An idea whose time has (finally) come
Like many revolutions, long-term care’s recent embrace of technology-based brain fitness tools began quietly. Then it exploded.
Most analysts trace the wave’s roots to 2006, when Nintendo introduced a game called Brain Age to America. Selling an eye-opening 600,000 games during its first four months, the game proved to be wildly popular.
Shortly thereafter, company analysts made an unexpected discovery about its success. As predicted, many buyers were baby boomers and youngsters. The real surprise was how many older people—and senior- living operators—were also pulling Brain Age off the shelves.
Nintendo President Satoru Iwata admits it was an eye-opening experience. In fact, he told reporters in July that the company will focus more on serving seniors’ cognitive needs going forward. And he is hardly alone.
Firms such as Dakim, Posit Sciences, Congnifit and are leading the charge into an area that has been largely overlooked in the past: the development of technology-driven tools that can help preserve and enhance seniors’ cognitive abilities. The market for “neurosoftware” topped $225 million last year and is expected to reach an eye-popping $2 billion by 2015, according to Alvaro Fernandez of market researcher SharpBrains. 
Brain fitness refers to a person’s ability to meet life’s various cognitive demands. In other words, it is the science of maintaining and training cognitive abilities. Its core principles are based on concepts derived from phenomena contributing to neuroplasticity and neurogenesis. Cognitive abilities such as attention, memory, visual/spatial processing, auditory processes and language, motor coordination, and executive functions such as planning and problem solving tend to diminish over time unless they are used regularly. A prevalent theory is that improving cognitive abilities through brain exercise leads to brain fitness, much as physical exercise tends to enhance physical fitness.
Advocates note that brain fitness can be improved by disciplined exercises that present a variety of challenges in a constructive environment. 
Fear factor
As people get older, dealing with aging-related infirmities tends to become a major cause of stress. A Mayo Clinic study found that seniors fear Alzheimer’s more than death. Unfortunately, Alzheimer’s—or age-related dementia—is no idle threat. Every 71 seconds, another senior is diagnosed with Alzheimer’s (the national total now exceeds 5 million), according to the Alzheimer’s Association. By age 65, 1 in 8 Americans are afflicted. By age 85, it’s half. Alzheimer’s and dementia rob victims of their essential humanity, and greatly diminish the quality of life that older people can enjoy. 
The Alzheimer’s Association estimates that the direct costs to Medicare and Medicaid for care for people with Alzheimer’s and other dementias, and the indirect costs to business for employees who are caregivers of persons with Alzheimer’s and other dementias amount to more than $148 billion annually. That includes:
• $91 billion in Medicare costs for care of beneficiaries with Alzheimer’s and other dementias in 2005 (this figure is projected to increase to $160 billion by 2010 and $189 billion by 2015).
• $21 billion in state and federal Medicaid costs for nursing home care for people with Alzheimer’s and other dementias in 2005 (this figure is projected to increase to $24 billion in 2010 and $27 billion in 2015).
• $36.5 billion in indirect costs to business for employees who are caregivers of people with Alzheimer’s and other dementias.
Multiple benefits
From a long-term care operator’s perspective, helping a resident minimize or stave off Alzheimer’s offers multiple benefits. Most important, it allows residents to enjoy a higher quality of life. It also can help staff feel they are truly delivering a valuable service.
For an assisted-living operator, a resident can represent a $40,000-to-$50,000 revenue stream. Not having to lose that customer to a skilled- nursing facility or a dementia-care center is one less hole in the fiscal leaky bucket, experts note.
For skilled-care operators, too, keeping residents from losing mental agility can reap numerous rewards. These include greater resident independence, as well as fewer injuries. It also can make facilities less vulnerable to lawsuits related to dementia-related behaviors, such as falls, attacks or resident-transfer injuries.
Looking for links
The available research seems to indicate that cognitive stimulation can help prevent dementia, and may reduce its risk substantially. Consider:
• A 2002 study appearing in the Journal of the American Medical Association found that those who reported frequent involvement in cognitive activities at baseline were 47% less likely to develop Alzheimer’s than those with infrequent cognitive activity.
• A 2003 study appearing in the Annals of Internal Medicine (the so-called “Nun study”) revealed that a considerable proportion of subjects with mild to moderate stages of Alzheimer’s disease pathology showed no symptoms of memory impairment.
• A 2006 study in the British Journal of Psychiatry found a link between cognitive-stimulation therapy and more cost-effective treatments.
• Also in 2006, the Journal of the American Medical Association published results from a clinical trial of nearly 3,000 people age 65 and older. In this investigation, known as ACTIVE (for Advanced Cognitive Training for Independent and Vital Elderly), participants were randomly placed in training groups for memory, reasoning strategies or speed-of-processing tasks. Compared to a control group, members of all three groups showed measurable improvements in areas where they had received training.
• A 2007 study in Psychological Medicine found that individuals with high brain reserve—which looks at the roles of education, occupational complexity, and mentally stimulating pursuits in preventing cognitive decline—have a 46% decreased risk of dementia when compared to those with low brain reserve.
• In this year’s “Evercare 100 @ 100 Survey,” sponsored by the company Evercare, 1 in 7 respondents who had lived to age 100 indicated they had played video games.
Yet doubters remain, and their concerns are legitimate. One unresolved issue is whether training or playing games improves cognition, or simply makes people more proficient at a certain kind of skill.
It’s still too early to issue a verdict on the new wave of products and services aimed at improving cognition, says Andrew J. Carle, who directs the Assisted Living/Senior Housing Administration program at George Mason University.
Carle said that it’s essential that people at any age make new mental networks. That involves tackling new skills and activities, rather than trying to become more proficient at things a person already can do. 
“People should exercise their brains,” he notes.
Scientific approach
Brain Age urges customers to get “the most out of your prefrontal cortex.” Dakim’s [m]Power bills itself as “a powerful new weapon in the fight against Alzheimer’s disease.” 
To augment their calls to action, vendors are turning to science to validate a cognitive-training benefit.
Dakim plans to put [m]Power to the test in a clinical trial. Posit Science has already done so. During 2006 and 2007, the company conducted a study that included 468 participants who averaged 75 years in age. Participants were randomly assigned to two groups. One group took tests and watched educational DVDs, while the other used the firm’s Brain Fitness program. Following 10 weeks of training, those in the Brain Fitness group improved their speed of processing and some measures of memory faster than those in the control group. 
In a related development, the National Institute on Aging and the McKnight Brain Research Foundation (no relation to McKnight’s Long-Term Care News) last year held a cognitive aging summit that attracted some of the nation’s leading researchers on aging. The result was a forward-looking agenda for age-related cognition research. Separately, the NIA has backed efforts designed to learn more about the effects of exercise, diet, social engagement and mental stimulation on long-term brain health. 
While firms such as Dakim and It’s Never 2 Late are at the fore in the eldercare market, it’s a safe bet that other new launches are waiting in the wings–or soon will be. Moreover, it also can safely be assumed that existing vendors will increasingly harness technology to improve their products/services.
In addition, recent breakthroughs (such as expanded Web-based options) are allowing technology-based vendors to deliver far more than was previously possible—often at a relatively low cost to operators.

Choosing what works
From a scientific standpoint, multiple factors apparently contribute to a sluggish senior mind, said Dr. Ronald Petersen, director of the Mayo Clinic Alzheimer’s Disease Research Center.
“There is often a genetic component, but the environment plays a role, as well. The cumulative impacts of medical issues such as vascular changes like hardening of the arteries also contribute to dementia,” he says.
He adds that there are no specific rules about what kinds of cognitive activities are best for warding off the effects of aging.
“Whether it’s a computer game, crossword or Sudoku puzzles, seniors should like what they’re doing,” Petersen says. “If the senior does not enjoy the activity, then it is not as likely to be beneficial.”