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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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