Many tech-based interventions exist for dementia from virtual reality to a cognitive training app, but do they work?
The CDC estimates that over 14 million Americans will be affected by 2050. Dementia affects 14% of people ages 71 years and older and 30% of those over the age 90. The cost of care worldwide is estimated at $422 billion and is multifaceted. Although we know much about the pathologic findings seen on imaging and autopsy, the ability to prevent this disease or treat it remains elusive.
The medical literature is littered with hundreds of failed dementia drug trials. Last year, 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.
Bill Gates of Microsoft fame invested over $50 million of his own money in the Dementia Discovery Fund. Also this week, the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial was published. We discussed this trial last year in our review of the BrainHQ app. At the time, the study authors were presenting preliminary results for the cognitive training app. The ACTIVE team previously showed the benefit of cognitive training in community-dwelling adults and have published other articles suggesting benefits in a variety of outcomes. ACTIVE included 2,802 community-dwelling adults without evidence of cognitive impairment at baseline aged 65 years and older (average 74 years at baseline, mostly white and mostly female) and followed them for 10 years.
Patients were randomized into three different cognitive training arms or a control group. The final results of the analysis showed a 29% decrease in dementia in subjects who utilized the speed-training exercises (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.50– 0.998, P=.049) compared to control, but memory and reasoning training did not (HR 0.79, 95% CI 0.57–1.11, P=.177 and HR 0.79, 95% CI 0.56–1.10, P=.163, respectively). Each additional speed training session was associated with a 10% lower hazard for dementia (unadjusted HR, 0.90; 95% CI, 0.85–0.95, P=.001).
Dementia was reduced by 8% per cognitive training session completed. The absolute difference in the speed processing group was 2.6% with a number needed to treat of 38. It is worth noting, however, the wide confidence intervals and near insignificance of the margins. Posit Science utilizes the exact same cognitive training in their app, BrainHQ. The Double Decision game is designed to expand our “useful field of view.” How that reduces dementia is not known. 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.
So will a cognitive training app like BrainHQ 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.
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.
