Cars don’t work because they don’t fly

Study Ques­tions Effec­tive­ness Of $80 Mil­lion Per Year ‘Brain Exer­cise Prod­ucts Indus­try for Elder­ly (Sci­ence Daily)

- “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.