Dementia is one of the most feared conditions of aging. The CDC estimates that over 14 million Americans will be affected by 2050. The cause is likely multifactorial and although we know much about the pathologic findings seen on imaging and autopsy, the ability to prevent this disease or treat it remains elusive. Just this week a highly touted experimental treatment called TauRx failed in its largest human trial to date. The drug targets one of the main suspected culprits of Alzheimer’s–accumulation of the Tau protein. Other treatments targeting the beta-amyloid protein have also met with mostly disappointment. But what if we could prevent dementia? We know already that patients with uncontrolled hypertension, certain genetic conditions, family history, high alcohol use, tobacco use, low cognitive reserve and professions without significant lifelong learning increase the risk considerably.
Many scientists have turned to cognitive training in an attempt to both prevent and treat dementia. This “brain game” training has turned into a billion dollar industry according to Forbes. Not everyone is happy about this however. The National Academy of Sciences published a paper suggesting most of the effects of cognitive training are nothing more than placebo. The hammer blow for the industry was the $50 million dollar fine (settled at $2 million) the Federal Trade Commission levied on Lumosity (the leading brain training company) in January 2016 that we reported on here at iMedicalApps. Lumosity simply made claims it couldn’t back up with hard science.
This week the news is much better for brain training games. Investigators for the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study presented 10-year follow-up data at the Alzheimer’s Association International Conference in Toronto. The ACTIVE team previously showed benefit of cognitive training in community dwelling adults and have published other articles suggesting benefits in a variety of outcomes. But these new results showed a 33% decreased incidence in dementia in subjects who utilized the speed training exercises that were part of the trial.
Posit Science utilizes the exact same cognitive training in their medical app, BrainHQ. In fact, most of the investigators reported honoraria from Posit Science; however, the study is funded by a National Institutes of Health (NIH) grant. Nonetheless, the results of the study are impressive. ACTIVE included 2,785 community-dwelling adults without evidence of cognitive impairment at baseline aged 65 years and older (average 74 years at baseline) and followed them for 10 years. Patients were randomized into three different cognitive training arms including a control group. According to results presented at the conference by the authors, dementia incidence was 14% in the control group, 12% in those completing 10 or fewer speed-of-processing sessions, and 8% in those who completed 11 to 14 speed-of-processing training sessions. Only the speed-of-processing training showed a significant effect on cognition (HR 0.67; 95% CI, 0.49-0.91). Dementia was reduced by 8% per cognitive training session completed according to the study’s authors.
So will the BrainHQ medical app do the same for you? No one knows at this point, but certainly the Double Decision speed training game may be worth a look for many over the age of 65 interested in cutting their dementia risk. Patients and providers should be cautious in attempting to generalize these results to a younger patient population, patients already with dementia or other games that are part of BrainHQ. Hopefully, answers to these questions will come in time. For now, let’s take a quick look at BrainHQ in action.
Video Review of BrainHQ
Evidence based medicine
Posit Science, the company behind the BrainHQ medical app, has been steadily increasing the quality of the evidence to back up their claims of the app improving memory, cognition, reasoning speed, etc. With the latest announcement from the ACTIVE investigators, the Double Decision game that is part of BrainHQ is now the first to show a decreased incidence of dementia. Obviously, the study population was much older (ages 74-84) than most potential customers. Future research will hopefully tell us if games like those in BrainHQ, if started earlier in life, can prevent/delay dementia or treat/lessen established dementia. The generalizability of the results of the ACTIVE study is limited in those respects.
What patients/providers would benefit from this Medical App?
Any patient or healthcare provider who is interested in a game based format to potentially delay/decrease the incidence of dementia.
Available on iOS for iPhone and iPad, Android (in browser only), and Mac/PC.
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
- Can play a limited number of games/times for free. Subscription to full content: $14/month or $96/year.
- RCT evidence of efficacy (at least for the mental speed processing games).
- Many different categories of games/levels.
- Can personalize training or play any game you wish.
- Detailed instructions on each game including science behind the game and information on each game’s developer/scientist.
- Navigation of app could be more intuitive as could personalization section.
- No Android app at this time (can play in browser only on Android devices).
- Price seems steep for the content, though with more published research than the competition, it may be worth it.
BrainHQ is likely to be an even bigger hit now that the ACTIVE study has published their 10 year outcomes and the speed training games developed by Posit Science and used in BrainHQ were shown to be effective in reducing the incidence of dementia. The battlelines are likely still just being drawn as the medical apps for cognition/dementia are still truly in their infancy. However, if a provider is looking for brain training medical app that has true quality evidence from an RCT with long term follow-up, then BrainHQ is the only game in town.
- Overall Score
- User Interface
Relatively easy to navigate and use. Layout could be more self-explanatory and include more “about” built into the app.
- Multimedia Usage
App contains many different games, scenarios, tracking, personalization, etc. and syncs over different apps and platforms.
Price for iPhone is $14/month or $96 per year which includes mobile and computer access. This may be too pricey for many, but it does have some published evidence for efficacy. The cost of dementia is clearly much greater!
- Real World Applicability
BrainHQ may be the “winner” in the post-Lumosity legal battles since it has “proof” of efficacy. Ideally, we will see more published literature supporting apps such as BrainHQ. In the meantime, for a public hungry to try just about anything to prevent dementia, this week’s publication is welcome evidence that games like BrainHQ may actually work.
- Device Used For Review
iPhone 6S running iOS 9.3.1
- Available for DownloadiPhoneiPad