I have just returned from attending the two day Sharp Brains Summit. Well, returned is not really the right word as the conference was held entirely online. So attending this conference involved sitting in my office and turning on my computer. The conference was both an information session on the emerging field of brain fitness software and, to be truthful, a marketing opportunity for the companies that are developing these programs. Several observations from the conference are of relevance to the ongoing discussion about the the neuroethics of cognitive enhancement.
First of all, I was pleasantly surprised at the breadth of cognitive domains that are being targeted by brain fitness software. Working memory, attention, and even emotional regulation are all fair game for this burgeoning field (improving driving skills, which ultimately makes everyone on the road safer, was highlighted). Secondly, I was impressed with the science. It became clear as the presentations went on that some companies were offering software that was backed up by solid, peer-reviewed research. They were able to state unequivocally that their software was able to demonstrate improvements as measured by good science. Equally obvious was the fact that other company offerings were not (or at least not obviously) backed by solid science, and to me their pitch less compelling. It seems that in this field, good science will be a marketing strength and this is a boon to the consumer as it is an antidote to hucksterism.
Perhaps the strongest scientific validation came from the IMPACT study, a multisite randomized controlled double-blind trial with two treatment groups which demonstrated that “the experimental program improved generalized measures of memory and attention more than an active control program”. Other brain fitness software also had impressive scientific validation, although without the strong imprimatur of randomized controlled double-blind trials. These included scientific studies utilizing an N-back strategy that has been demonstrated to improve fluid intelligence, to provide substantial and durable plasticity of executive functioning, and even to increase cortical dopamine D1 receptor binding. The importance of all of this work was reinforced by a presentation by Adam Gazzely from UCSF who reviewed the observation that the key deficit that accompanies normal aging is not the inability to remember things per se, but rather the a marked diminishment in the ability to ignore distracting stimuli. [In keeping with our general policy at the Core, we do not endorse specific products, but are happy to comment on the strength and weaknesses of scientific studies.]
One theme that ran through the best of the offerings was that they did not just train you to get better at the task (who really needs to be better at identifying whether the image you saw 7 seconds ago was a green ball or a red square, after all), but rather that their effects were generalizable to the types of cognitive tasks that people in the real world utilize. This is important, as we already have crossword puzzles to make us better at crossword puzzles.
A looming challenge is determining whether this market should be regulated in a manner analogous to that of pharmaceuticals, or allowed to remain buyer-beware as has been the norm for nutriceuticals. The fact that at least some of these brain fitness software products have undergone proper clinical trials is encouraging, and at least some participants discussed the idea of putting together a working group to develop guidelines for brain fitness sortware products – something like the Good Housekeeping seal of approval (which might represent a healthy middle ground).
Will brain fitness software dominate the world of cognitive enhancement? Prior to this conference I was quite skeptical, but the overall impression that I was left with was that brain fitness software may turn out to have some distinct advantages over pharmacological approaches.
- Cognition is not monolithic: there are multiple domains of cognition to be targeted, and the deficits that individuals have as they age vary. The software lends itself to both assessing which domain an individual is in need of ‘tuning up’ and then directing them to a particular product that is best capable of improving that domain of cognition. Pharmacological cognitive enhancement, even as it matures, may include drugs that target particular domains. However, the development costs for each drug are so great that it seems unlikely to me that there will be as many domains of cognition targeted with drugs as with brain fitness software.
- Brain fitness software is progressive: as one becomes more proficient at the task, it becomes difficult. Such individual tailoring is difficult to achieve with pharmacological agents.
- Using software is probably safe. I say probably, because as Mike Merzernich pointed out, nobody has systematically investigate the potential side effects of using this software. There may be some, but the likelihood of side effects is relatively low.
Probably the biggest disadvantage with brain fitness software is that you have to do it; just like physical exercise, if you don’t regularly ‘exercise’ your brain, you won’t improve. The software now needs to move from being useful to being compelling. Taking a cue from the gaming industry’s success might be an idea whose time has come.