Katherine Kam
WebMD
November 14, 2006

“I used to have a tremendous memory,” Maria Luisa Bravo, 72, says wistfully.

But a decade ago, the San Francisco woman started having memory loss that comes with agingaging. She forgot phone numbers, passages that she had just read in books, even where she parked her car. Often, she received parking tickets because she forgot to move her car on street-cleaning days.

“I am very, extremely upset that I’m losing my memory,” she says.

Can science offer any real help to older people such as Bravo?

Henry Mahncke, PhD, believes so. Mahncke is vice president of research and outcomes at Posit Science Corp. Six months ago, Bravo signed on for the company’s “Brain Fitness Program” computer exercises to try to improve her memory.

“Brain fitness” is an emerging concept, and researchers such as Mahncke are at the forefront. In the past few years, new software companies have sprung up to cater to seniors and the baby boomers not far behind them. Their mission: to help people keep a mental edge throughout life — even into old age.

“I think medical technology’s going to let us live longer and longer,” Mahncke says. “And I think we should be able to keep people’s brains sharp.”

Posit Science says that it builds its programs upon brain plasticity, the brain’s ability to create new neural pathways and connections in response to new experiences. “The brain is a complex, adaptive system,” says Mahncke, who serves as vice president of research and outcomes. And plasticity can happen at any age, even in the older years.

Nintendo’s Brain Age
The notion of brain fitness has even invaded popular culture. In April, Nintendo released Brain Age, a Japanese-inspired, handheld video game to help users’ minds stay active. While the game is marketed for all ages, the buyers — now numbering more than 655,000 in the U.S. — have mainly been older people, Nintendo of America spokeswoman Amber McCollom writes in an email.

Players take a nonscientific test that calculates a “brain age” for the purposes of the game. Through a series of puzzles and other challenges, they try to shave years or even decades off their brain age score.

A catchy gimmick, but people shouldn’t take it seriously. “The notion that there’s a brain age isn’t well accepted,” says Timothy Salthouse, PhD, a University of Virginia psychology professor who is an expert on cognitive aging. Calculating brain age is difficult because it depends on many different variables, and a person can perform well on one variable and poorly on another, he says.

McCollum likens Brain Age to crossword puzzles. “We’re not claiming that it does anything more than keep the mind active while letting people have fun.”

Software to Enhance Mental Ability
The real heavy lifting is happening at places such as Posit Science, a well-funded, serious endeavor backed by brain researchers and scientific advisors from universities, such as Johns Hopkins, Yale, Stanford, MIT, the University of California, and several brain research institutions abroad. The four-year-old company has also received grant money from the National Institutes of Health.

Within the past few years, Posit Science and a growing number of software companies have formed to offer older people tools to enhance mental ability.

“Various regions of the brain do tend to shrink,” Salthouse says. Some nerve cells die, while others produce lower levels of neurotransmitters that allow them to communicate with other cells. Salthouse’s research has shown that a general slowing in speed of information-processing plays a major role in cognitive agingaging.

The result? “As we get older, the speed and accuracy of information-processing in the brain gets worse,” says Mahncke. Slower thinking and memory lapses become more common.

Thirty years ago, scientists believed that the adult brain was hardwired; later in life, it endured a “slow downhill ride,” Mahncke says. Now, scientists believe that the brain can continually remodel itself, even late in life.

Stimulating the Mind
Just about everyone has heard of “use it or lose it.” In other words, do crossword puzzles, play bridge, learn a new language — whatever you can to stimulate your mind.

But Posit Science takes it further: it’s actually trying to attack the root causes that can contribute to larger cognitive problems, such as memory, according to Mahncke. He says, referring to older brains, “The machine fundamentally isn’t working as well as it used to. You can’t just ask it to do what it doesn’t do well. You have to understand why it isn’t doing so well and attack those root causes.”

He doesn’t believe that most current solutions are useful. “So much of what is out there right now for improving memory in older people is really more about strategies and flash cards and things like that. The problem with that stuff is that it doesn’t work. The reality is that you don’t use these tricks when you’re out and about in the world.”

“We’re trying to improve the speed and accuracy of information-processing in the brain,” Mahncke says. The goal is to produce stronger memory and clearer thinking.

Currently, the Brain Fitness Program is marketed to those age 60 and older with “normal, age-related cognitive decline — that feeling of slowing down and memory loss that hits all of us, but it’s prepathological,” Mahncke says. (Posit Science is conducting research, though, to see if its programs can help those people with Alzheimer’s or mild cognitive impairment.)

Clients such as Maria Luisa Bravo go through a series of exercises — for example, identifying sounds or following a string of simple instructions — at increasingly rapid speeds. “It fundamentally accelerates the rapidity with which your brain can process information,” Mahncke says.

In August, Posit Science published promising results in Proceedings of the National Academy of Sciences. It conducted a study that involved 182 men and women, ages 60 to 87. The experimental group used Brain Fitness training on home computers for eight to 10 weeks. A second group watched educational DVDs, and the third group did nothing.

When Mahncke and his fellow researchers measured the three groups on memory and cognition, the groups that watched DVDs or did nothing showed no significant improvement. But the brain-training group did. “The average 70-year-old had the cognitive performance of someone who’s around 60,” Mahncke says.

Can Decline in Mental Function Be Prevented?
Many brain-training programs focus on a particular task, for example, by teaching memorization tricks, but they don’t strengthen mental function overall, Salthouse says. “They are effective in what people are receiving training on. The criticism of those kinds of procedures is that they don’t generalize to other procedures.”

But he believes that Posit Science’s approach may prove useful. “Theirs seems like a promising approach. They’re not training for a specific approach. They’re trying to rewire the brain.” While he calls the method “experimental,” he adds, “I think it has a stronger rationale.”

But people shouldn’t consider brain training as a magic cure to stop brain agingaging, experts say. While it may be possible to improve memory and learning, Posit Science is careful not to claim that it can delay or prevent a decline in mental function, Mahncke says. “We — and frankly, everyone you talk to — should be quite careful about that because if we really wanted to say, ‘We want to prevent cognitive decline,’ we need to do a long-term study.”

And those studies haven’t been done, Salthouse says. While there’s evidence that targeted brain exercises can help improve performance on activities, he notes, the jury’s still out about whether they can actually slow or prevent a decline in mental function.

“Even the most scientific studies don’t look at whether you can slow the aging process of the brain or cognitive decline,” he says. “Aging takes place over years or decades. You have to follow people for five to 10 years — and no studies have done that.”

Boomers Take Heed
Has brain training paid off for Maria Bravo? Since she began the training six months ago, she’s better able to recall what she’s read, she says. She has also started remembering dreams — something she hasn’t done in years. And she says that she’s no longer getting parking tickets.

That’s the kind of message that the nation’s 78 million baby boomers may welcome — especially since the oldest ones have reached age 60.

Dan Michel, himself a 60-year-old boomer, is founder of Dakim Inc., the creator of the [m]Power cognitive fitness system. Healthy seniors, as well as those with mild cognitive impairment or moderate dementiadementia, can do mentally stimulating exercises on a portable touch screen monitor that requires no computer skills.

Michel started the company after noticing that his father, who had Alzheimer’s, seemed to do better when he was mentally stimulated through books, puzzles, and painting. “It made him happier, calmer, and it made him feel more human,” Michel says. “He wasn’t just vegetating.”

Beyond providing mental stimulation, Michel hopes his system will improve users’ mood and overall quality of life, he says. Currently, it’s used in retirement and assisted living communities, but will be released for home use next year.

He also wants [m]Power to be fun, he says. Michel worries that older people won’t stick with brain fitness programs unless they’re also entertaining. His system is refreshed with new games and puzzles of differing levels of difficulty to prevent seniors from getting bored and giving up. It also has lively voice-overs.

For example, some activities feature Jimmy Stewart movie clips to appeal to seniors “when their minds were most young, active, and receptive to new information,” he says.

“We can’t coerce seniors to do what’s good for them,” Michel says. “We believe that Mary Poppins was correct when she said that a spoonful of sugar makes the medicine go down.”

When Michel was planning his company a few years ago, he had no rivals, he says. Now, he counts several companies, including Posit Science, among his competitors. “You are seeing the birth of this industry,” he says.

What Does the Future Look Like?
But are these new programs, which can cost hundreds of dollars, really necessary if you already do crossword puzzles or Sudoku, the popular logic-based number puzzles?

“If you’ve been doing crossword puzzles for 20 years, it really doesn’t turn the brain on,” Mahncke says. “It’s like riding a bike.” The brain needs new, varied, and challenging stimulation, he says. In other words, it has to get out of its comfort zone.

In previous research, Salthouse found no evidence that doing crossword puzzles alone helped to slow cognitive decline or boost knowledge.

While the ultimate usefulness of brain training remains to be seen, proponents believe that brain fitness should be promoted in the same way as physical fitness. Decades ago, the nation witnessed the beginnings of a fitness craze that drove home the importance of caring for our bodies, including watching cardiovascular health. As a result, we now know more about preventing heart diseaseheart disease, Mahncke says, including exercise and diet strategies.

In the future, as media stories have begun hinting, will this country also see more mental athletes “pumping neurons” and doing “neurobics” well into their twilight years?

Mahncke hopes so. “We’re on the cusp of this revolution. The brain is at least as important as the heart — if not more important — and we know so much less about it.”