Check-engine-light for the Brain: Part 3
Brain Measurement for the Healthy
Here is the third installment of the exploration: “Check Engine Light for the Brain”, (see Part 1 and Part 2 for prior installments of the exploration).
In this email (Part 3 of our ongoing exploration) we continue exploring how to track changes in cognition over time — especially in those who would be considered by clinicians to have “normal” cognition for their age.
We start to explore whether the types of tests used in online brain training games are suitable for tracking cognition changes over time.
NOTE: This is NOT about the question of whether or not brain training games can improve cognition or stave off dementia (we will look at that in a later post). This is about whether the measurement techniques developed for brain training games can be useful for our brain check-engine-light concept.
What We Covered Thus Far
In Part 1 we described what we wanted in a “check-engine-light for the brain”. In Part 2 we started to explore the “measurement” part of the concept — a way to track cognition over time.
We started by looking at the tools clinicians use to screen for Mild Cognitive Impairment (MCI). We found a tool that worked well to “self screen” for that on a regular basis.
But, …. we decided that MCI Screening Tools are not quite what we need for the check-engine-light concept — due to the fact that they do not do a good job of highlighting cognition changes over time in people whose cognition is far above the “threshold” for “impairment”.
The Cognition Monitor We Want
Refining the description
What we want is something that measures cognition on a scale that includes the majority of the “older adult” public, and which you can use to measure two things:
How your cognition scores vs others (age adjusted perhaps); and
How your cognition changes over time.
In addition, we probably need some type of rather complex “score” that measures a variety of aspects of cognition— because there are numerous aspects of cognition, and we would like to understand how we are doing on all of them over time.
To explain this a bit further:
While many people think of “memory” as the attribute associated with cognition impairment, there are other aspects that also matter a lot, as we touched on in the discussion of MCI screening tools (Part 2 of this exploration).
There is a broad array of such cognitive functions that researchers in the field consider important to measure. The list includes: learning and memory; language; executive function; complex attention; perceptual-motor function; social cognition; and likely other aspects we have not mentioned. (See Ref 1 for background).
So, what we are seeking is a measurement tool that measures all of these and provides both individual scores and some type of “overall score” — and the capability to track scores over time.
Exploring Cognition Measurement Tools
The good news is that neuroscientists have invested a lot of energy and time and expertise to create a variety of cognition measurement tools. So, we thought perhaps it would be as simple as finding the right tool and trying it out.
Here are the first results of our exploration.
General Purpose Cognition Measurement Tools
As we explored this topic we learned a few key things:
Developing suitable cognition measurement tools relating to aging and cognition is an active topic of research. So likely in some number of years there will be available greatly improved tools compared to those we found thus far. This exploration is NOT about research, however, but rather about tools currently available to the general public!
We found some commercially available cognition measurement tools that look promising for our goals, and that we decided to explore (see below).
Rather than try and explore the entire universe of cognition measurement (including IQ tests, academic testing and the like), we decided we would zero in on one area that we hypothesized would be most relevant to our brain-check-engine light exploration. We focused on the cognitive measurement tools used by experts researching ways to “train” the brain. These researchers have a long term goal of “training” the brain in ways that can reduce dementia risk and or push out the time at which cognitive impairment becomes a “problem” in someone’s life. Measurement tools are a key aspect of this research.
Brain Training & Cognition Measurement
For years there has been an active field of research focused on measuring various aspects of brain function, and then “training” the brain using various techniques, often in the form of digital games.
If we unpack this idea, there are two important components. There are tools to “measure” brain function. And then there are “techniques to train / improve” brain function.
The topic of how well brain training “works” to improve cognition or stave off dementia is a subject of debate and research (see future installments of this exploration). But whatever your opinion is on this topic, that is quite separate to whether or not the “measurement tools” do a good job of measuring cognition — which is what we want for our check-engine-light concept.
Our working hypothesis for this exploration is that the measurement tools, developed for use in brain training, are likely to be good candidates for our check-engine-light concept.
Commercial Cognition Measurement Tools
There are quite a lot of companies who have brought to market products in this space. They typically market themselves as in the business of “brain training”, or “brain games”.
While some mainstream media reports have described some of these companies as being controversial, and lacking in scientific underpinnings (e.g. Ref 2), there is also a large body of scientific literature in which products from some of the companies in this space are used in promising research into the use of brain training to achieve a variety of relevant outcomes (Refs 3 & 4).
As with many of the topics we explore, this is clearly a space where not all companies are equal, and it is important to find the best products and services.
For this exploration, we set out to find two of the most scientifically credible / reputable of these companies, with the aim of trying out their products.
We did not do a systematic side by side comparison of all the brain training / measuring products, though. Instead we relied on a handful of inputs, described below.
We relied quite heavily on a couple of peer-reviewed, meta analyses of the ability of various interventions to impact cognitive decline (Ref 3 & Ref 4). The data in those was up to 2015 and 2016. If you know of equally thorough, more recent, meta analyses, please use the comments to tell us.
We also read some of the more recent peer-reviewed studies of individual products, including some which we will be discussing in more detail in future installments as they are relevant to whether brain training is a useful candidate for the intervention aspect of our check engine light concept.
We also took into account subjective feedback from various Longevity Explorers relating to ease of use of the products and overall “perceived reputation”.
And finally, we read about the “teams” behind the research in each of the companies and were influenced by things like academic pedigree.
There were seven different products (companies) covered in the comparative meta-analyses identified above. The full list is in Ref 5.
From that longer list, we found two companies in particular that had strong neuroscience teams, and for which there are numerous peer-reviewed papers studying the measurement tools they use, and the brain training approach they take, and the degree to which they had positive impacts on “users”.
Our working hypothesis was that exploring the products from these two companies was a good place to start.
The two “products” we decided we would start with were:
BrainHQ from Posit Sciences; and
Cognifit.
Links to both companies are in Ref 6.
There may well be other excellent companies too, but these are the ones we decided to explore first. Feel free to mention companies you have positive experience with in the comments, but please only do so if there are peer reviewed studies evaluating their products that you can point to.
And remember, at this stage we are focusing on the measurement tools, not the “training”.
NOTE 1: None of the companies mentioned in this article (or their competitors) have sponsored this exploration. We do not benefit financially in any way from mentioning them and using their tools (for which we paid). We do plan to reach out to them and ask for any feedback or corrections about this article.
Measuring Cognition vs Measuring Game-playing Ability
One of the concerns and criticisms sometimes mentioned in the context of brain training, and associated measurements of cognition, is the question of whether what you are measuring is some type of generalizable measurement of brain function, or rather just a measurement of how well you have learned to master various game skills.
At this point, we don’t claim to understand this topic in enough depth, and it will feature in future installments.
However, for our brain check engine light we are looking for some type of relative measurement that we can track over time, rather than a perfect absolute measurement.
Our current hypothesis is that this means the brain training cognition measurements might work rather well for the purpose of our check engine light concept. But we will return to this question in more detail in later installments, and welcome any expert inputs from readers re this question.
Brain Training Potential Too
Of course, these products also have the potential to “train the brain” — which might well satisfy the need for the “intervention” part of the check-engine-light concept.
Will they work well for that too?
Stay tuned for future installments of this exploration to find out what we learn about that.
Next: What We Learned From Trying These Products
In the next installments of this exploration, we will report on the experiences of a small group of explorers as they used the products from the two companies mentioned above during the last 6-9 months.
In addition, after Part 1 of this exploration some explorers drew our attention to a product offering from AARP in this space, and we intend to try that out too in future explorations. And a different explorer commented on a large scale NIH program for measuring various health indicators including cognition (called PROMIS), and we will be exploring that too.
NOTE 2: This exploration is a work in progress (we are “learning in public”), so there may well be gaps in our knowledge or errors in our understanding. If you notice some key points we overlooked, please share your knowledge in the comments at the bottom.
Background
(Repeated from Prior Installments)
About this Exploration
Before diving into the substance, here are a few caveats (repeated from the prior installment):
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.
Who is this Exploration For?
The way we conceive of the “check-engine-light for the brain” is as a tool to be used by older adults who want to plan for the future, and who want to have a tool to help them think about their own cognition and keep an eye on any changes to it.
In the world of healthcare, the sort of people who might want this are sometimes called the “worried well”.
This exploration is not designed for people who have cognitive impairment or dementia, or for their caregivers. However some of the things we learn might be useful for those groups.
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).
We are especially interested if you know of a product or service that does some or all of what we describe above. We would like to learn more about it, especially if you have personal experience with it.
To short circuit some of the likely comments:
we will definitely be including the opinions of experts (such as neurologists and geriatricians) in our exploration. If you are such a person and would like to help, please send us an email (or reply to this email);
we understand that many people have their own views on the perfect diets or supplements or exercise regimens to maintain or improve cognition. If you have peer-reviewed literature on this topic to share, we welcome your inputs. If you just want to tell us how “supplement x” is great, we are less interested, unless you have some evidence to share;
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.
References
Dr. Kernisan: How We Diagnose Dementia: The Practical Basics to Know.
Example of negative mainstream media on brain training: eg LA Times re “bogus claims”
AHRQ: Comparative Effectiveness Review #188. Interventions to Prevent Age-related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer’s-type Dementia
Neuropsychological Rev (2107) 27:62-80 (full text behind a Paywall). Enhancing Cognitive Functioning in Healthly Older Adults: a Systematic Review of the Clinical Significance of Commercially Available Computerized Cognitive Training in Preventing Cognitive Decline
Various Brain training Companies included in Ref 4: Posit Sciences (BrainHQ) | Cognifit | Cogmed | Brain Age (Nintendo) | My Brain Trainer | Dakim | Lumosity
The two products we chose to try out: BrainHQ (Posit Sciences) | Cognifit