Avoiding Dementia: Brain Training Update
New 20 year followup adds good news
A couple of years ago, we published a multi-part exploration of two things: the idea that we wanted a “check engine light” for our brains, and what existed to do that; and the idea that brain training, of the right sort, might help improve cognition and / or make dementia less likely.
Overall, our findings were encouraging but left some open questions. In the last few months a new scientific publication came out that added quite a lot of information. The media has covered it a bit, but we wanted to look at it in depth, and in light of our prior work.
Summary: TL;DR
A big study (5,000 individuals: the ACTIVE study. Ref 1.) published results from following up the enrolled patients in the study for 20 years. [In our previous analyses, results were only available for 10 years]. Results at 20 years look rather encouraging, and support the idea that brain training of a specific sort (important details) can reduce the incidence of dementia.
Specifically, after the right sort of brain training regimen, a significantly smaller fraction of patients in the brain-trained cohort developed a diagnosis of dementia over a 20 year followup period — when compared to the patients in the control group who did not take the same type of brain training.
after the right sort of brain training regimen, a significantly smaller fraction of patients in the brain-trained cohort developed a diagnosis of dementia over a 20 year followup period — when compared to the patients in the control group.
NOTE: There are quite a few important details relating to this. Read on to understand them The most important detail is that these positive results applied to one very specific type of brain training. They did not show up in several other types of brain training included in the study, or in the control group with no brain training.
So, the conclusion should NOT be “any type of brain training will reduce probability of dementia”. It should be, “there are positive results for one specific type of brain training”.
Brain Training & Check-engine Light
Prior Explorations
Check engine light for the brain
In 2023, we did a deep dive exploration into the idea that we really wanted some type of “check engine light” for the brain. You can see those articles at links below.
Here is the basic idea. The core concept has two parts:
We want some type of ongoing monitoring you can do that gives you a “score”, that relates in some way to “risk” of the thing you are monitoring (in this case cognition or dementia risk for example); and
We want some type of ongoing intervention you can do that can impact your score, so you can be proactive about maintaining “wellness”.
Brain Training
We then set out (in 2023) to look at several available brain training products to see how they might be helpful.
We tried several products, and wrote about one of them: BrainHQ: BrainHQ: Longevity Explorer Report (Pt 1).
We explored the evidence for whether (and how much) brain training of various sorts might have real benefits: Brain Training (Pt 2): How Real are the Benefits?
Disclaimers
We do NOT benefit financially in any way from the products or companies discussed in this post. 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.
The Latest Evidence: 20 yr followup
The recent publication (Ref 1) showed an analysis of 20 year followup of patients from a specific clinical study called the ACTIVE study.
The ACTIVE study already featured as one of the more notable things we found as part of our prior research back in 2023. It is large, and had quite a lot of publications looking at results over various time frames, with the longest being 10 year followup when we looked at it in 2023.
The key new happening is that we now have 20 year followup.
The end point they look at is “risk / incidence of Alzheimer’s Disease and related Dementias (ADRD)”. To keep things in lay terms, we use the word “dementia” in this article to denote ADRD.
The most important finding of the new paper (20 yr followup) is:
“Participants randomized to the speed-training arm who completed one or more booster sessions had a significantly lower risk of diagnosed ADRD (hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.59, 0.95), while speed-trained participants with no booster training did not have a lower risk of diagnosed ADRD (HR: 1.01, 95% CI: 0.81, 1.27). There was no main effect of memory or reasoning training on risk of ADRD.”
In our earlier analysis there was already some evidence for conclusions like this, based on 10 year followup (Ref 2). But the new publication has a longer followup, strengthening the evidence considerably..
Our Takeaways
Here are some key takeaways.
Prior Conclusions Strengthened
Here is what we concluded in 2023. The addition of this new 20 year followup strengthens the evidence for these conclusions quite a lot, in our opinion.
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.”
This latest study demonstrates that for a specific patient cohort, with a specific regimen of brain training, the incidence of dementia after 20 years is reduced.
Specific Type of Brain Training Matters
Repeatedly across a number of publications we see that the type of brain training makes a big difference to the results.
In the ACTIVE study, the type of training that was effective was something called “speed training”. They had arms of the study that used other types of brain training (memory and reasoning training) but those arms did not show statistically meaningful reduction in dementia incidence.
Now, this does not mean that other sorts of brain training have no value. However, it does strongly suggest that if you plan to try brain training, it makes sense to include speed training as part of the regimen (our opinion, not medical advice).
For more background on this see our prior work:
As best we can tell, the type of training which is called “speed training” in the ACTIVE study, is incorporated into the BrainHQ suite of training tools (but not with that name). We note that the ACTIVE study also includes a social interaction component which is not part of BrainHQ, so that is something to bear in mind.
Disclaimer: We have no business relationship with BrainHQ and get no financial benefit of any sort by mentioning them.
Importance of “Boosters”
Another extremely important learning from the recent publication (Ref 1), is on the importance of booster sessions.
The core protocol of the ACTIVE study involved an initial brain training regimen (baseline), followed by more training (which they call booster sessions) at intervals of 11 months and 35 months after the baseline training.
They followed several cohorts who had undergone the speed training, one of which had the baseline but no boosters, and another of which had both the baseline training AND the boosters.
The positive results about dementia incidence reduction applied only to the cohort that had both baseline and booster training.
It may be that a larger sample would have showed lesser but still positive results from baseline alone, but for now, we should conclude that adding booster sessions at roughly one and 3 year intervals likely has strongly positive benefits.
The Longevity Explorers who tried out the BrainHQ product back in 2023 took note of this, and are getting ready to do a booster training regimen. :)
And, it seems likely to us (not at all proven) that ongoing incremental brain training boosters every few years might well have additive benefits for reducing incidence of dementia.
References
ACTIVE study 20 year followup: Impact of cognitive training on claims-based diagnosed dementia over 20 years: evidence from the ACTIVE study. N.B. Coe et al. View paper on Pubmed.
Speed of processing training results in lower risk of dementia. J.D. Edwards et al. View paper on Pubmed.
There are many additional interesting references. See our prior articles for more references.