July 2017
As many of you know, I joined social discussion website Reddit a few weeks ago to answer questions about brain training and plasticity. The last I checked, the post had received 240 comments and over 5,000 views. This would seem to be a nice way to connect with the public (although, with a consideration of the wider world, this is not exactly a deeply impactful engagement). Perhaps more importantly, this kind of interaction helps in our understanding how laypersons are thinking about our field. You can find the questions and my responses here.
If you are new to Reddit’s webpage layout, click here for a beginner’s guide.
Now, onto a highly-abbreviated update of new studies, ongoing trials, and industry updates from the last few months.
A LITTLE NEWS
BrainHQ improves shooting discrimination and accuracy in law enforcement officers
Law enforcement professionals are under close public scrutiny and pressure over the appropriateness of their responses in potentially life-threatening situations. The high-profile cases of Eric Garner, Michael Brown, Freddie Gray—among over a dozen others made national news, are cases in point. A steady drum-beat in media coverage of these stories and graphic cell phone video footage have eroded the perceived legitimacy of the law enforcement system in many communities.
Recent research and agency reviews have recommended a variety of measures and initiatives—most often training and policy related—to address these problems stemming from real and imagined cases of inappropriate uses of force. The truth is that policing decisions are performed near the limits of human neurological ability and control. A high-stress work environment—one that requires split-second, life and death, decisions when literally “under the gun”—sharply increases the frequency of perceptual and cognitive failures, such that officers are slower to assess the environment, divide attention among the relevant targets, and accurately determine threat. Police-citizen interactions gone awry have a neurological basis.
Dr. Gary Lambert and colleagues are tackling this important issue. In a paper currently under review for publication in the Journal of Applied Research Memory and Cognition (JARMAC), they showed that a limited subset of BrainHQ exercises dramatically improved shoot/don’t-shoot decision accuracy, i.e. the decision to use force on threatening targets (person holding a gun) and withhold force for non-threatening targets (person holding, for example, a cell phone). Sixteen Hanover County VA Sheriff’s Office deputies were randomly assigned to one of two groups that both completed approximately 10-15 minutes of training a day, five days a week, over the course of four weeks. The experimental group trained on three BrainHQ exercises (Visual Sweeps, Eye for Detail, Freeze Frame) hypothesized to target speed and accuracy with service-issued firearms, and specifically, to help officers make better shoot/don’t-shoot decisions. A control group of officers trained on three different BrainHQ exercises (Mind’s Eye, Juggle Factor, Mental Map) hypothesized to have little or noeffect on shoot/don’t shoot decisions.
Officers engaged a robotic targeting system in a pre- and post-training test in which they were presented with an image of a person holding a gun (threat target; shoot) or a person holding a cell phone (non-threat target; don’t shoot). Trained officers were significantly better on the shooting task relative to controls (p < .05), with a large between-group effect size, (d = 0.94). Previous studies by Dr. Lambert showed that training effects generalized to real life outcomes in valuable ways. Use of force among BrainHQ trained officers decreased by 46%, citizen complaints decreased by 40%, injuries incurred on the job decreased by 31%, and preventable car accidents decreased by 73%.
Based on these data, Dr. Lambert recently submitted a $2 million dollar grant to the National Institute of Justice to produce, deploy, and further validate BrainHQ for officer training. If funded, 500 officers across four police and sheriff department sites in Virginia will be randomized to 16-weeks of in-home BrainHQ vs. an active control. Shoot/don’t-shoot discrimination accuracy, officer use-of-force, citizen complaints, officer deaths and assaults, and preventable automobile accidents will be assessed pre-test, post-test, and at a +6-month benchmark to ensure sustained benefit of the training intervention. This project has the potential for reducing fatalities and injuries, and of substantially improving the quality of lives of the individuals who so generously serve us.
Let’s help a MS-y situation
Multiple Sclerosis is a devastating autoimmune disease in which the body’s own immune system attacks the central nervous system. Dr. Leigh Charvet and colleagues from NYU’s Langone Medical Center tested whether debilitating cognitive changes observed in MS could be improved by targeted brain training. In the largest double-blind, randomized, placebo-controlled trial to date on MS and brain training (PLOS ONE, May 2017), 135 participants with MS from Stony Brook University Hospital were assigned to either BrainHQ or an active control. Both groups trained at home one hour a day, five days a week, for 12 weeks, for a maximum training duration of 60 hours. Those training on BrainHQ improved by 29% in overall cognition as measured through a composite score of neuropsychological tests of processing speed, working memory, verbal and visual learning and scanning. Participants felt these positive changes themselves with around 57% of the BrainHQ group reporting a subjective improvement in their cognitive status relative to 31% in the control group. In a disease with no treatment for cognitive impairment— a core part of the disease—a safe and effective treatment achieved via plasticity-based brain training could be very important.
BrainHQ’s Immediate Mood Scaler tool validated for documenting mood disorders
A major BrainHQ goal is to bring digital therapies to the market. We want to start seeing assessments and training schedules in our doctor offices and schools that are valid, scalable, and fast. We want to predict conditions before they arise, and track conditions once they manifest. We want to move as swiftly as we can toward the goal of creating a healthier society and a more efficient healthcare system.
On this path, studies led by Dr. Mor Nahum have resulted in the development of the Immediate Mood Scaler (IMS), a mobile tool with self-report questions that can track fluctuations in dynamic mood disorders such as depression and anxiety. In a recent study (JMIR Mhealth Uhealth, April 2017) a convenience sample of 110 participants took the IMS daily for 2 weeks, and, in parallel, completed electronic versions of the PHQ-9, GAD-7, and Ruminative Responses Scale. IMS measures were strongly correlated with these standard mood scales, actually showing greater sensitivity to mood dynamics, and predicted future scores. We have subsequently adopted this strategy to apply to ongoing assessment strategies in other clinical populations. Ecological tools like these offer value above and beyond the infrequent and discrete office care patients typically receive and we hope they’ll become a mainstay of the future. This approach has resulted in the awarding of a recent US patent.
TRIALS UNDERWAY
I’ve rather arbitrarily chosen to introduce you to a handful of the >100 studies using computer-delivered brain training programs that are now underway. Let me know about yourprojects so that we can tell other professionals in our research family about your work, in future newsletters.
BrainHQ in ICU survivors
The odds of mortality, physical disability, neuropsychological disability, and poor quality of life are increased in those admitted to the ICU. Several external investigators are using BrainHQ to test whether training critically ill patients after the ICU improves outcomes. One of these teams is led by Dr. Babar Khan from Indiana University who recently received an NIA-funded R01 on cognitive and physical exercise to decrease impairment and delirium in ICU survivors. A total of 300 ICU survivors will be recruited from three hospitals and randomized to BrainHQ or an active control either with physical exercise or an exercise control. Participants will train for three months and will be measured at baseline, post-test, and at a +6-mo benchmark. The outcomes are the RBANS, Quality of Life scale, depression scale, and physical exercise measures. Congratulations, Babar!
Vagal Nerve Stimulation and BrainHQ together
Dr. Michael Kilgard from the University of Texas at Dallas has shown that pairing brief bursts of vagal nerve stimulation with specific events can promote plastic reorganization that speeds learning and recovery. Pop science calls this brain hacking, I call it harnessing the brain’s natural ability to change.
In a project based on this body of research, BrainHQ has teamed Drs. Xiaoqin Wang, Bharath Chandrasekaran, Matthew Leonard and colleagues who were awarded $12 million as part of DARPA’s Targeted Neuroplasticity Training program. This research aims to understand the mechanisms through which vagal nerve stimulation enhances synaptic plasticity as well as to demonstrate rapid language acquisition in epilepsy patients and healthy adults across three sites. The team will compare invasive and non-invasive vagal nerve stimulation to discriminate phonemes, learn words and grammar, and produce the unique sounds observed in foreign languages. The end goal? A substantial acceleration in the rate of new-language learning.
NEWS FROM THE FIELD
National Academies on the primary prevention of cognitive decline
The National Academies of Science, Engineering, and Medicine recently published a review on the primary prevention factors and interventions that may delay, slow, or prevent cognitive decline (Preventing Cognitive Decline and Dementia: A Way Forward, 2017). The report arrived at three recommendations—brain training, maintaining normal blood pressure, and exercise—as having sufficient evidence that “the public should at least have access to these results to help inform their decisions about how they can invest their time and resources to maintain brain health with aging.” Of all thirteen interventions reviewed, brain training was shown to have the strongest evidence base. These recommendations are an improvement over the first draft of the report, which claimed there was insufficient evidence to make any recommendation. We raised a number of concerns with this initial review (detailed here), most notably the inexplicable number of missing (but highly relevant) articles and the complete dismissal of input from leading experts in the field. I thank everyone who commented during the open comment period last October.
From my read of these reports, we still have a long way to go to bring what we know about neuroplasticity out from our niche academic circles into the hands of the public so that they too can benefit from this body of knowledge. The National Academies lists a number of future research priorities including evaluating the effectiveness of different brain training interventions, identifying at-risk populations, implementing longer follow-up periods, using consistent cognitive outcome measures, and applying training in community settings. We agree with these priorities and would add evaluating the effectiveness of different brain training strategies (and companies) to the list. Let’s keep these priorities in mind as we continue our research.
Brain training, blanketed
Too common are news stories that unfairly generalize the inadequate evidence of most brain training companies to all brain training companies. In a recent story in the Washington Post, author Ulrich Boser cites Simons et al. (2016)review of brain training as providing an abundance of evidence against all forms of brain training. There were no efforts to qualify the effectiveness of different types of programs and no mention of the independent systematic review by Shah et al. (2017) that reported the great differences in empirical backing established by different companies. Here we have laypersons, wholly unaware of the full literature and its nuances, educating the public with blanketing terms.
I hope you’ll join me in making a concerted effort for public outreach. Write blogs, respond to news articles with misleading details in the comments section, post on Reddit and other social websites, and keep us informed about your own research so that we can organize press releases. We have more than 100 clinical trials, many from independent external investigators, that show that BrainHQ changes brains in ways that improve lives, sometimes better than standard medical treatment and especially when you balance risks with potential benefit. We need to continue to work hard to do a better job of getting the word out.
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.