Cognitive Training: Still a Questionable Area

by Guy McKhann, M.D.

February 2, 2016

This is a column from Dana's print publication, Brain in the News 

In a New York Times article, Paula Span takes on the highly questionable area of brain training and cognitive improvement or preservation. There are two problems in this area.

The first is demonstration that these cognitive training approaches actually work. Do they result in improvement in cognitive areas other than those that are the focus of the training exercises?

Studies that answer that question are difficult to execute. Who would you study, and for how long? Chances are that your study, which will have a study group and a control group, will not be a randomized population. More likely it will contain people motivated by cognitive problems in their family who are very anxious to participate in a positive trial. The cognitive intervention may be a computerized training program requiring 15 to 30 minutes each day for a defined period of time—say 10 weeks. But what else are these motivated subjects doing to aid their cognitive functions? There are all kinds of approaches making claims, such as diets, vitamin supplements, exercise routines, sleep programs and social interaction programs. Very few of these have been adequately evaluated. The most important factors, family history and genetics, are only recently being worked out. In a study of cognitive enhancement, are you sure that is all you are evaluating?

The control group is a particularly vexing problem. How do you keep them on board for an extended period of time (years)? Will they be searching for their own cognitive aids? Don’t underestimate the resourcefulness of the control group. I have been involved in studies where those in the control group had their own website and knew more about the trial than many investigators.

The other problem in this area is what companies are saying about their results. I am reminded of a discussion I had with David Mahoney some years ago. David was the first executive director of the Dana Foundation, and a superb marketer (he had been the head of Avis and Norton Simon). He told me in the health field you advertise two things: fear and hope.

In the area of cognitive function, or dysfunction, you don’t have to do much to create fear. Anyone who has been through the devastation of cognitive functions of a relative or close colleague associated with Alzheimer’s disease already is likely fearful. Some of these cognitive enhancement companies stop just short of saying that their program prevents Alzheimer’s or  slows its progression. Those kinds of statements forced the Federal Trade Commission to curtail Lumosity’s advertising.

What’s to be done? First, continue to monitor and exclude misleading advertising. This advertising is aimed at an extremely vulnerable group: an aging population anxious to preserve its cognitive abilities. Prevention of this hucksterism is the job of not only the feds, but also those of us in the neuroscience community. The stand taken by those participating with Stanford Center on Longevity, as outlined in Span’s article, is just a start. Of particular concern is the role of neuroscientists who are listed as advisors to these companies. These scientists are very valuable to the company in designing and interpreting studies. However, they should also help eliminate inaccurate advertising.

This area needs more carefully planned and performed research. I would suggest that a recognized institution, such as the National Institute of Aging or the National Academy of Medicine (or both) convene a group to plan a well designed study to determine efficacy of cognitive training. This group should include some representatives from industry. Such a study cannot be the sole province of a specific company—a favorable outcome could be viewed as biased; a negative result may never get published.

Getting this type of evaluation done is important; big bucks are involved. Lumosity, one of several companies in this market, has one million participants paying $80 per year.