[AI] Is it worth going to the mind gym?;

Sanjay ilovecold at gmail.com
Sat Feb 2 00:20:36 EST 2008


 Brain-training programs
          are all the rage, but to what extent will they boost
          your cognitive powers in the real world?

Graham Lawton

I'M CONCENTRATING hard, staring at a small white square in the
middle of my computer screen. Any second now a letter is going to
flash up inside the box. At the same time a bird will pop up
elsewhere on the screen. My task is to hit the bird with my
mouse, then type the letter in the box.

I'm playing a game called Birdwatching, and if my boss catches me
at it I'll have some explaining to do. But I've got an excuse:
I'm training my brain. The more I practise, the better I'll get
and the more powerful my brain will become - or at least that's
what I'm told.

Birdwatching is the brainchild of San Francisco-based Lumos Labs,
just one of the dozens of companies that have sprung up in recent
months to cash in on the "brain-training" craze. Like most of its
competitors, the theory behind its sales pitch is
straightforward. Your brain is like a muscle: the more you use
it, the stronger it will get.

For those who believe that claim, there are dozens if not hundreds
of brain-boosting games now on the market, not to mention a
plethora of books and magazines on the same subject. The
best-known product is a video game called Dr Kawashima's Brain
Age, developed by neuroscientist Ryuta Kawashima from Tohoku
University in Japan; it is marketed in the UK and Australia as
Brain Training: How Old Is Your Brain? and endorsed by actress
Nicole Kidman.

While each brain trainer makes slightly different claims, broadly
speaking they offer one of two benefits. Either they will
"enhance normal brain functioning" - things like attention,
memory and processing speed - or they will "slow down the
inevitable decline that comes with age". Practically all of the
companies say that their programs are based on the latest
scientific evidence.

So is it worth investing in brain training, and do you risk being
outsmarted if you don't? Unfortunately for the wannabe genius,
there are no simple answers. While there is no shortage of
studies suggesting that some cognitive functions can be trained,
the link between most of these programs and a better-performing
brain is still unproven. "Does brain training work? It depends,"
says Torkel Klingberg, a brain-training expert at the Karolinska
Institute in Stockholm, Sweden. "That's like asking, 'Do drugs
work?'. It depends on the molecule."

Commercial brain training has been around for at least a decade,
but has only really caught on in the past couple of years.
According to figures published in The New York Times  in November
2007, the US brain-training market was worth just $2 million in
2005 but was expected to be worth $80 million in 2007. The
catalyst for this exponential increase was probably the release
of Brain Age in 2005. The game runs on the Nintendo DS console
and has sold more than 14 million copies worldwide. For an
investment of around $20 (plus the price of the console) and a
few minutes' concentration a day, it promises to help you "get
the most out of your prefrontal cortex".

Like its competitors, Brain Age is a collection of puzzles and
video games that use cognitive skills such as memory, attention
and rapid processing. As with all video games, the more you play,
the better you get. What makes brain-training games special, so
the story goes, is that your improvements are not just within the
context of the game but manifest themselves in the real world as
well.

On the face of it, this makes a lot of sense. It's well known that
older people who stay mentally active are more resistant to
cognitive decline and dementia, and many scientific studies have
backed up this "use it or lose it" hypothesis . So if it works
for older people, shouldn't it work for everybody?

Perhaps it does. Over the past 15 years or so, neuroscientists
have gathered abundant evidence that important cognitive
functions such as memory, attention and processing speed can be
improved by training, not just in older people but in young,
healthy adults too. There are also numerous studies showing that
challenging a specific part of the brain encourages that region
to grow and develop, as in the well-publicised example of the
London taxi drivers, who develop a larger hippocampus - the part
of the brain responsible for spatial memory - as they learn their
way around the city (Proceedings of the National Academy of
Sciences , vol 97, p 4398).

Most companies offering brain training stop short of specifying
how their product will physically change your brain. For evidence
that brain-training programs work, they tend to point to the
sheer weight of accumulated data, but dig below the surface and
things start to look far from clear cut.

"There's 12 to 15 years of good laboratory science that we can
direct brains in a corrective direction," says Mike Merzenich, a
neuroscientist at the University of California, San Francisco,
who also runs a company called Posit Science, which develops
"brain-fitness" programs. "Just about anything can be improved.
The brain is massively plastic - if engaged in the right way."

It's a key distinction: the brain certainly appears to be
trainable - but you have to train it in the right way. "There's
lots of confusion in the field," says Klingberg. "People say 'use
it or lose it', but that doesn't mean anything unless you define
'use' and 'it'."

That means that each brain-training program needs to be evaluated
on its own merits. And when you do that, doubts begin to emerge.
Experiments on specific programs tend to be small and poorly
controlled. Unless a training program has been shown to succeed
under the stringent conditions of a proper clinical trial, the
results must be treated as provisional, says Merzenich. By the
same token, companies' claims need to be appraised with caution.
"It's an incredibly murky area," says Merzenich. "There are good
studies but not many controlled trials. There's a massive level
of underlying science but not much has been reduced to hard,
gold-standard levels."

Lumosity, created by Lumos Labs, is a typical example. According
to Mike Scanlon, chief scientist at the company, the
brain-training program was adapted from experiments in psychology
and cognitive neuroscience literature. The company's own trials
show that 30 training sessions produced significant improvements
on a battery of standard tests of visual attention and working
memory. This sounds impressive until you take into account the
trials only involved 14 people, plus eight controls who received
no contact, and that the results have not been published in a
peer-reviewed journal. Lumos claims that its program trains
processing speed and cognitive control, but it has yet to present
evidence to back this up.

This is not to say that Lumosity doesn't work or that the trials
were badly designed. There's no doubt the games are fun and that
you get better at them with practice. What it does suggest is
that Lumosity cannot claim to be a proven route to a better
brain, and that the company's results, and those of many of its
competitors, need to be understood for what they are -
provisional.

This situation is unlikely to change, particularly as there is no
incentive for companies selling brain training to conduct proper
trials. As Merzenich points out, it can cost $2 million to run a
controlled trial, and few companies are willing or able to shell
out that kind of money. "I want to continue the research," says
Scanlon, "but we're not going to keep on blowing out studies on
more and more people." In any case, the brain-training market is
not regulated by an FDA-like body that demands scientific proof
of a product's efficacy before allowing it to be sold. Nor does a
lack of clinical data seem to be a barrier to commercial success,
if the growth of the US market is anything to go by.

Despite a lack of large trials, Lumosity has at least been shown
to make generalisable improvements: trainees not only get better
at the training program itself, they also improve on independent
tests of working memory and visual attention. This, says
Merzenich, is one of the minimum requirements for a credible
brain-training program. "It's crucial, or you're making it up,"
he says. Not all companies show such evidence of
generalisability, however. Notable among these is Nintendo,
though the company is careful not to claim that Brain Age is
scientifically validated, merely stating that it is an
entertainment product "inspired" by Kawashima's work.

The absence of cast-iron evidence isn't necessarily seen as a
problem, however. Susan Greenfield of the University of Oxford
has publicly endorsed MindFit, a brain-training program for older
people, on the back of research that has yet to appear in a
peer-reviewed journal. She says she has seen enough evidence to
convince her that brain training is worth the effort. "I believe
it works," she says. "What is there to lose? There's no risk, and
every chance it might be doing something."

Looked at in this way, brain training is rather like an
anti-ageing cream: if people want to spend their money on
something that won't do them any harm and might do them some
good, who's to stop them? Also like anti-ageing cream,
brain-training companies are not as up front as they might be
when it comes to potential limitations. Klingberg says that
consumers should be more questioning. "I'm surprised that people
don't care more about the science," he says, "that they don't
ask, 'where's the evidence that this works?'."

Against this confusing background of sales pitches and celebrity
endorsement, is there any decent, independent evidence that brain
training can work? Encouragingly, there is. There may not be many
large-scale clinical trials, but those that have taken place all
point in the same direction.

In 2006, a group led by Karlene Ball of the University of Alabama,
Birmingham, published the results of a huge US government-funded
study of the "use it or lose it" hypothesis. Between 1998 and
2004, they put a total of 1884 healthy older adults through an
intensive six-week programme designed to train either their
memory, reasoning powers or processing speed.

When the volunteers were tested post-training, Ball's team found
the programme had not only worked but the improvements were
generalisable: those given memory training did significantly
better on other memory tasks, and so on. Remarkably, when
participants were re-tested five years later the effects were
still detectable, even with no further training (Journal of the
American Medical Association , vol 296, p 2805). On the downside
there was no evidence that the training had any effect on
real-world activities. Even so, some of the team are now
converting the results into practical brain-training programs for
the elderly, says lead author Sherry Willis of Pennsylvania State
University, State College.

Other trials have done even better. Merzenich and colleagues at
Posit Science published the results of another big trial in 2006.
They tested Posit's "Brain Fitness Program" - commercially
available for $395 - on 182 older adults. Those who received the
real thing - the rest were either given placebo training
(watching a DVD) or no contact - scored significantly better on
memory tests, and the improvement was still there three months
later (Proceedings of the National Academy of Sciences , vol 103,
p 12523).

Late last year Posit released preliminary results of another
trial. With 524 participants aged 65 or over, it is the largest
trial yet of a commercially available brain-training program.
Judging from the available information - the results were
presented as a  poster at a conference - the outcome was good.
Brain training significantly improved processing speed and
memory, and three-quarters of participants said they noticed
improvements in their day-to-day lives. "There's a very large
effect," says Merzenich. The memory results alone were the
equivalent of being 11.2 years younger, he says.

Klingberg, however, sounds a note of caution. He points out that
Posit expresses its memory results in terms of "effect size" - a
measure of statistical significance. "An effect size of 0.2 is
weak, 0.5 moderate and 0.8 is strong," he says. Yet Posit
reported an effect size of just 0.25 in the smaller trial and
0.28 in the larger one. Reassuringly, Klingberg says he has solid
evidence that working memory can be trained and that the effect
persists for at least three months (Journal of the American
Academy of Child and Adolescent Psychiatry , vol 44, p 177). All
things considered, it's hard not to conclude that brain training
has been proven to work - under certain circumstances.

It is also worth pointing out that no study has shown that brain
training makes cognitive abilities any worse. At the very least,
it's a fun way to while away a train journey or rainy day. Just
don't expect to develop a photographic memory or lightning
reactions overnight - or in fact, at all. "The analogy I use is
giving up smoking and taking up jogging," says Greenfield. "It
might reduce the risk of cancer. But it's not a guarantee."A
miracle cure? Graham Lawton

Brain training may or may not turn intellectual zeros into heroes,
but for psychiatric illnesses such as schizophrenia, depression
and obsessive-compulsive disorder (OCD), it seems to be a miracle
cure.

The most advanced research in this area has been done on
schizophrenia by Posit Science. For the past three years, Mike
Merzenich, a neuroscientist at the University of California, San
Francisco, who also runs Posit Science, has been running two
trials of intensive brain training. The trials are ongoing, but
Merzenich says the results to date are very encouraging. One of
the key deficits in schizophrenia is severe disturbances of
memory, attention and executive functions. Brain training can
restore these to near-normal levels, says Merzenich. "No drug can
do that."

Merzenich also says he has had promising early successes with
depression, OCD and with stopping people showing early signs of
schizophrenia from progressing to the full-blown disease. "This
is a superior strategy to manipulating the brain's biochemistry
with drugs," he says. "Instead, you direct the brain to sort
itself out. This is speculation, but I think neurological and
psychiatric illness will eventually be directed towards brain
correction."

This, perhaps, is where brain training will have its greatest
impact - not as a brain gym, but as a treatment for people with
serious mental health problems or brain injury. Torkel Klingberg,
a brain-training expert at the Karolinska Institute in Stockholm,
Sweden, also sees the power of using brain training as therapy.
His company, CogMed, sells a computer-based training program for
children with attention-deficit hyperactivity disorder and other
attention problems, and he says there is much promise in the
approach - but also a long way to go. "Brain training is where
internal medicine was in the 19th century," he says. "We need to
find the specific conditions under which it works."





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