Volume 61, Number 1 - Winter 2010

 

By Myra J. Mayesh, MFT

Over the last two years, a growing interest in “brain fitness” has spawned new industries, products, programs and services. Brain fitness programs, sometimes offered within “brain gyms,” are found in places as diverse as medical offices, physical fitness centers, libraries and senior living facilities. At the forefront of this trend are software products like the Posit Science Brain Fitness Program and the Dakim BrainFitness System.

Sorting through the goods and services currently making claims to improve memory, increase concentration, enhance cognition and delay the onset of dementia can be confusing for consumers and professionals alike. 

These products promise similar outcomes, but they try to achieve those outcomes by very different means. Most are computer-based software games and biofeedback programs, but there are varied low-tech options, such as whole-body movement classes, presenters who teach memorization techniques, and motivational speakers who promote positive thinking as a means of improving mental functioning. 

What is clear is that brain fitness appeals to seniors and baby boomers alike. Sharpbrains.com, a market research firm devoted to the industry, estimates that consumers, senior communities and insurance providers spent $265 million in 2008 on brain fitness software programs alone.[1] Sharpbrains estimates that annual revenues for brain fitness companies may reach up to $5 billion by 2015.

The impetus for brain fitness programs comes from the scientific discoveries and theories about the brain that are rapidly making their way into the mainstream. As the public has learned about neuroplasticity (the ability of the brain to “rewire” itself) and neurogenesis (the formation of new nerve cells), the notion of being able to protect and improve your brain and mental functioning has taken hold. In particular, the concept of “cognitive reserve” suggests that education and participation in mentally challenging activities may compensate for the loss of neurons and synapses caused by Alzheimer’s disease.[2]

At Primrose, a dementia care facility in Santa Rosa, we recently created a brain gym, using the SharpBrains Guide to Brain Fitness as a “how to” manual.[3] Given rising health care costs, the increasing lifespan of our elders, and the growing prevalence of Alzheimer’s disease and other dementias, we have a strong interest in promoting healthy lifestyle practices and non-medical interventions to augment conventional treatments for memory loss problems.

Primrose is a residential and day care facility that serves patients anywhere on the spectrum of disease progression. Most of our residents are in the mid to late stages of dementia, primarily with Alzheimer’s disease. The day program serves a similar but higher functioning clientele. Our brain gym is designed both for our residents and day-club members, but only for those who can participate independently or with limited assistance. The brain gym is also open to community members at no cost three days a week, irrespective of whether they have cognitive impairment. These users are best described as the “worried well” who are motivated to do whatever they can to prevent memory decline.

The purpose of the brain gym is twofold. The first purpose is to educate the community about lifestyle factors that contribute to brain health. The second is to engage community members and our residents in activities toward that end. We want to provide structured and entertaining activities with demonstrated cognitive and physical health benefits. Entertainment adds to motivation and increases the likelihood of participation, an especially important consideration when assisting the memory impaired, who are easily prone to frustration. 

According to the Sharpbrains guide, a good brain fitness program includes balanced nutrition, stress management, physical exercise, mental stimulation and social interaction. Our brain gym directly impacts all these factors with the exception of nutrition, which we address by providing brain-healthy recipes for home use. Our brain gym is a multi-use facility for mental and physical activity, social engagement, and education. 

The centerpiece of our brain gym is the Dakim BrainFitness system, a software program that comes with a proprietary touch-screen console and does not require prior computer experience or knowledge. The system transforms standardized neurological tests into cognitively stimulating games that self-adjust to the user’s optimal level. One advantage Dakim has over other brain game software is its user-friendly format and high entertainment value. There are five levels of challenge, so even people with mid-stage dementia can play the games with little or no guidance.

Other programs on the market have more clinical validation than Dakim, especially Posit Science’s Brain Fitness Program, which was used in two large-scale research studies, ACTIVE and IMPACT.[4,5] ACTIVE included approximately 2,800 subjects, 65-94 years of age. It not only showed improvements in each cognitive ability trained, but also found that the gains were retained after five years. The IMPACT study included 487 healthy adults over the age of 65 and recorded substantial improvements in cognitive abilities resulting from cognitive training. Despite the impressive clinical results, the Posit Science program requires significant motivation to do the exercises, which are repetitive and abstract. In a dementia setting, getting clients to use such a program consistently is challenging.

Stimulating brain activity is believed to increase neuroplasticity and neurogenesis. Physical exercise may enhance these processes by delivering additional blood and oxygen to the brain. To encourage exercise, our fitness program includes both a half-mile outdoor walking path and Nintendo Wii games. Wii is a virtual reality program that simulates players’ actual movements on the screen, requiring both mental attention and physical action to play. The games include tennis, baseball, golf and bowling, and they can be played with one to four players. Every player is represented by an on-screen character (a “Mii”) in the virtual game environment.

A 2003 study of younger game participants showed that virtual reality, when paired with exercise, was able to enhance mood and create positive thoughts about exercise.[6] A 2008 study of older adults showed similarly positive outcomes.[7] 

Wii has become popular in senior centers and communities. The Oakmont retirement community, for example, has a Wii bowling league and regularly hosts tournaments.

An acknowledged problem in the brain fitness field is a lack of valid and reliable cognitive assessments that can be used to compare competing programs. The National Institute of Health aims to provide such instruments for general use within the next four to five years. Meanwhile, skeptics argue that the jury is still out on the efficacy of brain training programs for delaying or preventing dementia. One review of 20 software studies, for example, found that the research behind most of them was marred by a lack of control groups and follow-up.[8] 

When our residents and day care members start our brain gym program, I administer an MMSE (Mini-Mental State Exam) and give them a score on the Functional Assessment Staging Tool, which documents the progress of Alzheimer’s disease. We also track observable behaviors on an instrument developed internally by Primrose. The brain gym opened in October 2009, so we have only established baseline assessments for our users; but we plan to retest them periodically to see if their participation has impacted any of these measures. For community members with little or no memory impairment, we additionally ask them to fill out a Subjective Memory Questionnaire. 

Thus far, we are encouraged by the results we are seeing. Our participants are enjoying the mental and physical exercises, and some have expressed feelings of accomplishment and a sense of agency. They recognize that they are doing something helpful for themselves.

Even if one finds the evidence lacking in terms of cognitive gains, there are secondary gains, not the least of which is increased confidence and perceived improvements by the participants. Similar to health clubs, brain gyms offer convenience, guidance, structure and specialized equipment to help users establish and meet their goals.