One of the most significant issue facing people with mental illness is their ability to integrate into society—to make friends, hold down a productive job, and contribute to their families. Imagine two people with bipolar disorder, both suffering the severe mood swings between manic energy and deep depression. One stays in touch with friends from high school, has a job as a delivery truck driver, and makes dinner with their parents every Sunday night—while the other doesn’t. Clearly the first person is managing their illness more successfully, and that path represents a better outcome for the person, their family, and society as a whole.
But why is one person more able to maintain those roles in society than the other? Scientists have investigated this question over the past decades. It turns out that the biggest factor that contributes to differences in society integration in people with mental illness is their cognitive function: their processing speed, memory, attention, and executive function. Comparing two people with similar levels of mood disorder, the person with stronger cognitive performance is more likely to make and maintain friends, get and hold down a job, stay integrated with their family, and on the whole be a part of and contribute to society.
This means that improving cognitive function in people with mental illness is a key treatment goal, because if we could improve cognitive function, perhaps we could provide ways for the less fortunate person succeed like the more fortunate person—with new medications, new psychosocial interventions, new types of counseling…or new types of brain training?
A new study from Dr. Eve Lewandowski at McLean Hospital (affiliated with Harvard Medical School) suggests that the brain training exercises in BrainHQ can help people with bipolar disorder improve their cognitive function. She and her team enrolled people with bipolar disorder in a clinical trial comparing a set of plasticity-based brain training exercises now found in BrainHQ to a set of ordinary computer games. Each group did about 70 hours of training (that’s a lot!), about three hours per week for about 24 weeks. Two sessions per week were done at home, with the participant working independently, and one session per week was done in the clinic, with a coach.
Thirty-nine participants were assigned to the brain-training group, and 32 to the computer games group. At the end of training, the brain-training group showed a significantly larger improvement in overall cognitive function as measured with standard pencil-and-paper cognitive tests—about two-and-half to three times larger that was seen in computer games group. This showed that brain training gains transferred to untrained, general measures of cognitive function. Interestingly, these cognitive gains were maintained at a six-month follow-up visit with no further training, showing that the cognitive gains were durable.
The researchers also looked at several measures of community functioning—questionnaires that ask a person how successfully they are integrated into their community. The researchers did not see a significant change on these scales, but they did see that the larger the improvement in cognitive function was, the larger the improvement in community function was. This suggests that a larger study, or one with a more sensitive measure of community function, might show an effect of brain training in this important domain.
Dr. Lewandowski and her team led a very impressive study. First of all, this is among the largest studies of any type of intervention to help cognitive function in people with bipolar disorder that has ever been done. It’s challenging to find enough people who want to contribute their time and effort to do a study like this. Second, the study is very well controlled—the computer game active control ensures that the results are truly specific to the brain training, and not the result of a placebo effect of just being enrolled in the trial and seeing the health care providers. Finally, using standardized cognitive measures and doing a follow-up assessment six months after training was complete answers the two biggest questions about brain training studies: do the improvements generalize to untrained measures (yes) and do the improvements last (also yes).
We and our research collaborators have more work to do. It will be important to see a trial in the future with sensitive measures of real-world community function, to document that changes in cognitive function have the effects that we think they should on a person’s life. And we’d like to see a multi-site trial, to document how to implement the training reliably across a broad network of treatment centers. That being said, this is a very important next step in the application of the science of brain plasticity and cognitive training to help people with mental illness improve their brain health to improve their lives. I’m honored to see technology from Posit Science being used to help some of the people in our society who have the greatest need.