Large Implications for Cognitive Aging and Dementia
SAN FRANCISCO — For the first time, a study shows a digital assessment can provide a scientific measure of acetylcholine – a key brain chemical whose decline signals the progression of cognitive impairment and Alzheimer’s disease. The assessment (here) can be self-administered and completed in about three minutes on internet-connected devices — with big implications for cognitive aging and dementia. The assessment was developed by Posit Science, the maker of BrainHQ brain training exercises and assessments, and examined as part of an NIH-funded study in collaboration with researchers at McGill University.
“Currently, it’s impossible for doctors to monitor this brain chemical despite its importance because it requires expensive imaging equipment and special expertise available at few research centers,” said Dr. Henry Mahncke, CEO of Posit Science. “This breakthrough shows a new path for routine monitoring of brain health by doctors and individuals.”
The brain’s neuromodulatory system produces brain chemicals that impact mood, learning, attention, responsiveness, and memory. Brain scientists have known for decades that the system (and its subsystems that produce various brain chemicals) operate more sluggishly (downregulate) with aging and various health conditions.
The assessment focuses on the cholinergic system — a subsystem that produces the brain chemical acetylcholine — sometimes called the “pay attention” chemical, because it is produced when you pay attention. The production of acetylcholine is known to down regulate with normal aging, and even more severely with pre-dementia and with Alzheimer’s disease and related dementias (ADRD).
Cholinergic function is recognized as a key biomarker of overall brain health, regulates the ability of the brain to change (“plasticity”), and is associated with stronger cognitive performance (in sensory processing, attention, learning, memory, and executive function). Poor cholinergic function is linked to the production of plaque and tangles associated with ADRD, as well deficits in other conditions.
Currently there is no easily accessible way to measure cholinergic function. No standardized blood test to directly measure it exists. Positron Emission Tomography (PET) brain imaging techniques can be used; however, this method is costly, requires specialized expertise, and exposes participants to radiation, limiting its use in clinical practice.
“We developed a digital cognitive test to be a sensitive measure of brain health. To validate the test, we approached the researchers at The Neuro at McGill University, because it is one of a small number of places on the planet with the imaging technology to measure acetylcholine directly,” said Dr. Henry Mahncke. “In this study, they measured acetylcholine alongside cognitive performance using our assessment.”
The imaging study enrolled 92 healthy older adults (average age 72). Each was measured using: a BrainHQ assessment (Double Decision); two other validated neuropsychological assessments; and a PET scan using tracer to evaluate cholinergic neurotransmission.
The study showed better scores on the Double Decision assessment correlated with higher cholinergic function, indicating that the assessment could estimate cholinergic function without the complexity and risk of doing a PET scan. These results align with prior studies showing a significant relationship between cholinergic function and cognitive performance as measured by clinician-administered tools.
The assessment was brief, taking an average of 3 minutes to complete, and demonstrated good usability with reasonable descriptive and psychometric properties. It was sensitive to age within the narrow band measured of 65-83 years and was not influenced by demographic factors such as years of education or gender.
The researchers conclude: “The results support the adoption of this scalable form of biomarker-informed cognitive assessment available to individuals with an internet-connected device.”
“These researchers also are looking at whether our brain exercises can upregulate acetylcholine, which would have a tremendous impact on cognitive aging and ADRD research,” Dr. Mahncke added. “We look forward to learning more.
BrainHQ exercises have shown benefits in more than 300 studies. Such benefits include gains in cognition (attention, speed, memory, decision-making), in quality of life (depressive symptoms, confidence and control, health-related quality of life) and in real-world activities (health outcomes, balance, driving, workplace activities). BrainHQ is used by leading health and Medicare Advantage plans, by leading medical centers, clinics, and communities, and by elite athletes, the military, and other organizations focused on peak performance. Consumers can try a BrainHQ exercise for free daily at https://www.brainhq.com.
This research was supported by the National Institute on Aging of the National Institutes of Health under Award Numbers R44AG039965 and 3R44AG039965-06S1. This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.