Groundbreaking cognitive neuroscience research has occurred over the last 20 years - without parallel growth of consumer awareness and appropriate professional dissemination. "Cognition" remains an elusive concept with unclear implications outside the research community.
Earlier this year, I presented a talk to health care professionals at the New York Academy of Medicine, titled "Brain Fitness Software: Helping Consumers Separate Hope from Hype". I explained what computerized cognitive assessment and training tools can do (assess/enhance specific cognitive functions), what they cannot do (reduce one's "brain age") and the current uncertainties about what they can do (i.e., delay Alzheimer's symptoms). At the same symposium, Dr. Gary Kennedy, Director of Geriatric Psychiatry at Montefiore Medical Center, provided guidance on why and how to screen for executive function deficits in the context of dementia.
I could perceive two emerging trends at the event: 1) "Augmenting Cognition" research is most commonly framed as a healthcare, often pharmacological topic, with the traditional cognitive bias in medicine of focusing on detection and treatment of disease, 2) In addition, there is a growing interest in non-invasive enhancement options and overall lifestyle issues. Research findings in Augmenting Cognition are only just beginning to reach the mainstream marketplace, mostly through healthcare channels. The opportunity is immense, but we will need to ensure the marketplace matures in a rational and sustainable manner, both through healthcare and non-healthcare channels.
In January 2009, we polled the 21,000 subscribers of SharpBrains' market research eNewsletter to identify attitudes and behaviors towards the "brain fitness" field (a term we chose in 2006 based on a number of consumer surveys and focus groups to connect with a wider audience). Over 2,000 decision-makers and early adopters responded to the survey.
One of the key questions we asked was, "What is the most important problem you see in the brain fitness field and how do you think it can be solved?". Some examples of the survey free text answers are quoted here, together with my suggestions.
Most important problems in the brain fitness field
- Public awareness (39%): "To get people to understand that heredity alone does not decide brain functioning". We need to ramp up efforts to build public awareness and enthusiasm about brain research, including establishing clear links to daily living. We can collaborate with initiatives such as the Dana Foundation's Brain Awareness Week and use the recent "Neuroscience Core Concepts" materials developed by the Society for Neuroscience to give talks at schools, libraries and workplaces.
- Claims (21%): "The lack of standards and clear definitions is very confusing, and makes a lot of people sceptical". We need an easy-to understand taxonomy to help consumers and professionals evaluate claims focusing on cognitive functions, not on mental health diagnoses. The classifications should be grounded on a standardized research taxonomy. However, over time we may have to develop a "labeling system" based on the targeted cognitive domain and level of validation. Press releases often only add more confusion. We should blog study results in depth, become trusted resources to trusted reporters and differentiate new findings from previous ones.
- Research (15%): "Determining what activities are most beneficial to the user with the minimum level of effort or most overlap of already existing effort". A high priority would be to ensure widely-accepted output standards (either commercial or following consensus processes such as the schizophrenia MATRICS Cognitive Battery) with a transparent architecture of outcomes and relationships covering the impact (brain-based, cognitive, behavioral performance) by age groups and by healthy vs. specific disorders.
- Culture (14%): "Integration within existing healthcare infrastructure will require research, education and cultural change. If brain fitness remains a niche alternative approach for the well-healed, we will have failed". We need to improve the partnership with clinicians and their professional associations.
- Assessment (6%): "Development of standardized and easily accessible assessments of cognitive status that could be used by individuals and organizations to test the efficacy of cognitive improvement methods". Perhaps the single most effective way to bring cognitive research into the mainstream conversation would be if people took an "annual brain check-up" serving as a cognitive baseline (as objective, functional information to track changes and to inform about interventions and diagnoses). Computerized assessments are already being used in a variety of contexts, from sports neuropsychology to military Traumatic Brain Injury (TBI) detection. A recent report by the Alzheimer's Foundation of America advocating for widespread cognitive screenings after the age of 75 or even 65 may open up a very interesting public policy debate.
- Exposure (5%): "Get information and products out to all the people, perhaps a drive to get them into public libraries". We have a major opportunity now to help prepare society to thrive in this cognitive age. We need to improve research and focus on public awareness and standards for this opportunity to come to fruition.
Dr. Bill Reichman, CEO of Baycrest, puts it this way, "We have an opportunity to make major progress in Brain Health in the 21st century, similar to what happened with Cardiovascular Health in the 20th, and technology will play a crucial role". For that prediction to come true, research on augmenting cognition will need to become mainstream. Neuroscientist Torkel Klingberg is optimistic, "In the future we may be as aware of cognitive function as we now are obsessed with calories, diets, glycemic index and cardiovascular training".