Contributed by: Dennis Fortier, President, Medical Care Corporation
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As most physicians will tell you, one of the barriers preventing patients from pro-actively voicing memory concerns is the patients' fear of losing the right to drive. However, the medical system is poorly equipped to assess driving ability and the steps between discussing a cognitive concern with a doctor and losing one's driving license are not as clear or straight forward as most patients would presume.
One the one hand, we all empathize with the natural desire to remain independent and, in the USA, where public transportation is spotty at best, the right to drive is a key enabler of independence. On the other hand, driving is a judgment intensive activity and impaired drivers need to be taken off the roads for everyone's safety.
The reality is that a patient must be severely impaired before actions initiated in the medical system will result in the loss of driving privileges. The American Academy of Neurology recently updated guidelines to help their members better assess driving skills as part of delivering comprehensive care. The new guidelines can be downloaded at their site.
The principle findings of the panel that issued the guidelines were that patients and caregivers are not very reliable sources of information about the patients' driving skills nor are standard neuro-psychological tests like the Mini-Mental State Exam. One of the best indicators that the patient may no longer drive safely is if they admit to having changed driving habits to avoid challenges such as driving in unfamiliar locations or night time driving.
How Much do Brain Games Help your Brain?
Contributed by: Dennis Fortier, President, Medical Care Corporation
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Following a recent study sponsored by the BBC and published in Nature Magazine, this topic has been in the news a great deal. I will share my opinion about the answer to the question posed in my headline but would like to first comment on how this story is being reported.
As I described in this post yesterday, we must all be careful in how we interpret scientific commentary. This is because scientists speak in a language of precision that should be regarded as such, and very precise comments should not be generalized. A common example is when scientists comment that a particular hypothesis or phenomenon "has not been proven" and the comment is erroneously generalized to mean that the hypothesis is false. That is not how a scientist would interpret the comment; they would understand that the hypothesis may well be true but more study is required to prove or disprove it.
And so it may be with brain games.
I know that many game manufacturers have cast outlandish claims into the commercial marketplace in an effort to sell "health" to the worried well. As such, I think that the scientists involved in the BBC study have correctly suggested some claims have probably been too aggressive given the current level of evidence of a benefit from brain exercises.
However, please note that their study was not particularly well designed as they were looking for an improvement in cognition based on very little brain exercise, over a short period of time, compared to a group of control subjects who also used their brains in similar exercises. These limitations are described here by Berard Croisile of HAPPYneuron and here by Alvaro Fernandez of SharpBrains, both affiliated with the brain exercise industry and both well versed in the state of the science in this field.
Keep in mind that the scientific process encompasses more than a single study, even when the study is well-designed. The full process involves hypothesis generation, iterative testing of hypotheses, and reproduced results through various study designs. Scientific facts are rarely plucked from a single study but rather shaped and codified through a series of controlled experiments and analysis. In terms of understanding the health benefits of playing brain games, the scientific process is still in its infancy.
On the whole, the hypothesis that using your brain in challenging ways will exercise neural circuits and keep them healthy is both plausible and supported by a growing body of scientific evidence. We all agree that questions about how much exercise, which types of exercises, and how much benefit one can accrue are topics requiring more study.
However, we must not generalize the conclusions from the BBC study into the false belief that the scientific jury has reached a verdict on this matter. The preponderance of evidence suggests that exercising your brain is most likely good for your cognitive health.
________________________________________________
Following a recent study sponsored by the BBC and published in Nature Magazine, this topic has been in the news a great deal. I will share my opinion about the answer to the question posed in my headline but would like to first comment on how this story is being reported.
As I described in this post yesterday, we must all be careful in how we interpret scientific commentary. This is because scientists speak in a language of precision that should be regarded as such, and very precise comments should not be generalized. A common example is when scientists comment that a particular hypothesis or phenomenon "has not been proven" and the comment is erroneously generalized to mean that the hypothesis is false. That is not how a scientist would interpret the comment; they would understand that the hypothesis may well be true but more study is required to prove or disprove it.
And so it may be with brain games.
I know that many game manufacturers have cast outlandish claims into the commercial marketplace in an effort to sell "health" to the worried well. As such, I think that the scientists involved in the BBC study have correctly suggested some claims have probably been too aggressive given the current level of evidence of a benefit from brain exercises.
However, please note that their study was not particularly well designed as they were looking for an improvement in cognition based on very little brain exercise, over a short period of time, compared to a group of control subjects who also used their brains in similar exercises. These limitations are described here by Berard Croisile of HAPPYneuron and here by Alvaro Fernandez of SharpBrains, both affiliated with the brain exercise industry and both well versed in the state of the science in this field.
Keep in mind that the scientific process encompasses more than a single study, even when the study is well-designed. The full process involves hypothesis generation, iterative testing of hypotheses, and reproduced results through various study designs. Scientific facts are rarely plucked from a single study but rather shaped and codified through a series of controlled experiments and analysis. In terms of understanding the health benefits of playing brain games, the scientific process is still in its infancy.
On the whole, the hypothesis that using your brain in challenging ways will exercise neural circuits and keep them healthy is both plausible and supported by a growing body of scientific evidence. We all agree that questions about how much exercise, which types of exercises, and how much benefit one can accrue are topics requiring more study.
However, we must not generalize the conclusions from the BBC study into the false belief that the scientific jury has reached a verdict on this matter. The preponderance of evidence suggests that exercising your brain is most likely good for your cognitive health.
NIH Says "Alzheimer's not Preventable"
Contributed by: Dennis Fortier, President, Medical Care Corporation
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Based on current evidence, the recent conclusion reached by a National Institute of Health panel of experts, is pretty sound. They concluded that we do not yet have proof that the progression of Alzheimer's disease pathology can be slowed by actively reducing known risk factors and by adopting certain lifestyle changes such as smoking cessation, intellectual stimulation, and physical exercise.
Careful Interpretation Required
As we often write in this blog, scientists speak in a language of precision that serves them well amongst themselves but often leads to unintended conclusions in the public realm. This is a case where I think it is worthwhile to translate the panel's conclusion for public consumption.
Here is a quote from one of the panel experts; this was one of the direct comments that generated the hopeless headlines in countless news outlets over the past week:
I understand that many commercially driven entities are selling solutions with exaggerated claims about efficacy. We all appreciate the consumer advocacy the expert panel has provided in helping us understand how well certain supplements or brain games have been (or have not been) validated with solid science. However, it is important to stay balanced and to understand that certain approaches, although not proven, have growing evidence of benefits. When those approaches have no harmful side-effects and are supported by rock-solid common sense, it might be best to present them with some degree of optimism.
________________________________________________
Based on current evidence, the recent conclusion reached by a National Institute of Health panel of experts, is pretty sound. They concluded that we do not yet have proof that the progression of Alzheimer's disease pathology can be slowed by actively reducing known risk factors and by adopting certain lifestyle changes such as smoking cessation, intellectual stimulation, and physical exercise.
Careful Interpretation Required
As we often write in this blog, scientists speak in a language of precision that serves them well amongst themselves but often leads to unintended conclusions in the public realm. This is a case where I think it is worthwhile to translate the panel's conclusion for public consumption.
Here is a quote from one of the panel experts; this was one of the direct comments that generated the hopeless headlines in countless news outlets over the past week:
"There is not a high level of evidence that any of these factors (supplements, mental exercise, medications) can prevent Alzheimer's or age-related cognitive decline."Now let me state it in another way that would be equally acceptable to the independent and precision minded scientists on the panel:
"There is not a high level of evidence that any of these factors (supplements, mental exercise, medications) do not prevent Alzheimer's or age-related cognitive decline."It is a simple switch in perspective but might have dramatically changed the message that most lay-readers take away.
I understand that many commercially driven entities are selling solutions with exaggerated claims about efficacy. We all appreciate the consumer advocacy the expert panel has provided in helping us understand how well certain supplements or brain games have been (or have not been) validated with solid science. However, it is important to stay balanced and to understand that certain approaches, although not proven, have growing evidence of benefits. When those approaches have no harmful side-effects and are supported by rock-solid common sense, it might be best to present them with some degree of optimism.
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