the silos, to aggre­gate knowl­edge, to help advance our knowl­edge of the brain 50 years in 5 years.” — Patrick Dono­hue, founder of the Sarah Jane Brain Project.
Full Inter­view Notes.

Con­ver­sa­tions in 2009

My dream in all of this is to have stan­dard­ized and cred­i­ble tools to train the 5–6 main neu­rocog­ni­tive domains for cogni tive health and per­for­mance through life, cou­pled with the right assess­ments to iden­tify one’s indi­vid ual needs and mea sure progress” — Dr. Michael Merzenich, Emer­i­tus Pro­fes­sor at UCSF, and pio­neer in brain plas­tic­ity research.
Full Inter­view Notes.
“We have an oppor­tu­nity to make major progress in Brain Health in the XXI cen­tury, sim­i­lar to what hap­pened with Car­diovascular Health in the XX, and tech­nol­ogy will play a cru­cial role.” — Dr. William E. Reich­man, Pres­i­dent and CEO of Bay­crest.
Full Inter­view Notes.
Growth only really comes at the point of resis­tance, but that is the moment that we tend to stop. Because it hurts…pushing our lim­its is a mus­cle that can be cul­ti­vated like any other–incrementally” — Joshua Wait­zkin, chess cham­pion and author of The Art of Learn­ing.
Full Inter­view Notes.
“The cor­re­la­tion between iden­ti­cal twins reared apart gives an over­es­ti­mate of her­i­tabil­ity because the envi­ron­ments of iden tical twins reared apart are often highly sim­i­lar. But the main con­tra­dic­tion of her­i­tabil­ity esti­mates lies in the fact that adop­tion pro­duces a huge effect on IQ” –Dr. Richard Nis­bett, Pro­fes­sor at Uni­ver­sity of Michi­gan and author of Intel­li­gence and How to Get It: Why Schools and Cul­tures Count.
Full Inter­view Notes.

For more, please visit our Neu­ro­science Inter­view Series.

Update: Innovation to Upgrade Brain Care

Here you have the July107px-gray1197thumbnail edi­tion of our monthly eNewslet ter cov­er­ing cog­ni­tive health and brain fit­ness top­ics. Please remem ber that you can sub­scribe to receive this free Brain Fit­ness eNewslet­ter by email, using the box in the right column.

Tech­nol­ogy to upgrade brain care: In this exten­sive inter­view, Dr. John Docherty helps con­nect the dots on why new frame­works and tools are a must to put recent brain research to good use. A must read for all pro­fes­sion­als in the field.

Research

Find­ings from NIH Expert Panel: The Amer­i­can Soci­ety on Aging asked Alvaro Fer­nan­dez to com­ment on the find­ings from a major cog­ni­tive health research review by the National Insti­tutes of Health. Lifestyle still mat­ters, and pro­tec­tive fac­tors against cog­ni­tive decline are led by cog­ni­tive train­ing, phys­i­cal activ­ity and cog­ni­tive engagement.

Sci­en­tific cri­tique of BBC brain train­ing exper­i­ment: Dr. Eliz­a­beth Zelin­ski shares her con­cerns about the April 2010 BBC study, which included sub­stan­tial and unex­plained dropout rates, and ques­tion­able out­come mea­sure­ment and interpretation.

The value of being bilin­gual and build­ing a Cog­ni­tive Reserve to pre­serve learn­ing and mem­ory even in the face of brain dam­age are explored in recent studies.

San Fran­cisco Bay Area study seeks par­tic­i­pants: The Gaz­za­ley Lab at UCSF is look­ing for par­tic­i­pants aged 20–59 to explore the impact of dis­trac­tion and mul­ti­task­ing on per­for­mance across the lifespan.


Inno­va­tion

What impressed Inno­va­tion Awards Judg­ing Panel: Get some insight into what most impressed the Judg­ing Panel about each Win­ner and Final­ist of the 2010 Brain Fit­ness Inno­va­tion Awards.

New — Sharp­Brains’ 2010 Mar­ket Report:  Sharp­Brains’ flag­ship, 207-page, third annual mar­ket report finds con­tin­ued growth for dig­i­tal tech­nolo­gies to assess, enhance and treat cognition.

To man­age brain fit­ness through life, we need to put puz­zle pieces together: inno­v­a­tive tools to help us bet­ter mon­i­tor our cog­ni­tive health and take informed action are badly needed.…and already emerging.

The inter­net will fry your brain. Sure: In his lat­est book, Nicholas Carr does a great job high­light­ing the impli­ca­tions of life­long neuro­plasticity, but picks the wrong enemy.

“Seri­ous Games”:  Can video games inspire peo­ple to per­form acts of altru­ism? Kyle Smith reports.

Teasers

Yahoo Opti­cal Illu­sions and teasers: Yahoo! has cre­ated an expanded sec­tion of illu­sions and teasers, and we were glad to con­tribute to it. Enjoy…and have a great summer!

Technology as the missing link to enable a brain-based model of brain care: interview with Dr. John Docherty

Dr. John Docherty is an Adjunct Pro­fes­sor of Psy­chi­a­try at the Weill Med­ical Col­lege, Cor­nell Uni­ver­sity, Direc­tor of Post Grad­u­ate Edu­ca­tion there, and Chief Med­ical Offi­cer of Brain Resource. Trained as a clin­i­cal research fel­low in neu­ropsy­chophar­ma­col­ogy at NIMH, he later returned as Chief of the Psy­choso­cial Treat­ments Research Branch, respon­si­ble for all fed­er­ally sup­ported psy­choso­cial treat­ment research in men­tal health nation­wide. He over­saw the land­mark National Col­lab­o­ra­tive Study of the Treat­ment of Depres­sion and served as a mem­ber and Chair­man for over 10 years on the NIMH and then NIDA Treat­ment Research IRGs. Dr. Docherty has wide expe­ri­ence in suc­cess­fully imple­ment­ing inno­va­tion in both clin­i­cal oper­a­tions and man­aged health care. He founded North­east Psy­chi­atric Asso­ciates in 1985. As National Med­ical Direc­tor for National Med­ical Enter­prises, he over­saw med­ical con­trol and qual­ity improve­ment in 74 hos­pi­tals in 34 states. He was the Exec­u­tive Vice-President and Chief Med­ical Offi­cer for Merit Behav­ioral Care, which then cov­ered 30 mil­lion peo­ple. In 1998, he founded Com­pre­hen­sive Neu­ro­Science (CNS). Its Care Man­age­ment Tech­nolo­gies are cur­rently imple­mented in 17 state Med­ic­aid plans. Dr Docherty has received numer­ous hon­ors and awards and has authored over 100 sci­en­tific publications.

(Editor’s note: this inter­view with Dr. John Docherty was orig­i­nally pub­lished in Sharp­Brains’ mar­ket report Trans­form­ing Brain Health with Dig­i­tal Tools to Assess, Enhance and Treat Cog­ni­tion across the Lifes­pan, pub­lished in July 2010)

Alvaro Fer­nan­dez: Dr. Docherty, it is a plea­sure to be with you today to dis­cuss the main theme of Sharp­Brains’ 2010 mar­ket report – how the con­ver­gence of sci­en­tific find­ings and tech­nol­ogy plat­forms and tools is reshap­ing how as a soci­ety and as indi­vid­u­als we will take care of cog­ni­tion and men­tal well­ness along the life­course, giv­ing birth to the emerg­ing dig­i­tal brain health and fit­ness mar­ket. Can you first briefly dis­cuss your career tra­jec­tory and your cur­rent role at Brain Resource?

Dr. John Docherty: Sure. The main theme of my work since the 1960s has remained the same, “How do we put knowl­edge into effec­tive use to improve men­tal health?” Over the last cen­tury, med­i­cine made tremen­dous progress in gen­er­at­ing sci­en­tific and clin­i­cal knowl­edge. Basic research dis­cov­ery sci­ence and clin­i­cal treat­ment devel­op­ment sci­ence have made great progress. Within Psy­chi­a­try there was stan­dard set­ting advance in the 1960’s through the NIMH-VA coop­er­a­tive stud­ies to the method­ol­ogy of assess­ing the effi­cacy of psy­chophar­ma­co­log­i­cal drugs. This work estab­lished prin­ci­ples adopted for the study of med­ica­tions in the other areas of med­i­cine. The study of psy­chother­apy, how­ever, lagged in devel­op­ment. In my role of Chief of the Psy­choso­cial Treat­ments Branch of the NIMH , I helped con­tribute to the advance of that work by sup­port­ing the efforts of an extra­or­di­nary group of indi­vid­u­als led by Irene Waskow who car­ried out the TDCRP. This study estab­lished the method­olo­gies that made pos­si­ble the effec­tive sci­en­tific study of the effi­cacy of psy­chother­a­pies. The evi­dence base and of such treat­ments as CBT, DBT, Moti­va­tional Enhance­ment Treat­ment and other evidence-based psy­chother­a­pies derives directly from this study and its sem­i­nal influ­ence. This was a con­tri­bu­tion to the sci­ence of Clin­i­cal Treat­ment Devel­op­ment research.

I would say that my major inter­est, how­ever, has been in the next step, the sci­ence of knowl­edge trans­fer. There has been and remains a long and costly (in terms par­tic­u­larly of unnec­es­sary suf­fer­ing) lag between the devel­op­ment of new knowl­edge and its com­mon and effec­tive use in practice.

In order the help the field moved for­ward, I have worked for the last 20 years in the devel­op­ment and imple­men­ta­tion of meth­ods to effec­tively trans­fer knowl­edge into prac­tice. Read the rest of this entry »

Learn about the 2014 SharpBrains Summit in 2 minutes

Watch Larry King’s interview

» Click HERE in the USA, or HERE else­where (opens 28-min program)

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