Neuropsychology

Do Brain-Training Programs Work?

I often get asked questions about the various brain-training programs available. Questions like “will these programs really help me improve my memory” or “will these programs help prevent Alzheimer’s disease”.

 You’ve probably heard these programs advertised on TV, radio, or online. Most of these brain-training programs involve computerized activities that require you to solve puzzles, or briefly remember information. Some people find these programs fun and enjoyable, others find them frustrating and challenging.

Many of these programs make broad claims about the benefits of using the program. Lumosity’s website says “sharpen the skills you use every day” and “just a few minutes a day for 3 brain games – that’s all it takes”. The website for CogniFit says the program “help stimulate cognitive functions and improve brain plasticity”.

So do these programs actually work as they claim?

Let’s take a look at just what these brain-training programs are claiming to do. Often these companies promote their products as being helpful for a wide range of problems, everything from improving your school performance, to reducing the risk of developing dementia. Even just thinking practically it is hard to believe that just a few minutes each day with one program can help with so many different cognitive problems!

Many of these brain-training programs claim to improve what’s called neuroplasticity. Neuroplasticity is simply the brain’s ability to adapt and develop by forming new connections. Some areas of the brain are more adaptable than others, but our brain shows neuroplasticity every day. Each time we learn a new fact or a new skill our brain is forming new connections. This isn’t some incredible advance that these companies have figured out, it’s a normal brain function.

We know that our brains can learn. It makes sense that the more you practice a skill the better you get at it, right? Just like learning any skill, the research suggests the more you practice these brain-training programs the better you will get at them.

But the companies that advertise these products aren’t just claiming you will get better at the games, they are implying that getting better at the games will improve your memory and other cognitive skills in daily life.

What these brain-training programs claim to rely on is a concept of transference of learning. This is the finding that in some situations learning one task will make it easier to learn a second task. Transfer of learning only works well with tasks that are very similar, however. For example if you learnt how to use one type of coffee pot you will be faster in learning how to use a new coffee pot because the tasks are so similar. Learning does not transfer well to different tasks, however. Just because you can operate a coffee pot doesn’t mean you can fly an airplane. This sounds facetious I know, but this is the type of claim many of these programs make (i.e. you will prevent Alzheimer’s by playing a computer game). The evidence in the research says that just because you get better at a brain-training program does not mean you are going to improve your memory in daily life. Getting better at the brain-training program is not going to make it easier for you to remember where you put your keys, or to keep track of the list of groceries you need to pick up. There is even less evidence to suggest that these programs will reverse any cognitive decline or cognitive difficulties.

Interestingly, the concern regarding the validity of the claims made by these brain-training companies was so significant that the US Federal Trade Commission became involved. In January 2016 the FTC announced that it had charged Lumos Labs, the people who created Lumosity, with “deceptive advertising” regarding some of the claims the company made about Lumosity’s efficacy. Lumos Labs agreed to settle with the government and pay a $2 million fine while agreeing to change some of its sales and marketing practices. The FTC stated that Lumosity did not have the science to back up their claims about the benefits of the program on school performance, work performance, and reducing cognitive impairment.

It’s important to keep in mind that most brain training companies are privately held. In 2013 the market research firm Sharp Brains reported that American adults directly spent about $322 million on digital brain-training products. These products are not just a business, they are a big business.

When deciding if you want to participate in one of these brain-training programs I would encourage you to consider the costs and benefits. If you like these types of computer activities, great. Participating in activities that challenge your thinking skills and that you enjoy has health benefits. However there is no evidence to suggest that these programs (which you pay for) are better than free activities (like regular reading) at preventing cognitive decline or improving cognitive performance.

If you’re looking at ways to maintain your cognitive health I would encourage you to stick with what we know works and that includes regular physical exercise, eating a healthy diet, participating in social activities (like spending time with friends and family), and participating in activities that keep your brain active (like reading a library book or participating in hobbies that you enjoy).

Can we learn after removing large parts of the brain? What patient H.M. taught us about memory

When you think about memory what comes to mind? Do you think about an important event from your past, or the list of groceries you need to pick up on your way home from work today? There are many different types of memory, which require different brain processes. Memories from important events in our past are called episodic memories, and remembering to pick up groceries on the way home requires prospective memory. Some memories are clearly tied to a specific point in our life, like our favorite birthday. But other memories aren’t tied to a time and place. For instance do you remember when you learnt what an apple is? Probably not. But you know that an apple is a fruit that grows on trees. Your knowledge of an apple is part of a different memory system called your semantic memory, or your memory for facts and information.

Some types of memory are made even without us being consciously aware of them through what’s called implicit learning. For example the more that we repeat an action more ingrained it becomes in our minds and the less effort is needed to use the memory. Think about learning to ride a bike. When you were young it took a lot of effort. You to think about staying balanced, peddling, keeping the handlebars straight, and so on. But as an adult even if you haven’t ridden a bike and over 10 years, once you get on a bike your body will remember how to ride. Just like the phrase “it’s just like riding a bike”, some skills once we learn them we have them for life, even if we don’t practice them regularly. Knowing how to ride a bike is a procedural memory, which is part of our implicit memory system. We know how to do it even without consciously thinking about the skills required.

Our knowledge that there are many different types of memory, and that certain brain regions are important for learning is relatively recent. Before the 1950s we thought memory was tied to intelligence and perception.

We have a famous patient named Henry Molaison (commonly referred to as patient HM), and a Canadian Neuropsychologist named Brenda Milner to thank for our modern understandings of memory.

Henry Molaison developed seizures when he was 10 years old. His seizures started small, but progressed to convulsive seizures before he was 16. He was able to work for a while as an adult, and worked on an assembly line. But in 1953, when Henry was 27 years old his seizures became so incapacitating he was no longer able to work or lead a normal life. Anticonvulsant medications weren’t helping Henry. A neurosurgeon named William Scoville offered Henry an experimental procedure that involved removal of parts of his bilateral temporal lobes (which are on the sides of your brain, from about your temples back over your ears). We now know that the temporal lobes, which include a structure called the hippocampus, play a critical role in our ability to make new memories. But we didn’t know this when Henry had his surgery.

After the surgery Henry’s epilepsy was controlled, but he developed severe memory impairment. Dr. Milner was asked to travel to his memory difficulties.

What Dr. Milner observed when she met Henry was someone who forgot daily events almost as fast as they happened. Henry described to Dr. Milner that he felt “like waking from a dream… every day is alone in itself”. He forgot names of people he was introduced to almost immediately, and after working with Henry for 50 years Dr. Milner had to introduce herself each time they met. He would also say his own age wrong because he was not able to remember that time had passed, and would incorrectly state the year.

Although Henry would forget information very quickly, other components of his thinking skills remained strong. His intelligence was preserved. Henry also had a remarkable ability to maintain attention and he could remember some information for a brief time after he heart it. As a result, he could carry on conversations, and he was able to remember information as long as he kept repeating it in his mind. But if he was distracted he completely forgot what he was trying to remember, and didn’t recall ever being asked to remember something in the first place!

Henry was also able to learn new skills, even if he didn’t remember ever doing the task before. For example Dr. Milner would have him perform repetitive motor tasks like copying a star that was reflected in a mirror. His performance would improve over time, and when asked to do the same task days later his performance would remain strong, even though he would insist he had never done the task before. This type of memory is called procedural memory, which is a type of non-declarative or implicit memory.

Henry could also remember things that had happened before his surgery. He remembered important events from his past, and famous people from before his surgery. When he was show pictures of people that became famous after his surgery, however, he did not recognize them, even if they were regularly in the news.

Henry died on December 2, 2008 at the age of 82. Although Henry did not remember the contributions he was making to neuroscience from day to day, his story forever changed how we understand memory and the brain. Thank you Henry Molaison and Dr. Milner for your contributions to science.

How to maintain cognitive health as we age

The population in most developed nations, including Canada, is aging with the Baby Boomers. For the first time in 2016 there were more people over age 65 then under age 14 in Canada. There were more older adults than there were children. Not only is our population aging, more people are living well into our retirement. What can we do to maintain our health as we age so we can get the most enjoyment out of our later years?

There are some changes in cognition and brain health that are part of normal, health aging. For instance did you know that our thinking efficiency and response speed reach a peak in our 20s? After that our thinking starts to slow. But not every skill declines as we age. Our vocabulary and our store of knowledge grows throughout our lives. Just because our speed declines, however, does not mean we are worse off.

Timothy Salthouse studied the performance of transcription typists (people who type while someone else talks) in a 1984 study. People in the study ranged in age from 19-72. What they found was that age and typing ability were not related. Although older individuals were slower at making individual key strokes, they were not slower in terms of the number of words they typed. Why? Because older individuals had more experience typing, they were able to compensate for age-related slowing by anticipating the next word in the sentence. They used their experience to help overcome their slower response speed.

Although not all skills decline as we age, we do know that many people experience negative changes in physical, mental, and cognitive health as they age. Statistics Canada estimates that the average Canadian can expect to live the last ten years of their life with some type of disability. How do we avoid this? What can we do to live healthy into our 80s and 90s?

A Swedish study (the Kungsholmen Project) followed 1810 individuals over age 75 for 18 years to see how lifestyle factors impacted longevity and health. They found that people who made healthy lifestyle choices lived longer. For example, people who were of normal weight lived on average one year longer than those who were underweight. Those who never smoked lived one year longer than smokers. Regular participation in leisure activities added a year to life expectancy. Those who had rich social networks (i.e. had regular contact with family and friends) lived 1.5 years longer. Those who participated in regular physical activity lived more than 2 years longer.

What can you do to live a longer, healthier life? Exercise. Exercise is one of the best research-supported activities to promote health aging. Even 30 minutes a day of moderate intensity activity (i.e. activity where you can still carry on a conversation but it is challenging, like a brisk walk) can improve health and brain functioning.

Keep your brain active. Participate in hobbies you enjoy or volunteer. These activities can improve your cognitive skills, but they can also improve mood, sleep, and physical health.

Keep socially active. Spend time with family and friends. This helps reduce stress but also keeps your brain active.

Eat a healthy, balanced diet. The Mediterranean diet which is high in fruits and vegetables, whole grains, fish, and olive oil is associated with brain health.

These activities don’t have to be expensive. Regular reading is associated with brain health. Many libraries offer free memberships or relatively low-cost memberships.

This sounds like a lot of work to stay healthy right? The good news is, if you can make it to your 90th birthday you can throw all these healthy habits out the window. The 90+ study in California followed 1600 people every six months who were over age 90 years. What they found was that people who drank moderate amounts of alcohol or coffee lived longer than those who abstained. People who were overweight lived longer than normal or underweight people. There was some evidence that high blood pressure in your 90s is protective, and that a higher calorie diet is also protective in the oldest old. So if you can make it to your 90s, enjoy those extra glasses of wine and extra pieces of chocolate cake.

Can Meditation Improve Our Decision Making

We make hundreds of if not thousands of decisions each day. Take a simple example of deciding what to eat for breakfast in the morning. You have to consider what’s in your pantry, how much time you have to prepare the meal, what you like/dislike, and even sometimes the time of year (what we eat on holidays is probably different from what we eat after New Year’s resolutions start). Once we have decided on what to eat then we have to make a whole host of other decisions in order to act. Say I pick toast. I need to know that toast is made from bread, that it needs to be toasted with some type of heat source, and how to operate the toaster. Once the toast is made I need to decide what to put on for toppings.

But it probably wasn’t this hard for you to decide on breakfast this morning. Why was it so much easier to make that decision?

In the 1960s and 70s the predominant theory in psychology and medicine was that our brains were like computers. We took information in, processed the information, and made reasoned judgments based on evidence.

Two Israeli psychologists Amos Tversky and Daniel Kahneman challenged this belief. They proposed that our brains use a number of mental shortcuts called heuristics to make decisions.

These heuristics are generally helpful and they save time and energy. Rather than thinking about all the potential choices our brains use shortcuts to make decisions faster. Unfortunately this means these heuristics are prone to error.

Here’s an example of how these errors can happen. Say I flip a coin and it comes up heads. I flip it again, and again, and again, and again and each time it’s heads. It’s been heads 5 times in a row. What would you bet on next? Tails? Heads?

What if I flipped 20 heads in a row? Would you change your bet?

After a coin lands on heads several times in a row we are more likely to bet tails. This is because of what’s called the Gambler’s Fallacy, which is the belief that strings of good and bad luck occur, and that after so many heads the odds have to “even out” and there will be a run of tails.

But that isn’t how probability works. When you flip a coin the chance of heads is 50/50 each time. The odds of each coin toss are independent. It doesn’t matter what was flipped the first time.

The Gambler’s Fallacy is sometimes called the Monte Carlo effect. On August 19, 1923 at the Monte Carlo Casino the ball fell on black 26 times in a row at the roulette wheel. People lost fortunes betting on red because of the belief that this run of luck had to run out eventually. The ball did eventually fall on red, but then people continued to lose money favoring red because of the belief that more red spins were likely after that long run of black. The chances of getting 26 black spins in a row of course are very low. But when betting on a coin flip or roulette spin you are not betting on the sequence, you are betting on the individual toss, with 50/50 odds each time.

Another heuristic or mental shortcut described by Tversky and Kahneman is the availability heuristic. This is the tendency we have to judge how often an event occurs by how easily we can think of examples. The easier it is for us to think of an example of an event the more frequently we think it occurs. This works well most of the time. It’s usually easier for us to think of examples of events that happen more often. The problem is that some events stand out more in our memory than others.

Here’s an example. Are you more likely to be killed in a shark attack or by a cow? Worldwide about 6 deaths per year occur due to shark attack. In comparison, cows kill about 20 Americans per year. We should really be terrified of mosquitoes because they kill three quarters of a million people per year due to transmission of malaria and dengue fever.

Plane crashes are equally low frequency. Your chance of being in a plane crash is about 1 in 11 million. You have a better chance of winning an Oscar, or drowning in your bathtub.

We fear shark attacks and plane crashes for a few reasons. The less common something is, the harder it is for our brains to judge how often it happens. Also, you can probably easily remember the last time you saw a news story of a fatal plane crash, but when is the last time you heard of someone being killed by a cow, or malaria. Media coverage significantly influences our perception of how frequent events are.

Tversky and Kahneman proposed a dual process theory of cognition. System 1 uses heuristics. It makes decisions fast with minimal effort, but can be prone to error. System 2 is slower and requires more effort to think through the possible choices. This means System 2 is more controlled, but this system uses up a lot of brain resources. We’ve probably all had the experience that it’s harder to make well thought out decisions when we are tired, under stress, or sick.

The good news is that we can change from System 1 to System 2 thinking in some circumstances. A 2013 study found that just 15 minutes of meditation led participants to make more well-reasoned decisions. It’s probably okay to leave easier decisions like what to have for breakfast to System 1 thinking. But if you need to make an important decision, like deciding on a new job or how best to approach a difficult conversation with a colleague, try stopping for 15 minutes of meditation before you make this decision. There are many great resources online for guided meditations (try the Calm app for example). You might find you make better decisions after this brief mental break.

Should we trust our memories? Consolidation and reconsolidation of memory.

Think about a special event from your past. Maybe a favorite trip, a wedding, or when you started your dream job. What do you remember about that day? Do you remember where you were, who you were with, what the weather was like, or maybe even what you were wearing? In psychology we call memories for important and emotionally charged events like these “flashbulb memories” because we often recall them so vividly it is like we took a snapshot of the event. Or so we think. There is a good chance that some part of that special memory you can see so clearly didn’t happen the way you remember it. You are remembering it incorrectly without even being aware. Why does that happen?

 

To make a memory of an event like the one you are thinking about we need to get the information into our memory, store it there, and then be able to get it back out when we need it. If a memory is strong enough it can become part of our long term memory storage.

 

For a long time our standard view of this long term memory storage process was consolidation theory. According to consolidation theory once memories formed in long term memory they are stable. This means each time you remember an event from your past you are recalling the original, stored memory. This theory views our brains like computers. We store memories in our brain’s hard drive, and when we want to think about a memory we open up a file, read the contents, and store it back again.

 

Reconsolidation theory challenges this view that our memories of our past are fixed, and there is research support for this theory from both cognitive psychology and the neurosciences (see this 2009 article in Karim Nader and Oliver Hardt in Nature Reviews Neuroscience for a review). According to the reconsolidation theory of memory each time we pull a memory from our memory storage it becomes unstable and susceptible to change. Just by thinking about that memory we can change the memory itself. As a result, when we send that memory back to the storage vault we are actually storing the modified memory. Each time we recall that memory the process repeats, resulting in small changes in our memory for the actual event. In effect, when we think about an event from our past we are not recalling the original memory, but a memory of a memory. Reconsolidation theory implies that we have some ability to change our memories, which might be of benefit for people who have experienced past traumatic events.

 

Perhaps it is better to think about our memories less like computers and more like that game of telephone we used to play when we were kids. Each time the message is passed down the line it is changed a little until “the car is green” becomes “by far the spleen”. So next time you are arguing with your partner about what you ate on your first date, keep in mind that you both might be wrong.