Training your brain for real-world functional improvement with Dr. Henry Mahncke.
What’s the difference between a brain game and a classic game like Monopoly? Unlike other games, brain games are specifically designed to drive structural and functional changes in your brain, leading to improvements in cognitive speed and accuracy. Not all brain games are created equal, however. In this episode, Dr. Henry Mahncke shares some of the exciting clinical research behind brain games developed by BrainHQ, including one study that showed a 48% reduced risk of a car crash for seniors who practiced one type of brain game!
Online games that are designed to improve cognitive function
What does the research show?
Study: Improvement in Memory with Plasticity-Based Adaptive Clinical Training
Showed improved memory and cognitive function in brain training group
Performed on adults over 65
More than 100 papers to date show these benefits
Study: Gaming for Health: Systematic Review and Meta-Analysis of the Physical and Cognitive Effects of Active Computer Gaming in Older Adults
Study: A Large-Scale, Cross-Sectional Investigation Into the Efficacy of Brain Training
Study: Emerging Cognitive Intervention Technologies to Meet the Needs of an Aging Population: A Systematic Review
Study: Enhancing Cognitive Functioning in Healthy Older Adults: A Systematic Review of the Clinical Significance of Commercially Available Computerized Cognitive Training in Preventing Cognitive Decline
Not all brain games have been researched, be careful
Review on brain games showing most games did not have science
What can brain games improve?
Brain plasticity aka rewiring
Improved processing speed and accuracy by reducing neural ‘noise’
Summary … 00:00:42 Episode Intro … 00:03:16 Brain Game Basics … 00:05:01 What the Research Says … 00:07:30 Measuring Improvement … 00:10:51 How it Works … 00:14:26 Broad Application of Brain Exercise … 00:18:25 Attention, Attention … 00:23:09 The Best Way to Use Brain Games … 00:28:15 100% Adherence is Not Required … 00:33:11 How to Get the Most out of the Tool … 00:36:12 Episode Wrap Up …00:41:53
Dr. Michael Ruscio: Hi everyone. Welcome to another episode of Dr. Ruscio Radio. Before we get into the show today, I want to give you a quick summary. Today I discuss brain games with Dr. Henry Mahncke. The interesting thing about brain games is they have been documented, in over a hundred clinical trials, to benefit the user cognitively outside of just the game. One of the questions we should be asking is, “If I’m playing this brain game that’s supposed to give me better memory, better processing speed, better creativity, better problem solving, am I just getting better at that game; or will I get better at other stuff in the world that is cognitively dependent?” The answer seems to be yes. We talk about this and we talk about how you have to be careful with the brain game that you use.
There are a bunch of what appear to be free, knockoff apps that claim to be brain games in many of the app stores. If I’m referencing his citation correctly, an analysis found that only two of the available brain games on the market actually have clinical trials supporting the games that are used in each of these offerings. So there’s definitely some very interesting stuff here regarding brain games that are available, that are cheap and easy to use, are actually fairly fun, and can help with your cognition, processing speed, memory, and problem-solving skills.
I have been using two of the available apps: BrainHQ and CogniFit. Henry is from BrainHQ. We talk about their science and the rigor they’ve gone through to bring to you a simple game you can play for 10 minutes every morning that can improve your brain health. Again, you can start using these games most mornings. If you miss some time because you’re busy or traveling, that’s fine. But there is a carryover that can improve your cognition. It’s hard to think of a scenario of anyone’s life where more cognition would not be a benefit. So with that, we will now go to the interview Dr. Henry Mahncke and the discussion on brain games.
DrMR: Hi, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. I’m here today with Dr. Henry Mahncke, and we’re going to be talking about brain games. More specifically if and how much brain games may be able to help keep you cognitively sharp. This is something I’ve personally experimented with, so I’ll share my story as we get rolling here. But first, Henry, welcome to the show. I’m excited to talk with you about all things brain games.
Dr. Henry Mahncke: It’s great to be with you
here today, Michael. Thank you.
DrMR: Can you tell people just in brief your
background and how you got involved in the space of brain games?
DrHM: Sure. So, my background is as a scientist. I did a Ph.D. at the University of California, San Francisco, and during my Ph.D. I worked for a guy named Dr. Michael Merzenich. Mike is legendary in the field of neuroscience for discovering the idea of adult brain plasticity, which I think we’ll talk quite a lot about over the course of our time together. Long story short, what adult brain plasticity taught us was that the adult brain can rewire itself really at any age. So eventually Mike Merzenich founded this company, Posit Science, and recruited me to come to help him get off the ground with the idea of being that we could apply this science and help millions of people have sharper, faster, better brains.
DrMR: Awesome. We have checked the research just to make sure there’s at least a preliminary research leg to stand on, and there definitely appears to be. So for the kind of evidence-based facet of our crowd, we will get into that in a little bit, but I want to get some of the basics out of the way first.
Brain Game Basics
If you’ve never played a brain game, the idea may not be appealing to you. However, as someone who has played brain games, I can tell you that often you don’t even realize you are doing something good for your brain. They just seem like a game. They’re fun and they’re engaging, but can you explain or define what a brain game is?
DrHM: Well, we usually think about it as something that you can do that is designed to and does drive structural and functional change in your brain. It is directed at making your brain better at processing information so that you end up with sharper, faster, better cognitive abilities. Usually, when I talk about this, I actually divide the world into at least two groups. There are a million games out there you can do, right? You can play Monopoly, which engages your attention and makes you do some planning, right? You can play Tetris, which probably involves your 3D spatial abilities. But none of those things were specifically designed to change the brain. Most importantly, from an evidence-based medicine perspective, none of them have ever been through good, randomized, controlled trials to show that they do change the brain or improve brain function.
I usually think of the other side of that coin as brain training. What I mean when I say brain training are things that share some of those properties. They’re engaging, they’re visually compelling, they can be fun to do, but they’re designed with a deep understanding of what changes about the brain that gives us worse cognitive function. They are designed with a deep understanding of how to rewire the brain to give us better cognitive function. Most importantly, they have gone through gold-standard clinical trials to show that they actually improve cognitive function.
DrMR: So, there’s definitely a difference between an ordinary game, which you may get some benefit from, and a brain game. A brain game is much more specifically designed and they’ve been tested. Maybe that’s a good segue to what some of the research does show. Whenever confronted with something new and novel and interesting, we check to make sure that the claims are supported. Because sometimes what you have is six rats played this game and then they seem to have improved mood, in whatever way we can assess the rat’s mood. Then some company says, “Oh, we’ll improve your mood with this brain game,” and it’s really a stretch. There have been human outcome studies, although I’m a little fuzzy on the details of what’s been found because we reviewed this data maybe six months ago. So give us a refresher on what’s been published here.
What the Research Says
DrHM: Yeah. It’s been really quite an interesting field. We certainly have our share of rats, and I can tell you about those in a bit. That becomes of interest too, but we have more than our fair share of human trials as well at this point. When we founded Posit Science back in the day, at that time there really wasn’t very much scientific literature around brain training. There were a ton of people who thought, “Hey, this just can’t be done.” They were coming from the belief that essentially adult cognitive abilities are fundamentally crystallized, that they’re fixed in their ability.
That while you might train and get better at a specific task – like I can get better at juggling or I can get better at bridge or I can get better at a game like Mario Brothers or Call of Duty – there wouldn’t be any broader benefits. At least that was the general belief. So, when we got Posit Science going, one of the core things we wanted to do was to put the program that we built through large-scale, randomized, controlled trials. To show that we had built something that not only that worked in rats, which is always a good start, and was sensible from a neurological perspective, but really had the evidence behind it just the way you’d expect a new drug or a new medical device to have. One of the first things that we did at Posit Science was we ran a large clinical trial called IMPACT. Every trial, as you probably know, has got to have a funky acronym. Ours was Improvement in Memory with Plasticity-Based Adaptive Cognitive Training, and if you pick out exactly the right letters from that, you can get the word IMPACT, which seemed like a good name for a clinical trial. We ran IMPACT with independent academic investigators at several different clinical trial sites.
We worked with Dr. Glenn Smith at Mayo Clinic up in Minnesota, and Dr. Elizabeth Zelinski down at the School of Gerontology at USC. We actually enrolled 487 healthy older adults, people over the age of 65, into the trial. We randomized this group. Half of them did the brain training program that we had built, and half of them did what we call an active control, which is kind of like brain training but is missing what you might call the secret sauce of our particular type of brain training. I’ll say a bit more about probably both those things in a moment.
So we ran that trial, measured everyone’s cognitive performance before training and then after, and showed a beautiful, significant improvement in standardized, generalized measures of memory, kind of things that a neuropsychologist would use to test your memory. And that improvement was specific to the brain training group, the Posit Science group, and was considerably larger than was seen in the active control group. That was really the first gold standard trial to show that a specific kind of brain training designed to do a specific thing in the brain could yield the kind of generalized cognitive gains that are required to say that the program is effective.
That got published in the Journal of the American Geriatrics Society. At this point, there have actually been more than 100 published, peer-reviewed papers showing that these exercises in BrainHQ work, which is to say they improve cognitive function and they improve real-world function, so the field’s just come a long, long way over the past 15 years.
Improvement & Transfer Benefits
DrMR: That’s a great preemptive answer to the next question I wanted to ask, and it’s a question I often ask myself as I complete these games. Is there really cognitive improvement….or am I just getting better at the games? Because I definitely did see improvement. Whether it be visual processing speed or short-term memory, but I wonder, is this going to transfer over to my working memory, to my vocabulary, to my creativity. As you just suggested, there was a cognitive measure outside of the test, a kind of independent measure that showed benefit. Can you explain a little bit more about what kind of transfer benefits people are seeing in some of the research?
DrHM: Yeah, it’s a great question, and you should be
asking that question, and you should be skeptical. That’s a good way to be, and
it’s a good way for people listening to this podcast to be as well. We’d
encourage that. This question is a great one, and it’s fun to kind of rewind
the clock where one of these ideas came from was this very influential I guess
case study back in the early ’70s where people were looking at memory training.
What they showed is that you can train someone to remember, to memorize I guess
I should say, an enormously long list of numbers, right? You can train someone
using tips and tricks and strategies and practice that they can remember 100
digits or more in a row.
interestingly, if you ask them then to try and remember 100 letters or so in a
row, they haven’t gotten much better at it.
This kind of led to the original notion that training benefits were
incredibly narrow and specific. And, I mean, hey, that observation is probably
true. I mean, I haven’t personally tried to replicate it, but I believe
it. Because it’s so strategy-dependent.
It’s quite specific.
trying to do with the BrainHQ exercise is really something quite different. To
ask this question about what we’re trying to do, you have to ask, “Hey,
what’s going wrong in the brain as we get older that’s causing poor cognitive
A lot of psychologists would say, “Well, memory is getting worse. There’s a place in your brain that’s involved in memory, and that’s getting worse, and that’s what’s happening.” Of course, there’s some truth to that, right? The hippocampus shrinks, as you know and your listeners know, and the hippocampus is involved with memory. But there’s a ton more going on in the brain as well, and one of the most important things in the brain that happens as we get older is the speed and accuracy of our information processing actually gets worse. What I mean by that is the ability of the brain to resolve fine differences in time or to resolve fine differences in what a person sees or hears actually gets worse.
The best way to think about it is that as we get older, it’s almost like we have a source of internal noise in our brain. It’s like our brain’s a radio that slowly gets turned off the station and gets more and more static behind it. And as a result of that internal noise, our brain has to work harder to process what we hear and what we see, and because it’s working harder just to do the basics of that processing, it’s actually not able to engage attention and memory and thinking systems as effectively as it used to. As a result of that, a person starts to notice problems with, well, attention, memory, and thinking.
Those problems, in many cases, contribute to this core problem in the speed and accuracy of information processing, or the problem of neural noise. So, when we build brain training exercises in BrainHQ, there are about 29 of these exercises and each one of them is different. But that being said, they all do share some core principles, and one of the core principles they share is that in each of their own unique way, they’re trying to improve the speed and accuracy of information processing in the auditory system, or the visual system, or the cognitive control system, or what have you.
How it Works
The idea is that while you improve speed and accuracy, how information flows through a system, well you might be able to improve how all kinds of information flows through that system so that the benefits that you gain from practicing on those exercises might then see these kinds of real-world benefits that we’re looking for. So, let me take that abstract idea and make it specific. We worked very closely with some wonderful scientists who had invented a cognitive training exercise they call it generically speed training or useful field of view training.
And the way this training works is that you look at a computer screen, and in the center of your vision you see an object that you have to tell apart. You might see a little car or a little truck, and at the same time that all your attention is focused on the center of your gaze, they also flash up something in your peripheral vision. And you don’t have to tell what it is, you just have to notice where it was, was it at 12:00 or 3:00. That sounds like a pretty easy task, but if you make it fast enough it becomes quite hard, and the reason is that your attention is captured by the hard task in the center of your vision, “Do I see a car or a truck?” And you literally almost don’t notice or don’t see the target in your peripheral vision.
Now, this turns out to be a really interesting task, because if you’re bad at it, you have a high car-crash risk that’s been shown over and over again in studies with thousands of people in it. It kind of intuitively makes sense, right? If you’re driving and you’re focused on, let’s say the car in front of you, and you have the kind of brain that doesn’t notice something in your peripheral vision, well you might get in a car crash, right? You might be crossing an intersection and a truck might jump a stop sign, or a kid might run out on the street and you might not see it fast enough.
got exciting was they show that if you practice on a task that is very much
like that, captures the center of your gaze and you have to notice things in
your peripheral vision very quickly, not only do you get better at the task,
but you actually show safer driving. And in a study of more than 1,000 people
funded by the NIH, they showed that people over the age of 65 who did that
training actually reduced their risk of having an at-fault car crash by about
And that’s a beautiful demonstration of how practicing what seems like an abstract computer task, can be related to a world task by making the brain faster and more accurate, especially in peripheral vision. It can help you out in a real-world situation, so that’s what we really think about when we think about the generalization of real-world activities.
DrMR: Now, I know we have a number of people listening to this who are health care providers of various sorts, or even laypeople who are kind of acting as their own health advocate. And I’m wondering when it comes to … I guess this would be perhaps abstract problem-solving for the layperson trying to just figure out, “Okay, I’m not feeling well. How do I go on the internet and take this mass of information and use it to abstract problem-solve X symptom that I’m being plagued with?” Or practitioners may be trying to identify patterns in the patients that they’re seeing. Is there any data there that might be worth mentioning?
DrHM: Well, yeah. And again, I’m a Ph.D. scientist, I’m not a doctor in the helpful way that you are, I’m the kind of doctor you call if you need surgery done on your rat, as I said before.
DrMR: Hey, we’re all working together, right?
DrHM: That’s right. But what’s interesting about the science of this to me
is that there are a lot of disorders, neurological and psychiatric disorders,
which are of course quite different, right? A person who has genetics that
cause them to have schizophrenia is different than a middle-aged person who
falls off their bike and gets a concussion, and that’s different than an older
person who’s starting to have cognitive decline associated with aging. Those
are all different, without a doubt.
Broad Application of
But that being said, when we look at what the cognitive symptoms are in those cases, they’re really a lot more similar than they are different. And what I mean by that is all those kinds of people are going to suffer cognitive slowing, some more than others, without a doubt. All of them are going to suffer attention problems, concentration problems, memory problems. That has led us from a basic science perspective to start to wonder what’s going on that there are a lot of different ways that you can impair or you can damage, so to speak, brain information processing, speed, and accuracy. There are a lot of ways you can create a noisy brain, and again, mental illness, neurological disorder or aging.
the brain is in that noisy state, maybe a similar set of brain exercises
designed to improve speed and accuracy and take out noise, maybe they’d be
helpful in a broad variety of these kinds of situations. Now, I want to be
careful and respectful to your medical audience. There’s a ton of science here
to be done, and we are just at the earliest days of seeing whether this kind of
approach can be helpful in a broad spectrum of issues like this.
But what kind of gets my attention about it is we know that physical exercise is great medicine, right? We know that there are many, many situations where physical exercise can help improve a person’s mood and cognitive function, even though the person might have bad cognitive function or bad mood for a whole variety of different reasons. Maybe certain kinds of cognitive exercises are going to be like physical exercise in that way in that they will be able to help with a lot of these conditions, and that would start to be quite exciting if the data really took us in that direction.
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DrMR: Yeah, agreed. I’ll just share what I have observed, not in myself, although I find benefit. But I find it easier to comment on me watching someone else. It’s easier to see the benefit when you’re the outside observer looking in. And so I got my mother plugged in to do these games. I’m sure everyone can relate to this, anytime you’re trying to show your mother how to do something on the phone or the computer, you want to pull your hair out because they just have such a difficult time navigating.
And what was interesting in observing my mother do these brain games is exactly what you commented on a moment ago, which was this noise. It seemed that even though the instructions were clearly listed right in front of her, she would just click without reading. And she wasn’t actually paying attention to the instructions right in front of her, and it just seems that all the other stuff on the page, the banner, your navigation options, your forward, backward navigation arrow, the clock in the bottom right-hand corner of your screen, all those things it seemed were distracting her from the one sentence of salient data right in front of her on the screen. Love you, mom – Just wanted to say that really quick.
And as she
started playing the game, she started realizing, “I’m not really paying
attention when I’m on the computer, when I’m doing things on my phone.”
But she was able to start filtering out all the information that wasn’t relevant on the screen in front of her, and really honing in on the directional items that she needed to complete the task. So for her, this appeared to be very helpful, because as I watched her over a couple of weeks, she really was better able to focus on the salient information and not get distracted. And actually, she slowed down with how quickly she would click through the screens, but her accuracy was way higher. I think that’s one thing that happens, is people don’t really read, they click, and then they can’t figure out why they can’t get X, Y or Z to work. So, I’ve definitely seen in some regards the ability to kind of filter, focus and execute more accurately.
DrHM: Yeah. That story brings up so many interesting issues, one of which is, of course, this issue of attention. Attention is a precious resource, and particularly in modern life, there are so many things clamoring for our attention at all times, both visually you’re out in the world and on your computer, there are banners going off, and ads popping up. And if you’re outside in Downtown San Francisco, for example, where I am, there are 42 things going on the street at all times. There are so many distractions in the auditory environment, so many cognitive distractions. Attention is a precious resource, and we start to shelter it, right? We start to move through life a little bit more like automatons. We need to shelter our attention from all those distractions.
But of course, attention is absolutely required for brain change. Your brain does not change through the principles of brain plasticity unless you’re paying attention. There are, of course just hundreds of rat and humans experiments that show this, right? If you were to … We’ve built brain training programs for rats, as I’ve mentioned, and as a control what we’re shown is that if you play all the same sounds or show all the same images to a rat but it doesn’t pay attention, nothing in the rat’s brain changes. And of course, we probably all know this from personal experience. I think probably each of us, Michael, had a class or two we probably didn’t give our full attention to when we were getting our medical and scientific education. And ever so slightly, maybe that was the class that we didn’t learn as much from.
DrHM: So, attention is required for brain change. And what I love to hear from your mom’s experience is that she was able to kind of take down those guards around her attention that she had set up because computer experiences are so distracting in the modern age, and able to re-engage and focus that attention. By focusing that attention, then open up her brain for change, and that’s exactly what we want to see from these kinds of programs.
DrMR: Is it fair to say that … And this might be, excuse me, a hard
question to answer. I’m not sure what the breadth of ages of the different
samples in these studies has been, but I’m assuming that the older audiences
may benefit more. Just like with an exercise program, you’ll probably see more
of a carryover to mortality, morbidity with a younger population than an older
population. But is there any nuance there or anything that’s interesting
regarding the age-associated effect with this brain training?
DrHM: I hate to be semantic, but it all depends on what you mean by better and how you measure it. And what I mean by that is most tests of memory or cognitive function, for better or worse they were designed for people with bad memory and cognitive function, right? Neuropsychologists didn’t spend a ton of time on how to measure the cognitive performance of smart, sharp, fast people. They were interested in measuring cognitive performance in brain-damaged people.
That creates a problem for us as clinical scientists. What I mean by that is when we run a clinical trial, we, of course, want to use standardized measures of memory and attention and what have you. But in many cases, those measures can have sealing effects with younger, healthier populations. It’s a little bit difficult to see improvement on some of these measures in younger, healthier populations. So, in that sense, sure, from a numerical basis. People who have more room to grow, we often see them grow more. I’m not really convinced that’s a biological phenomenon. I think a lot of the time that’s a phenomenon of the testing instruments that we have to use.
And to go back to your physical fitness analogy, sure, you might see greater physical gains in a population that’s, let’s say sedentary or already having some health problems. But at the same time, as a physician, I’m sure you would recommend to your middle-aged patients that they start to invest in their physical fitness health now, right? No one would ever say, “Hey, ignore physical health until you turn 60 or 70. That’s the time you’re going to get the most benefits,” right? You’d be laughed out of the room. We know that these are lifelong habits that should be developed, and not only should we develop them now so we have them when we’re older, but we should also develop them now because it’s kind of like putting money in the bank to have good physical fitness when you’re in middle age, right?
I am pretty sure that cognitive fitness works exactly the same way. It’s just more and more interesting studies coming out around the concept of cognitive reserve, which is to say the cognitively-challenging activities that you engage within your work, in your family life and your social life. The more of those that you do when you’re young and middle-aged, you have more gas in the tank, so to speak, when you get older, and then you’re more likely to resist the effects of dementia successfully as you get older.
Now, these are incredibly hard studies to do scientifically, right? It’s hard to randomize a group of 45-year-olds and tell half of them, “Don’t do anything with your brain. Let’s see how it works out when you’re 70,” right? That’s not an easy study to do. It’s probably not even an ethical study to do. But we see more and more evidence of this, and so I’d have to believe that the benefits of involving yourself in cognitive training at younger ages or middle age ages are likely to be highly useful as a person gets older.
The Best Way to Use
DrMR: Yeah, that makes complete sense. A couple of questions now regarding the best way to use these. To briefly my experience, I’ve used BrainHQ, and I’ve also used another company called CogniFit, and they both seem pretty friendly on the user interface, and the games are engaging and fun, and there is some reporting. I’m looking right now at my reports. Over the month I was using this program, I kind of went back and forth just to kind of test them both out and feel them. I can see that my AQ, I guess it’s the measure here, went up quite dramatically over the month that I was training. One of the things I wonder about is, how is someone to best use these over time? And I’ll just share one of the things that I perhaps got a little bit lazy regarding, but after doing this faithfully 15 minutes on almost every day, I got a bit kind of burned out on it.
assuming that happens. So, are there some techniques that I can use to be
better about this? And maybe once I’ve got somewhat fit, I can go two, three
times a week. Or do you recommend people cycle on and cycle off? What does this
look like in the longer term?
DrHM: Yeah. It’s a great question. The big picture is this probably works like physical fitness, which is that, hey, training a couple of times a week and aiming in that week to achieve maybe 90 minutes, 120 minutes of training is an excellent goal. And that both physical fitness and brain training are different than taking a drug, right? If you’re taking a drug and you stop taking the drug, well, within a couple hours or days at most, the effects of that drug go away too.
But as you know with physical fitness, if you exercise for a while and then you stop for whatever reason, the benefits of your improved physical fitness don’t vanish within hours or days. They do go away step by step. That’s a shame. I exercised a lot in my twenties and it didn’t last to my forties, I’m afraid to say. But you have to get back to it, and of course, there are wonderful studies in brain training that show exactly that, so we’ve got studies done by the NIH and studies done by us and studies done by independent academic partners, all using these exercises in Brain HQ. This shows that you can see the improved performance benefits weeks later, months later, and really in many cases, years later after a person has stopped.
And you might say, “That’s crazy. How could you train for some amount of time and then see the benefit a year later? I can’t even remember someone’s name after I meet them, right? How could the benefits last that long?” And the answer is that these kinds of cognitive training exercises are … The kind of work you’re doing for your brain, it’s not like learning a new fact. If I teach you that Moscow is the capital of Russia, you might remember or you might forget it a while later. This is more like learning a new skill. So, my daughter for example, when she was about 10, she learned to ride a bike, and I’m in San Francisco, so kids learn to ride bikes late here. That’s just the way it is.
But after about 10 hours over the course of about a month or so fooling around on the bike, she could ride a bike. And if she stopped, that knowledge wouldn’t just drip out of her head and she can’t ride a bike anymore. She’ll be able to ride a bike for the rest of her life. She might not be as good at it as if she practiced all the time, but that bike practice has kind of permanently changed her brain so that she now has a brain that can ride a bike. BrainHQ training exercises are like that. It’s not like learning facts, it’s like practicing skills, and in that sense, once you have improved your performance, the benefits can last quite a while.
And so what that means is we’re pretty comfortable telling people that these kinds of on, off cycling patterns, are just fine, and many people have experiences like yours. They’ve trained for a while, and then hey, life gets in the way, they get busy, they got other things to do, they’re traveling and they go away for a while. And then they come back and they see that their brain AQ has worn down a bit, they boost it back up, they see that your scores on the exercises have gone down a bit, they want to get them back up, and that’s a perfectly reasonable use pattern.
And frankly, you probably know this from your patients as well, that’s true for physical exercise as well. I’m actually a pretty reliable gym-goer. I get up at 5:00 in the morning and I go to my local Y two or three or four times a week. But there’s always over the course of the year a couple of weeks, sometimes a month where I’m not able to go. I get distracted, I don’t feel like getting up in the morning, and that’s fine. Time passes and I get back on the wagon and I keep going. Franky, that’s good enough, and that’s great news because I think that is something that most people can eventually get organized to focus on. You don’t really have to do this every single day for the rest of your life. It’s not like taking a pill, which you might have to do for the rest of your life.
100% Adherence is NOT
DrMR: No, I mean, that’s fantastic, because it kind
of motivates me to get back on the horse, and I think this is also just a good
lesson for practitioners. If we deliver, let’s say as an example, as a proxy
here, a diet here recommendation and we tell someone, “Well, if you miss
any of the days and you’re going to cause all these inflammatory up regulations
in your intestines, and it’s really going to be damaging,” it makes people
much more prone to give up.
DrHM: Right, exactly right.
DrMR: Yeah, just hearing from you, Henry, the fact that it’s okay to take
some time off and then get back to it makes me actually not feel like I failed
and I’m back to square one, but okay, I got kind of busy, I got kind of bored,
and I’m going to now get back to it knowing that I haven’t irrevocably lost my
results and I have this foundation I can build on.
DrHM: And you’re exactly right to tie it to dietary
interventions, right? If you tell a patient that 100% rigorous adherence is
required, you’re really just going to scare them off, because people know that
they can’t do that and they’ll just not even try. And again, if we go to the
physical fitness metaphor, if you have a patient who’s sedentary, not getting
much exercise, you don’t tell them, “Well, you need to run three miles
five times a week.” That’s a nonstarter.
thing you do is say, “Hey, why don’t you get off the couch and let’s just
try and go out for a 10-minute walk?” Right? Okay, well once we’ve
achieved that milestone, let’s see if we can grow that a little bit. And that’s
how we think about brain training as well.
I would never want someone not to start because they think, “This is so intensive, I’m never going to get to it.” What I would tell anyone who’s thinking about brain training is exactly kind of what you did, “Hey, why don’t you start, do it for 10 minutes a day? Try and do it two or three times a week. Once you have a little bit of habit like that, see if you can up it a bit, maybe do it 20 minutes a day. Maybe make sure you’re doing it three times a week, and then try and grow from there. Then when you go on a vacation or you have friends in town or life just gets in the way, hey, celebrate what you did and then make sure you get back to it over time. Don’t feel bad, don’t feel like you did a bad job and your brain training program is disappointed in you. You don’t need any of that, right? Just make sure, again, like any good habit, you eventually get back on the wagon and keep going”
DrMR: Yeah, that’s a great, great perspective. When I look at the homepage, there are a few options. I’m just wondering if there are some best practices you can share so that when people plug into BrainHQ, they know what might be the best way to use this. And one thing I always wondered was there is this personal trainer option, it’s called Personal Trainer with Daily Spark, and then there’s kind of select your own exercises. I know you can set goals. Does the system kind of learn what you need and adapt it to you? Should I be sculling into the exercises and trying to set specific exercises based upon my goals? What’s the best way to get the most out of this tool?
DrHM: Yeah, you’re exactly right. BrainHQ has got two modes of operation.
One of them is kind of exploratory, right? Pick an exercise that you might like
and do as much of it as you want, right? It’s kind of like going to the gym and
saying, “Hey, I want to lift that weight, and I want to do some sit-ups,
and I’m going to build my own program.” If a person has confidence and
kind of knows what they want to work on and starts to develop a sense of what’s
hard and what’s easy for them, we want to put those options out there. We think
of it as a buffet menu. But lots of people, they want some guidance, and they
should want some guidance, right? Brain science is hard.
And so the
majority use the personal trainer, and what the personal trainer is, is a smart
set of algorithms that basically look at everything you’ve ever done in BrainHQ
and kind of automatically figure out, “Hey, which exercise does this
person need to do more of? Because they have the biggest opportunity for
improvement. What are exercises that they trained on months ago and we need to
bring back now to make sure they’re still sharp on? What are exercises that
they’ve done really well on and probably don’t need to spend any time working
more on this?” And so the personal trainer is meant to be a one-button way
of saying, “Hey, just you’re the brain scientist. You tell me what I
should be training my brain on.”
exactly what the personal trainer does. Lots of users log in to BrainHQ, start
the personal trainer right there on your dashboard, and it’s going to give you
the exercises that are right for you. And we have users who trained on BrainHQ
for years with that mechanism, and in fact the personal trainer will walk you
through all of the exercises and all of the brain training levels step by step
if you do that. And it’ll bring back the ones you need to get more practice on
sooner or later if you’d like to do that.
DrMR: That’s great to know because it was one of the things that was a bit discouraging for me. I wasn’t sure if the daily personal trainer was an “everyone kind of does the same thing” trainer, like you have a workout of the day on Monday and a different one on Tuesday and so on. I was thinking that it was adapting to what I was doing better or worse at. This is actually, I think, one of the nicest features of the program. It meets you at a level where if you’re doing really good and you’re kind of just snapping through the exercises, it makes them a bit harder.
But if you’re just getting buried and you’re doing terribly, it makes them a bit easier, so you never feel like you’re getting totally defeated. Obviously, for compliance and enjoyment, you want to be in that kind of sweet spot where you’re doing good, you’re getting some wrong, you’re getting more than 50% right, so you’re feeling good about it. It’s not so easy that you’re going, “This is a breeze,” but it’s not so hard that you just want to shut off the computer.
DrHM: That’s exactly right. That good from a user experience standpoint, in the sense that, as you’re saying, as soon as you start a BrainHQ exercise, it starts to adapt to you. As soon as you get a few trials right, it’s going to get a bit harder. And as soon as you get one or two wrong, it’s going to get a bit easier. It’s like having a personal trainer at the gym, right? If you can lift that much, well let’s add a little more. And if you’re really struggling, well let’s take a little off so it’s right for you.
DrHM: And of course that’s wonderful because it means that the scale of the exercises from let’s say your mom, as you mentioned, all the way to Tom Brady, who as you probably know is one of the finest quarterbacks in the NFL. He uses these exercises, and they will get to a level that’s extremely demanding even for Tom Brady’s extremely fast, sharp, accurate brain, so in that sense, they rapidly figure out exactly what the right level of difficulty is for you.
And then the personal trainer itself kind of builds on that and introduces that adaptation to the level of the individual exercises so that if you and I were to both be training on the personal trainer, over the course of a couple of days or even a couple weeks our personal trainers would be giving us somewhat different exercises in different levels. Kind of the way a memory foam mattress sort of eventually kind of learns your shape and gives you the right-shaped mattress for you. The personal trainer learns your strengths and weaknesses and gives you the right exercises for them.
DrMR: Yeah, it’s really a nice feature, that
adaptability, because it’s a terrible feeling when you get a number in a row
wrong, and so it’s nice when it lightens up a little bit, and the exercise
analogy is great. If you’re being piled underneath all this weight that you
can’t lift, it’s not a good feeling, so yeah, it’s a very, very visceral
DrHM: We also know from brain science, the brain
itself will not change if it’s doing something too easy, because why does it
need to change? If we’re getting 100% of things right, there’s no reason for
the brain to change. You’ve got a great brain, right? But interestingly, the
brain also doesn’t change if the task ahead of it is too hard. If the brain can’t even get a foothold, one
might say, can’t even get one right, then the brain also doesn’t change.
There’s not enough information about how it should change, because the brain’s
getting everything wrong. So, a key aspect of brain training is finding that
kind of sweet spot that gives a person getting enough of these right to get the
hang of it, and gives the brain enough information to change.
DrMR: Will you tell us a little bit more about BrainHQ? If you want to give them a specific URL. But anywhere you want to point people to and anything else you want to mention about BrainHQ or just this work in general as we kind of move to a close?
DrHM: Yeah, probably really two things I’d sum up
with, Michael. One of which is I’ve talked a lot about BrainHQ, we’ve talked a
lot about evidence that brain training is effective, improves cognitive
function, improves real-world function. I’m really proud of the work that we
and our clinical collaborators have done to show that efficacy, and it’s
important to say that that doesn’t mean that every brain game works. Now,
different brain training programs, different brain games, they’re different
just the way different medicines are different.
expect cancer medicine to help you with asthma. And there are some medicines
that we find out are completely ineffective at helping people at all. They fail
all their clinical trials. So when we look at the evidence that the BrainHQ
exercises work, I just want to be careful and make sure people listening don’t
think that that means that Monopoly works, or it doesn’t mean that anything
that they might do with their brain.
DrMR: Yeah, and that’s a great point. Not to cut
you off, but there’s a number of things in the app store that I wonder, are
these knockoff, cheap games that are in this kind of free app, so I’m assuming
there’s probably some knockoffery, if that’s even a word, going on in the
DrHM: Oh, there’s just tons of craziness, Michael. There’s just tons of
craziness. You search for brain games on the app store, you’ll find a thousand
of them, and I guarantee you that most of those thousands have never seen a
clinical trial one way or the other.
In fact, there was really quite a nice review that was done by a set of Alzheimer’s disease researchers where they looked at brain training programs aimed at older adults, and they found right off the bat most of the programs advertised simply had no science behind them at all. And of those that did have some science behind them, most of them, the science was pretty weak. They found only two programs that had gold-standard randomized, controlled trials, and of those two it won’t surprise you, Michael, that they found that BrainHQ had the most evidence behind it. If you’re looking at a brain training program, you should go to the science page, and if they’re just spouting a lot of general feel-good about, “Hey, brain training is good for you,” well that’s not good enough.
You should be
looking on that science page and see, “Hey, do they have real trials with
their program to show that it works?”
DrMR: Love it.
DrHM: The other thing I’d point out because you asked, is anyone who’s listening can go to brainhq.com. If you register, you can register for free and it will give you one exercise every day, and the idea is it gives you something to kind of try out, see if you like it, see if you feel like this is something you enjoy, seeing if this is something you want to continue with. And then you can subscribe and unlock, and it will unlock all 29 exercises, it will unlock the personal trainer and so forth and so on. And we wanted this to be affordable for people. To subscribe for a year, it’s only $8 a month. And when we founded the company, it was important to us from the beginning as we were taking this science out of the lab and into the world to build something that can help millions, if not billions, of people. And of course, to do that we wanted to make sure it was not priced like a cancer drug at $100,000 a year, but priced at something that an ordinary person could afford to give a swing at.
DrMR: Well, it’s a great operation, Henry. I’ve
used it personally. I’ve found it to be enjoyable. Sometimes challenging, but
mostly enjoyable, kind of in that sweet spot like we talked about. Again, the
fact that you guys have done such rigorous work to document that the games that
you’re using actually have an impact and aren’t just something that looks fun
and looks challenging with a creative label slapped on it, that really means a
lot to me. Because if I’m going to spend 10 or 15 minutes on most days, I want
to know that this is something that’s actually been shown to work just like
with a dietary supplement. If we’re going to use a dietary supplement, it’s
nice to know that there’s some evidence showing it has been documented to have
X, Y or Z benefits.
So, just really appreciative. Also, I should thank you for my mom. Even if she doesn’t realize it, she’s gotten a lot better at dealing with stuff on the computer and the phone, which has made my life less stressful. So, yeah, just really appreciate it and appreciate the work that you’re doing, and for the time and the call today.
DrHM: Well, thanks for having me on the show. You cover a lot of interesting topics, and I think it’s great that someone with your authority and knowledge is out there helping tell people hey, what matters for their brain health and how can people spend their time on things that are effective, so thank you.
I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!
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