October 2018
Many interesting things are afoot in our research area, all on the path to changing the world very much for the better. I’d like to share a few new and exciting studies with you, they provide some new information about ongoing trials and industry updates that have come up over the past several months.
You’re receiving this newsletter 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 still be friends.
A LITTLE NEWS
BrainHQ improves cognition in Bipolar Disorder
Bipolar Disorder (BD) is marked by dramatic fluctuations in mood that impair cognitive and functional abilities and that may, in severe forms, preclude an enriching, stable, and fulfilling life. Low-risk interventions with strong remediation potential are on the horizon. Independent researchers Dr. Eve Lewandowski and colleagues at McLean Hospital and Harvard Medical School recently published the results of a randomized, parallel-group, double-blind, placebo-controlled clinical trial showing that BrainHQ can improve cognition in individuals with BD (J Clin Psychiatry, 2017; see registered protocol here).
In this NIMH-funded study, 75 patients diagnosed with BD with a history of psychosis (aged 18 to 50) were randomized into an intervention of BrainHQ training using both visual and auditory exercises or to an active control of leisure computer games. The intervention group was asked to use a combination of computerized exercises from BrainHQ delivered through an intensive schedule of three one-long sessions per week over the course of 24 weeks, for a target of 70 sessions total. The control group spent an equivalent amount of time on computerized games that focused on quiz-style games, such as identifying locations on maps, solving basic math problems, and answering questions about popular culture. Assessments were taken at pre, mid, post, and at a +6 month benchmark. Immediately following training, the participants in the BrainHQ exercise group displayed medium to large effect sizes on the primary outcome measure of overall cognitive performance (as measured by the MATRICS Consensus Cognitive Battery) that were approximately 2.5 to 3 times larger than control (Cohen’s d = 0.80). There was also a large gain on visual learning and memory (d = 0.92), and a medium gain on processing speed (d = 0.42; trending). Change in a secondary measure of community functioning was not significant, but participants with the largest cognitive improvements showed the largest gains in community functioning across the sample. Critically, researchers found enduring gains in overall cognition (d = 0.83) and processing speed (d = 0.65) at the +6 month follow-up.
A brief, intensive epoch of neuroplasticity-based brain training improves cognition in this high-risk, high-needs population and sustains those gains out into the future. If these findings are replicated in a larger multisite trial we should integrate cognitive training in our clinical practices as a low-risk, nonpharmacological treatment for cognitive decline in BD.
TRIALS UNDERWAY
I’ve rather arbitrarily chosen to introduce you to one of the 250+ trials 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.
U.S. POINTER trial
Led by Drs. Laura Baker, Mark Espeland, Miia Kivipelto, and Rachel Whitmer and coordinated by Wake Forest School of Medicine, the U.S. Study to Protect Brain Health through Lifestyle Intervention to Reduce Risk trial (U.S. POINTER) is a multicenter, randomized two-year clinical trial that will examine whether lifestyle modification can protect cognitive function in adults 60-79 years old who are at increased risk for memory loss and Alzheimer’s disease down the road. U.S. POINTER builds on the results of Finland’s FINGER study, to adapt the lifestyle intervention for Americans and to develop a healthy lifestyle program that could be sustainable using community resources if the results are positive. This study involves collaborations with several academic institutions, non-profit organizations, and for-profit organizations including BrainHQ.
CURRENT PERSPECTIVES
Find, Assess, Restore, Confirm, Sustain, Document
In a collaboration with the Stronger Brains and EVOLVE foundations, we have been envisioning strategies for addressing ‘soft brain damage’ in young and older populations who have faced traumatic life circumstances such as abuse, neglect, stress, et alia. About one in four American children have a very significant level of ‘soft’ brain damage arising in childhood from environmental sources like these. At an older age, they are at greater risk for addiction, mental illness, suicide, criminal offending, marital instability, poor parenting, under-employment, poor physical health, early onset of cognitive decline, and a shortened lifespan. Current approaches to these problems fall far too short. We feel we can help to reliably ‘rescue’ individuals in need by stabilizing their lives and improving the performances at school and in life, through the use of a largely computer delivered (inexpensive; scalable) intervention strategy.
There are six major challenges for creating a scalable approach that has any hope of broadly addressing this kind of complex therapeutic problem.
- How can we FIND and enroll all individuals in our target population in need of help?
- How do we affordably and efficiently ASSESS their neurological status, to individuate our interventions to help?
- How can we reliably (and inexpensively) RESTORE them to neurological normalcy?
- How can we CONFIRM that this restoration has been achieved?
- How can we SUSTAIN the health of the brain over the span of the brain-wounded person’s life?
- How can we DOCUMENT the impacts of this new form of help for that individual, and for this population as a whole?
Academic institutions, clinics, and foundations can help us FIND these individuals in need of help and can help manage the compliant use of these new therapeutic tools. A specialized app can help us ASSESS these identified individuals via automated standardized assessments that apply to the neurological status of each individual. On the basis of those assessments, and with the assistance of an automated analysis of this outcomes data, a clinical specialist would RESTORE the individual to functional normalcy by creating an intensive, individuated brain plasticity-based training program alongside lifestyle changes. Periodic (scheduled) re-assessments delivered via the app would be used to CONFIRM that treatment goals have (or have not) been achieved and that neurological gains have been SUSTAINED in ways that continue to assure a positive level of resilience against a progression to mental illness, suicide, addiction, cognitive decline, et alia. Critically, a big-data AI analytic approach would be designed to DOCUMENT and publish treatment outcomes data in real time to define best-treatment strategies, based on the neurological profile of individuals entering this treatment program and to begin to cross-reference life outcomes and public records data to document dollar costs savings associated with training as it impacts on under-employment, marital stability/divorce, spousal abuse, criminal offending, mental illness, suicide, alcohol and drug addiction, neuropathological illness, and longevity.
Therapeutic strategies should be based on an understanding of brain organization, function and plasticity generated by integrative and fundamental neuroscience. Our therapeutic goal is to restore brain health—to renormalize the physical and functional brain via intensive, progressive, natural plasticity-enabled physical and functional remodeling. We invite you to join us in this effort and help us and the Stronger Brains and EVOLVE foundations.
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.