Whether doing jumping jacks or playing video solitaire, the underlying principle is the same: “Use it or lose it.” For physical exercise, it’s muscle tone; for “brain fitness,” it’s mental acuity.Based on the wave of new electronic programs flooding the long-term care marketplace in recent years, “brain fitness” has gained a lot of momentum as an activity that proponents say can keep the mind in shape, staving off the onset or progression of Alzheimer’s and dementia. Fueled by newer technology, video terminals are springing up in activity centers across the country as residents indulge in a multitude of mind-challenging word puzzles, card games and memory quizzes.
But while new-age electronic formats have become popular as “brain fitness” tools, they are merely the latest twist on a traditional concept, says Kathy Laurenhue, CEO of Bradenton, FL-based Wiser Now.
“Residential care communities have always offered ‘brain fitness’ programming, even if they didn’t call it that,” she says. “Activity programming has long included word games, trivia quizzes and current events discussions, but they were listed on the calendar as that.”
Developments sparking the “brain fitness” movement of today are threefold, she says: An increased awareness of the importance of keeping an active mind as an element of aging well; the opportunities brought on by technology; and renewed appreciation of novelty and socialization as elements of brain fitness.
“One of the things that has pleased me most in reading about successful mental fitness programming is the acknowledgement that socializing with others is its own brain enhancer,” Laurenhue says. “Another aspect of brain fitness we are learning more about is the importance of exposing yourself to new information.”
Simple concept
“Whenever we learn something new, we are creating new pathways in our brain,” she says. “When we simply retrieve an embedded fact, we are deepening ruts in our brain. That’s not bad, but a lot of studies are pointing to the importance of creating reserve capacity. If you don’t know the answer and have to look it up, that’s a new pathway created.”
While the brain fitness movement has picked up steam, “the adoption rate is a bit slower than we would like,” notes Shlomo Breznitz, Ph.D., founder of New York-based CogniFit.
“This is a new idea that requires new technological capabilities and thus, it takes time,” he says. “The direction however, is clearly to introduce brain fitness enhancement to such facilities.”
An important new trait among the latest generation of cognitive training products, Breznitz says, is the ability to assess individual needs and provide a systematic “workout” for each person.
“As long as the cognitive decline does not prevent computer usage, the software should be able to adapt the level of difficulty as well as duration of stimuli exposure and speed of presentation accordingly,” he says.
Lori Snow, director of sales and marketing for Centennial, CO-based It’s Never 2 Late, adds that technology allows for traditional games to be “cool” and “less condescending” for participants.
“Another benefit of technology applications is that they allow for immediate tracking of improvement,” she says.
Efficacy controversy
The Washington Post recently reported that the brain fitness industry earned $850 million in worldwide revenue in 2007—up substantially from $250 million in 2005. In the piece, Alvaro Fernandez, CEO of a market research group called SharpBrains, said he expected “tremendous growth” to continue.
The story also asserted “there is no strong medical evidence that games such as these boost mental capacity or slow the aging process.”
Representatives from the brain fitness industry acknowledge the controversy over whether evidence-based research supports claims of prevention, yet they contend valid data do exist.
“There is a growing body of scientific evidence that indicates the cognitive gains of people affected with some degree of dementia after cognitive training,” Breznitz says. “These gains sometimes delay onset of symptoms or slow predicted deterioration. Patients diagnosed with mild cognitive impairment have been shown to actually get better in spite of time passed during training. In some studies, the positive effects have been shown to last at least six months.”
More research
At the same time, Breznitz says he realizes that there is still a need for much more additional research.
“This is not only a complex issue, but also still a bit controversial,” he says. “Only when more new research makes similar claims again and again will the skeptics be convinced. This may still take some time.”
Snow cites “plenty of research studies proving the benefits of brain fitness.” Some of the results are obvious, and some are controversial, she acknowledges.
“We’re delighted to have several of our programs being driven from a research perspective–multiple references are available,” Snow says. “However, as much as we love to see the positive outcomes from this research, our feeling is that what simply needs to be done is for administrators to scrutinize their own activity and therapy programming to see if it is something they would like to participate in when they are 88 years old. If they wouldn’t want to participate in these activities, why should they make their residents?”
The National Institutes of Health and National Institute on Aging are apparently interested in generating concrete outcomes data, as evidenced by a recent $1.5 million grant to Akron, OH-based Creative Action, producer of the Memory Magic program.
Creative Action CEO Ronni Sterns emphasizes that her program is not electronic in nature. Originally developed as “memory Bingo,” the program has participants utilize long-lasting abilities, such as reading, reminiscing and interacting together in a structured and supported setting.
The Memory Magic concept is designed to “create an enjoyable failure-free experience” for players in which any answer can be treated as correct and everyone wins. Its contexts and materials include familiar phrases, elements from well-known stories, popular movies and music from the times when participants were young. Group knowledge of the answers means that when one person knows the answer, everyone will soon know the answer.
“It is a comprehensive therapeutic intervention,” Sterns says. “It lets people with cognitive impairment use their remaining abilities using cueing and repetition. When people use these abilities, they feel a sense of accomplishment.”
The ‘fun’ factor
Games and puzzles are inherently fun for most people, but for those with cognitive impairment, they may seem more like a grueling 20-mile run. The makers of brain fitness programs understand this, which is why they put a lot of effort into making their activities as entertaining as possible.
“My philosophy related to keeping an active mind can be summarized in three words:
Ha-ha, ah-ha and aaaahhh,” Laurenhue says. “I want people to laugh and have fun because relaxed learners learn more—that’s the ‘ha-ha.’ Second, I want to foster curiosity so they learn new information—that’s the ah-ha. Third, I want them to get lost in the pleasure of doing something they really enjoy. That’s the ‘aaaahhh.’”
Snow says the entire premise of It’s Never 2 Late is based on enjoyment.
“If you enjoy an activity, then you’re going to come back and do it more and more,” she says. “Age or cognitive decline does not slow down your ability to enjoy certain experiences. We are trying to reach the whole person – not just the brain. We would rather improve the quality of someone’s life than just the quality of their brain function.”
Even so, Breznitz contends that while it helps with motivating the trainee, “fun isn’t intrinsic to the value” of brain fitness therapy.
“What is essential to their success is the optimal level of challenge,” he says. “They should not be too easy, which is boring, or too difficult, which is frustrating. It should be just at the right level of challenge.”
Mind-stimulating activities
Aside from regular “brain fitness” sessions, there are myriad other ways to stimulate cognitive function:
Traditional thinking games, such as bridge, chess and checkers, as well as crossword puzzles and Sudoku, are a few. Also, physical exercise increases blood supply to the brain. And art appreciation is yet another. Research shows people with dementia relate well to abstract paintings.
Artistic activities such as painting and crafts can give a new voice to dementia patients who might have lost their ability to speak.
Also, singing and poetry can trigger memories of rhymes and phrases learned in childhood, prompting positive facial expressions, laughter, verbalizing and social interaction.
From the May 01, 2010 Issue of McKnight's Long-Term Care News
