“Beyond the Controversy: Defining ‘Brain Training’ and Its Applications”
Ed. Note: we are live blogging selected sessions of this year’s SharpBrains Virtual Summit: Retooling Brain Health for the 21st Century.
2:05 PM: The session has wrapped up. We’ll be back tomorrow for one more session, “From Lab to Marketplace: How Science Reaches Users” at 8:30 AM.
2:02 PM: Dr. Wilson introduces Sophia Vinogradov, who works on cognitive training for individuals with psychotic illness at UCSF and the SFVA Medical Center.
She begins by talking about schizophrenia. In people with schizophrenia, they exhibit psychosis (hallucinations, delusions, etc) but also a range of cognitive impairments in how the brain is processing information. They have problems with early neural responses, integration of neural responses across the network, maintenance of attentional control, and the ability to associate, encode, and retrieve salient events, thoughts, and actions.
We know from basic science: the accuracy, fidelity, and efficiency of neural systems can be improved through intensive, progressive, adaptive, heavily rewarded perceptual and cognitive training (she cites studies by Jenkins, 1990 and Merzenich, 1999.) Using these principles, Vinogradov and Merzenich collaborated to test this in people with schizophrenia at the SF VAMC.
This version of targeted cognitive training consisted of a heavy schedule of stand-alone computerized training (Posit Science Brain Fitness Program.) The psychophysical training is embedded within a suite of increasingly complex auditory and verbal working memory exercises. The goal was to increase the accuracy, resolution, and power of speech inputs feeding the processes, to induce widespread plastic changes throughout the verbal encoding network. The issue of working memory in people with schizophrenia contributes to their inability to hold a job, deal with reality, etc.
After 10 weeks of targeted cognitive training (TCT) – cognitive improvement is seen – as compared to computer games control condition (CG.) TCT showed significant improvements in global cognition, speed of processing, and verbal learning and memory. Many of the participants have been ill for 20+ years. After 6 months of no contact, TCT are still better in global cognition than baseline.
They also measured Serum BDNF levels – TCT participants showed an increase in Serum BDNF from baseline to end of training. A variety of MEG readings show that functional connectivity is significantly increased after TCT.
What about generalization? In a more complex task known as “reality monitoring”, an important area of deficit for schizophrenia, monitored by pre- and post-fMRI tests. At baseline, schizophrenic subjects show deficits in self=generating words. But after this training they show improvement in the fMRI and the task. Their brains look like healthy subjects in this task. The medial prefrontal task is active. This shows that a task that’s not trained has improved, and improves social functioning up to 6 months later.
With younger patients, you get a slightly different pattern of results but it’s even more effective. The goal is preventive or preemptive training.
1:44 PM: Dr. Gazzaley uses the understanding of brain changes underlying cognitive changes to inform the design of cognitive interventions. Neural recording should be a component in the development, evaluation, and optimization of training interventions.
He notes that computerized training programs are being developed to improve perception, attention, and memory abilities in older adults. One approach has been to induce perceptual learning via repetitive exposure to stimuli in adaptively challenging tasks. The ability of discrimination training to transfer benefits and result in memory improvements has not been proven in older adults, so Dr. Gazzaley’s lab evaluated two groups of older adults- a control group, and an active group who did 10 hours of perceptual training on Posit Science’s “Sweep Seeker” module (a part of the InSight program.) The active group did 1 day of EEG testing and behavioral tests – 5 weeks of training on this perceptual task – another day of EEG testing and behavioral tests.
The EEG recordings measured working memory. The older active training group was compared to an older control group and a young control group. Those who did the 10 hours of training move from being aligned with the older group to being aligned with the younger group. If you look at the neural data, the brain in the active group has changed. It’s an impressive change to notice that information processing has changed and become more efficient post-training.
To sum up, this study is the first evidence of direct transfer-of-benefits from perceptual discrimination training to working memory performance in older adults. Moreover, EEG evaluations reveals neural evidence of functional plasticity in older adult brains. These findings demonstrate the strength of the perceptual discrimination training approach by offering clear psychophysical evidence of transfer-of-benefit and a neural mechanism underlying cognitive improvement.
1:30 PM: In the Q&A portion, Dr. Edwards points out that it’s really important not to refer to “cognitive training” as one thing, because not all training programs are created equal. Some that are on the market are not adaptive so may not work. It’s also important to note that “cognitive stimulation” activities are not created equal either. Edwards stresses that she does not believe that cognitive stimulation is enough–training is the key.
Dr. Adam Gazzaley is beginning his portion. He’s a neurologist who works with aging adults in his lab at UCSF.
1:24 PM: Jerri Edwards of University of South Florida begins. She begins by asking: what is cognitive training?
Cognitive stimulation through leisure activities is one thing – reading, travel, board games, crosswords, etc. Cognitive training can be strategy-based to improve memory, reasoning, etc., or perceptual practice like auditory (Brain Fitness Program) or Visual (speed of processing, InSight.) Edwards believes that cognitive training is more effective than cognitive stimulation for improving or maintaining cognitive skills.
Transfer of training is key – the improvement in abilities not directly practiced by training (like every day functioning.) Key components of transfer are that there need to be large training effects- through an identified deficit in targeted population, and adaptive techniques.
There is a belief that cognitive training does not transfer to real world abilities, but Speed of Processing training has been proved to do many things, including 40% reduction in driving cessation rates over 3 years, 48% reduction in at-fault crashes over 5 years, improvement in instrument ctivities of everyday life (IADL.)
Results in a study of 278 people in adaptive cognitive training with 3 control groups (no contact, cognitive stimulation, non-adaptive cognitive training) – showed that no contact controls and cognitive stimulation showed NO gains, and the only one with significant gains was the adaptive cognitive training.
The underlying mechanisms: programs that improve useful field of view and attention improve other things in everyday life. The Posit Science InSight program enhances the P3b response, showing that cognitive processing may be enhanced by this specific training.
1:15 PM: Question for Dr. Bavelier: How can we be sure about transfer of skills?
Dr. Bavelier answers that the gamers have surprised the researchers at every turn, but they have found that they are better learners and better at attention. Their ability to suppress irrelevant information is what allows this.
Question: What about other games? What games or types of games will work?
Their lab is working on what it is in an action game that’s important. Is there a lot of demand on divided attention? That’s a key. You also need to adapt the difficulty to the learner; if you’re using an adult at the prime of their capacity, you really have to push them. With children and older adults, you may be able to use simpler games.
1:06 PM: Dr. Daphne Bavelier begins her presentation. She studies the effect of video games on brain function and organization.
For context, 90% of children play games, but also many adults. 70% of heads of household play. The mean age of gamers is 33 years old.
Is there no gain from brain games? It depends what you mean by games. She mentions “the curse of learning specificity” – same stimuli, same task, different things to pay attention to – but benefits of learning are lost. There is a lack of transfer. Real life examples are chess, classroom learning, Tetris. For example, if you’re great at Tetris, that doesn’t mean you’re great at mental rotation–it just means you’re great at Tetris.
Conversely, Dr. Bavelier’s studies have showed what happens to our brains on action video games- like shooting games (first or third person)- can actually enhance vision, attention, task switching and multitasking, and decision making.
One skill that has been tested is ontrast sensitivity: the ability to distinguish small differences in shades of gray. You can train people on a boring task for contrast sensitivity or have them play an action game. Those who play the game do better. To find the causal role of playing action games, they test people on different types of games: action games and control games. The improvement is marked in those who played action games for 50 hours. The effects last 5 days, 5 months, and 1 year after training.
Important: action games have that effect; social games, Tetris, etc. do not. This effect is not about correcting the optics of the eye, but rather changing the visual cortex.
Why do we see all of these changes? People playing action games are learning to attend to a stimulus. Their attention is very strong, and they have greater sustained attention than normal people. They are also better at focusing on task-relevant information (ie, not getting distracted.) The ability to suppress distractors is important for attention.
To sum up:
- Action video game play enhances attention
- Gamers are better able to select task-relevant information and ignore distrations
- They perform more informed decisions; advantage seen in many tasks
- This leads to unprecedented transfer of learning
12:52 PM: Dr. Jamie Wilson of SharpBrains is introducing the session. The speakers will be:
- Dr. Daphne Bavelier, University of Rochester
- Dr. Jerri Edwards, University of South Florida
- Dr. Adam Gazzaley, UCSF
- Dr. Sophia Vinogradov, UCSF