Science to the People!

The Boston Globe had a a nice article about the relationships between brain function, aging, and driving.  So much news coverage of this issue focuses exclusively on how to get older drivers to stop driving, without pointing out the driving is crucial for maintaining independence and quality of life during aging.  This article takes a very different tack, and points out that there are new ways to maintain cognitive function during aging, which can keep older drivers behind the wheel safely.

Henry W. Mahncke, Vice President for Research & Outcomes

My colleague Dr. Jerri Edwards recently published a very interesting paper showing that UFOV training helps people maintain their driving skills over a three-year period.  In particular, this study compared changes in driving space (the area over which a person is comfortable driving) and the driving exposure (how much a person drives) across three groups - individuals with a good UFOV score at baseline, those with a poor score who did a control computer activity, and those with a poor score who did UFOV training.  Those with a poor baseline UFOV score doing the control activity showed meaningful declines in driving space and driving exposure - they began to reduce their driving over the three year study period, perhaps because they noticed the decline in their driving skills associated with their decreased UFOV.  However, those with a poor baseline UFOV who did UFOV training significantly reduced that decline - and in fact, they looked like the group with a good UFOV score at baseline.

These important results show that this kind of training, now a key part of DriveSharp and InSight, generalizes to a real-world activity like driving that has tremendous functional importance.  Maintaining the ability to drive is a key part of maintaining independence - and these results show that the right kind of cognitive training can help people do that.

Henry W. Mahncke, Vice President for Research & Outcomes

My colleague Dr. Frederic Wolinsky has just published a very exciting paper (free download - full disclosure, I am also an author) on the implications of Posit cognitive training for healthy care costs.  He analyzed data from the ACTIVE study, which employed speed training (the predecessor to InSight), and found that individuals using that training program were likely to cost their health care payors ~$250 less in the year following training.

This reduction in predicted medical expenditures was caused by improvements in health-related quality of life, which was measured using the standardized SF-36 assessment.  Another research group led by the developers of the SF-36 and the Federal Agency for Healthcare Research and Quality had previously shown that health-related quality of life scores are related to total medical expenditures, meaning that changes in health-related quality of life could predict changes in total medical expenditures.

We’re excited about the data because it shows the broad impact that properly designed cognitive training can have - not only for the person doing the training (and their family, friends, and co-workers) but for society at large.  The data suggested that the cost savings to health care payors could amount to ~3% of total medical expenditures - a huge potential savings, particular in the current economic environment where providing better care at a lower cost is more important than ever.

Posit is currently working with Capital Health Plan to make this program available to plan members as a free member benefit, and it’s our goal to help them improve their members’ brain fitness while reducing their overall costs.  The publication of this data validates that approach, and we hope to work with many more health plans going forward to ensure that as many people as possible can benefit from this technology.

Henry W. Mahncke, Vice President for Research & Outcomes

My colleague Dr. Sophia Vinogradov is having a tremendous summer - she and her research team now have four papers published or in press describing the results in individuals with schizophrenia using Posit Science technology.  Cognitive dysfunction is an important problem in schizophrenia - it’s generally independent of the overall psychotic symptoms and it relates closely to overall real-world function.  Improving cognitive function would offer the potential to improve work function, social function, and overall quality of life in individuals with schizophrenia.

Together these papers, all derived from her Cognitive Remediation in Schizophrenia (CRIS) study, comprise a landmark body of work that establishes the promise of brain-plasticity-based cognitive training programs in this condition.

The key paper from this series has just appeared in print (I’ll discuss the later papers in future posts):  ”Using neuroplasticity-based training to improve verbal memory in schizophrenia” (Fisher et. al., American Journal of Psychiatry, June 2009) describes the main results from the CRIS study.  The study is among the most rigorous ever performed in the field of cognitive training in psychiatry, with a large participant number (55 individuals), randomized assignment of participants into treatment or control groups, the use of a strong active control group who played ordinary video games, assessors who are blinded to group assignment, and the use of the now standard MATRICS consensus cognitive battery as the primary outcome measure.  As a result, the data coming out of the study are very solid - and show a significant effect on cognitive function with an effect size larger than any yet shown for a drug.

Dr. Vinogradov has been working with Posit’s co-founder Dr. Merzenich for over a decade now to apply the basic science of brain plasticity to improve cognitive function in individuals with schizophrenia.  It’s very gratifying to see the first results from this long and productive collaboration make their way into print, and to have the opportunity to develop these these programs to help these patients and their families.

Henry W. Mahncke, Vice President for Research & Outcomes

Wired news published a great article on DriveSharp today, and our own Mike Merzenich (co-founder and Chief Science Officer) and Steven Aldrich (CEO) were interviewed on Fox Business News about the DriveSharp launch.  It’s great to see the interest!

Henry W. Mahncke, Vice President for Research & Outcomes

The International Conference on Alzheimer’s Disease (ICAD) is going on right now in Vienna.  There’s been quite a lot of interesting news already about cognitive decline, Alzheimer’s disease, and aging:

• In a study of individuals with Alzheimer’s disease, omega-3 fatty acid supplements were shown to have no effect on cognition or the progression of the disease; however in a different study (MIDAS) a positive effect was seen on cognition (Paired Associate Learning component of the Cambridge Neuropsychological Test Automated Battery) in individuals with with memory impairment (but without a formal diagnosis of Mild Cognitive Impairment or Alzheimer’s disease).
• My colleague Dr. Deborah Barnes studied the relationship between exercise habits and cognitive function in older individuals.  Crucially she looked not only at how much exercise a person currently engaged in, but what the changes in their exercise habits had been.  She was able to show that purely sedentary people had the worst cognitive function, but that those people who had begun to exercise regularly had better cognitive function.  This overcomes a traditional problem with cross-sectional studies in that it is very difficult to to determine cause and effect - by specifically looking at people who had changed their exercise patterns, she was able to better determine that the change in exercise pattern drove the improved cognitive function.  Dr. Barnes worked with Posit previously on a pilot study using Posit programs in Mild Cognitive Impairment, and is currently leading the Mental Activity and eXercise (MAX) study, which is examining the interaction between Posit cognitive training and physical exercise on cognitive function.

Henry W. Mahncke, Vice President for Research & Outcomes

We’re launching DriveSharp today!  DriveSharp is a new training program focused specifically on maintaining and improving the brain skills required for safe driving.  DriveSharp includes Road Tour, a core Useful Field of View training exercise originally developed by Dr. Karlene Ball and Dr. Daniel Roenker.  There’s a huge amount of clinical data that shows that this program improves driving safety, including studies showing improvements in on-road driving safety (Roenker et. al. 2003), maintenance of confident driving behaviors (Edwards et. al. 2009),  and perhaps most importantly a direct reduction in the number of automobile crashes (Ball et. al., 2009).

We’re particularly excited that the DriveSharp program and the evidence behind it are so strong that the American Automobile Association Foundation for Traffic Safety is partnering with Posit to launch DriveSharp.  We worked with the AAAF to build a free crash risk evaluator to provide a fun and easy way introduce people to the science behind the Useful Field of View and how DriveSharp works.

You can learn more about DriveSharp, try an exercise on-line, read our press release, or read AAAF’s press release.

Henry W. Mahncke, Vice President for Research & Outcomes

The  Foresight project of the British Government recently issued a very interesting report entitled “Mental Capital and Wellbeing” which covered the potential for cognitive training to fundamentally improve human wellbeing over the next twenty years.  Foresight brings together academia, industry, and government to examine the public policy implications of new science.  For each issue they tackle they put together a very comprehensive set of science briefings as well as policy summaries written by experts in the field.  The project had big goals:

The aim of the Foresight Project on Mental Capital and Wellbeing has been to advise the Government on how to achieve the best possible mental development and mental wellbeing for everyone in the UK in the future

The full report has been issued (executive summary), and the project page contains a wealth of fascininating reading describing the thinking that went into the final recommendations.  Among the science reviews is a very comprehensive review of cognitive training from Dr. George Rebok, which (among many things) covers the ACTIVE study and cites our own work at Posit Science.

I worked as a science and technology consultant to the British Consulate in San Francisco before coming to Posit, and did some work with Foresight projects  - it’s great to see that work coming full circle back to my work at Posit now.

It’s exciting to see governmental groups begin to evaluate the impact of this technology on societal issues, and consider how to best ensure that this science gets out of the lab and into the world where it can help people.

Henry W. Mahncke, Vice President for Research & Outcomes

New results from the ACTIVE study published in the Journal of Gerontology and announced today show that people using Useful Field of View training (UFOV) experience an unexpected benefit - they have a 30%  lower risk of showing a clinically significant worsening in depressive symptoms.

The investigators analyzed depressive symptoms as measured by the Center for Epidemiological Studies-Depression scale (CES-D-12) scale and measured the risk of showing 0.5 or 1 standard deviations of decline 1 year and 5 years after completing training.  People using the UFOV training showed significantly reduced risks of such decline, whereas people doing classroom-based cognitive training did not.

Depressive symptoms are important - they are correlated with a huge range of other problems, including poorer health-related quality of life and risk of frailty and even mortality.

These results are quite surprising - the training program wasn’t designed to improve depressive symptoms specifically, and the results represent a very significant generalization of benefits from the directly trained ability of UFOV and the already demonstrated benefits to driving safety and health-related quality of life.

Henry W. Mahncke, Vice President for Research & Outcomes

Dr. Timothy Salthouse published a paper recently suggesting that age-related cognitive decline begins in our late 20’s.  The paper is already getting a lot of media coverage - late 20’s is a bit earlier than most people want to be thought of as “declining.”  But the paper tackles a very interesting scientific controversy, as outlined in the introduction:

Cross-sectional comparisons have consistently revealed that increased age is associated with lower levels of cognitive performance, even in the range from 18 to 60 years of age. However, the validity of cross-sectional comparisons of cognitive functioning in young and middle-aged adults has been questioned because of the discrepant age trends found in longitudinal and cross-sectional analyses.

Which is to say when studies have looked at cognitive function cross-sectionally - by measuring cognitive function in lots of people of different ages - decline is evident, and that decline looks roughly linear starting around age 30.  However, if individuals are tested longitudinally - repeated testing across multiple years - they don’t appear to be declining.  Intuitively, the longitudinal testing seems like it should be giving a more reliable result - after all, it’s the same people being tested again and again.  So why don’t they decline?  Many ideas have been suggested, including the hope that we’re all just more resistant to cognitive decline than our grandparents were.

Unfortunately, Dr. Salthouse’s analysis suggest that the cross-sectional data are in fact more reliable - the stable (or even increasing) cognitive function shown in the longitudinal studies is a result of people become more familiar/comfortable/good at the tests themselves, and this effect masked their underlying cognitive decline.

An interesting implication noted by Dr. Salthouse is that interventions designed to maintain/improve cognitive function might be best used starting when cognitive decline begins - in the late 20’s and into the 30’s.  This is consonant with our everyday notion about physical fitness - we know that people should adopt a lifetime commitment to physical fitness and not wait until they retire to begin such a program.  Cognitive fitness seems likely to work in exactly the same way.

Dr. Salthouse was kind enough to pay us a visit at Posit Science a few years ago, when we were just beginning the IMPACT study.  He asked all of the right questions about our clinical trial data, and then summarized in his very conservative style: “Well, I wouldn’t bet against you.”

Henry W. Mahncke, Vice President for Research & Outcomes