Sharp Brains: Brain Fitness and Cognitive Health News

Neuroplasticity, Brain Fitness and Cognitive Health News

Icon

Michael Merzenich on Brain Training, Assessments, and Personal Brain Trainers

Dr. Michael Merzenich Dr. Michael Merzenich, Emer­i­tus Pro­fes­sor at UCSF, is a lead­ing pio­neer in brain plas­tic­i­ty research. In the late 1980s, Dr. Merzenich was on the team that invent­ed the cochlear implant. In 1996, he was the found­ing CEO of Sci­en­tif­ic Learn­ing Cor­po­ra­tion (Nas­daq: SCIL), and in 2004 became co-founder and Chief Sci­en­tif­ic Offi­cer of Posit Sci­ence. He was elect­ed to the Nation­al Acad­e­my of Sci­ences in 1999 and to the Insti­tute of Med­i­cine this year. He retired as Fran­cis A. Sooy Pro­fes­sor and Co-Direc­tor of the Keck Cen­ter for Inte­gra­tive Neu­ro­science at the Uni­ver­si­ty of Cal­i­for­nia at San Fran­cis­co in 2007. You may have learned about his work in one of PBS TV spe­cials, mul­ti­ple media appear­ances, or neu­ro­plas­tic­i­ty-relat­ed books.

(Alvaro Fer­nan­dez) Dear Michael, thank you very much for agree­ing to par­tic­i­pate in the inau­gur­al Sharp­Brains Vir­tu­al Sum­mit in Jan­u­ary, and for your time today. In order to con­tex­tu­al­ize the Summit’s main themes, I would like to focus this inter­view on the like­ly big-pic­ture impli­ca­tions dur­ing the next 5 years of your work and that of oth­er neu­ro­plas­tic­i­ty research and indus­try pio­neers.

Thank you for invit­ing me. I believe the Sharp­Brains Sum­mit will be very use­ful and stim­u­lat­ing, you are gath­er­ing an impres­sive group togeth­er. I am look­ing for­ward to Jan­u­ary.

Neu­ro­plas­tic­i­ty-based Tools: The New Health & Well­ness Fron­tier

There are many dif­fer­ent tech­nol­o­gy-free approach­es to harnessing/ enabling/ dri­ving neu­ro­plas­tic­i­ty. What is the val­ue that tech­nol­o­gy brings to the cog­ni­tive health table?

It’s all about effi­cien­cy, scal­a­bil­i­ty, per­son­al­iza­tion, and assured effec­tive­ness. Tech­nol­o­gy sup­ports the imple­men­ta­tion of near-opti­mal­ly-effi­cient brain-train­ing strate­gies. Through the Inter­net, it enables the low-cost dis­tri­b­u­tion of these new tools, any­where out in the world. Tech­nol­o­gy also enables the per­son­al­iza­tion of brain health train­ing, by pro­vid­ing sim­ple ways to mea­sure and address indi­vid­ual needs in each person’s brain-health train­ing expe­ri­ence. It enables assess­ments of your abil­i­ties that can affirm that your own brain health issues have been effec­tive­ly addressed.

Of course sub­stan­tial gains could also be achieved by orga­niz­ing your every­day activ­i­ties that grow your neu­ro­log­i­cal abil­i­ties and sus­tain your brain health. Still, if the ordi­nary cit­i­zen is to have any real chance of main­tain­ing their brain fit­ness, they’re going to have to spend con­sid­er­able time at the brain gym!

One espe­cial­ly impor­tant con­tri­bu­tion of tech­nol­o­gy is the scal­a­bil­i­ty that it pro­vides for deliv­er­ing brain fit­ness help out into the world. Think about how effi­cient the drug deliv­ery sys­tem is today. Doc­tors pre­scribe drugs, insur­ance cov­ers them, and there is a drug store in every neigh­bor­hood in almost every city in the world so that every patient has access to them. Once neu­ro­plas­tic­i­ty-based tools and out­comes and stan­dard­ized, we can envi­sion a sim­i­lar sce­nario. And we don’t need all those drug stores, because we have the Inter­net!

Hav­ing said this, there are obvi­ous obsta­cles. One main one, in my mind, is the lack of under­stand­ing of what these new tools can do. Cog­ni­tive train­ing pro­grams, for exam­ple, seem counter-intu­itive to con­sumers and many pro­fes­sion­als “ why would one try to improve speed-of-pro­cess­ing if all one cares about is mem­o­ry? A sec­ond obvi­ous prob­lem is to get indi­vid­u­als to buy into the effort required to real­ly change their brains for the bet­ter. That buy-in has been achieved for many indi­vid­u­als as it applies to their phys­i­cal health, but we haven’t got­ten that far yet in edu­cat­ing the aver­age old­er per­son that brain fit­ness train­ing is an equal­ly effort­ful busi­ness!

Tools for Safer Dri­ving: Teens and Adults

Safe dri­ving seems to be one area where the ben­e­fits are more intu­itive, which may explain the sig­nif­i­cant trac­tion.

Yes, we see great poten­tial and inter­est among insur­ers for improv­ing dri­ving safe­ty, both for seniors and teens. Appro­pri­ate cog­ni­tive train­ing can low­er at-fault acci­dent rates. You can mea­sure clear ben­e­fits in rel­a­tive­ly short time frames, so it won’t take long for insur­ers to see an eco­nom­ic ratio­nale to not only offer pro­grams at low cost or for free but to incen­tivize dri­vers to com­plete them. All­state, AAA, State Farm and oth­er insur­ers are begin­ning to real­ize this poten­tial. It is impor­tant to note that typ­i­cal acci­dents among teens and seniors are dif­fer­ent, so that train­ing method­olo­gies will need to be dif­fer­ent for dif­fer­ent high-risk pop­u­la­tions.

Yet, most dri­ving safe­ty ini­tia­tives today still focus on edu­cat­ing dri­vers, rather that train­ing them neu­ro­log­i­cal­ly. We mea­sure vision, for exam­ple, but com­plete­ly ignore atten­tion­al con­trol abil­i­ties, or a driver’s use­ful field of view. I expect this to change sig­nif­i­cant­ly over the next few years.

Long-term care and health insur­ance com­pa­nies will ulti­mate­ly see sim­i­lar ben­e­fits, and we believe that they will fol­low a sim­i­lar course of action to reduce gen­er­al med­ical and neu­rode­gen­er­a­tive dis­ease- (Mild Cog­ni­tive Impair­ment and Alzheimer’s- and Parkin­sons-) relat­ed costs. In fact, many senior liv­ing com­mu­ni­ties are among the pio­neers in this field.

Boomers & Beyond: Main­tain­ing Cog­ni­tive Vital­i­ty

Main­stream media is cov­er­ing this emerg­ing cat­e­go­ry with thou­sands of sto­ries. But most cov­er­age seems still focused on does it work? more than “how do we define It”, what does work mean? or work for whom, and for what? Can you sum­ma­rize what recent research sug­gests?

We have seen clear pat­terns in the appli­ca­tion of our train­ing pro­grams, some pub­lished (like IMPACT), some unpub­lished, some with healthy adults, and some with peo­ple with mild cog­ni­tive impair­ment or ear­ly Alzheimers Dis­ease (AD). What we see in every case: 1) despite ones age, brain func­tion­ing can be improved, often with pret­ty impres­sive improve­ment in a short-time frame and lim­it­ed time invest­ed (10 or 20 or 30 or 40 hours over a peri­od of a few weeks up to 2 or 3 months). 2) Basic neu­ro­log­i­cal abil­i­ties in 60–90 year olds that are direct­ly sub­ject to train­ing (for exam­ple, pro­cess­ing accu­ra­cy or pro­cess­ing speed) can be improved to the per­for­mance lev­el of the aver­age 20 or 30 or 40 year old through 3–10 hours of train­ing at that spe­cif­ic abil­i­ty. 3) Improve­ments gen­er­al­ize to broad­er cog­ni­tive mea­sures, and to indices of qual­i­ty of life. 4) Improve­ments are sus­tained over time (in dif­fer­ent con­trolled stud­ies, doc­u­ment­ed at all post-train­ing bench­marks set between 3 to 72 months after train­ing com­ple­tion).

In nor­mal old­er indi­vid­u­als, train­ing effects endure “ but that does not mean that they could not ben­e­fit from boost­er or refresh­er train­ing — or from ongo­ing train­ing designed to improve oth­er skills and abil­i­ties that lim­it their old­er lives. Impor­tant­ly, a lim­it­ed con­trolled study in mild­ly cog­ni­tive­ly impaired indi­vid­u­als showed that in con­trast to nor­mal indi­vid­u­als, their abil­i­ties declined in the post-train­ing epoch. These folks had improved sub­stan­tial­ly with train­ing. Even while there abil­i­ties slow­ly dete­ri­o­rat­ed after train­ing, they sus­tained their advan­tages over patients who were not trained. We believe that in these high­er-risk indi­vid­ual, con­tin­ued train­ing will prob­a­bly be absolute­ly nec­es­sary to sus­tain their brain health, and, if it can be achieved (and that is com­plete­ly unproven), to pro­tect them from a pro­gres­sion to AD. More­over, for both these high­er-risk and nor­mal indi­vid­u­als, inter­ven­tions should not be thought of as one-time cure-alls. Ongo­ing brain fit­ness train­ing shall be the way to go.

A major obsta­cle is that there is not enough research fund­ing for appro­pri­ate tri­als to address all of these issues, espe­cial­ly as they apply for the mild­ly cog­ni­tive­ly impaired (pre-AD) or the AD pop­u­la­tions. We’d wel­come not only more research dol­lars but also more FDA involve­ment, to help clar­i­fy the claims being made.

Next Gen­er­a­tion Assess­ments

A key ele­ment for the matu­ri­ty of the field will be the wide­spread use of objec­tive assess­ments. What do you see in that area?

Unfor­tu­nate­ly, most researchers and pol­i­cy ini­tia­tives are still wed­ded to rel­a­tive­ly rudi­men­ta­ry assess­ments. For exam­ple, I recent­ly par­tic­i­pat­ed in meet­ings designed to help define a very-well-sup­port­ed EU ini­tia­tive on how cog­ni­tive sci­ence can con­tribute to drug devel­op­ment, in which most applied assess­ments and most assess­ments devel­op­ment were still paper-based. This is a major missed oppor­tu­ni­ty, giv­en the rapid­ly grow­ing devel­op­ment and avail­abil­i­ty of auto­mat­ed assess­ments.

I believe we will see more inde­pen­dent assess­ments but also embed­ded assess­ments. For instance, in Sci­en­tif­ic Learn­ing we rou­tine­ly use ongo­ing embed­ded assess­ments and cross-ref­er­enced state test achieve­ment scores to devel­op mod­els and pro­files designed to deter­mine the regimes of neu­ro­plas­tic­i­ty-based train­ing pro­grams that must be applied so that indi­vid­ual stu­dents, school sites and school dis­tricts may achieve their aca­d­e­m­ic per­for­mance goals.

Impli­ca­tions for Med­i­cine and Men­tal Health

It seems clear that neu­ro­plas­tic­i­ty-relat­ed assess­ment and train­ing tools will impact med­i­cine and men­tal health. Where and how do you think that may hap­pen first?

This may sur­prise peo­ple who haven’t been fol­low­ing the area close­ly, but I believe cog­ni­tive train­ing may well become a cru­cial part of the stan­dard of care in schiz­o­phre­nia over the next 3 or 4 years. With aca­d­e­m­ic part­ners at UCSF, Yale and Kon­stanz Uni­ver­si­ty, and through the devel­op­ment of pro­grams that effec­tive­ly address cog­ni­tive deficits that lim­it this patient pop­u­la­tion, we have already designed a train­ing pro­gram that is appro­pri­ate for eval­u­a­tion in a med­ical-device-direct­ed FDA tri­al. There is already agree­ment about the appli­ca­tion of the MATRICS neu­rocog­ni­tive assess­ment bat­tery for an FDA out­comes tri­al in this pop­u­la­tion, and NovaVision’s FDA approval of their stroke & TBI rehab strate­gies pro­vide any impor­tant FDA prece­dent.

The NIH has been a key enabler of the NIH Tool­box, and the MATRICS process, both to stan­dard­ize assess­ments. What impact may these have in schiz­o­phre­nia and beyond?

The FDA’s adop­tion of MATRICS as a stan­dard is a cru­cial step, because it pro­vides a clear set of bench­marks that apply for any drug or non-drug approach to treat­ment. We would like to see the FDA estab­lish sim­i­lar bench­marks for all major clin­i­cal indi­ca­tions in neu­ro­log­i­cal and psy­chi­atric med­i­cine. I haven’t fol­lowed the Tool­Box so close­ly, and can’t real­ly com­ment about its pos­si­ble util­i­ty.

If we talk about wider clin­i­cal prac­tice, we must rec­og­nize that many psy­chol­o­gists are attached to old­er forms of ther­a­py that don’t incor­po­rate con­tem­po­rary cog­ni­tive neu­ro­science find­ings, and that neu­rol­o­gists and psy­chi­a­trists are strong­ly phar­ma­ceu­ti­cal­ly ori­ent­ed, and in any event are great­ly pressed for time. Per­haps clin­i­cal prac­tice will only change once we have devel­oped the tools nec­es­sary to help pro­fes­sion­als mon­i­tor the brain func­tion and train­ing (treat­ment) sta­tus of the very large num­ber of patients that might typ­i­cal­ly be under their care.

Inte­grat­ing Cog­ni­tion with Home Health and Med­ical Home Mod­els

That’s a very inter­est­ing point. How may remote mon­i­tor­ing and inter­ven­tions hap­pen? Is this sim­i­lar to the mod­el Cogmed uses today to deliv­er its work­ing mem­o­ry train­ing via a net­work of clin­i­cians?

We will prob­a­bly see hybrid mod­els emerge first. The clin­i­cian will, as usu­al, estab­lish a diag­no­sis and ini­ti­ate treat­ment in their office or clin­ic, prob­a­bly with the assis­tance of a trained ther­a­pist. At some point, the ther­a­py will con­tin­ue at home. The ther­a­pist and the super­vis­ing clin­i­cian would be able to remote­ly mon­i­tor the patient’s per­for­mance by the use of our Inter­net tools. This mod­el, orig­i­nal­ly devel­oped and wide­ly applied by Sci­en­tif­ic Learn­ing, has also been employed by Cogmed.

Only lat­er may full telemed­i­cine mod­els emerge, where per­haps a neu­rol­o­gist mon­i­tors the brain func­tion of sev­er­al patients using appro­pri­ate tools, and iden­ti­fies poten­tial per­son­al­ized pre­ven­tive inter­ven­tions with red flags that call for an office (or vir­tu­al) vis­it.

What’s Next?

This has been a fas­ci­nat­ing con­ver­sa­tion, and a great con­text to the themes we will cov­er in depth in the sum­mit. What else do you think will hap­pen over the next few years?

First, I believe we’ll need to focus on pub­lic edu­ca­tion, for peo­ple to under­stand the val­ue of tools with lim­it­ed face val­ue. One impor­tant aspect of this is the need to find bal­ance between what is fun and what has val­ue as a cog­ni­tive enhancer “ which requires the activ­i­ties to be very tar­get­ed, repet­i­tive and slow­ly pro­gres­sive. Not always the most fun “ peo­ple need to think fit­ness as much or more than games.

Sec­ond, I believe the role of pro­vid­ing super­vi­sion, coach­ing, sup­port, will emerge to be a crit­i­cal one. Think about the need for hav­ing a piano teacher, if you want to learn how to play the piano and improve over  time. Tech­nol­o­gy may help fill this role, or empow­er and rich­ly sup­port real coach­es who do so.

Which exist­ing pro­fes­sion­al group is more like­ly to become the per­son­al brain train­ers of the future? or will we see a new pro­fes­sion emerge?

Frankly, I don’t know. To give you some con­text, at Sci­en­tif­ic Learn­ing we exper­i­ment­ed with offer­ing free access to ther­a­pists for a 2-month train­ing. At Posit Sci­ence we first exper­i­ment­ed with vir­tu­al coach­es that many peo­ple seemed to hate, and lat­er encour­aged peo­ple who had com­plet­ed the pro­gram to vol­un­teer and coach new par­tic­i­pants. Results were mixed. We’re now explor­ing oth­er pos­si­bil­i­ties.

Let me men­tion a few oth­er aspects. I believe we will also see a grow­ing num­ber of appli­ca­tions in lan­guages oth­er than Eng­lish, which will be key giv­en grow­ing inter­est in South Korea, Japan and Chi­na on aging work­force issues (until now they have been most­ly focused on child­hood devel­op­ment, using Eng­lish-based pro­grams). We will also see the pro­grams wide­ly avail­able to peo­ple who may not have com­put­ers at home. For exam­ple, Posit Sci­ence recent­ly donat­ed soft­ware equiv­a­lent in val­ue to $1m to the Mass­a­chu­setts pub­lic library sys­tem, as a mod­el of how wider access (in this case, to help old­er dri­vers) might be pro­vid­ed.

My dream in all of this is to have stan­dard­ized and cred­i­ble tools to train the 5–6 main neu­rocog­ni­tive domains for cog­ni­tive health and per­for­mance through life, cou­pled with the right assess­ments to iden­ti­fy one’s indi­vid­ual needs and mea­sure progress. For exam­ple, I’d like to know what the 10 things are that I need to fix, and where to start. Assess­ments could either mea­sure the phys­i­cal sta­tus of the brain, such as the degree of myeli­na­tion, or mea­sure func­tions over time via auto­mat­ed neu­ropsych assess­ments, which is prob­a­bly going to be more effi­cient and scal­able and poten­tial­ly be self-admin­is­tered in a home health mod­el.

Mike, thank you very much once more for your time and insights.

My plea­sure. I am look­ing for­ward to the very inno­v­a­tive Sum­mit that Sharp­Brains is putting togeth­er to con­vene our lit­tle grow­ing com­mu­ni­ty.

Leave a Reply...

Loading Facebook Comments ...

2 Responses

  1. Thanks Alvaro and Dr. Merzenich for an enlight­en­ing and thought-pro­vok­ing inter­view! I’m par­tic­u­lar­ly inspired by your dis­cus­sion re: ramp­ing up the con­ver­sa­tion from “Does it work?” to engag­ing folks in think­ing the myr­i­ad of pos­si­bil­i­ties opened up by encour­ag­ing neu­ro­science research, new forms of biotech assess­ment and an on the ground, whole system’s approach to ther­a­putic sup­port.

    A thought: for those who have seen the new film “Avatar,” how ’bout we take more seri­ous­ly the excit­ing future of neu­rotech that will no doubt change the assess­ment game for how pol­i­cy mak­ers and the pub­lic regard brain fit­ness? Even Hol­ly­wood is address­ing the chang­ing ancient metaphor of “Know Thy­self,” with the likes of neu­rotech. Seems we’re in the midst of a Bacon­ian rev­o­lu­tion, as I sus­pect Dr. Merzenich might agree, and wait­ing to move to a new stage of Enlight­en­ment!

    P.S. I’m galvinized to be in dis­cus­sion with those who wish to ener­gize the “ed-psych” meth­ods ques­tion of how to coach the brain injured. Look­ing for­ward to the SharpBrain’s Sum­mit in Jan 2010.

    Grate­ful­ly and synap­ti­cal­ly yours,

  2. I also would like to thank Alvaro and Dr. Michael Merzenich for the great inter­view.

    As a lay­man who is inter­est­ed in main­tain­ing good brain func­tion as I age, I have had dif­fi­cul­ty in find­ing afford­able pro­grams that can be used at home and actu­al­ly work. Posit Sci­ence is the one com­pa­ny that gets men­tioned most often, espe­cial­ly con­cern­ing their dri­ving improve­ment soft­ware.

    One of the prob­lems is that the sci­ence of brain func­tion is quick­ly evolv­ing. Anoth­er prob­lem is that it appears that just one activ­i­ty can be worked on at a time, rather than one pro­gram that can improve the entire range of brain func­tion activ­i­ties.

    Thanks for the open dis­cus­sions on this top­ic.

    Charles

Leave a Reply

Categories: Cognitive Neuroscience, Education & Lifelong Learning, Health & Wellness, Neuroscience Interview Series, Professional Development, Technology

Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,