Under what conditions does brain training work?
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Despite ongoing controversies, the evidence is clear: Some brain training interventions (in a broad definition, including cognitive training, virtual reality and brain stimulation) work, and some don’t. What explains the difference? What conditions maximize the probability of transfer into real-life benefits? Understanding these conditions, as outlined in The SharpBrains Guide to Brain Fitness, is crucial to separate wheat from chaff. - Chair: Dr. Peter Whitehouse, Professor of Neurology at Case Western Reserve University - Alvaro Fernandez, CEO & Co-Founder of SharpBrains - Dr. Bruce E. Wexler, Professor of Psychiatry at Yale University - Dr. Roy Hamilton, Assistant Professor in Neurology at the University of Pennsylvania Presentation @ The 2015 SharpBrains Virtual Summit http://sharpbrains.com/summit-2015/agenda
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Under what conditions does brain training work?
- 1. Under what conditions does brain training work?
- 2. Under what conditions does brain training work? Chaired by: Dr. Peter Whitehouse, Professor of Neurology at Case Western Reserve University Alvaro Fernandez, CEO & Co-Founder of SharpBrains Dr. Bruce E. Wexler, Professor of Psychiatry at Yale University Roy Hamilton, Assistant Professor in Neurology at the University of Pennsylvania
- 3. UNDER WHAT CONDITIONS DOES BRAIN TRAINING WORK? Alvaro Fernandez
- 4. Japanese edition in 1-2 months (Hankyu Communications)
- 5. Complex & longer lives place new demands on our brains…
- 6. …so “work” is about brain functionality and fitness, not about disease Improve performance Delay decline
- 7. No one shoe fits all AGE PERFORMANCE 25 50 75 100 PERFORMANCE AGE
- 8. Source: The SharpBrains Guide to Brain Fitness (second edition)
- 9. Mental activity vs. mental exercise Source: Maguire, Woollett, & Spiers, 2006
- 11. Five conditions to maximize transfer To maximize real-world value of training… 1. Target neural processes that support real-world activities 2. Minimum “dose” of ~15 hours of training per targeted improvement 3. Address an individual’s bottleneck/ deficit 4. Adaptive challenge 5. Continued practice Source: The SharpBrains Guide to Brain Fitness What does the “BBC brain training study” (2010, 2015) prove?
- 12. We better start educating users and professionals
- 13. Conditions Under Which Brain Training Works Bruce E. Wexler Professor of Psychiatry, Yale University Founder and Chief Scientist, C8 Sciences
- 14. Conditions Under Which Brain Training Works • Clear neurocognitive target for training – For diseases, you must understand the pathology – For enhancing normal function, you must have a consistent neural system target • Effective training program – Multi-dimensional and systematic – Sophisticated data-driven individualization of training – Good training schedule: dose, duration, frequency • Engaged users
- 15. Geriatric Depression: A Clear Target, Good Results
- 16. • Pre-identified neurocognitive dysfunction associated with failure to respond to medication – Cognitive executive dysfunction – Hypo-activation on fMRI stroop paradigm in dorsal ACC (BA 24/32), superior prefrontal cortices (BA 6), and the middle frontal gyrus • Rx trial in 11 pts who had failed to respond at all to 12 weeks of supervised medication • 8/11 met criteria for remission (MADRS < 11) in 4 weeks, one more met criteria in 6 weeks, one did not reach remission and one dropped out Neuroplasticity-based computerized cognitive remediation for treatment resistant geriatric depression Morimoto SS, Wexler BE, Liu J, Hu W, Seirup J, Alexopoulos GS Nature Communications: August 5, 2014
- 17. • Executive Functions Improved – Stroop color word, p = .014 – Trails B, p = .024 – Design Fluency (Delis Kaplan EF System), p = .002 – Semantic Clustering (Mattis Dementia Rating), p =.052 • Verbal WM did not improve • Improvement on Trails B was correlated with improvement on the MADRS, spearman r = .72, p = .018. Neuroplasticity-based computerized cognitive remediation for treatment resistant geriatric depression Morimoto SS, Wexler BE, Liu J, Hu W, Seirup J, Alexopoulos GS Nature Communications: August 5, 2014
- 18. Group: F(1,49.2)=0.019, p=0.892 Week: F(1,71.2)=30.97, p<0.0001 Group*Week: F(1,61.8)=5.32, p=0.024 Lexipro group: historical controls, unselected for prior failure to respond to treatment Neuroplasticity-based computerized cognitive remediation for treatment resistant geriatric depression Morimoto SS, Wexler BE, Liu J, Hu W, Seirup J, Alexopoulos GS Nature Communications: August 5, 2014
- 19. Neural System that Supports Executive Functions Sustain Attention, Resist Distraction, Category Use, Emotion Regulation, Memory, Flexibility Inattention, Distractibility, Impulsivity, Decreased Memory, Rigidity, Limited Categorizing Multi-Dimensional Brain Training for Depression Neuropathology
- 20. Memory Training • Memory function is affected by factors along multiple dimensions – Number of things to remember – Study time, inter-stimulus interval, retention interval – Similarity of things to remember to each other and to things in recent memory – Distraction during encoding, maintenance or recall – Requirement to manipulate the information in memory • Many memory training games only train recall of increasingly long lists of things. These are likely to improve function in only limited ways in limited situations. • With a more complex and multidimensional training, a new problem arises: when to move a user from training along one dimension to training along another?
- 23. List Sorting WM test from NIH Toolbox: Children are shown pictures of animals or furniture and have to report them back in order from smallest to largest. If they get 2 correct, they are shown 3, then 4, etc; score is total correct. After Activate all grades are above Fall score of next grade.
- 24. Enhancing brain training with electrical stimulation: Promises and perils Roy Hamilton, MD, MS Assistant Professor of Neurology & Physical Medicine & Rehabilitation Director, Laboratory for Cognition & Neural Stimulation (LCNS) University of Pennsylvania NO RELEVANT DISCLOSURES
- 26. 9-Volt Nirvana
- 27. 9-Volt Nirvana “Zap your brain into the zone: Fast track to pure focus” New Scientist, 2012
- 28. 9-Volt Nirvana “Zap your brain into the zone: Fast track to pure focus” New Scientist, 2012 Is Sally right?
- 29. 9-Volt Nirvana “Zap your brain into the zone: Fast track to pure focus” New Scientist, 2012 Is Sally right? What if she is? What if she isn’t?
- 30. 9-Volt Nirvana “Zap your brain into the zone: Fast track to pure focus” New Scientist, 2012 Is Sally right? What if she is? What if she isn’t? What else do we need to think about?
- 31. Transcranial Direct Current Stimulation (tDCS)
- 32. Transcranial Direct Current Stimulation (tDCS) • Subthreshold stimulation
- 33. Transcranial Direct Current Stimulation (tDCS) • Subthreshold stimulation • Neurons alter firing rates
- 34. Transcranial Direct Current Stimulation (tDCS) • Subthreshold stimulation • Neurons alter firing rates • Anodal or cathodal stimulation may have different effects.
- 35. Transcranial Direct Current Stimulation (tDCS)
- 36. Transcranial Direct Current Stimulation (tDCS) • No known serious adverse side-effects
- 37. Transcranial Direct Current Stimulation (tDCS) • No known serious adverse side-effects • Portable
- 38. Transcranial Direct Current Stimulation (tDCS) • No known serious adverse side-effects • Portable • Can be worn during other therapies
- 39. Transcranial Direct Current Stimulation (tDCS) • No known serious adverse side-effects • Portable • Can be worn during other therapies • Costs ranging from $100s-$1000s
- 40. Transcranial Direct Current Stimulation (tDCS) • No known serious adverse side-effects • Portable • Can be worn during other therapies • Costs ranging from $100s-$1000s • Usable without advanced training
- 41. Motor learning
- 42. Motor learning
- 43. Task-dependent working memory enhancement Gill et al., Brain Stimulation. 2015
- 44. Task-dependent working memory enhancement Gill et al., Brain Stimulation. 2015 Online domain-specific cognitive task+atDCS results in offline improvement in performance within-domain
- 45. “Use it to hammer nails?” Novel Uses Chrysikou et al., Cognition, 2013 Frontal lobe functions Impulse Control, Cognitive Control & Creativity
- 47. Repurposed Iontophoresis Units tDCS Device Kits Homemade Devices Wexler, 2014 DIY-tDCS
- 50. Iuculano & Cohen Kadosh, 2013 6 days of training + TES •Posterior parietal cortex •Dorsolateral prefrontal cortex Unintended tradeoffs…
- 51. Iuculano & Cohen Kadosh, 2013 6 days of training + TES •Posterior parietal cortex •Dorsolateral prefrontal cortex • PPC: Increased learning but reduced automaticity • DLPFC: Increased automaticity but decreased learning Unintended tradeoffs…
- 52. Trait and individual-specific outcomes… Sarkar et al., 2014
- 53. tDCS & psychopharmacology • Glutamate/NMDA modulators – Blocking receptors eliminates aftereffects; enhancement enhances facilitatory plasticity • GABA modulators (e.g. lorazepam) – Delayed then enhanced & prolonged anodal excitability • Monoamine modulators (e.g. amphetamines) – May enhance facilitatory plasticity • Dopamine modulators – L-dopa: converts facilitatory plasticity to inhibition, prolongs inhibitory plasticity – D2 antagonists: abolish induced plasticity; D2 agonists: variable dose-dependent effects • Acetylcholinergic modulators – Reuptake inhibitor: similar effect to L-dopa • Serotonergic modulators – Reuptake inhibitor enhances facilitatory plasticity, converts inhibitory plasticity to facilitation Brunoni et al., 2013
- 54. Conclusions • Neither snake oil nor panacea • Potential for a different kind of harm/risk? • Different research (mechanisms & mechanics) needed
- 55. Conclusions • Neither snake oil nor panacea • Potential for a different kind of harm/risk? • Different research (mechanisms & mechanics) needed
- 56. Conclusions • Neither snake oil nor panacea • Potential for a different kind of harm/risk? • Different research (mechanisms & mechanics) needed
- 57. Follow us on Twitter @PennMedLCNS LCNS email: braintms@mail.med.upenn.edu LCNS website: http://www.med.upenn.edu/lcns Faculty Roy Hamilton, MD, MS H. Branch Coslett, MD Sudha Kessler, MD Research Staff Olufunsho Faseyitan, MS Daniela Sacchetti Juliann Purcell Nicole White Quan Wan Postdoctoral Fellows Rachel Wurzman, PhD Denise Harvey, PhD John Medaglia, PhD Perelman School Of Medicine Catherine Norise Daniel Cristancho Penn School of Nursing Darina Petrovsky, MSN Undergraduates Jonathan Muruakuo Joely Mass Students Special thanks to Martha Farah, PhD, Anna Wexler, and the Penn ELSIs of NBS Focus Group
- 58. Watercooler chats: Time to meet
- 59. To learn more, visit sharpbrains.com