BrainHQ is an evidence-based brain training program. That means that it has been used in many gold-standard clinical trials – and been proven to help people think faster, focus better, and remember more (you can have a look at our science results page here). However, most of these clinical trials have been conducted in healthy adults – showing BrainHQ can improve a generally healthy brain. But what about brains that aren’t as healthy? Perhaps even one that has suffered some damage?
This question became particularly important during the Iraq and Afghanistan conflicts. An all-too-common experience in those conflicts has been service members experiencing a blast exposure or a concussion (also called a mild traumatic brain injury, or “mTBI”). These mTBI’s have been called the “signature injury” of the Iraq/Afghanistan wars. Initially, they were not viewed as having potentially life-altering consequences. Even their classification as “mild” suggested they were of little consequence. But service members exposed to multiple blasts have an elevated risk of long-term consequences, including depression, post-traumatic stress disorder (PTSD), and cognitive impairment.
And, of course, concussions are not unique to the military on the battlefield. Even in the military, it’s unfortunately common to have service members suffer an mTBI in a vehicle accident. And outside the military, the group of people most likely to visit an emergency room after a concussion are older adults, who can suffer a concussion from a fall.
The Department of Defense recognized that new solutions were needed for treating mTBIs, and they asked for researchers to propose new clinical trials to find out what might work.
At Posit Science, we already knew that BrainHQ could help improve cognitive function in healthy older adults (you can see the evidence here). But could BrainHQ also help in people who had long-lasting cognitive impairment after an mTBI? On the one hand, we knew that the cognitive issues associated with mTBI looked broadly similar to those associated with aging – so perhaps BrainHQ would be helpful. On the other hand, the reason healthy adults have cognitive issues is the natural aging process, while the reasons people with an mTBI have cognitive issues is that they had a brain injury.
So we put together a team, including a great set of collaborators at military hospitals and Veterans Administration medical centers from around the country (including The National Intrepid Center of Excellence at Walter Reed National Military Medical Center in Bethesda MD, Schofield Barracks in Oahu HI, the Michael E. DeBakey VA Medical Center in Houston TX, the VA Boston Healthcare System in Boston MA, and the VA Connecticut Healthcare System in West Haven CT). We proposed a clinical trial to the Department of Defense, and our team was selected through a very competitive process to proceed – launching the BRAVE study.
The BRAVE study enrolled participants with current cognitive impairment and a history of mTBI. Most were service members and veterans. On average, participants had cognitive deficits that had persisted for 7 years since their most recent mTBI (a long time!). The group was randomized into a treatment group (who used BrainHQ) and an active control group (who used ordinary computer games).
Both groups were asked to train for the same amount – one hour per day, five days per week, for three months. People trained at home, using their own computers and internet. Clinicians provided remote coaching for both groups by phone – every week, a clinician would review a person’s progress, and provide technical support and encouragement.
We saw the brain training program significantly improved overall cognitive function – as measured by a composite assessment of memory and executive function – as compared to the active control. In fact, the improvement in the brain training group was 24 percentile points – equivalent to moving from the 50th to the 74th percentile, while there was essentially no improvement in the active control group. And furthermore, we saw that the benefits were sustained for at least three months after the completion of 12 weeks of training (without further training).
We also looked at a number of other outcome measures, including questionnaires and a functional measure. Here, we did not see differences between the groups. But on several measures – including self-reported cognitive symptoms and depressive symptoms – we saw that both groups showed significant improvement. This suggests that the telehealth coaching itself, as used in both the BrainHQ and computer games groups, was effective on improving these measures.
This is an exciting result! BRAVE is the first multi-site trial of a computerized cognitive training program with people with cognitive impairment and a history of mTBI that’s ever been done. It also is the first trial of any intervention to show an effective treatment of mTBI that is highly scalable and can be administered remotely. It shows us that it’s possible to drive cognitive improvement in this population – even when they have suffered from cognitive impairment for a long time after injury.
But it takes a particular kind of cognitive stimulation. Training with crossword puzzles and boggle – which are cognitively demanding tasks used in the active control group – did not improve overall cognitive performance. But training to improve the speed and accuracy of information processing through the brain – as done in the BrainHQ group – did improve cognitive performance.
But why do the same BrainHQ exercises improve cognitive performance in healthy older adults and in younger people with cognitive impairment following mTBI? At Posit Science, we think this tells us that both groups of people have “noisy information processing” – like a radio with a little bit of static. The static noise makes it harder to hear and see quickly and accurately – and as a result, slows down thinking, and leads to attention, memory, and concentration problems. BrainHQ training improves the speed and accuracy of information processing, and lowers the noise in the processing – helping people think faster, focus better, and remember more – regardless of whether the source of the noise is the normal aging process or the consequence of an mTBI.
This trial was just published in the neurology journal Brain, and you can read the entire paper here for free.
We’re grateful to all our collaborators in the BRAVE trial, and to the many service members and veterans who volunteered their time as trial participants. And we feel very fortunate that the power of brain plasticity continues to show us more people who can have better brains and better lives through brain training!
Happy brain training!
Henry W. Mahncke, PhD