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article imageComputerized brain training tackles bipolar disorder: Interview Special

By Tim Sandle     Oct 20, 2017 in Science
A new study from Harvard University and McLean Hospital is the first to show that a type of computerized brain training can drive gains in measures of cognition among patients with bipolar disorder. To find out more, we spoke with the researchers.
Problems with cognitive function (like processing speed, memory, and decision-making) are a common symptom of bipolar disorder, and this condition contributes to challenges to successfully functioning in the community. There is no commonly-prescribed treatment for such issues.
With the new study, the Harvard University and McLean Hospital researchers found significant and large gains in overall cognitive function, as well as significant gains in separate cognitive domains. The researchers wanted to understand if a specific type of cognitive training — plasticity-based brain training — could help improve cognitive function in people with bipolar, and if that improvement was specific to the brain training and not a placebo effect of simply being enrolled in the study and working with the researchers.
To find out more we spoke with both lead Investigator Dr. Eve Lewandowski of Harvard Medical School and McLean Hospital and Dr. Henry Mahncke, CEO of Posit Science (maker of the intervention that was successful in the study).
We began by asking Dr. Eve Lewandowski about mental health issues.
Dr. Lewandowski is director of clinical programming at McLean OnTrackTM and assistant professor in p...
Dr. Lewandowski is director of clinical programming at McLean OnTrackTM and assistant professor in psychology at Harvard Medical School.
McLean Hospital
Digital Journal: What are the major mental health disorders of concern?
Dr. Eve Lewandowski: We studied patients with bipolar disorder with psychosis
DJ: How do these relate to problems of cognitive function?
Dr. Lewandowski: Cognitive deficits are quite common in patients with bipolar disorder even when mood and psychotic symptoms are in remission. These cognitive deficits are strongly associated with poor functional outcomes.
DJ: Are there any standard treatments that are effective?
Dr. Lewandowski: There are currently no effective, standard treatments for cognitive deficits in patients with bipolar disorder.
DJ: What are the main features of bipolar disorder?
Dr. Lewandowski: Bipolar disorder is a serious and persistent psychiatric disorder characterized by episodes of mania and depression. Bipolar disorder with psychosis also involves transient psychotic symptoms such as delusions or hallucinations. Bipolar disorder is relatively common, with a lifetime prevalence rate in the United States of approximately 4 in every 100 people.
DJ: How can computerized brain training drive gains in measures of cognition?
Dr. Lewandowski: Computerized brain training is believed to drive improvements in cognition through repeated use of carefully-designed cognitive activities that modify neural networks through a processes known as neuroplasticity. Over time and repeated trials, this intensive training is designed to activate and strengthen neural systems that underpin cognitive processes. Our finding that cognitive improvements persisted 6 months after the end of the computer training supports the idea that once the brain is better at performing cognitive tasks, it will maintain or even continue to strengthen these processes over time.
The interview moved onto the technology, and our questions to Dr. Henry Mahncke.
Dr. Henry Mahncke is the CEO of Posit Science.
Dr. Henry Mahncke is the CEO of Posit Science.
BrainHQ
DJ: How can computerized brain training drive gains in measures of cognition?
Dr. Henry Mahncke: BrainHQ is a unique kind of brain training that is drawn directly from the research that led to the discovery in the late 1970s and 1980s of lifelong brain plasticity 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.
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: What types of technology enable this?
Dr. Mahncke: BrainHQ exercises are available online at brainhq.com and as native apps through the Apple App Store and the Android Play Store. A special regimen of exercises was used in this study to create 70 hours of training that started with more elemental cognitive functions and moved on to more complex ones. Because smart algorithms measure responses and continuously adjust the exercise stimuli, each user has a unique and personalized journey through the training.
DJ: How did you develop your own technology?
Dr. Mahncke: BrainHQ is the product of more than 30 years of research into applied brain plasticity. This work has been conducted in labs at more than 70 research universities and institutes. Hundreds of university-based scientists contribute to BrainHQ through their involvement in the design, testing, refinement and validation of BrainHQ exercises and assessments.
DJ: How long did the technology take to develop?
Dr. Mahncke: The venture-backed company which makes BrainHQ, Posit Science, was created more than a decade ago to get the technology out of the labs and into the hands of people who might be helped.
DJ: Has you research been published?
Dr. Mahncke: BrainHQ is unique in the brain-training field for its dedication to the advancement of brain science. More than 150 peer-reviewed studies have been 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 brain’s natural plasticity.
This is the first study published on the application of BrainHQ to bipolar disorder. Prior studies have focused on healthy adults, as well as on populations across a broad range of cognitive disorders and diseases
DJ: What have been the reactions from the medical community?
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.
In the first systematic review of commercial brain programs targeting older adults, experts from five Alzheimer’s research institutions found that only BrainHQ was backed by multiple high quality studies. In their article published in Neuropsychological Review, the reviewers wrote “Multiple peer-reviewed articles evaluating Posit Science programs have fulfilled the gold standard for clinical trials.”
DJ: What are your future expansion plans with the technology?
Dr. Mahncke: Currently, BrainHQ is marketed to healthy people, who want to improve their cognitive function and brain health. Typical users range from older individuals concerned about normal age-related cognitive decline to elite athletes and other peak performers, seeking a cognitive edge.
There are now more than 70 studies indicating benefits across a range of clinical conditions. We are committed to working with appropriate regulators to finding the most efficient path for getting these clinical applications to market.
DJ: What else 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.
Because our technology focuses on first improving the speed and accuracy of sensory perception, we work with many elite athletes and sports teams.
The improvements in speed and accuracy also are core to being more productive, so we work increasingly with enterprises committed to becoming learning organizations.
DJ: What other areas of healthcare technology are of interest to you?
Dr. Mahncke: In addition to our consumer business, we are focused on bringing this individual wellness tool into healthcare systems interested in monitoring and improving brain health throughout life. Studies of our technology have shown this not only improves health outcomes but lowers healthcare costs.
Our research arm focuses on three areas of cognitive disorders and diseases: Mental Illness (e.g., depression, schizophrenia, bipolar, addiction, ADD/ADHD); Brain Injuries (e.g., TBI, PTSD, Stroke, Chemobrain, Cardiobrain, HAND) and Neurodegenerative Diseases (e.g., Dementia, MCI, MS, Parkinsons).
The study has been published in The Journal of Clinical Psychiatry in an article entitled “Treatment to Enhance Cognition in Bipolar Disorder (TREC-BD): Efficacy of a Randomized Controlled Trial of Cognitive Remediation versus Active Control.”
More about Bipolar disorder, Brain training, cognitive measures, computer training
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