Cognitive Training and Brain Fitness Computer Programs: Interview with Dr. Elkhonon Goldberg

Dr. Elkhonon Gold­berg is a clin­i­cal pro­fes­sor of neu­rol­o­gy at New York Uni­ver­si­ty School of Med­i­cine, and author of over 50 peer-reviewed papers. His areas of exper­tise include exec­u­tive func­tions, mem­o­ry, atten­tion deficit dis­or­der, demen­tia, trau­mat­ic brain injury, and oth­ers. Dr. Gold­berg was a stu­dent and close asso­ciate of the great neu­ropsy­chol­o­gist Alexan­der Luria. His book The Exec­u­tive Brain: Frontal Lobes and the Civ­i­lized Mind (Oxford Uni­ver­si­ty Press, 2001) has received crit­i­cal acclaim and has been pub­lished in 12 lan­guages. His recent book The Wis­dom Para­dox: How Your Mind Can Grow Stronger As Your Brain Grows Old­er (Gotham Books, Pen­guin, 2005) offers an inno­v­a­tive under­stand­ing of cog­ni­tive aging and what can be done to fore­stall cog­ni­tive decline. It has been, or is in the process of being, pub­lished in 13 languages.

We are for­tu­nate that Dr. Gold­berg is Sharp­Brains Co-Founder and Chief Sci­en­tif­ic Advi­sor. His book The Wis­dom Para­dox inspired me to embark in this path, and has been a key sound­ing board in the devel­op­ment of what we are doing.

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Key take-aways

- “Use It and Get More of It” reflects real­i­ty bet­ter than “Use It or Lose It”.

- Let’s demys­ti­fy cog­ni­tion and the brain. Every­one needs to have a basic under­stand­ing of the brain-and how to cul­ti­vate it.

- Well-direct­ed men­tal exer­cise is a must for cog­ni­tive enhance­ment and healthy aging.

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Roots: Vygot­sky and Luria

Alvaro Fer­nan­dez (AF): Elkhonon, maybe we could start with Vygot­sky. At one of my Stan­ford class­es, I became fas­ci­nat­ed by his the­o­ry of learn­ing. Which links into mod­ern neu­ropsy­chol­o­gy.

Dr. Elkhonon Gold­berg (EG): Vygot­sky pro­posed that learn­ing requires inter­nal­iza­tion. And that inter­nal­iza­tion equals, lit­er­al­ly, a change in the brain of the learn­er. Of course there weren advanced neu­roimag­ing tech­niques those days, so sci­en­tists could only spec­u­late about what hap­pened in healthy brains. But they could care­ful­ly ana­lyze what hap­pened with patients who had suf­fered any kind of seri­ous brain prob­lem, from strokes to trau­mat­ic brain injury. And this is how neu­ropsy­chol­o­gy was born: Alexan­der Luria, Vygot­sky dis­ci­ple, and my own men­tor, was com­mis­sioned to help reha­bil­i­tate Russ­ian sol­diers with brain injuries dur­ing WWII. This pro­vid­ed invalu­able clin­i­cal mate­r­i­al for under­stand­ing the mech­a­nisms of the healthy brain. Much of mod­ern cog­ni­tive neu­ro­science rests its foun­da­tion in Luri­a’s work.

Neu­roimag­ing

AF: and now we have new neu­roimag­ing techniques.

EG: Pre­cise­ly. It is often said that new neu­roimag­ing meth­ods have changed neu­ro­science in the same way that the tele­scope changed astron­o­my. We use MRI, PET, SPECT, fMRI and MEG both in neu­ro­science research and in clin­i­cal prac­tice. None of these tech­niques is per­fect, but used prop­er­ly they pro­vide us with a much bet­ter under­stand­ing than we had only 30 years ago.

Research and work

AF: please tell us about your main research and prac­ti­cal inter­ests.

EG: As you can see in my papers and books, I will cat­e­go­rize them in 3 areas‑a) com­put­er-based cog­ni­tive training/ Brain Fit­ness over­all, b) healthy cog­ni­tive aging, and c) frontal lobes and exec­u­tive func­tions. I am also inter­est­ed in mem­o­ry, hemi­spher­ic inter­ac­tion, and in a gen­er­al the­o­ry of cor­ti­cal func­tion­al orga­ni­za­tion, but we will leave this for anoth­er occa­sion and focus today on those three areas.

First, Cog­ni­tive Training/ Brain Fit­ness. Rig­or­ous and tar­get­ed cog­ni­tive train­ing has been used in clin­i­cal prac­tice for many years. It can help improve mem­o­ry, atten­tion, con­fi­dence and com­pe­tence, rea­son­ing skills, even how to reduce anx­i­ety and deal with uncom­fort­able situations.

Sec­ond, healthy cog­ni­tive aging. The brain evolves as we age. Some areas, such as pat­tern recog­ni­tion, get bet­ter with age. Some require extra-work­outs in order to reduce “chinks in the armor” and increase neu­ro­pro­tec­tion through the Cog­ni­tive (or Brain) Reserve). Hence, the need for tar­get­ed cog­ni­tive training.

Third, the Frontal lobes and exec­u­tive func­tions, which per­me­ate seem­ing­ly very dif­fer­ent prob­lems such as ADHD and Alzheimer’s, are crit­i­cal for our iden­ti­ty and suc­cess­ful dai­ly func­tion­ing so they require extra attention.

Frontal Lobes and exec­u­tive functions

AF: Please tell us more about what the Frontal Lobes are

EG: We researchers typ­i­cal­ly call them the Exec­u­tive Brain. The pre­frontal cor­tex is young by evo­lu­tion­ary terms, and is the brain area crit­i­cal to adapt to new sit­u­a­tions, plan for the future, and self-reg­u­late our actions in order to achieve long-term objec­tives. We could say that that part of the brain, right behind our fore­head, acts as the con­duc­tor of an orches­tra, direct­ing and inte­grat­ing the work of oth­er parts of the brain.

I pro­vide a good exam­ple in The Exec­u­tive Brain book, where I explain how I was able to orga­nize my escape from Rus­sia into the US.

Sig­nif­i­cant­ly, the path­ways that con­nect the frontal lobes with the rest of the brain are slow to mature, reach­ing full oper­a­tional state between ages 18 and 30, or maybe even lat­er. And, giv­en that they are not as hard-wired as oth­er parts of the brain, they are typ­i­cal­ly the first areas to decline.

Cog­ni­tive Train­ing and Brain Fit­ness

AF: And is that one of the areas where cog­ni­tive training/ Brain Fit­ness Pro­grams can help

EG: Yes. Most pro­grams I have seen so far are bet­ter at train­ing oth­er brain areas, which are also very impor­tant, but we are get­ting there, with exam­ples such as work­ing mem­o­ry train­ing, emo­tion­al self-reg­u­la­tion and domain-spe­cif­ic deci­sion-mak­ing. Some of the spec­tac­u­lar research and clin­i­cal find­ings of the last 20 years that remain to be dis­cov­ered by the pop­u­la­tion at large are that we enjoy life­long brain plas­tic­i­ty and neu­ro­ge­n­e­sis, that the rate of devel­op­ment of new neu­rons can be influ­enced by cog­ni­tive activ­i­ties, and that intense men­tal chal­lenges pro­vide extra resis­tance to aging.

Exer­cis­ing our brains sys­tem­at­i­cal­ly ways is as impor­tant as exer­cis­ing our bod­ies. In my expe­ri­ence, “Use it or lose it” should real­ly be “Use it and get more of it”. And com­put­er-based pro­grams are prov­ing to be a great vehi­cle for that.

Emo­tions and Art

AF: We have been talk­ing most­ly about cog­ni­tion or “think­ing”. What about the role of emo­tions, as shown by the great research by Dama­sio?

EG: Great ques­tion. Until recent­ly, emo­tions were sim­ply not rel­e­vant for many cog­ni­tive neu­ro­sci­en­tists. That is chang­ing, and there is more and more research look­ing into what makes us “unique­ly human”: attrib­ut­es like moti­va­tion, judg­ment, empa­thy, insight into oth­ers, emo­tion­al self-regulation.

AF: how does that link into the role of art? Can we con­sid­er art cre­ation and appre­ci­a­tion as brain exer­cise?

EG: Indeed, and a great one. This is still open ter­ri­to­ry, but my per­son­al opin­ion is that art’s main pur­pose is in fact exer­cis­ing brains. As I men­tion in The Wis­dom Para­dox, I would­n’t be sur­prised if piano lessons were shown to improve over­all sharp­ness and lucid­i­ty. Any activ­i­ty changes the brain, and sys­tem­at­ic pro­grams can be designed to lead that change in a bet­ter way than ran­dom dai­ly activ­i­ties. Learn­ing a com­plex skill such as learn­ing the piano helps train and devel­op some parts of the brain. Well-designed com­put­er-pro­grams help train and devel­op oth­er parts.

Key Mes­sages

AF: if we had to sum­ma­rize your key mes­sages to the pub­lic, based on your research and clin­i­cal career, what would you say?

EG: first, I would say, “For­get about Use It or Lose It”. It is “Use It and Get More of It!”. Sec­ond, I would like to con­tribute to demys­ti­fy cog­ni­tion and the brain, enabling peo­ple to increase their self-aware­ness, their knowl­edge of the brain and how to cul­ti­vate it through­out life. Final­ly, I would high­light the impor­tance of well-direct­ed men­tal exer­cise, on one hand, and of sup­port­ive social net­works, on the oth­er. I am enthused about the oppor­tu­ni­ty to work with you and Sharp­Brains and get the word out.

AF: so are we. It is a plea­sure to col­lab­o­rate on such an endeav­or. Which I am sure will pro­vide us with plen­ty of brain exercise.

EG: as long as you don’t stress out, that’s good! Good night, Alvaro.

AF: Good night, Elkhonon.

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- Cog­ni­tive Neu­ro­science and Psy­chol­o­gy Inter­view Series: in-depth inter­views with 11 sci­en­tists and experts in cog­ni­tive train­ing and brain fitness.

- Books on neu­ro­plas­tic­i­ty and mem­o­ry train­ing: reviews of Train Your Brain, Change Your Mind, by Sharon Beg­ley, and The Brain That Changes Itself, by Nor­man Doidge. Both books are fas­ci­nat­ing and pow­er­ful; each would have mer­it­ed appear­ing in the 2007 New York Times List of 100 Notable Books.