The science of intelligence

When her son Alex was diagnosed with attention deficit hyperactivity disorder at the age of 10, Karen George was reluctant to put him on medication.

Instead, she enrolled him in a clinical trial designed to test the efficacy of a brain stimulation programme made by Cogmed, a private company that uses computer programmes to exercise parts of the brain responsible for short-term memory.

Alex versus the robot
The five-week programme required Alex to spend up to an hour a day on a computer, pitting his wits against a robot. Among other exercises, the robot blinked out sequences of flashing lights that Alex was required to replicate.

The programme made a dramatic difference in Alex's ability to concentrate, remember and act on daily chores, his mother says.

"I noticed it immediately," said George, 47, who lives with her physician husband in Santa Rosa Valley, California. "The programme was like a game and my son was loving it."

Brain fitness software
Cogmed is part of an emerging brain fitness software industry that could expand rapidly as aging baby boomers seek ways to stave off dementia and Alzheimer's disease.

The size of the US market for brain stimulation products - which can range from games such as Nintendo's Brain Age to programmes backed by research showing they can improve memory or other cognitive functions - more than doubled between 2005 and 2007, to $225 million, according to a new report by the consulting group SharpBrains.

Just as baby boomers' desire to delay cardiovascular and other diseases fueled the health club boom, their desire to delay dementia is expected to keep the market for brain stimulation products growing.

Even health insurers are getting in on the act. Humana, for example, has teamed up with Posit Science, which makes programmes to enhance learning and memory, to offer brain fitness programmes to certain Medicare members at a discounted price.

The industry is so young, however, that it is unclear which business model will be most successful over time: companies like Nintendo that develop games that are fun, but have no proven clinical benefit - or those such as privately held NovaVision Inc, whose product has been cleared by the US Food and Drug Administration (FDA) to improve vision in patients recovering from stroke or traumatic brain injury.

Clinical data required
Jonas Jendi, chief executive of Cogmed, says games without clinical data will never be successful in the long run.

"I think it will be very difficult to make money in the field of games, even though I think a lot of people will try," he said. "Our approach is to prove our product works through proper research."

Cogmed's product has not been cleared by the FDA as a treatment for ADHD or any other memory or attention-related disorder, yet the company can point to a certain amount of published research to support claims that its programme helps improve short-term memory. It distributes the product through networks of clinicians.

Short term results are encouraging
Stephen Bozylinski, a child neuropsychologist in Ventura County, California, who tests children with learning and attention difficulties and is a paid adviser to Cogmed, says the short-term results are encouraging, but it is unclear how long they will hold up.

Karen George said she noticed Alex begin to relapse after about a year, and two weeks ago she put him on medication for his ADHD.

"For the programme to work, a parent needs to supervise and coach their child, and right now we don't have that amount of time to invest," said George. "We might try it again later."

Alvaro Fernandez, co-founder of SharpBrains, said that while circumstantial evidence exists that brain stimulation software programmes work, especially over a short period, it is too early to tell if they lead to a lower incidence of Alzheimer's disease long term.

Preserving overall brain health
Dan Michel, chief executive of privately held Dakim Inc, says the only way discover that is if products are used for long periods of time, much like studying the impact of long-term training on the physical body. And for that to happen, programmes must be fun, at least to a certain degree.

"We start from the position that there is tons of research out there showing that significant cognitive stimulation delays the onset of dementia," said Michel, who markets his products to retirement communities. "What we are offering is not short-term memory stuff where you need to work on specific tasks; we are talking about preserving overall brain health."

Marian Harris is a case in point. The 81-year-old resident of Belmont Village Senior Living in Sabre Springs, a suburb of San Diego, exercises her mind three times a week using Dakim's device, which combines hardware and software with a touch screen that is easy to use and fun.

"I feel like my mind is pretty good right now, but I want to keep it that way," said Harris. "I want to stay interested in life and not go into my little world as I get older."

And using the system, which might require her to identify a song or gradually increase her memory for numbers, "is just a fun thing", she says.

Bill Reando, activities co-ordinator at the retirement centre, said he notices a difference in the residents who use the Dakim machine.

Improved memory, increased confidence
"Their confidence is higher - they are more active, they are quicker in remembering what they had for lunch."

So far, not much money has been made in the sector. One of the leaders, Scientific Learning Corp, has struggled with its marketing strategy, said Fernandez, and most other companies in the field are venture-funded.

But the industry is young and only just finding its feet.

"My subjective feeling is that many of these companies will be acquired," Fernandez said. "I think the health companies, the educational companies, will be interested in adding these products to their portfolios."

(By Toni Clarke, Reuters Health, 12 March, 2008)

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