Brain Training: How Real are the Benefits?

As part of our search for a brain check engine light, we started evaluating a specific brain training product (BrainHQ) that has the ability to both measure aspects of brain function, and potentially “train” and improve them.

In this second part of our report on Longevity Explorers using BrainHQ (Ref 1), we look at what is known about the benefits of this type of brain training, and try and answer the question “Will brain training improve my everyday life (now or in the future)?”

Whenever a group of Longevity Explorers discusses the idea of brain training, brain games, and their desire to avoid dementia as they age, two things inevitably come up.

1. Several explorers typically comment on the fact they use one or other brain game product — and like it; and
2. Another explorer says something like “I heard Dr xxx (from prestigious medical institution yyy) give a talk about dementia and they said brain games don’t work”.

For years we have been looking for an excuse to dig deeply into the topic of what is and is not known about the effectiveness of brain training. We finally got around to it, and this post shares what we learned.

[In case you missed it, here is the prior installment: Part 1 of our BrainHQ exploration].

Disclaimers

We do NOT benefit financially in any way from the product or company discussed in this post. See full disclaimer at end of the post for more details. This is not intended to be medical advice. If you have questions relating to your own mental or physical health, please consult an appropriately qualified clinician.

We think we are as good at reading the scientific literature as most scientists, but we are NOT experts in this area of science, and believe in “learning in public”. If you are reading this and disagree with our positions, please do join the discussion in the comments. However, please try and reference specific data to support your point, rather than just make assertions.

Measuring and Improving?

When we started exploring the idea of a check engine light for brain, and realized that certain brain exercise companies made cognition measurement tools that might be relevant, the obvious question was “maybe we can also use those brain exercises to “improve cognition” and not just “measure it””.

But, given what we have heard over the years from Longevity Explorers, and various clinicians, we were unsure whether this was realistic.

This post is about the topic of what is and isn’t known about the effectiveness of brain exercise. It’s mostly about the field as a whole, but to a lesser extent it is about a specific brain training tool: BrainHQ(TM) from the company Posit Science (TM) (Ref 1).

Is Brain Training Worth the Bother (and Expense)?

In addition to understanding the big picture, and learning the nuances of what the evidence does and does not support, the big question our Longevity Explorers wanted to answer was: “Is it worth the trouble of doing this?”

To answer this, we needed to learn about the “risk vs benefit” of brain training. We discuss both of these below.

Read on for the deep dive. If you just want the take away, see below.

The Takeaway (TL;DR)

We are cautiously optimistic that the right sort of brain training can have real impact on a person’s everyday life by changing aspects of how their brain works.

The basic idea is that with the right sort of training, the brain can be taught to essentially “rewire itself” by a process called brain plasticity, and this can lead to brains that have various types of impairment being able to function better than before.

However, it is still early in terms of “proof”. There is very encouraging (to us) evidence, and a large body of underlying science about the “principles”. But the medical establishment is not yet ready to declare that the studies are sufficient to “prove” things like “brain training might reduce your risk of dementia”.

The big open question is the extent to which the right type of brain training can improve the brain — in ways that translate to every day life. For example, it would be great if the right sort of brain training could make the risk of dementia in the future less than it would have been without brain training. And if everyday activities like driving, and remembering things, or falling, could be improved by the right sort of brain training.

The scientists behind products like BrainHQ believe that these types of everyday improvements in life will in fact come about after the right sort of training (at least in some people, to some extent). We wanted to learn just how much this was supported by the studies that have been done thus far, and what the “best consensus scientific opinion” is about this topic.

We came away cautiously optimistic, but there are quite a few caveats and open questions, and if you want the nuance, please read the rest of this post.

This is one of those topics where soundbites can be quite misleading. Below we try to unpack the subtleties, based on what we learned after we dug deeply into the scientific literature.

In addition to the foregoing thoughts, it seems likely (to us) that there will be big differences between the results achieved with different brain training approaches — so choosing the right “brain exercise regimen” is likely to matter quite a lot (ie not all products will be equally effective).

AND, as with many of the topics we explore, it seems clear that different individuals are likely to benefit from different interventions, depending on the exact state of their brain at a given stage in their life. Thus not only do we need to chose the “right” brain exercise regimen, we need the “right regimen for a given person.”

Background & Context

The basic idea behind “brain training” is as follows.

• If you expose the brain to carefully designed “exercise”, changes take place inside the brain (plasticity) which can cause it to function “differently”.
• Depending on how they are designed, these changes can go in both directions, leading to either “better” or “worse” outcomes depending on the specifics of the exercises.
• The changes might lead to a variety of desirable outcomes such as making falls less likely; improving ability to drive safely; and even staving off cognitive decline or dementia.

The big questions are the degree to which all of the above is or is not correct; and the level of “proof” that exists in the form of clinical studies that support these ideas; and which types of people are most likely to benefit.

As we researched this topic, we learned a few key things that need to be kept in mind as you read this.

1. The field of brain exercise / training is still being very actively researched, and this means each year there are new learnings that can shed light on the key questions.
2. Many of the mainstream media publications on this topic (and other things you can Google) are out of date and do not include the most recently published research studies — and thus in our opinion are not helpful. We needed to dig deeply into the peer-reviewed scientific literature to understand the state of current knowledge.
3. There were some widely publicized (negative-ish) expert opinions expressed a decade or so ago (Ref 12, and see discussion below). But it seems to us that some of the newer research sheds light on the concerns they expressed.
4. The most current “expert consensus on the effectiveness of cognitive training” that we could find is from the National Academies of Sciences, Engineering, Medicine (2017: Ref 2). They have a whole section on “Communicating with the Public”, and they recommend the following wording:

[The] positive effects of [cognitive training is] supported by encouraging although inconclusive evidence: ….. Source: National Academies of Sciences, Engineering, Medicine. (Ref 2).

The Science Behind Brain Training

Here we unpack what we have learned about the science behind brain training, and the results from the clinical studies looking at benefits.

Brain Training & Plasticity: The Underlying Idea

As explained above, the basic idea behind brain training is that the brain is “plastic” and can change and adapt to various stimuli in rather profound ways, and that this plasticity continues into advanced age.

There is a great deal of research behind this idea. A lot of it is nicely summarized for the lay person in a book written by one of the pioneers of the field, Dr Michael Merzenich — called “Soft-Wired” (Ref 3).

Dr. Merzenich has impressive academic credentials (UCSF Prof Emeritus; Kavli Prize for neuroscience, and much more (Ref 4). He is also a founder of Posit Science (the company behind BrainHQ).

Key Takeaways re the Science

As we read about the underlying science of brain plasticity, there were a few key points we felt were particularly relevant to this article.

• It is far from trivial to get a specific desired change in the brain from stimuli and exercises. Understanding exactly what types of training are likely to cause which types of brain remodeling is complex. Thus we concluded that the idea that “any old brain related work will do” is probably not correct. On the contrary, we have the opinion that one would want to be quite expert in how the brain works, and in which stimuli create which responses, in order to design a successful brain training exercise that would lead to a useful change in brain function.
• There seems to be widespread agreement in the research community that the right type of training of a specific type of brain function (eg brain processing speed) will indeed lead to improvements in that “trained” function. For example, training brain speed will lead to faster brain speed (although the size of the improvement will vary).
• However, there is quite a lot of debate still about the extent that improved brain function (from training) will translate to things that are useful in “everyday life”. For example, will improved brain speed lead to a greater ability to remember the grocery list, or a reduced risk of having a driving accident? Below we look at what is and is not known about this.
• A lot of the focus in “cognitive training” is on computerized cognitive training (brain games). Some people also recommend quite different types of brain “exercise”, such as learning a foreign language, studying a new topic, or doing sudoku or cross word puzzles. We noted in our reading of the literature that there was some evidence that some of these non-game approaches work better than others. For example, we found some studies suggesting cross word puzzles were NOT effective at improving cognition, but that jigsaws of the right type might be “good” (Ref 3). We did not try and get to the bottom of this as yet, but it is worth flagging for future study. This article is really about the “brain game” sort of cognitive training.

Not all Brain Training / Brain Games are the Same

For the reasons explained in the first bullet of the prior section, we don’t think it is realistic to assume “any old brain stimulation is equally good”. And nor do we expect “any old brain training program” should be equally good.

We think it is critical to look carefully at the evidence behind a specific brain training program before forming an opinion of how well it works.

In Brain Check Light Part 3, we looked at a number of comparative reviews of the evidence behind various commercially available brain training products. As we discussed in that post, two products emerged as having considerably more scientific evidence behind them than their competitors. We are starting our exploration with one of those two products: BrainHQ.

This is not to say that BrainHQ is the “best”. [We have not tried to pick the “best” product, as yet.] However, it is one of two with the most scientific evidence behind them, so it seemed a good place to start. The fact that one of the pioneers of brain plasticity is a founder seemed to us to be an additional positive factor.

Clinical Studies Include a Social Component. Differ from Commercial Products.

Below we look at the results from various clinical studies on how well brain training leads to positive impacts on everyday life, and we found the results to be rather encouraging.

However, a detail we did not initially appreciate is that the clinical studies actually have some critical differences from the commercially available brain training products, relating to inclusion of a “social component”. This muddies the waters considerably.

In the clinical studies we discuss below, some of which show encouraging results, the typical design involves a cohort of people who use some computerized brain training exercises over time and are evaluated over time to see how they perform against various metrics of relevance (like cognition, fall risk etc).

The good news is that the training techniques used in the studies often parallel closely the techniques used by commercial brain games (in particular by BrainHQ).

But in the studies, the training often involves some type of group interaction at intervals, and hands on explanations by a person. In contrast, if you set out to use a commercially available product like BrainHQ, you typically do it alone with no social interactions.

The unanswered question is the extent to which the social aspect influences the benefits that are seen in the clinical studies, and this is a criticism that has been raised by some researchers.

This is one of a number of reasons why the official position is “encouraging results but not conclusive”.

How do we take this into account?

Our “educated guess” is that the social component might well make an intervention “better”, but it seems unlikely that the positive results below are entirely from the social interaction.

Thus we see the clinical studies below as being “positive” for a brain training program like BrainHQ, even though questions still remain to be answered.

Does Brain Training “Work”?

This is a headline or theme that has appeared in various popular media articles over the last decade. We think it is a rather bad way to frame the question!

1. First, as explained above the whole idea of “brain training” depends enormously on the exact details of what is being trained and by what precise technique. There is agreement that some approaches do NOT work. The right question is whether specific, carefully designed brain training regimens “work”.
2. Second, what does “work” mean? There seems to be agreement in the research community that carefully designed training protocols can “work” to improve specific areas of cognitive brain function (like brain processing speed). Where there seems to be mixed evidence is the extent to which those carefully designed brain training regimens can create long lasting changes that impact everyday life.
3. Third, there is likely no “one size fits all”, but rather different people likely benefit from different types of training and may need a somewhat personalized solution.

So, we would reframe this question as “Does a carefully designed, personalized brain training regimen, based on the latest science, lead to impacts on a person’s cognition or life that make a material impact to that person?”

Positive Results

After reading a lot of the peer reviewed literature, we found a number of very promising results.

The reason there continues to be debate is that the studies thus far are not “perfect” — and thus there remain questions about how strong the evidence is.

But, as discussed further below, we found studies that showed evidence of each of these important everyday “improvements”:

• reduced incidence of driving accidents, and longer “time before one stops driving”;
• reduced fall risk;
• reduced risk of developing dementia (caveat: the evidence on this one seems “promising but far from conclusive”).
• reduced decline of self-reported “Instrumental Activities of Daily Living” (iADL’s)

ACTIVE Study

While there have been numerous studies over the years, a particularly notable one is called the ACTIVE study, which looks at a variety of results from various types of cognitive training in a large-ish cohort of older adults (2,800 older adults), with followup over a 10 year period.

Read on for more details.

Better Driving Safety. Continuing to Drive for Longer.

Driving Safety

In research published in 1998, and expanded on in a larger and more elaborate study published in 2013, and further in results published in 2021, researchers showed that older drivers were significantly more likely to experience motor vehicle collisions if they had impairments in specific cognitive function tests (Refs D1).

The most commonly used cognitive function test was the visual processing speed test called the Useful Field of View (UFOV) test, although some of the published work suggests other cognitive functions may also be relevant to crash risk.

In summary: the studies showed that impaired cognitive function of a specific type (relating to visual processing speed) led to increased risk of crashing while driving.

This led to the hypothesis that “training” the brain in ways that improve performance in the brain functions above (particularly the visual processing speed) would lead to reduced risk for driving accidents.

In a study published in 2010, Ball et al (Ref D2 ) showed that “After adjusting for age, sex, race, education, mental status, health, vision, depressive symptoms, and testing site, participants randomized to the speed-of-processing and reasoning interventions had an approximately 50% lower rate (per person-mile) of at-fault MVCs than the control group.”

Their conclusion: “Cognitive speed-of-processing and reasoning training resulted in a lower at-fault MVC rate [Motor Vehicle Collision Rate] in older drivers than in controls”.

We would like to see results from the ACTIVE study after 10 year followup examining this hypothesis too, but as best we can tell they have not yet been published.

Continuing to Drive for Longer

In addition to the above, a separate analysis published in 2017 (Ref D3) tested whether some specific brain training interventions (the ACTIVE study) could prolong the time for which older adults continued to drive.

The results showed that in a specific group of people at risk of giving up driving due to specific cognitive impairment (low UFOV scores), the right type of brain training intervention (speed of processing training) could lead to 70% reduction in the likelihood of giving up driving over a 10 year period following start of the training program.

Relevance to BrainHQ and Longevity Explorers

According to the BrainHQ website, the UFOV test and the training protocols used by Ross et al above were licensed by Posit Science and incorporated into the BrainHQ product. As best we can tell they make up what is now called the Double Decision module, within the “Attention” set of exercises.

So, while not absolutely proven as yet, we think there is a reasonable chance that both the following are correct:

• IF you score low on the Double Decision module in BrainHQ, it seems quite possible you are at increased risk for motor vehicle accidents; and
• IF you score low on the Double Decision module and then train using that exercise (and others in the Attention set of exercises) and increase your score on it substantially, it seems possible that your likelihood of a crash would go down somewhat, and that the time for which you will continue to drive could be prolonged.

Are we “sure” this is correct? No. Do we plan to proceed in our own lives as if it is? Yes. Feel free to add comments if you are an expert and think we are missing something.

Reduced Fall Risk

The ACTIVE study results were analyzed to try and answer the question of “Does Cognitive Training Reduce Falls across Ten Years?”

In an analysis from the ACTIVE study published in 2023 (Ref F1), researchers concluded that the answer to this question was “Yes” with some significant qualifications.

More specifically, what they observed was:

In a specific subgroup, which was at “greater risk of future falls” (defined as having already fallen within 2 months prior to baseline), some specific types of cognitive training (speed of processing, also known as divided attention and useful field of view training) reduced the risk of falls by 30% over a 10 year period.

As best we can tell, the hypothesis is that the improved cognitive function that comes from training might improve overall lower limb coordination, and both help you be more aware of surroundings and potential hazards, and help you react more rapidly to recover your balance after you trip etc.

Relevance to BrainHQ and Longevity Explorers

We believe the Attention set of exercises within BrainHQ are designed to train some of the cognitive functions included in the ACTIVE “speed of processing” cohort, and we suspect the Brain Speed set of exercises in BrainHQ might likely also be relevant.

So, while not absolutely proven as yet, we think there is a reasonable chance that the following is correct:

• IF you have a high risk for falling (eg fell within the last 2 months), training using the Attention and Brain Speed modules (and perhaps other modules as well), might well help reduce your fall risk going forward (NOTE: there are other exercise-related interventions that should also help a lot with this, and might well be more important than brain training).
• The question of whether or not such training could also reduce fall risk if you are NOT in the “high fall risk group” does not have a definitive answer based on the research we have found. It does not seem unreasonable to think it might help however, but this has definitely NOT been “shown”.

Are we “sure” this is correct? No. Do we plan to proceed in our own lives as if it is? Yes. Feel free to add comments if you are an expert and think we are missing something.

Reduced Dementia Risk

Of course, what we would all love is some type of cognitive training that reduces our risk of getting dementia or mild cognitive impairment.

Is there any evidence that current brain training techniques might accomplish that?

Once again, there are some intriguing results from the ACTIVE study.

In an analysis of the ACTIVE study 10 year followup, published in 2017 (Ref Dem1), researchers DID see signs that the right types of cognitive training could reduce risks of dementia in a subgroup of the studied population.

More specifically, they found that:

“Initially healthy, well functioning older adults randomized to speed of processing cognitive training had a 29% reduction in their risk of dementia after 10 years of follow-up compared to an untreated control group”.

The researchers go on to say “The underlying mechanism for the dementia risk reduction is not yet clear but could relate to positive changes in brain reserve as a result of cognitive training.”

This seems like a pretty exciting result to us, but there are a few things to bear in mind.

• The risk reduction had not shown up as yet at the time of the 5 year followup in the ACTIVE study, so this is a relatively new result (a reason why media publications prior to 2017 would have overlooked it).
• This result was specific to one of the several types of cognitive training evaluated but not to the others, so as we discussed earlier it is vital that the right type of brain training is used if one wants to get the benefits one hopes for.
• The researchers acknowledge several strengths but also some weaknesses in the analysis, and so like most science there is more to be learned — and it is always possible that deeper research and better studies will change the conclusions.
• There is currently a new study underway (Ref Dem2), which has been designed by researchers (including those who did the above analysis) to address any perceived shortcomings of the prior work and expand on it. This study is called “The Preventing Alzheimers with Cognitive Training (PACT) Randomized Clinical Trial”, and it focuses on the use of a UFOV cognitive training protocol to reduce the incidence of mild cognitive impairment or dementia, and is quite large (targeting 7,000+ participants). The study was described in a publication in 2022 (Ref Dem2) and appears to be underway, but presumably it will be some years before results are available.

Relevance to BrainHQ and Longevity Explorers

As with the Driving Safety, it seems to be the Useful Field of View training that is primarily responsible for the positive results. We believe this is the training that is now incorporated into the Double Decision exercises in BrainHQ.

We see the positive results above as somewhat preliminary, especially as there are many causes of cognitive impairment. So we think it is premature to conclude something like “training with DoubleDecision might reduce your risk of developing dementia in the future.”

On the other hand, the idea that this type of cognitive training might well increase your brain reserve, and that this could be one of many factors that might make cognitive impairment less likely, seems logical, and supported by the preliminary evidence we have seen.

Meanwhile, we are going to watch with great interest for the results of the PACT study. Feel free to add comments if you are an expert and think we are missing something.

Activities of Everyday Life

One of the concerns about brain training that is often expressed is:

Criticism: “It trains a specific brain function, but may not translate to improvement in everyday functioning”.

What have we learned about this topic?

Again, we look at results published from the ACTIVE study. We found two relevant publications: one published in 2006 with 5 year followup, then another published in 2014 with 10 year followup. (Refs ADL1).

In both cases, researchers looked at the impact of several different types of cognitive training on “cognition and every day functioning” of older adults. The outcomes measured included both self reported ability to perform the iADLs (Instrumental Activities of Daily Living), and some objective tests of daily function.

[iADLs are things like grocery shopping, and managing ones finances.]

Researchers concluded: “[At the 10 year followup], each ACTIVE cognitive intervention resulted in less decline in self-reported iADL compared with the control group”.

However:

• the magnitude of the “improvements” were “small to medium”; and
• the improvements in the objective, performance-based measures of daily function were “weak to absent” — which the researchers speculate might be due to the fact that such measures of everyday function really require training of multiple different aspects of cognition, whereas the ACTIVE study intentionally trained each group in just one area of cognition.

Relevance to BrainHQ and Longevity Explorers

Of the different areas we have covered in this article, the strength of evidence seems to us weakest for the improvement in iADLs.

However, the researcher’s hypothesis that “everyday living functionality uses multiple aspects of cognition, and thus is likely to require multi-functional training to show a clear benefit” seems logical.

If someone says “Translation to the activities of everyday living has not been proven”, we would tend to agree with them (especially if you don’t include driving or falling as “everyday living”).

However we would frame our conclusion a bit differently and as follows:

“Self-reported iADLs seem to benefit from cognitive training even 10 years after the training. And, in addition there seems logic that makes one think multi-factorial cognitive training (such as one might get from a suite of exercises like BrainHQ) might well lead to objectively quantifiable (and perhaps more noticeable) slowing of iADL decline. But the definitive studies of that have not yet been done.”

Why Do We Keep Hearing “Dr X says Brain Games Don’t Work”?

As mentioned in the intro to this article, when Longevity Explorers get together to discuss brain training, there is usually someone in the group who says that they attended a talk about dementia where “Dr xxx” told them “brain games don’t work”.

Why is this?

First of all, there is a big difference between someone saying “It has been shown “not to work””, and someone saying “It has not yet been proven to work”. People sometimes misinterpret the latter as meaning the former. 🙂

Second, there have been numerous media articles over the last decade or so that cast doubt on the effectiveness of brain training as a whole. And some of the brain training companies have made unrealistic claims that have muddied the waters and cast doubt on the whole field.

Third, there was a very widely circulated article published in 2014 (“The Stanford Center on Longevity Letter”) by a prestigious set of authors, which many interpreted as saying “Brain Training Does not Work”. (Ref 12a)

In fairness, that is not really what the letter said. Our interpretation of what the letter said boils down to:

• there is a lot of misleading advertising exaggerating the effectiveness of brain training;
• “studies have shown that cognitive training produces statistically significant improvement in practiced skills that sometimes extend to improvement on other cognitive tasks administered in the lab. In some studies such gains endure, while other reports document dissipation over time. In commercial promotion these small, narrow, and fleeting advances are often billed as general and lasting improvements of mind and brain” …… direct quote from the letter (Ref 12a);
• much more research is needed;
• watch out for opportunity costs. For example, playing brain games instead of doing things like exercise or social activity, both of which have been shown to be important risk factors in dementia, might be an error.

In response to the Stanford letter, a second group (also with many prestigious authors, including Dr Merzernich) published a rebuttal (Ref 12b).

We don’t want to take a position on the difference of opinions between these two luminary groups, but think it extremely important to note that a number of the studies we mention above have been published after the appearance of the Stanford Letter, and so it is our opinion that that letter is no longer “current”. And, in addition, we think the “consensus” of luminary opinion has moved on a bit and is now best described in the next section (see also Ref 12c).

So, often when people have heard that brain games “don’t work”, it may be because they heard it some time ago, and that whatever they heard then no longer reflects the latest knowledge.

We do think the criticisms in the Stanford Letter are important though — especially the one about opportunity cost. We think of that as the “Risk / Benefit” Question, and talk about it more below.

What is the “Current Medical Establishment Opinion”?

We set out to find the most recent publications that might be thought of as “the current expert consensus (as of 2023)”. Here is what we found.

We found numerous “Systematic Reviews” which we read, but we decided there were three publications of particular relevance (below).

National Academies of Science, Engineering, Medicine. AHRQ.

The one we decided represented the best “current expert opinion on the effectiveness of cognitive training” was published in 2017 (not as recent as we would like, and an update is expected in the next year or so) and is entitled “Preventing Cognitive Decline and Dementia: A Way Forward — A Consensus Study Report of the National Academies of Sciences, Engineering, Medicine.” (Ref 2). This in turn draws on a Comparative Effectiveness Review from the AHRQ (Ref 13).

They include an entire section on “messaging the public”. and here is what they say.

“When communicating with the public about what is currently known, the National Institutes of Health, the Centers for Disease Control and Prevention, and other interested organizations should make clear that positive effects of the following classes of interven­tions are supported by encouraging although inconclusive evidence:

• cognitive training—a broad set of interventions, such as those aimed at enhancing reasoning, memory, and speed of processing—to delay or slow age-related cognitive decline
• blood pressure management for people with hypertension to prevent, delay, or slow clinical Alzheimer’s-type dementia
• increased physical activity to delay or slow age-related cogni­tive decline

There is insufficient high-strength experimental evidence to justify a public health information campaign, per se, that would encour­age the adoption of specific interventions to prevent these condi­tions. Nonetheless, it is appropriate for the National Institutes of Health and others to provide accurate information about the potential impact of these three intervention classes on cognitive outcomes in a place where people can access it (e.g., websites). It also is appropriate for public health practitioners and health care providers to include mention of the potential cognitive benefits of these interventions when promoting their adoption for the preven­tion or control of other diseases and conditions.”

…………. reprinted from Ref. 2

Lancet 2020: Dementia Prevention, Intervention, and Care

In 2020, the Lancet Commission published a report on Dementia Prevention and Intervention and Care, published in the Lancet (Ref 14).

This publication describes a 12 risk factor model of dementia, including some new ones since 2017 when some related prior work was published, and makes for interesting reading.

This report does include a section on “Cognitive Interventions in Normal Cognition and Mild Cognitive Impairment”. And in that section it mainly focuses on the idea of the sort of cognitive training we are discussing here.

However, the statements are not at all positive, and if one relied solely on this Lancet report one would come away with the impression that the evidence in support of dementia prevention is rather weak.

This seems to be at variance with the National Academies Report above. Although, if you focus solely on “dementia prevention” — and do not include things like fall risk reduction and driving safety — we can see how that might be the conclusion.

How Do We Interpret All This?

Well, there is not complete consensus as yet among the experts! But we think clear patterns and directions are emerging.

If you broaden the question to be about overall benefits to older adults from cognitive training as we do here, we believe the data is rather encouraging. However if you focus solely on “dementia prevention”, then it seems as though there needs to be more research before one can be too excited.

And, of course there is always the possibility we are being over enthusiastic! If you are an expert on this topic, and think we are missing some important aspects, please use the comments to tell us.

Should We Use Cognitive Training?

What we and many Longevity Explorers want to know, of course, is whether it is worth the trouble and expense of incorporating some type of brain training into our own lives.

We think the answer comes down to the balance of Risk vs Benefit — which will vary from person to person.

Risk vs Benefit

We think a rational position on the topic of cognitive training and how to incorporate it into our lives as older adults is to consider the risks and the benefits.

Risks (and Costs)

It’s not obvious there are many risks, as we normally think about them.

Unlike pharmaceuticals, we don’t have information about “side effects”. Perhaps there are some, however.

Certainly we are starting to see lots written about the adverse effect of daily use of screens, social media etc.

The training regimens used in the scientific studies we looked at tend to involve a rather modest amount of exposure. For example, 10-100 hours of training in total seems to span the likely requirements.

Maybe doing “too much” would be a bad idea?

A less obvious risk is the idea that you would stay home playing “brain games”, instead of going out for a hike or to an enriching social event — both of which relate to known risk factors for dementia.

Maybe the right idea is to do the brain training instead of something like watching TV, rather than instead of something more likely to be good for you!

In addition to “Risks”, there is also “Cost”. But truthfully, at about $100 / yr for the solution we are exploring in this report, the cost is rather modest compared to many things that many people are likely to consider an everyday essential (cell phones, Netflix etc). And there are likely other less expensive options too. Nonetheless, this belongs in the “negatives” column.

Benefits

If you read the section above on “Positive Results”, the list of potential benefits is quite significant (Driving, Falls, Dementia delay).

However, since the studies are not yet “perfect”, we really can not be too sure just how big these effects will be, or be certain they will apply to us!

As you will see in the Positive Results section, our read of the literature made us pretty enthusiastic about the Benefits. But if you are more skeptical, you might feel you would prefer to wait for more evidence.

Our Takeaway (for ourselves)

Considering all of the above, our takeaways (for ourselves) are as follow.

• The potential benefits are rather important and could be quite large, even though it is hard to be sure.
• The risks seem rather modest (especially if we watch out for not displacing other beneficial activity).
• Overall, to us it seems that for an older adult it is well worth finding a way to incorporate some type of brain training regimen into one’s overall fitness routine.
• However, it definitely should be one of the regimens that have extensive clinical “supporting evidence”. We lean toward the approach of the ACTIVE study, in which an initial period of training (10-50 hours perhaps) is followed a year later by a “booster”, with perhaps additional boosters at intervals in the future. We are not thinking in terms of “doing it daily and for ever”.
• It is clearly very important to select brain training products that have been developed based on the principles of the clinical evaluation studies. It is clearly NOT the case that “any old brain stimulation is equally good” for cognitive training.

IMPORTANT NOTE: This is not advice for YOU. We are just sharing what we think. Feel free to consider the evidence yourself, using the references, and act as you see fit. Above all, this is NOT meant to be medical advice.

The Next Decade

As we researched this topic, we came across a number of very intriguing research studies and initiatives, the results of which sound like they will be fascinating but are not yet complete. These are worth watching out for, as they may well make big changes to the state of knowledge. They include:

• The PACT study mentioned above (Ref 13);
• A citizen science initiative to enroll 30,000 volunteers to test whether exercises to improve memory and attention are valid — and if so, for whom (Ref 15 — you can be part of it if you wish).
• Deployment of more advanced cognitive training methodologies, including Virtual Reality and other sophisticated gaming techniques (eg Neuroscape Ref 16).
• Explorations of the combination of both structured exercise and cognitive training together (various groups eg Ref 17), and perhaps cognitive training plus electrical brain stimulation (various groups).
• Design of more sensitive and precise “metrics” to evaluate the effectiveness of various interventions.
• Investigation of regimens that go beyond a sort of “one off training intervention”, to include ongoing training over long periods of time.

No doubt there are more. Stay tuned.

Background

(Repeated from Prior Installments)

About this Exploration

Here are a few caveats (repeated from prior installments):

• we are doing this exploration because a group of Longevity Explorers are interested in finding out whether or not there is a way they can cobble together some type of “check-engine-light for the brain” to use for themselves.
• We are not doing it to try and sell anything to anyone. Apart from possible subscriptions to this newsletter, we do not make money in any way by doing this work. The companies (if any) mentioned in this exploration do not compensate us either directly or indirectly.
• During this exploration, we will be “learning in public”. This means we will be sharing what we learn as we learn it. While we try to be objective and accurate, it is possible we will make mistakes. Feel free to share what you know in the comments, and help us learn, and correct us if we make errors (please provide facts and references rather than assertions).
• While our explorer community includes individuals with relevant experience for this exploration, you should not rely on results of our exploration for medical advice of any sort. When it comes to your personal health, “consult your physician” is always good advice.
• Several luminaries in the field of cognitive training were kind enough to review this work and provide feedback. However, if there are errors, they are solely the responsibility of Tech-enhanced Life.
• To find the earlier portions of this exploration see: Brain Check Engine Light Part 1, | Part 2, | Part 3. And BrainHQ: Longevity Explorer Report (Pt 1).

Disclaimer

This exploration was NOT sponsored by Posit Science or by any third party. We do NOT include affiliate links or advertisements in this post (except an AMZ link in the reference section). We do NOT have any business relationship with the company or products described in this post at the time of publication, nor have we had one prior to the exploration. The explorers who used the BrainHQ products in this exploration were typical “consumers”, and received no special treatment by the company.

For products we like, we do sometimes enter into collaborations with the companies, and reserve the right to do so in the future with companies mentioned in this post — although none are contemplated at the time of publication.

• To learn why we started with this brain training tool rather than one of the many competing products, see “Check Engine Light for the Brain Part 3”.
• This is not intended to be medical advice. If you have questions relating to your own mental or physical health, please consult an appropriately qualified clinician.

Please Share Your Opinions and Ideas

Some of you may well have opinions on this topic. We welcome your comments and suggestions in the comments (button below).

To short circuit some of the likely comments:

• please don’t post comments that are infomercials or affiliate links or other marketing material. They will be blocked.
• If possible, please use the comments rather than sending us an email, so others can benefit from your opinions too.
• We are reaching out to BrainHQ, and other researchers whose work is mentioned above, to get their help educating us further, and will update as we learn more. If you are an expert in this field and would like to help, please reach out to us.

References

1. Here is the product we are exploring in this post: BrainHQ (PositScience)
2. National Academies of Sciences, Engineering, and Medicine. 2017. Preventing cognitive decline and dementia: A way forward. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24782. (A new NAS report is underway, scheduled to come out in late 2024)
3. Soft-Wired (Buy on Amazon [ affiliate link]) or see Soft-Wired website.
4. Prof Michael Merzenich Bio on Wikipedia
5. Ref D1: (a) Owsley et al: JAMA: 1998; 279:1083-1088. (b) Friedman et al: Invest Ophth. & Vis Science, 2013, 54, 778-782. (c) Ball et al: J. Aging and Health, 2021, V0(0) 1-7.
6. Ref D2: Ball et al: Am. Ger. Soc. V 58, Issue11, Nov. 2010, pp 2107-2113
7. Ref D3: Ross et al. Gerontologist, 2017, V57, No. 5, 838-846.
8. Ref F1: Sprague et al.: Int J. Environ. Res. Public Health. 2023, 20, 4941
9. Ref Dem1: Edwards et al: Alzheimers & Dementia: Translational Research and Clinical Interventions 3 (2017) 603-611
10. Ref Dem2: Nicholson et al: Contemporary Clin Trials 2022 Dec. 123: 106978.
11. Ref ADL1: (a) Willis et al: JAMA 2006, 296(23), 2805-2814. (b) Rebok et al: J Am Geriatric. Soc. 2014 62(1): 16-24.
12. (a) Stanford Center for Longevity Letter and (b) The Cognitive Training Data Response Letter. Also see (c) a more recent forward looking discussion of the state of the field: Green et al: Improving Methodological Standards in Behavioral Interventions for Cognitive Enhancement: J. Cognitive Enhancement, Jan. 08, 2019, https://doi.org/10.1007/s41465-018-0115-y
13. Interventions to Prevent Age-related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer’s-type Dementia: Agency for Healthcare Research and Quality (AHRQ), Comparative Effectiveness review 188 (2017).
14. Lancet Commission report: Lancet, V396, Aug. 8, 2020, p413.
15. (a) Jaeggi et al: Scientific American: Does “Brain Training” actually Work? and (b) if you want to learn about the study
16. Neuroscape (at UCSF)
17. Anguera et al: Integrated cognitive and physical fitness training enhances attention abilities in older adults. npj Aging 8, 12 (2022)

To read the references above that do not include links, you can find them easily using PubMed, (a data service provided by the National Library of Medicine), where you enter the references provided above into the search bar.