An explosion of brain training games and apps has people spotting patterns, adding numbers and remembering sequences in hopes of boosting their mental fitness. A new study finds that a modest amount of brain training can improve cognitive speed, reasoning and memory, with effects lasting as long as a decade. But skeptics say many of the claims we hear are largely hype, and that even if you grow more proficient at a specific game or task, there’s no larger benefit. We explore the popularity of brain games and the questions about their effectiveness.

Guests

  • Sandra Bond Chapman Founder and Chief Director of the Center for Brain Health at the University of Texas at Dallas; Distinguished University Professor; author of “Make Your Brain Smarter: Increase Your Brain's Creativity, Energy, and Focus”
  • Henry Mahncke CEO, Posit Science
  • George Rebok Professor, Bloomberg School of Public Health at Johns Hopkins University; co-investigator on the Advanced Cognitive Training for Independent and Vital Elderly study on brain training

Transcript

  • 12:07:53

    MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. It's "Tech Tuesday." For a long time, experts thought of the brain as a sort of mental machine that took shape at an early age and then slowly wore out over time. Now, researchers say the brain is actually an ever changing organ that can still learn new tricks later in life. That finding has sparked an explosion of brain training apps and computer programs that aim to improve cognitive functions like memory, reasoning and processing speed for children and adults alike.

  • 12:08:42

    MR. KOJO NNAMDIA number of companies claim their brain games will make you smarter and boost your mental fitness, but skeptics say those claims are more hype than fact. Joining me to explore the science behind brain training is George Rebok. He is a Professor at the Bloomberg School of Public Health at Johns Hopkins University. George Rebok joins us in studio. Thank you for joining us.

  • 12:09:04

    MR. GEORGE REBOKIt's a pleasure to be here, Kojo.

  • 12:09:06

    NNAMDIJoining us by phone from Dallas is Sandra Chapman, founder and Chief Director of The Center For Brain Health at The University of Texas at Dallas and distinguished University Professor. And author of "Make Your Brain Smarter." Sandra Chapman, thank you for joining us.

  • 12:09:23

    MS. SANDRA BOND CHAPMANYou bet. Glad to be here.

  • 12:09:25

    NNAMDIJoining us from the studios of KQED in San Francisco is Henry Mahncke, CEO of Posit Science. Henry Mahncke, thank you for joining us.

  • 12:09:36

    MR. HENRY MAHNCKEIt's a pleasure. Thank you.

  • 12:09:37

    NNAMDIYou too can join this conversation, if you'd like to have a call, make, pose a question or make a comment at 800-433-8850. Do you have a brain training app on your phone? If so, how do you use it? Give us a call. 800-433-8850. Let's start with the claims brain training companies are making. Here's a commercial from the company Lumosity.

  • 12:10:34

    NNAMDILet's start with you, George Rebok. What is your reaction to that ad?

  • 12:10:38

    REBOKWell, I think that there is a growing evidence base for the efficacy of brain training, and a lot of the programs are based on very solid scientific evidence. I think what we don't know yet is how long some of these effects are gonna last. In other words, how durable are the effects, and whether the effects really affect anything that is practically important, in terms of our everyday lives. Does it impact on our daily functioning?

  • 12:11:06

    NNAMDISandra Chapman, your response.

  • 12:11:08

    CHAPMANYeah, I agree with George. I think there is significant evidence, but I think what's important for each of us is to think. Your brain is very specific as to what makes it better. Whatever you practice, you get better at. So, I would ask you when you're doing those games, is this something you really want to be better at, because things like high order thinking, decision making, judgment, may be more important than some of the specific processes.

  • 12:11:36

    NNAMDIAnd your response, Henry Mahncke.

  • 12:11:39

    MAHNCKEWell, it's a beautiful ad with a lovely narrative voice and a compelling jingle, but I think anyone who's interested in brain training should be asking a question, have these programs been shown to work? And George knows this, of course, cause George, you're from the active study, which is the largest study ever involved in brain training. We show that certain things really work. And Sandy, of course, knows this as well. She's been involved in large scale studies. And we at Posit Science know this, cause we've been involved in large scale studies.

  • 12:12:02

    MAHNCKEBut I think anyone doing this should ask the question, has this specific program been shown to work, and I guess I'm compelled to say, cause you had a Lumosity ad, that that program actually hasn't been through large scale controlled trials. So, we don't really know if it helps improve brain function or memory.

  • 12:12:16

    NNAMDIGeorge Rebok, let's talk about the study you did, funded by the National Institutes of Health. It showed benefits from brain training could last as long as a decade. Explain what kind of training you gave participants in the study to improve their memory, their reasoning, their speed.

  • 12:12:32

    REBOKYes. There were three different training programs involved in this study, the active study. One of them focused on memory abilities, and how we can improve memory. Can we teach people strategies that will help them better remember lists of information, like a grocery list or a newspaper story? And those -- the memory training program really focused on common memory techniques like visualizing things that you want to remember or associating it with material that's already familiar to you. This training was all done in small groups and it lasted for 10 sessions, about an hour per session.

  • 12:13:14

    REBOKThe second training program we used was a reasoning and problem solving training that looked at things like pattern perception. Can we recognize patterns, for example, in a medication schedule or a bus schedule? So, we taught people to recognize patterns and develop different strategies. For example, in a list of numbers, like, or a list of letters like A, A, B, B, B, C, C, C -- what would be the next letter in that sequence? And so, we would develop different patterns. Some become quite complex, but that kind of pattern recognition is an important ability for our everyday lives.

  • 12:13:52

    REBOKAnd then the third program was the speed of processing training, which is done on a computer, and it was designed, basically, to try to have people take in information, more complex information, in shorter and shorter periods of time. And so, for example, they would have to recognize a stimulus in the middle of a computer screen like a car or a truck, and then decide what object that was that appeared very briefly on the screen. At the same time, there were objects appearing at the periphery of the screen where you had to divide your attention.

  • 12:14:24

    REBOKAnd, of course, that kind of attentional control is very important in our everyday abilities like driving behavior.

  • 12:14:31

    NNAMDIYou found that even a modest amount of training, a dozen one hour sessions, and in some cases, a few booster sessions, continued to help people 10 years later. What were the lasting benefits of that brain training?

  • 12:14:44

    REBOKWell, we were actually rather surprised at that, because we had last assessed these participants at five years, and all three training conditions showed significant effect at that point. And those gains are also translated into people feeling that they had less difficulty carrying out their everyday life tasks. So, at 10 years, we weren't really quite sure whether these effects would maintain, but, in fact, at least for two of the three interventions, the reasoning intervention and the speed of training -- the speed of processing intervention, that there were effects 10 years out.

  • 12:15:19

    REBOKAnd as you point out, this is a rather modest amount of training. 10 hours minimally, with some people getting this extra training, or booster training. And this would be typically less than an undergraduate would get in a course. So, this kind of brief training had these long lasting effects, so it's suggesting, I think, that even a modest investment in brain exercises can pay very long term dividends.

  • 12:15:45

    NNAMDIIn case you're just joining us, you can ask a question or make a comment by calling 800-433-8850. Sending an email to kojo@wamu.org. You can shoot us a tweet at kojoshow. Do you think apps and computer programs can improve your cognitive function? You can also go to our website, kojoshow.org. Join the conversation there. Sandy Chapman, you're a believer in the brain's ability to become smarter, but only with the right kind of training. Why is deep thinking and synthesizing so important for the brain?

  • 12:16:19

    CHAPMANWell, what we know is that when you're taking in a lot of information, right now, we're in a day of information overload. We're taking in so much, but not really retaining it, because detail memory is the most fragile form of memory that we have. But if you go deeper and make sense of it in more abstract ways, it's much longer lasting. So, we've been able to show, by taking what we call a top down approach, to say, what does this mean to you in your life, rather than bottom up -- what are the facts that were presented here?

  • 12:16:51

    CHAPMANIn our cerebral cortex paper, we were able to show brain changes at all level of health. Increasing connectivity, speed of reaction, increase in white matter and actually brain blood flow. So, synthesized thinking, deeper thinking, and to realize what not to pay attention to is -- really seems to be important for everyday thinking smarter.

  • 12:17:12

    NNAMDIYou know, Henry mentioned earlier that most studies have been done in relation to the commercial that we aired earlier. But Sandy, do the apps available today help with that kind of brain expansion? What do people need to ask themselves before they start a brain training regimen? Sandy Chapman?

  • 12:17:31

    CHAPMANOh, Sandy. Oh, OK, I thought you were directing it to Henry. You know, I think the brain training -- you have to stop and say, is it better that I do this activity to get better at? Or, what if you eliminate toxic habits and free your brain up, instead of spending time when you're free on airplanes, getting this false sense that it's moving you forward. And, in fact, it's keeping you busier, more crazy, in terms of your brain energy. So, the brain games, I think there will be some, and Henry's company is working with some, that will help us to go beyond just rote level of responsiveness.

  • 12:18:11

    NNAMDIHenry, your company, Posit Science, makes a brain training program that's available online and on the iPad, but it's not on a smart phone yet. It's called, "Brain HQ." What does it do?

  • 12:18:24

    MAHNCKE"Brain HQ" is a brain training program that's designed to improve the speed and accuracy of how your brain works, literally to speed up the connections that your brain needs to have and make, in order to think fast and remember more. And in fact, one of the exercises in "Brain HQ" comes right out of the study that George and his colleagues led, the speed of processing training that he and his colleagues have been studying for, I guess, more than 10 or 15 years now, is part of "Brain HQ."

  • 12:18:52

    MAHNCKEAnd so, what it's really trying to do is, you know, sharpen the brain. Make it faster, make it quicker, and as a result, give a brain that processes information better and can store things in memory better. And pay attention better. And, in general, do all the things we want our brains to do.

  • 12:19:06

    NNAMDIWent on the website this morning, took the test. My brain seemed to improve each time I take the test. I haven't gone any farther than that as yet.

  • 12:19:17

    MAHNCKEYeah, that's the first step, of course, just getting better at exactly what you practice at. But the real broad question for brain training is, does it generalize to everyday life? Cause, of course, we're gonna get better at everything we practice at. And with George's studies, and in fact, many others, including some from Posit Science, have shown that, you know, certain kinds of training do, in fact, generalize beautiful to everyday activities, like driving safety. Or the speed at which we can conduct everyday activities like, you know, read medicinal labels.

  • 12:19:43

    MAHNCKEOr keep track of things in our house. And that's the kind of benefit we really want to see. We want to see better everyday life.

  • 12:19:51

    NNAMDIYou mean I need skills beyond being able to find that different looking bird in a millisecond?

  • 12:19:58

    MAHNCKEYou know, when you're driving your car down the street, you do. Absolutely. You want to notice something out of the corner of your eye so that you can stay safe on the road, for example. And that's what we want to see.

  • 12:20:07

    NNAMDIHere's Carol in Baltimore, Maryland. Carol, you're on the air. Go ahead, please.

  • 12:20:13

    CAROLOh, thank you so much. Unfortunately, I only heard the last 10 minutes of your show, because I just got in the car. But, I have a specific question, OK? On public television, you all know, of course, Dr. Daniel Amen, the, you know, who did "Change Your Brain, Change Your Life," and he did several of those things on public TV. And I was watching one, and he offered, as one of the gifts -- I bought the whole caboodle thing, because -- the whole kit and caboodle because of the one thing.

  • 12:20:42

    CAROLYou can go to specific website for a year, every day, and you can tune in to one of like five, or all five, if you want, to train your brain. I have an anxiety disorder, OK, so I bought it to try to lessen that anxiety disorder. Now, I haven't used it yet. I just got it. But I'll tell you, I thought I would just run this by you and say, because he's Dr. Daniel Amen, it never even occurred to me, will this work and could there be anything bad coming from it? Because he's Dr. Daniel Amen, the world famous psychiatric neuro whatever. And I want to know what you all think of this.

  • 12:21:18

    NNAMDIWell, we know the advice that we've already gotten from Henry Mahncke, so I'll ask, on this occasion, George Rebok.

  • 12:21:25

    REBOKWell, I think these programs serve a variety of different purposes, and you have to sort of look at them within the whole context of your life. Why do you want to use these programs? I think they can help boost peoples' confidence. There are some studies that suggest that they can lower things like depression. And I think that's one of the main benefits of these programs, is giving you a sense, you know, helping overcome defeatist attitudes and things like, I really can't learn any new information. I can't remember.

  • 12:21:54

    REBOKAnd so that's one of the benefits, but I think people also have to look, sort of, at the whole context of their lives. You know, this is part of, you know, a whole program of getting more mentally stimulated, maybe carrying out better daily habits, in terms of your exercise, your sleep, your stress reduction. And so that, you know, if you devote 24 hours a day to just doing brain training, you have to ask yourself, what aren't you doing during that time? And you're forgoing certain opportunities that, perhaps, can make you feel less anxious, make you feel healthier, less stressed.

  • 12:22:32

    REBOKAnd so, brain training may be part of that, but I wouldn't just rely exclusively on brain training as a way of either improving, you know, different cognitive skills or lower anxiety.

  • 12:22:43

    NNAMDIAnd Carol, did you buy it just because of who recommended it?

  • 12:22:47

    CAROLBecause it was part of the gift from public television to -- from Dr. Daniel Amen. He developed these programs himself. That's why I trusted this, because he's Dr. Daniel Amen. And, of course, I wouldn't do it 24/7. I work and I live a life, but I thought if I go do it, maybe four or five times a week, and run through the exercises, do you think that could be helpful?

  • 12:23:09

    NNAMDIAny comment on that, Henry, Mahncke?

  • 12:23:12

    CAROLThe woman who talked, I forgot her name, on your show now. Can you ask her what she thinks?

  • 12:23:16

    NNAMDISandy Chapman. Sandy Chapman, care to comment?

  • 12:23:19

    CHAPMANYes. You know what? I would say, and I agree, really, with George, is anxiety is something that when we step back from some of our toxic habits of pushing all time, physical exercise looks like it helps. And sleep, actually, is proven to be one of the most important things we can do to kind of down regulate anxiety and increase our deeper level thinking and overall brain health. So, I would be, you know, I think, try it a couple of times. And see how you experience it.

  • 12:23:54

    CHAPMANI think, intuitively, once you do, you will know, is this helping you or not? And there certainly are some other options, as well.

  • 12:24:02

    NNAMDIThank you very much for your call. Henry Mahncke, you commented on this earlier, but I'd like to return to it. Let's say I spend a lot of time on a brain training game. How can you tell if I'm improving cognitive function, or just getting better at that particular game through repetition and familiarity?

  • 12:24:21

    MAHNCKEWell, there's really two ways to tell that. The first, and maybe -- the first of the two ways is how a scientist would do it, which is to say, run a large scale study, You know? Take 500 people, have half of them do that brain training exercise, and have half of them do something else, like, oh, I don't know, attend an adult ed. class, for example. And before everyone starts, measure their cognitive function, using some standardized tests, like read them a list of 12 words and see how many they can remember.

  • 12:24:48

    MAHNCKEAnd then after the brain training, and after the adult ed., give the same test again. Read them a list of 12 words and see how many they remember. And see which groups improve their memory better. That's really kind of the gold standard way of assessing whether a brain training exercise, or really anything you can do for your brain, actually improves your cognitive function. And, of course, there have been beautiful studies like this done on a couple of these kinds of brain training exercises, including ours.

  • 12:25:11

    MAHNCKEAnd they've shown, of course, that that potential is there. At the same time, it's important to say that not everything works. I think it's -- we're at a point now where it's no longer sensible to group everything into one category and call it brain training games, and they either work or they don't. For example, a researcher in the UK a few years ago, published a beautiful study in nature where he developed a bunch of new brain training exercises in his lab.

  • 12:25:34

    MAHNCKEAnd actually, in a study that ran online, with more than 10,000 people, gave those brain training exercises to those 10,000 people, and showed that those exercises didn't improve cognitive function at all. And so, the short answer is, unfortunately, there's hard work to do, which is to run these kinds of gold standard clinical trials and see what works and what doesn't. So, that's the first answer. Yeah.

  • 12:25:53

    NNAMDIHow is technology affecting the development of brain training programs and their popularity?

  • 12:25:59

    MAHNCKEWell, you know, the reason we have the kind of brain training exercises we have now is because of the intersection of changes in neuroscience. We know that the brain is plastic, and it can constantly change and reorganize itself, even very far into old age. And also, the technology revolution. You know, in the 70s or 80s, it would have been essentially impossible to develop these programs without computers, because good brain training programs are adaptive. They change constantly in response to what a user does.

  • 12:26:27

    MAHNCKEAnd good brain training programs use very fancy and complex visual and auditory stimuli, things that you see and things that you hear. And the computer technology just wasn't there in the 70s and 80s. And it became possible in the 90s. You know, Kojo, during your intro, you mentioned that the desktop computer revolution at the beginning of this show, and that's what really enabled the first truly effective brain training exercises to be built. And now, as you also mentioned during your intro, we're all carrying around these computers in our pockets.

  • 12:26:52

    MAHNCKEAnd that's made brain training available to us on the subway, for example, as we go to work. And I think that like physical fitness, where the physical fitness revolution has permeated just every element of our life, we can engage in physical fitness activities. The brain training revolution's gonna go the same way, and with the advent of technology we can use and carry everywhere, we're gonna have effective brain training exercises everywhere.

  • 12:27:15

    NNAMDIGeorge Rebok, playing a brain training game on your phone is an individual act, but if lots of us can boost our brain function, that benefits society at large. What are the public health implications of brain training?

  • 12:27:27

    REBOKWell, I think that's a really important question, Kojo, because, you know, a lot of the brain training has been done with individuals and with looking at individual gains, but, as you point out, we want to know about, at a population level, what effects this brain training is having. And when we started the active study, back in the 1990s, we had to have a computerized arm of the active study, but we also had paper and pencil versions of these, this training, where we had to bring people in to a classroom setting and actually have the training carried out by a certified instructor.

  • 12:28:07

    CAROLAnd that sort of limits the public health access to the training, because people have to actually come in to be trained. And so, one of the things we did with the active materials in the follow up studies, is actually take the materials and send them home, and have older couples train one another, in kind of a trainerless training paradigm. And we would check in with them periodically, but, essentially, they were training each other using the materials we had used in the study.

  • 12:28:37

    REBOKAnd, in fact, we found that that kind of approach was just about as effective as these small group sessions that we used in active. So, I think that that is a way to sort of extend the reach of these programs, and I think at a population level, and people often talk about well, the gains aren't really that dramatic with a lot of these brain training programs. But if you leverage it across a whole population, even small gains can translate into very meaningful savings, in terms of economic savings, admissions to nursing home.

  • 12:29:11

    REBOKEven if we could delay that by a month, or two or three months, it's a tremendous economic savings to society, as well as tremendous personal savings to an older individual and their family.

  • 12:29:21

    NNAMDIHow about leveraging it across a demographic group? Sandy Chapman, you have worked with middle school students on brain training. How is it being used with children, and how should it be used?

  • 12:29:32

    CHAPMANYeah, and one thing that's very different about the brain, unlike physical exercise, where we go off and should work out three times a week for an hour. What we're showing both with middle school as well as young adults and older people -- what's important is to teach people strategies of how to think, so that they can adopt it throughout their day and use it, not just in this 15 minute brain game, but really a way of thinking, whether you're on a radio show like this, or reading the newspaper, or students learning science and math.

  • 12:30:07

    CHAPMANAnd we've been able to show, in middle school -- we've done almost 25,000 teenagers in the last three years, training them in 10 hours, how to think in kind of this top down processing. And the students have been able to show double their scores in science, math, history and English. So, when you teach the brain more how to think deeper, synthesized, rather than just kind of quick tricks to remember. And we actually did a randomized trial of just fact based learning. They didn't get better, and their scores didn't get better.

  • 12:30:41

    CHAPMANSo, strategic thinking, deeper level, looks like it matters both in our use, but it never stops being important for even old age.

  • 12:30:49

    NNAMDIIt's a "Tech Tuesday" conversation on brain training. We're gonna take a short break. If you have called, stay on the line. We'll get back to your calls. If the lines are busy, and it does look like they are, you can send us email to kojo@wamu.org or send us a tweet at kojoshow. Do you notice that your memory or reasoning skills aren't what they used to be? Do you think you would benefit from brain training? We're gonna take a short break, and when we come back, of course, this is our winter membership campaign, but we will be returning to this conversation on brain training. I'm Kojo Nnamdi.

  • 12:38:34

    NNAMDIWelcome back to our "Tech Tuesday" conversation on brain training. We're talking with George Rebok. He is a Professor at the Bloomberg School of Public Health at Johns Hopkins University. Henry Mahncke is the CEO of Posit Science, and Sandra Chapman is Founder and Chief Director of the Center For Brain Health at the University of Texas at Dallas, where she's also a distinguished Professor and author of "Make Your Brain Smarter." We're taking your calls at 800-433-8850, and we have Marlis in Kingstown, Virginia. Marlis, you're on the air. Go ahead, please.

  • 12:39:08

    MARLISHi. Thank you, Kojo. I have an autistic child, and I've also read about Howard Gardner's nine areas of intelligence, and I was wondering, with these games, and the focus, is it possible to train an autistic brain? My son is high functioning, but also, when you look at the nine levels that he classified, where there's music, special reasoning, and you mentioned already, fitness and body exercise. That type of thing. How can all of those areas be incorporated so a person that is autistic could improve in those nine areas?

  • 12:39:44

    MARLISLike, one is existential thinking, you know. What does it mean to be human?

  • 12:39:50

    CHAPMANLet me just -- can I address that, Kojo?

  • 12:39:52

    NNAMDIPlease do, Sandy Chapman.

  • 12:39:54

    CHAPMANYes, we're actually working with high functioning autism, using a virtual reality platform to engage theory of mind and social interaction and -- because I think people -- you know, teaching them how to learn in the classic sense, when what really is impairing their ability to function can be social cognition. And we've been able to show very significant changes. So check our website out.

  • 12:40:21

    CHAPMANThere's information. And we're now doing it with Yale with virtual platforms, you know, so trying to think about, like, dyslexia or math issues. What about social cognition training them? And we're showing brain change in the very areas of theory of mind and being able to understand and relate better to people which many people with Asperger's and autism really long for.

  • 12:40:48

    NNAMDIThank you very much for your call, Marlis. We got this email from Lee: "Have there been any studies that compare the cognitive benefits of regular meditation practice to those of brain training?" Know anything about that, George Rebok.

  • 12:41:03

    REBOKI'm not sure if there's been any head-to-head comparisons. There certainly is a lot of interest in pairing things like mindfulness-based training with cognitive training. And that seems to be kind of the wave of the future and not just thinking about just doing mental training, but also combining it with other types of approaches, more of a systems approach where you look at brain training combinations with things like physical exercise enhancement or nutritional enhancements or pharmacological types of approaches.

  • 12:41:37

    REBOKSo -- or even just cross-training, doing different types of training and not just focusing on one mental ability. So I'm not sure if there's been any head-to-head comparisons with mindfulness-based training and cognitive training. But certainly that's something that probably should be done.

  • 12:41:55

    NNAMDIOn to Victor in Alexandria, Va. Victor, you're on the air. Go ahead, please.

  • 12:42:00

    VICTOROh, thanks for taking my call. My question to the panel of the distinguished neuroscientist is about brain training an aging brain. With respect to aging personal genome, there's news that certain genes control the neurotransmitters in the brain, dopamine, serotonin, nicotine interceptors, which affect the learning memory and attention. What's the news? I heard that, like, the terror of ApoE4 cannot excel in brain training. Even the physical exercises is a waste of time for it. What's the news in this regard?

  • 12:42:49

    NNAMDIHenry Mahncke?

  • 12:42:52

    MAHNCKEYeah. That's a great question. I think the genetics of learning are something that's advancing every day. I'd have to say I'm not aware of anything that says that people who carry the ApoE4 allele can't benefit from brain training. Others may want to chime in on this. But certainly in the studies we've done and seen others do, we see very, very broad groups of people who are benefitting from brain training.

  • 12:43:15

    MAHNCKEAnd put another way, we have yet to see anything in older adults that stops people from benefitting from brain training. I think we are going to learn more as the science of personal genetics unfolds. For example, there was a very interesting paper a few years ago that showed people who had slightly different genes for brain-derived neurotrophic factor, which is a growth factor that helps neurons grow and connect to each other -- the people who had slightly different genes from that learned at slightly different rates, which was incredibly interesting.

  • 12:43:42

    MAHNCKEBut it was important to note that both groups still learned well. It's just that people who carried a certain gene learned slightly faster. So I wouldn't let your ApoE4 status slow you down from trying some brain training.

  • 12:43:53

    CHAPMANYeah. In fact, I would support what Henry's saying. If you have a gene for poor heart problems, you exercise more, eat better. The same is true for brain. If you have some risk factors, it doesn't mean step back more and give up. It means, let's work. There's a whole field now, epigenetics, that we -- if we can push off even if you are at risk for developing it, to give people longer, good years of cognitive brain health, that's everything. So I completely agree with Henry.

  • 12:44:22

    REBOKAnd I would agree with both Henry and Sandy. I think that the question really has gone beyond just, does brain training work to, you know, who benefits from brain training under what conditions. And I don't know anything that would suggest that people with the ApoE variant of the gene would not be able to benefit from brain training.

  • 12:44:43

    REBOKWe've done some studies looking at personal and other factors that impact on training and really haven't found that any of them really limit your ability to gain from these types of programs. For example, we looked at people who were depressed at the beginning of the training to see whether or not that would limit their ability to benefit from training.

  • 12:45:06

    REBOKAnd, in fact, even though they started at a lower point -- and this was, you know, with memory training -- they were able to improve just as much as the people who were non-depressed. And so people from a whole variety of different background experiences, ability levels seem to be able to benefit from this type of approach.

  • 12:45:27

    NNAMDII read that the number of people with Alzheimer's is expected to triple in coming decades. Can brain training help prevent or slow that disease? Yes.

  • 12:45:39

    REBOKWell, I think that's really the million-dollar question. We don't really have any concrete evidence yet that behavioral approaches in brain training can really prevent or lower the incidents of Alzheimer's disease. The study we did -- the active study -- was not set up as a dementia prevention study. And we did not have any kind of formal diagnostic criteria for dementia.

  • 12:46:09

    REBOKAnd, in fact, we did an analysis and published a paper suggesting that even though there seemed to be some protective effect from having gone through these interventions earlier that -- and this was at five years post-intervention -- that it didn't -- there wasn't a significant effect on reducing or lowering the incidents of dementia. But, again, it wasn't really set up as a dementia prevention study.

  • 12:46:35

    REBOKAnd the fact that we were able to improve different cognitive outcomes as well as everyday functional abilities, like your ability to manage your medications or manage your finances -- and these are the things that are part of the diagnostic criteria of Alzheimer's disease -- would suggest that at least we're moving some of the risk factors for dementia. And we have an opportunity now with data that are 10 years after the intervention to actually look at that question. And we're doing that at this time.

  • 12:47:11

    NNAMDIHenry Mahncke--

  • 12:47:11

    CHAPMANYeah, Kojo. Oh...

  • 12:47:12

    NNAMDIOh, please go ahead, Sandy Chapman.

  • 12:47:13

    CHAPMANYeah. I was just going to say we've done a coupe studies in Alzheimer's, one in the very earliest stages, and showing significant brain change when people engage in the things that they can still do. So I think the possibility may not change the incidents. But if we can push out and give you more years of cognitive health, that's going to be very substantial.

  • 12:47:38

    CHAPMANOnce people already have the diagnosis, we've been able to show intervening both at early to moderate stages that when they stay cognitively active, socially engaged, we're able to slow the rate of the progression. So, again, I think we need to think -- just like in cancer, if I can -- you may have terminal cancer, but if I can give you three more good years, that is very significant gain.

  • 12:48:05

    NNAMDIHenry Mahncke, "BrainHQ" made by Posit Science started out as a CD. It's now available online and on the iPad as a freemium where you get a couple of tries for free -- I got mine -- and then pay to keep playing. How do you think the market for brain games will shake out in the coming years?

  • 12:48:22

    MAHNCKEYou know, I think it's going to shake out exactly like physical fitness, which is to say there's going to be all kinds of this at all kinds of price points for all kinds of people. With brain fitness, we're going to see everything from, you know, games that maybe have never been shown to work, and you can play them for free at Yahoo Games or try them out at Lumosity or what have you. We're going to see things that have been proven to work, that are appealing to people who are, you know, serious about staying sharp or improving their cognitive function.

  • 12:48:47

    MAHNCKEAnd, actually, step-by-step, we're going to see this fully integrated into the medical system where we're going to treat people who have very significant cognitive function problems, like Alzheimer's disease, as we were just mentioning, schizophrenia where people have very significant cognitive functions versus, like, chemo brain where people who have been through chemotherapy report feeling foggy and having poor cognitive functions afterwards.

  • 12:49:08

    MAHNCKEWe're going to see doctors using validated brain training tools to help these kinds of patients. So there's going to be the right piece of this for everyone as time goes on. And it's going to fully permeate everything we do, just the way physical fitness does now.

  • 12:49:21

    NNAMDIHere's Anthony in Annandale, Va. Anthony, you're on the air. Go ahead, please.

  • 12:49:25

    ANTHONYOh, how you doing? I've been doing puzzles most of my life. And then when I was -- I stopped doing them, like, in my middle years. I'm 50 now. And my troubleshooting skills waned. And then when I started doing the puzzles again, my troubleshooting skills came back up. And I'm talking about across the board, not just fixing cars and doing computers.

  • 12:49:53

    ANTHONYBut any time I needed to troubleshoot something, I could do it real quick when I was doing the puzzles. And, I mean, puzzles like rebuses, any kind of puzzle that made you do some thinking. And I do them every day, and they're not a bother. I just do them. Whenever I have a free moment, I'll play one game or something like that. And how does that fit into your brain training thing?

  • 12:50:15

    NNAMDIIndeed, Sandy Chapman. What's the difference between using brain training games and apps and just sitting down and working a crossword puzzle or a Sudoku puzzle or playing a new video game? We got an email from Barbara who writes, "I am 84. Recently, I taught myself how to solve Rubik's cube as part of a self-imposed mental exercise regimen which includes Sudoku, crosswords, and playing Scrabble against my computer. The results have been astonishing. I can remember better where I put things and have much improved recall of recent events." Sandy Chapman?

  • 12:50:47

    CHAPMANWell, I think that -- like I said, the brain changes very dramatically by everything we do. And so if it's working for you and you find that you're enjoying it -- you know, I see a lot of people that are doing crossword puzzles, and they really hate them, and they say it makes you better and better crossword puzzles. So is that something you want to do? So it's really important to think about the energy that you're giving it.

  • 12:51:12

    CHAPMANAnd for us, what I want to know, is it making you better at making financial decisions, planning your day, figuring out right judgments for really the top-down thinking that sometimes we don't see a benefit from that type of activities? But, Kojo, I love it that your show is stretching all of us to think deeper. We're holding a summit on brain health fitness April 28 in D.C. to raise awareness for all of this across the age because I think it's such a timely issue.

  • 12:51:45

    NNAMDIYou force me to read this email from Constance in Silver Spring: "Do you want to improve your brain? Listen to 'The Kojo Nnamdi Show.' You'll engage your brains"...

  • 12:51:52

    CHAPMANThere you go.

  • 12:51:53

    NNAMDI"...higher order capacities. Or go to the National Gallery and really look at the works of art. Or grab a good book. For cognitive function, you can't beat Shakespeare and Dickens for your brain. It's the best of times. It's the worst of times." I'm afraid that's just about all the time we have. Is there, just quickly, George, any self-assessment available so people can have a baseline measure of their cognitive function and then see if it changes over time, with or without a training program?

  • 12:52:20

    REBOKWell, there are several online cognitive assessments that you can go and do online, and as a way of getting a baseline. And I think, you know, the point about trying to find ways we can mentally stimulate ourselves in our everyday life -- just kind of going back to that earlier point -- is really something that we need to think about that -- just like with exercise, we may want to take the stairs instead of taking the elevator.

  • 12:52:44

    REBOKAny ways that we can mentally challenging ourselves, like listening to this radio show or, you know, learning a musical instrument. There's good evidence now that these kind of mentally stimulating activities can result in improvements and lower your risk of dementia.

  • 12:52:57

    NNAMDIGeorge Rebok, he is a professor at the Bloomberg School of Public Health at Johns Hopkins University. Henry Mahncke is the CEO of Posit Science. And Sandra Chapman is founder and chief director of the Center for Brain Health at the University of Texas and the author of "Make Your Brain Smarter." Thank you all for joining us. And thank you all for listening. I'm Kojo Nnamdi.

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