Cognitive training to battle 'chemobrain': Interview Special

Posted Dec 10, 2017 by Tim Sandle
Cognitive changes are common among breast cancer survivors. Scientists have developed a new approach to guide the management of cognitive changes in those who have undergone chemotherapy.
Metastatic breast cancer in pleural fluid.
Metastatic breast cancer in pleural fluid.
The company Posit Science is working with regulators to find the most efficient path to market for making brain training that addresses clinical conditions broadly available. This is to address the phenomenon of 'chemobrain', an important medical issue. The implications of this were examined in an earlier Digital Journal article "Dealing with cognitive side effects of cancer."
In this follow-up article, Dr. Henry Mahncke, Posit Science's CEO explains about BrainHQ, an approach for tackling cognitive diseases and disorders. BrainHQ uses smart algorithms to personalize the exercises in minutes, and to progressively challenge users with micro-adjustments in multiple dimensions of sensory processing, to create a unique bottom-up approach.
Dr. Henry Mahncke is the CEO of Posit Science.
Dr. Henry Mahncke is the CEO of Posit Science.
The approach has now been extended to survivors of breast cancer and the research has been published in the peer reviewed journal Breast Cancer Research and Treatment.
Digital Journal: How was BrainHQ developed?
Dr. Mahncke: BrainHQ is a unique kind of brain training that is drawn directly from the research that led to the discovery of lifelong brain plasticity, three decades ago, by our co-founder, Dr. Mike Merzenich.
Dr. Merzenich is credited with discovering lifelong brain plasticity, first applying it in the invention of the cochlear implant, and pioneering plasticity-based computerized brain training. Last year, he was awarded the Kavli Prize in Neuroscience, the highest honor in the field, for his body of work. He leads a global team of hundreds of scientists who design, test, refine and validate BrainHQ exercises and assessments.
DJ: How does BrainHQ work?
Dr. Mahncke:BrainHQ uses smart algorithms to personalize the exercises in minutes, and to progressively challenge users with micro-adjustments in multiple dimensions of sensory processing, to create a unique bottom-up approach — first improving speed and accuracy, then working memory, then other forms of memory and higher brain functions, such as planning, reasoning and decision-making.
DJ: Which types of training activities do patients engage in?
Dr. Mahncke:Patients engage in game-like brain exercises in which they are asked to attend to visual and/or auditory information of increasing difficulty. For example, the information may be presented at increasing speed, or with distractors that are increasingly similar to the target. Typically, a user is asked to complete anywhere from 10 to 60 problems in time blocks of a minute or two each.
As an example, in the Double Decision exercise, one of a pair of objects (e.g., a car or a truck) flashes for an instant in the center of the screen, while another target (e.g., a road sign) flashes on the periphery. The screen then goes blank, and the user must indicate which of the pair of objects appeared in the center and where the target was on the periphery. As the user gets the answers correct, the difficulty continuously adjusts -- the display time becomes shorter (i.e., faster), distractors are added along with the target on the periphery, the objects in the center become more similar, and the background becomes more complex. This exercise targets visual speed of processing, visual search, visual acuity, useful field of view and shuttling between selective and divided attention.
DJ: Please explain the studies undertaken to assess BrainHQ.
Dr. Mahncke: Exercises and assessments in BrainHQ have been tested extensively in randomized controlled trials – the gold standard for scientific efficacy. More than 95 percent of these studies have been conducted by university-based researchers, with grant funding for their independent studies coming primarily from the US National Institutes of Health. The assessment is that BrainHQ is unique in the brain-training field for its dedication to the advancement of brain science.
DJ: What are the outcomes of these studies?
Dr. Mahncke: More than 100 studies have been completed and published on the proprietary exercises and assessments found in BrainHQ, showing benefits across varied populations in standard measures of cognition (e.g., speed, attention, memory, and executive function), in standard measures of quality of life (e.g., mood, confidence, health-related quality of life) and in real-world activities (e.g., balance, gait, driving and everyday cognition).
Studies also have shown that exercises in BrainHQ drive changes in brain chemistry and structure – a demonstration that they harness the brain’s natural plasticity. This is the third study published on the application of BrainHQ to cancer patients. Other studies have focused on healthy adults, as well as on populations across a broad range of cognitive disorders and diseases.
BrainHQ  computerized brain training for those with bipolar disorder.
BrainHQ, computerized brain training for those with bipolar disorder.
DJ: How has the clinical evidence been compiled?
Dr. Mahncke: The only systematic review comparing the science behind different commercially-available brain training programs was published earlier this year. That review was conducted by experts in Alzheimer’s from five institutes. It looked at programs marketed to older adults. It found only BrainHQ was backed by multiple high-quality studies.
DJ: What has been the reception from the medical profession to BrainHQ and its applications?
Dr. Mahncke: There is a growing awareness in the medical community that this type of non-pharmacological intervention may play an important role in addressing cognitive disorders and diseases. While BrainHQ is mostly used by individuals at home, various clinical regimens of BrainHQ are used at dozens of hospitals and clinics.
DJ: What other projects are you working on?
Dr. Mahncke: With more than 100 additional studies in progress, we are committed to applying these brain training and monitoring tools to a large pipeline of conditions. These cognitive conditions fit into three broad categories: Brain Injuries (e.g., traumatic brain injuries, stroke, chemobrain, cardiobrain, addiction); Mental Illness (e.g. depression, bi-polar, schizophrenia) and Neurodegenerative Diseases (e.g., dementia, Parkinson’s multiple sclerosis).
We also continue to focus on helping people remain sharp as they age, with many more studies underway and with some new distribution channels, such as public libraries, senior centers and health plans, to supplement the direct availability of BrainHQ at
Because our technology focuses on first improving the speed and accuracy of sensory perception, we now work with many elite athletes, sports teams, and the military.
The improvements in speed and accuracy also are core to being more productive, so we work increasingly with enterprises committed to becoming learning organizations.
Dr. Henry Mahncke is the CEO of Posit Science, the maker of the BrainHQ web and app brain exercise platform. In an earlier article, the researcher discusses 'chemobrain' and its side-effects