February 2017
A belated “Happy New Year” to all neuroplasticity research and development professionals out there in the world. A lot of interesting things are afoot in our research area, all on the path to changing the world very much for the better. Because so much is happening, I’ve decided to send out bi-monthly newsletters updating what’s happening in our field. You’re receiving this first newsletter of 2017 because you are a former collaborator or scientific friend—or you have collaborated with me or other scientists at Posit Science—and I thought you might be interested in keeping up with ‘what’s happening’. Please let me know if you’d like to be removed from this list. We can always stay in touch in other ways.
A LITTLE NEWS
Combating chemobrain
Following the brain poisoning that we call ‘chemotherapy’, patients often self-report negative changes in attentional focus and processing speed, loosely described clinically as “chemobrain” or “chemofog”. Broad-ranging deficits recorded in standardized tests of perception, attention, cognition and executive function show that these emergent deficits actually apply for the majority of treated cancer patients. At the University of Sydney, Dr. Victoria Bray and colleagues have extensively studied the impacts of a Posit-BrainHQ training suite in post-treatment chemobrain patients. In this randomized controlled trial (J Clinl Oncol, Jan 2016), two hundred and forty two adult cancer patients were assigned to either a Posit-BrainHQ visual training program group, or to a standard-of-care treatment group. Participants trained for a total of 40 hours across 15 weeks, with comparisons between active and control subjects made at baseline, after training, and at a +6 mo benchmark.
At follow-up, brain-trained patients reported improved cognitive function, had substantially improved qualities of life, and had significantly reduced levels of anxiety, depression, and fatigue. Benefits were well sustained at 6 months. This study nicely confirmed and extended a previous randomized controlled trial by Dr. Diane Von Ah and colleagues at Indiana University Purdue, who showed similar cognitive benefits with brain training delivered in-clinic (Breast Cancer Res Treat, Aug 2012).
Given the large percentage of cancer patients undergoing chemotherapy, it is important that we continue to work to develop simple yet effective programs that restore function and promote a greater sense of health and well-being in this very large patient cohort. Dr. Bray’s team is energetically continuing this important work, to help assure that before long, most cancer survivors can be expected to have their cognitive lives restored, on the path to more complete post-treatment normalization and recovery—and to reduce the probability of an accelerated decline to older-age dementia.
Improvements of verbal abilities in veterans with alcohol use disorders
An interesting NIDA-supported study published in the Journal of Dual Diagnosis by Yale University’s Dr. Morris Bell and colleagues showed that a Posit-BrainHQ auditory training program suite sharply improved verbal abilities in veterans that had acquired speech production impairments as a result of historic alcohol use disorders (J Dual Diagn, Jan 2016). Thirty-one veterans in the early phase of recovery received 3 months of either 1) training plus work therapy, or 2) work therapy plus standard care. Assessments were taken at baseline, at the end of training, and at a +6 mo benchmark. The Hopkins Verbal Learning Test was a primary outcome measure. Strong improvements were recorded in actives vs controls at the end of training, for both ‘verbal learning’ (Cohen’s d = 1.3) and ‘verbal memory’ (Cohen’s d = 1.1) composite scores. These very positive effects of training were sustained at +6 months.
Restoration of more-normal speech reception and language usage is an under-appreciated aspect of recovery in alcohol use disorder patients because enduring verbal speech can so strongly impact successful re-socialization and re-employment. Dr. Morris’ team has made great strides in helping our variously-neurologically-wounded veterans successfully return to the workforce, their families, and our wider society. My guess is that almost all of you out there are also committed to doing whatever you can to help these men and women make better progress on life’s journey!
Attention-deficit / hyperactivity disorder
Jyoti Mishra (UC San Francisco) continues to work hard to help children and adults with attention impairments, and has reported outcomes in a provocative (but still early) study on attention control in severely impacted ADHD kids, achieved through brain-exercise training (Translational Psychiatry, April 2016). Using a customized program suite enriched by more variations in tools designed both to improve accurate visual and auditory perception and alertness, and to strengthen distractor suppression, Dr. Mishra showed that 30 hours of training resulted in improvements in attention that matched those achieved through the administration of stimulant drugs (Ritalin; Adderall). However, in striking contrast to drug treatment, attention measures were not only sustained at the +6mo benchmark—but had further GROWN in power, presumably because the kids who had trained were putting their neurological gains to very good use.
Of course there is a second major advantage for training over drugs. You don’t have to take the drugs.
TRIALS UNDERWAY
I’ve rather arbitrarily chosen to introduce you to a few of the hundred or two studies using computer-delivered brain training programs that are now underway. Let me know about your projects so that we can tell other professionals in our research family about your work in future newsletters.
Brain training and insomnia
In a study recently submitted as a Phase 1 clinical trial to NIH/NIA, Dr. Tom Van Vleet and colleagues are defining the behavioral and neurological impacts of Posit-BrainHQ training on chronic, late-life insomnia. Their computerized program uses a variation of the BrainHQ exercise Freeze Frame, an exercise that was specifically designed to up-regulate two primary regulators of sleep, noradrenaline, and acetylcholine. Freeze Frame is a continuous performance task in which rich visual images are sequentially displayed for brief durations with ‘players’ viewing a small percentage of targets (about 10% of all trials) presented in a background of more-frequent non-target distractors. Responses to the target are always withheld. In studies in waking monkeys, scientists have shown that this task form very heavily engages the locus coeruleus (a primary forebrain source of noradrenaline) and the nucleus basalis (a primary source of acetylcholine), and that by this repeated engagement, the metabolic status, neurotransmitter production and cortical innervation from these sources are significantly up-regulated. Pilot data collected by collaborator Dr. Joe DeGutis and colleagues at Harvard has shown that this training improves sleep initiation and maintenance as measured by single-unit EEG sleep monitoring, actigraphy, and subjective self-reports.
Given the fact that nearly half of all adults over the age of 60 experience have some form of sleep disruption, a restoration of good sleep regulation is clearly an important public health issue. Chronic insomnia has been argued to increase the risk of cognitive impairment, of comorbid conditions, and of mortality–and in some cases appears to herald abnormal neurodegenerative decline. One could argue that it is not insomnia per se that engenders this risk—but the broader consequences of a slow age-related deterioration in the expressions of the neurotransmitters that, among many other very important functions, also regulate sleep. In any event, a low-risk training intervention for improving sleep quality should be superior to common pharmacological sleeping aids—with their attendant adverse side effects—AND should have other important generalized neurological values. With Dr. DeGutis’ collaboration, Dr. Van Vleet’s research in this initial field trial is on a path to eventual FDA approval. If successful, this would be the first software-based medical device for the treatment of insomnia to be made publicly available.
Brain training and HIV-Associated Neurocognitive Disorders (HAND)
HIV-AIDS infections are now pretty reliably pharmaceutically controlled in the body—but, alas, not in the tissues of the brain. Uncorrected, HIV-AIDS patients bear high risks for the onset of neurobehavioral problems, and for a premature advance to dementia. We’re working hard, on several fronts, to address this looming medical crises before it sweeps across a very large, affected world population.
In one scientific effort, Dr. Tom Van Vleet has been evaluating the effectiveness of a Posit-BrainHQ training suite in a random-assigned controlled trial setting, with wonderful help from Drs. Robert Paul (University of Missouri), Steven Paul Woods (University of Houston), and David Vance (University of Alabama at Birmingham). A Phase 1 SBIR is now nearing completion; a Phase 2 application has been filed. Initial results are very hopeful. After 30 hours of intensive training, measures of brain speed, executive control and learning rates are restored to normal age-indexed abilities, in individuals who were already significantly struggling with HIV-AIDS-associated decline.
A second important effort, The Brain Health Now study, is being led by Dr. Lesley Fellows at McGill University, backed up cross-Canada researchers supported by a Team Grant from the Canadian Institutes of Health Research. This landmark study applies a comprehensive platform of assessments to characterize the complete health status of roughly 900 adults with HIV-AIDS. This cohort, assembled from 5 clinics across Canada, being tracked over the course of 3 years on measures of cognitive ability, mood, symptomology, biological status, and quality of life. With this valuable information in hand, this team of experts hopes to identify, understand, and optimize brain health recovery and maintenance in these increasingly-high-needs individuals. They also hope to validate a brief, computerized cognitive assessment battery that, if accurate, could be administered at each doctors’ visit associated with routine clinical exams. This project is designed to propel important research into non-pharmacological therapeutics. One trial evaluating possible interventions using a Posit-BrainHQ training suite applied in a random controlled trial setting is now nearing completion. You can find the details of their study protocol in BMC Neurology here and visit their consumer-facing website here. Investigators have been recording after training vs before training and experimental group vs control group behavioral and brain imaging data that should accurately define direct training impacts and real-life-generalized changes resulting from this brain training remedial approach. One special consequence of these wonderful efforts has been the translation of Posit-BrainHQ programs and materials into Canadian French.
In parallel with these other American and Canadian efforts, Dr. David Vance has been awarded an R01 grant from the National Institute of Aging to examine the benefits of speed training (Posit-BrainHQ’s Double Decision and related tasks) in two hundred and sixty four older adults with HIV. In this proposed study based on positive preliminary evidence, patients are assigned to either 10 or 20 hours of speed training, or to a computer-contact control group. Outcomes will be used to optimize brain-training dosages and to assess the immediate and long-term cognitive and functional effects of training. Of course, observed improvements in speed of processing should also spill over to everyday tasks that are particularly impaired in older adults with HAND. In that vein, a secondary outcome comparing performance in a driving simulator to the participant’s real driving record is designed to evaluate this important aspect of the generalization of training impacts into the real world. If effective, this speed-training-focused intervention could again provide a valuable non-pharmacological tool for the rapidly increasing population of older HIV adults who dearly hope to stay in the driver’s seat!
Dr. Vance has also received funding for an R21 through the National Institute of Nursing Research. Way to go, David! In this project a hundred or so participants with HAND will be randomly assigned to either 20 hours of training, or to a no-contact control. The unique aspect of this second trial is that training does not follow a one-size-fits-all approach. Instead, engagement in computerized training will be tailored to the specific cognitive impairments that led to each participant’s HAND diagnosis. In very preliminary studies, this approach has already shown promise for potentially reducing the severity of HAND, for mediating improvements in driving ability, for improving Instrumental Activities of Daily Living, for reducing progressions to depression, and other health-related life quality benefits.
As the results of these studies come in, I’ll provide you with a summary of outcomes. We’re trying our hardest to help provide a safer older-age landing for the millions of individuals with a history of HIV-AIDS out there in the world who must now approach the final decades of their life with a realistic fear of premature neurological decline and collapse. While our efforts are very hopeful, a lot remains to be done, with time being of the essence. Let us know, if you’re willing or able to help us further improve or accelerate this process.
NEWS FROM THE FIELD
Cognitive Aging Summit
Cognitive Aging Summit III will be held in Bethesda MD on April 6-7. Registration opens soon, and will solicit submissions that target age-related brain changes that increase neurological resilience and cognitive reserve. The intimate nature and the diversity of researchers studying the problems of aging at different levels of analysis makes this summit a good place for finding out what’s happening in our broader discipline, and for making valuable connections with other scientists and clinicians working hard to change the world for the better.
AAA again shows, in a large trial cohort, that brain training focused on speed of processing and divided attention reduces the risks of automobile crashes.
We’ve known for decades that older drivers have more accidents because of their sluggish response times, restricted peripheral visual processing, and poorer divided-attention abilities. Dr. Karlene Ball (University of Alabama at Birmingham), Dan Roenker (University of Western Kentucky), Jerri Edwards (University of South Florida) and colleagues have repeatedly shown that accident rates are lowered by speed-challenged “Useful Field of View” training (Posit-BrainHQ’s Double Decision) by as much as approximately 50%. We have further elaborated this training by adding still more divided attention, multiple object tracking, optic flow, and speed training assets (embodied in Posit-BrainHQ’s Target Tracker and Optic Flow exercises), in designing our BrainHQ-DriveSharp training program suite.
Still more results are in, on improving driving safety in our elder population. For > 7,000 members tracked by AAA who completed BrainHQ-DriveSharp since 2011, collision claims were reduced by 30% in the six months following course completion. Specifically, Posit Science brain training prevented 315 car crashes per year – which likely included 128 injuries and 2 deaths prevented. Since benefits of training have been shown by the Ball/Roenker/Willis team, to endure for at least FIVE YEARS, more savings in accidents, $$, mayhem, deep distress, and death can be anticipated, far out into the future. Imagine what a difference could be made if we actually MANAGED brain health, controlling dosing to make sure that older individuals were ALWAYS pretty safe!
If you know any drivers of an older age, you might think about cueing them in to these findings. Put another way: If every older citizen in America simply spent their 12 hours completing this simple brain training course, then took a brief ‘booster shot’ every year or two from that time forward, a helluva lot of damage and suffering and LIVES would be spared.
This, my dear friends, is exactly what your and our collaborative efforts are all about!
CURRENT PERSPECTIVES
In this and in future newsletters, I would like to share my current views on issues that I think are important to all of us–such as the aging process, catastrophic neurological illness, mental illness, cognitive impairment arising from environmental and genetic factors in children and in adults, and the medical treatment of patients with cognitive dysfunction and decline. Like you, we are especially interested in how we can best move our field forward to help as many people in need as we can, as fast as we can.
The truth is, I have become almost pathologically impatient with the resilience of increasingly out-of-date practices now addressing neurological “disease” in human populations. Neurological medicine is substantially in the way of an important transformation of treatment approaches, in a brain plasticity-informed world in which prevention so obviously trumps disaster-based medicine. Modern medicine waits for the formal declaration that the train wreck of AD has occurred (or shall very obviously soon occur), for example, before they deign it worthy of their close medical attention. It’s better, obviously, to prevent the train wreck. Brain health medicine is obviously in need of incorporating our science into their thinking. With the goal of contributing to a change in this now-dominant medical perspective, I’m writing a book series to express my views, first targeting Neurology, then Psychiatry, then Child Psychiatry/Child Neurology. The first book, which I’ll complete later this Spring, is tentatively titled Alzheimer’s is Not a Disease. While it is meant to help medical professionals, I think that it is likely that not every neurologist shall be charmed about what I have to say about the state of their medical discipline. For those neurologists out there who share my concerns and interests, let me know if you’d like to read and advise me about the book’s content—remembering that the goal is to help the specialist, and not to just poke a finger in the eye of physicians or neuropsychologists who deeply care about and strive to help their patients – before I tell the world about my appeal for the transformation of brain health medicine.
On a final subject for this Newsletter: Our new administration, and the dominant forces in our cabinet Departments and Congress appear to be running over science and scientists like a steam-roller. The devaluation of established science, now threatened to be trumped by forces in the service of political or commercial gain, is utter folly. The notion that scientific reports about issues related to subjects like climate change or environmental poisoning, or the monitoring of planet earth by NOAA should be vetted by politicians is a completely unacceptable contamination. Because science is, by definition, apolitical, most scientists I know are pretty passive about defending the righteousness of our great enterprise. However, we’re also citizen-scientists, and science teachers. With my citizen and teacher hats on, this scientist is going to make a lot of noise about how wrong this all is, whatever the personal cost.
A shared publication database
The scientific literature in our field is scattered across many journals. We try to keep up with it, and am committed to making our efforts public. We ask you to help us keep up with this fast-moving feast! You can see our shared database of published randomized controlled trials in brain training online. It’s worth taking a look, as you might find something you weren’t aware of before that can be helpful for you. As always, please email us any papers that you know about that you find to be missing from this compendium.