April 25, 2014
Miami Herald
Howard Cohen

Detail-oriented brain functioning? Check.

Speedy brain processing. Check.

I’m sitting before a touchscreen laptop inside the University of Miami’s just-opened Brain Fitness Pavilion on its downtown medical campus. The new center opened in March to offer comprehensive cognitive programs, neuropsychological assessments, assessments of everyday living skills. The pavilion also features one addictive tool: BrainHQ.

The online brain training program, designed by PositScience, is the only cognitive remediation intervention to be considered by the FDA as a medical device.

Staff members of the Brain Pavilion, including professors of psychiatry at the University of Miami Miller School of Medicine, Dr. Phillip Harvey and Dr. Sara Czaja, along with Dr. Jessica Taha, senior research associate at the Center on Aging at UM, monitor patients’ progress with the program and can use the scores to determine treatment.

“The idea of the Brain Fitness Pavilion is to use the software package, which is designed to improve multiple aspects of cognitive functioning. It has been shown in previous studies to improve people’s everyday functioning,” Harvey said.

Studies of PositScience’s exercises found that participants, healthy adults aged 65 and older, more than doubled the speed at which they could accurately process visual information.

Playing mind games

Here’s an example: A brain speed test, Hawk Eye, is one of five tests in this category that includes visual and auditory cues. The test flashes a flock of birds on screen. The aim is to spot the bird that is different and recall its location on the screen immediately thereafter. You will click on that position once the birds disappear. This test is meant to help people increase brain speed, a key component of good health.

I’m suddenly an accomplished bird hunter at age 50. Managed to slash my score from 316 milliseconds (and a one-star rating on first attempt) to 133 milliseconds on a third attempt (scoring the game’s top five-star rating.) As I improved, the birds appeared for fewer milliseconds. The score reflects how quickly a participant can take in and accurately respond to what they saw.

“Think about crossing the street. You are processing whether to walk or not,” Czaja said. “Or making a left turn, processing speed is crucial to that.”

When it comes to brain speed, milliseconds matter. How quickly your brain can process events around you determines how you can react to and remember those events. But with age (and certain cognitive conditions) the brain slows down. And that can have a major effect, as in the ability to avoid a crash when driving.

Ah, but here we hit a bump. Two other skills tests — Navigation (determining whether two shapes are identical when inverted in your mind or are mirror images) and Intelligence, a Card Shark game in which you must remember whether a set of ever-changing cards are the same or not — found me in the cosmos of falling stars. I forgot to mentally invert the shapes and resorted to guessing on first attempt.

These two, out of six skills, which also include focusing attention, improving memory and enhancing people skills, suggest I’ll not pose a threat to anyone at the Hard Rock Casino’s poker table. That is, if I can find my way to the Hollywood hotspot without turning on Google Maps.

Also challenging, the People Skills section. Users listen in on a conversation between cartoon figures of a man and two women chatting at a kitchen table. You are to try to remember what they said and who said what.

“Demetrius gave a great concert” in one conversation, I correctly responded. But Raven really “didn’t dress like a bunny rabbit” in the same gossip session. I thought he had. This task was difficult — and to be a good witness, say, on cross examination, you better be able to pay close attention to conversations.

Brain workout

Practice, with games like BrainHQ and the similar Lumosity, a popular online subscription-based brain strengthening tool that was launched in 2007 and now has 60 million users worldwide, can help fine tune brain functioning. (The company, however, has not sought FDA approval.)

“Lumosity is like a gym for your brain,” said Dr. Joe Hardy, vice president of research and development at San Francisco-based Lumos Labs, the makers of Lumosity, in an email. “ Games are based on a combination of common neuropsychological and cognitive tasks, many of which have been used in research for decades, and new tasks designed by an in-house science team.”

The reason these kind of games are said to work is that BrainHQ and Lumosity’s more than 40 games focus on strengthening the neural pathways of the brain through repetition of the exercises. This process helps fire bioelectrical changes in the brain. In other words, use it or lose it.

“Reading, doing crossword puzzles, whatever stimulates you intellectually,” can be fruitful said Dr. Brad Herskowitz, a neuroscience consultant and neurologist at Baptist Health.

The gym metaphor Hardy touted is apt, Harvey said. “The brain is like a muscle that is built not by lifting one-pound weights but more and more weights and now we know that everything changes your brain.”

In addition to mind games, social interaction is paramount to keep the brain as healthy as possible. “Evidence is coming out of the importance of social engagement,” said Czaja. “It’s important to be active and engaged.”

When to check

So when to worry?

Some “senior moments” are OK if you eventually get where you want to go.

“There is normal aging where people might forget where they put their glasses but they can generally retrace their steps. Or they forget a name but can remember it later. But if it’s something persistent this may be a sign that this may be more than normal aging,” Herskowitz said. “Other things like forgetting words. If it’s something where you can’t have a conversation or a more pervasive problem there is concern as well.”

Patients who seek help can expect a detailed consultation with a neurologist. These visits often will start with lengthy chats and trying to get to know a patient’s history before testing begins.

One test, the Mini Mental Status Exam, for example, is a 30-question query of generally simple questions about the current date, season, mode of transportation to the office visit. Basic mathematical calculations and spatial tests and composing sentences are standard features. Each question answered correctly is worth a point. Someone who aces the test is more than likely fine. Someone scoring 20 or fewer could undergo further neurological testing.

At UM’s Brain Fitness Pavilion, patients are referred for various reasons. “You have a memory complaint or a diagnoses of a memory cognitive decline,” Czaja said. “Just forgetting your glasses is common. If you start to notice you don’t remember people’s names or where you are or how to get to places it’s a good idea to discuss this with a physician and get a cognitive work-up. In the field of memory decline disorders, early diagnoses is better as you have more time for treatment.”

The scene

Some who come here are healthy seniors who wish to keep their brains sharp with the BrainHQ cognitive tests, which they can also perform at home once they purchase the program at $96 per year. The center is laid out in a casual, non-hospital-like atmosphere to reduce anxiety during visits. Patients work on laptops, a coffee pot keeps fresh brew — it’s almost like a Starbucks.

Still others come because they have suffered a traumatic brain injury or have severe mental illness. These programs “are designed to train multiple different aspects of functioning,” Harvey said. “Attention. Memory. Problem solving and knowledge in general.”

By late summer the Brain Fitness Pavilion medical staff aims to add a training package component in which patients will integrate the BrainHQ portion with actual simulations of things that people do every day, like banking, refilling prescriptions and managing meds, Czaja said.

“You get the fastest gains if you improve cognition and teach skills at the same time,” Harvey said.