A half-hour south of Baltimore, in a suburban office park, Kate Ortman is holding an open house. She’s the proprietor of Brain Training of Maryland, a facility specializing in cognitive training programs aimed at one goal: improving brain function. About three-dozen curious visitors have shown up on this Sunday in late October. One of the employees giving demos is Kate’s son, Greg, a soft-spoken 27-year-old. People watch colored bars on a computer screen blink as he claps in time to a program called Interactive Metronome, pausing to explain how it had helped him.
Kate, a welcoming, chipper woman, used to be a life coach for young adults with attention-deficit disorder. She switched careers after Greg’s older brother, Daniel, needed help recovering from a nine-hour brain surgery to relieve internal pressure caused by a congenital defect. She had learned online about cognitive exercises to improve activity in the cerebellum, the region affected by the operation. But the nearest providers for any of the therapies were an hour away, and Daniel would experience intense migraines after just 30 minutes in the car. So Kate took classes to become certified in two key programs: Interactive Metronome and Integrated Listening Systems. Over time, her dining-room-table practice expanded into a full-fledged business with office space, where she and her staff could attend to clients with brain impairments.
Companies have long hawked computer-based games or other programs predicated on the idea that you can enhance your brain function. Lumosity is probably the most well-known, thanks to ubiquitous advertisements pitching its online tools as a way to boost memory and processing. More recently, you may have heard about BrainHQ, a suite of computer-based exercises developed by San Francisco company Posit Science. New England Patriots quarterback Tom Brady swears by its ability to keep him alert on game day. Through mental workouts, the thinking goes, we can recover from a deficit or injury, stave off decline as we age, or simply become sharper thinkers.
The practice hinges on a concept scientists call “far transfer”: that drilling in specific tasks will improve not just performance of those exercises, but also other everyday actions. Listen to music while standing on a balance beam, and your brain’s processing speed will get better. Keep track of a rapidly blinking object on a computer screen, and you’ll brake faster next time you’re out driving.
If this sounds too good to be true, that’s because, skeptics say, it is. In 2014, 75 neuroscientists and cognitive psychologists signed their names to a letter, published by the Stanford Center on Longevity and the Max Planck Institute for Human Development, challenging many of the claims that brain-training companies make. “To date, there is little evidence that playing brain games improves underlying broad cognitive abilities, or that it enables one to better navigate a complex realm of everyday life,” they wrote. They objected to exuberant ads that were not supported by existing research, much of which showed mixed results or failed to rule out other reasons for cognitive improvements. They cautioned consumers to look out for conflicts of interest, anecdotal evidence, and overblown promises. Two months later, proponents responded with their own letter, signed by more than 100 scientists, arguing that a growing body of research demonstrates that “certain cognitive training regimens can significantly improve cognitive function, including in ways that generalize to everyday life.”
A year and a half later, the Federal Trade Commission fined Lumos Labs, makers of Lumosity, $50 million for deceptive advertising, citing “false or unsubstantiated real-world performance claims.” The agency eventually suspended the fine after Lumos paid $2 million in damages to the FTC. Brain training has nonetheless become a big business, expected to clear $3.3 billion in sales by 2020, according to market-research firm SharpBrains. At Ortman’s company, about 100 clients pay anywhere from $200 to $1,200 a month for help with conditions like ADD, dyslexia, stroke, and dementia. Those who, like Kate, use the techniques in their own practices say the empirical evidence is right in front of them. But the underlying question remains: Can training your brain make your life any better?
In 2014, a 23-year-old Greg Ortman found himself living in the basement of his parents’ house, unemployed, and with an injured brain.
He’d grown up in the Baltimore suburbs, the fourth of six siblings and one of three adopted children. He’d played high school football and was a good athlete—a compact, stocky running back. That, however, made him a target for linebackers. In his senior year of high school, he suffered his first concussion, and when he moved on to college football, he suffered three more. His memory grew foggy. He was constantly tired. Unable to keep up with his coursework, he dropped out as a sophomore in spring 2012. From there, he struggled through a string of low-level jobs. One day, while packing pallets at a warehouse, a box fell from above and conked him on the head. Concussion number five.
Virtually all concussions begin the same way: A blunt force causes the brain to move within the skull, stretching cell membranes and allowing potassium to seep out and calcium to leak in while blood vessels constrict. This interrupts the brain’s electrical activity at the very time its cells are demanding more energy to kick-start recovery.
After his last concussion, Greg’s symptoms grew even more debilitating: chronic fatigue, confusion, an inability to process what people said, splitting headaches.
Behind the wheel of a car, he’d forget he was driving. He had so many fender benders, he came to rely on others for rides. Quick to anger and increasingly depressed, he lost jobs and pushed friends away.
We see about 9,000 patients a year and do not prescribe brain-training games for any.
“There was very deep depression and thoughts,” Greg says, reflecting back on those times, “like, suicidal, honestly. Just not thinking my life was worth it.”
So he moved back home, with one condition: Kate insisted he wear special earphones for at least three hours a week and immerse himself in classical music. This was part of the Integrated Listening Systems, or iLs, therapy program. Mozart’s masterpieces played at select frequencies, while tiny vibrations from the headset sent sound waves through Greg’s skull. He hated it. “I was upset and angry, thought it was stupid, and didn’t think it would work,” Greg says.
Then one day at 6:30 in the morning, Kate recalls, “I come downstairs, and he looks at me and says, ‘I still don’t like this music, but I always feel better afterward.’” Kate wasn’t surprised at all. She had been hearing similar comments for years as the first hint of a client’s progress.
Soon Greg coupled iLs with Interactive Metronome. Holding a trigger hooked up to a computer, he would listen to a cowbell beat while watching red, green, and yellow bars onscreen, and try to clap to the beat; success lit a green bar. Because the program tracked his timing to the millisecond, playing on cue was difficult at first. Eventually, though, Greg could stomp along with his feet, hit the sides of his legs, and clap hundreds of repetitions while standing on a balance board—all of it while keeping time.
“Two, three months down the road, I started noticing differences,” Greg says. His memory improved, and he could multitask again. He held his temper more easily, and he no longer slept for most of the day.
Both techniques that Greg used are designed to improve the brain’s response to stimuli. Our gray matter comprises about 100 billion neurons, each of which is capable of making several thousand connections. Networks of these nerve cells communicate by converting electrical signals into chemical neurotransmitters, which carry messages from neuron to neuron across synapses, the tiny spaces between the cells.
For decades, scientists held that the brain was a piece of hardware that matured into a fixed state and remained that way until old age. Neuroscience has recently shown that it is, in fact, pliable. As we begin to master a task, the brain establishes and strengthens all of the connections that contributed to its success. As it responds to visual, auditory, and motor-process stimulation, it actually changes shape and function, forging new connections and reforming old ones. This is called neuroplasticity. It’s the linchpin of our ability to learn—and for the science undergirding brain training.
Companies routinely cite neuroplasticity as evidence for brain training’s value in their marketing literature. After all, they contend, if different cognitive interventions can help the brain shape-shift throughout life, then surely a host of disorders—dyslexia, ADD, traumas like stroke and concussion, and the cognitive decline associated with old age—can be treated through training. Not only that, but even people with healthy minds should see gains if they are able to improve their working memory, the term of art for the organ’s short-term ability to hold information and make use of it.
Makers of brain-training therapies and programs say they are designed to accomplish these benefits. Integrated Listening Systems claims to help reorganize the brain through stimulation of the cerebellum—the region at the base of the skull near the spinal cord—which manages motor output and communicates with the frontal lobes to help regulate memory, language, and emotions. “ILs repairs torn and disrupted pathways,” says Ron Minson, clinical director of Integrated Listening Systems. “It is creating new neural pathways that have to do with listening, with organization—the big one is memory.”
Interactive Metronome achieves a similar effect by synchronizing auditory and motor functions in its users, improving the brain’s ability to process sensory inputs by speeding up its “neurotiming.”
Other therapy programs use computerized games to provide the benefits. For example, BrainHQ created a product called Double Decision to help older adults improve their driving. It’s a speed-training exercise meant to augment peripheral vision. Depending on their needs, Brain Training of Maryland’s clients may find themselves on a regimen of IM, iLs, and games by BrainHQ and other companies. Across all training methods, Kate tells her customers to look for coincidences or changes in their behavior. Maybe this week they remembered where they left their keys, or the quiz they took didn’t seem so hard. “When coincidences become a pattern, you know that the training is starting to work,” Kate says.
Studies appear to show brain training’s ability to improve people’s daily lives. Neurobiologist Nina Kraus, founder and director of Northwestern University’s Auditory Neuroscience Laboratory, published a randomized, controlled study in 2013 demonstrating that BrainHQ’s Brain Fitness Program could help older adults distinguish consonant sounds in noisy environments.
The boldest claims for neural training’s efficacy come from the largest and longest cognitive intervention study ever conducted, the Advanced Cognitive Training for Independent and Vital Elderly, or ACTIVE. Funded by the National Institutes of Health, and begun in 1998, ACTIVE enrolled some 2,800 healthy adults over the age of 65. It divided them into a control group and three cognitive training groups for reasoning, speed of processing, and memory. The exercises included games like Double Decision, which participants played for at least 10 hours over six weeks. Investigators evaluated participants immediately after the training and at follow-ups as far as five and 10 years out. (A 20-year follow-up is forthcoming.)
Study subjects who were drilled in reasoning and speed of processing showed less decline in those abilities 10 years later versus the untrained ones, according to a 2014 report published in the Journal of the American Geriatrics Society. The biggest claim, however, came during the 2016 Alzheimer’s Association International Conference: ACTIVE participants who had performed the speed of processing task showed 29 percent less risk of dementia a decade out compared to the control group.
“Most people will be protected from a progression to dementia by appropriate forms of engagement or training,” says neuroscientist Michael Merzenich, a co-founder of Posit Science whose pioneering work on auditory neuroplasticity in the 1980s led to the invention of the cochlear implant. “It’s just plasticity, and it’s all reversible.” Put another way, it turns out that science might be able to manipulate our minds in remarkable ways: “We can basically change the brain at will,” Merzenich says. “I could train you and quite quickly turn your hand into a useless claw. … Or I could take you and refine the way your brain represents information at speed or in the presence of noise so you’re essentially a superior listener.”
Other researchers’ thinking has evolved more cautiously. In 2008, two investigators published a groundbreaking study in the Proceedings of the National Academy of Sciences. They demonstrated that young adults who played a game designed to exercise their working memories showed improvements in their fluid intelligence—the ability to solve new problems—by scoring several points higher on intelligence tests. Brain training, the results suggested, wasn’t just for people with cognitive deficits.
Since then, one of the study’s authors has moderated her expectations. Susanne Jaeggi is a neuroscientist and principal investigator at the Working Memory and Plasticity Laboratory at the University of California at Irvine. She’s one of the scientists who signed the consensus letter questioning how effective brain training is in improving real-world outcomes for people.
There’s no doubt that brain plasticity exists. What’s not clear, she says, is whether training has the wide-ranging benefits some companies claim. At her lab, where her team develops brain-training programs for research, Jaeggi has observed that individuals respond to the techniques in different ways. Some show improvement; others don’t. The NIH is backing an ongoing study into what makes some programs work.
“We have pretty good evidence that people across their life spans can get better in training with these specific games,” she says. “Where it starts to become controversial is whether it might translate to other tasks that were not part of the training.”
A systematic review of the studies cited by brain-training companies finds them lacking. The 84-page paper, published in 2016 by the Association for Psychological Science, even finds fault with the ACTIVE study: “In effect, each training regimen led to improvements on the trained task, with some near transfer to proximal measures of the same skill but no evidence of transfer beyond the trained task,” the authors write.
“The vast majority of these studies don’t actually look at transfer to some real-world activity,” says co-author Zach Hambrick, a Michigan State University psychology professor. “They look at transfer to other laboratory tasks.”
Even in young adults, the claim of transfer looks dubious, based on the results of a randomized controlled trial published last summer in the Journal of Neuroscience by University of Pennsylvania researchers. Psychology professor Joe Kable says they expected that cognitive training with Lumosity would not only improve working memory in young adults, but that it also would influence their decision-making abilities: how willing they were to forgo immediate rewards for future ones. Instead, what they found was that cognitive training had no effect at all.
“Not only did we not see far transfer, which was disappointing, but we also didn’t even see near transfer, which is kind of even more disappointing,” Kable says. “I mean, we were really going after the question: Can you optimize cognitive ability? We saw no evidence for that.”
Companies such as Lumosity grew their subscriber bases by advertising that brain training would have wide-ranging transfer effects. In its legal action against Lumos Labs, the FTC said that the claims Lumosity made—that its computerized, cognitive tasks could improve performance on everyday tasks, protect against cognitive decline, and even reduce impairment associated with health conditions such as traumatic brain injury and attention-deficit hyperactivity disorder—did not meet its standard of proof, which demands “competent, reliable, scientific evidence” to support health claims. “I think the FTC settlement is poorly understood and gets misrepresented,” says Bob Schafer, Lumos Labs’ head of research. “The settlement was about historical marketing materials from 2009 to 2014, not necessarily about the research we’ve published or the products.”
Cases like Greg’s are even trickier. There’s scarce research examining whether iLs and IM training improves concussion symptoms. Greg saw neurologists, psychiatrists, and therapists. He exercised regularly. But nothing really helped him, he says, until he began brain training.
Still, at its most basic, scientists would consider Greg’s story just that: an anecdote. And in terms of concussion, it’s particularly difficult to assess the efficacy of a treatment for a condition that often naturally gets better over time, or for which the patient also underwent targeted treatments that make use of occupational therapy, physical therapy, psychotherapy, and other forms of cognitive remediation.
“I certainly wouldn’t tell them not to do things that are helping them,” says Micky Collins, director of the Sports Medicine Concussion Program at the University of Pittsburgh Medical Center. “Absence of proof doesn’t mean proof of absence, right? I can tell you one thing: We see about 9,000 patients a year at our clinic, and we do not prescribe brain-training games for any of them.”
Kate counters as only a parent could: “If I was waiting for recovery, Greg would still be in my basement. Unemployed. Angry. And not where he is today.”
In November 2017, Greg spent a long weekend in Washington, D.C., a trip that would have been nearly impossible for him a few years ago. He and his girlfriend visited the National Museum of African American History and Culture, appreciating a moment of quiet contemplation amid the exhibits on offer, navigated the subway system, and walked throughout the noisy city—all activities that his concussion symptoms once prevented him from doing.
After a year of training, Greg went back to school. He graduated from community college this past May with his associate’s degree. He lives and drives on his own again. He’s personable and engaging. This past summer, he joined the nine-person staff at Brain Training of Maryland in addition to working as a personal trainer. It’s hard to view him as anyone who was once fatigued and angry.
Science rightfully considers stories such as Greg’s to be anecdotes and will have to continue the careful progress in settling the argument. What’s needed is more research into how cognitive function might be improved through training to the point where it carries over into real-world behavior. Serious organizations like the NIH are doing work in that arena. There are also completed studies that have tried to assess real-world performance in one way or another, including the ACTIVE study, which clearly showed that training memory, for instance, improved memory performance.
In December 2017, the Journal of Cognitive Enhancement published a special issue focused on the merits of cognitive training. In an opening editorial, the guest editors, which included Susanne Jaeggi, conclude that brain training can be effective in improving everyday life tasks, but the evidence remains limited. Still, there are studies, including a couple in that special issue, that suggest that brain training has the potential to produce real-world effects. “But they’re certainly not as clear-cut and as evident as many companies make it seem,” Jaeggi says.
To Kate Ortman, Greg’s results are pretty clear-cut: “This was not medication,” she insists. “This was not therapy. This was training.”
Soon Brain Training of Maryland will rebrand as Brain Train America, a reflection of the customers across the country who book virtual appointments. They’re clients that, Kate says, have improved much in the same way as her own son. And for the first time since his concussions, Greg is living a different life. “I’m happy,” he says, “and I’m ready to take on whatever life gives me.”