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Preparing Society For the Cognitive Age With New Brain Research, Education and Tools

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”.

The process in under way.

Copyright (c) 2009 SharpBrains

Surgery Robots Mean More Education And Training For Both Nurses And Doctors

More and more hospitals in the developed world are employing robots in surgery, including Japan, for example. Iseikai Hospital in Osaka and Nagoya Kyouritsu Hospital in Nagoya are just two Japanese hospitals that use these labor-saving surgical automation systems.

However, despite their success in the surgery room, these robots also had unintended consequences like creating issues in the way the insurance companies are billed for “services rendered.” Billing for operations performed by robots are already a topic of controversy in Japan since they are not categorized as “regular surgical operations.”

In British Columbia, Canada, a “Da Vinci” brand robotic system will start operating this Fall (2007) to help doctors during surgeries that require accessing tight areas like the pelvis or the chest. Vancouver General Hospital is planning to use Da Vinci in urological (e.g., Radical Prostatectomy), cardiac (e.g., Mitral Valve Repair) and gynecological (e.g., Hysterectomy) surgeries.

Canadian news reports claim that “robot-assisted surgery offers patients fewer surgical complications, less post-operative pain, faster recovery times, shorter hospital stays and improved health outcomes.” Purchasing Da Vinci, installing it, training the personnel and maintaining it for three years will cost the hospital somewhere around $6.5 million.

Here in the United States, did you know that robots are performing cancer surgeries in Charlotte, North Carolina? CyberKnife, a $3.7 million knifeless robot, is operating on cancer patients with precision radiation at the NorthEast Medical Center. CyberKnife is also used in Mission Health and Hospitals in Asheville and UNC Hospitals in Chapel Hill.

Other “radiosurgery” machines used in surgery include the Gamma Knife in Winston-Salem and Greenville and the XKnife and a Varian device in Durham.

This irreversible trend of course requires both surgeons and nurses require new technical skills to allow them work with such computerized and programmable wonders. Our healthy future will demand even a higher level of training and technical competence from our nurses and healthcare providers.

Cincinnati Schools Establishes Programs That Unite Educators and the Community

Cincinnati Schools’ Parent Leadership Institute

This summer saw the creation of the Cincinnati Schools ‘ Parent Leadership Institute. The program reflects the changing role that parents play in public education. As Vanessa White, the Board President of the Parents for Public Schools (PPS) stated: “The days of bake sales are long gone. Today, parents need a new set of skills and knowledge if they are to realize their full potential to impact student achievement and drive school improvement.” Organizations such as PPS work to align the needs of Cincinnati schools with the resources of parents in order for both sides to work together for the benefit of children attending Cincinnati schools.

One of the models that the Cincinnati schools have been looking at is the Pritchard Committee of Lexington, Kentucky. The Pritchard Committee established the Commonwealth Institute for Parent Leadership and trained over 1300 parents from a variety of backgrounds in the ways that they could be productive in assisting the public school system. Cincinnati schools have seen the success of the Lexington program and have worked diligently to see if such a program could have a similar positive effect on parental involvement in Cincinnati schools. Ms. White is eager to see how Cincinnati schools will benefit and expresses high hopes for the program: “Expectations have been raised for students and teachers, and it’s time for parents to step up to the plate as well. This program will greatly enhance our ability to identify and develop parent leaders who can then engage other parents to ensure that our schools provide a quality public education for all children.”

Other educational professionals in the Cincinnati schools have also welcomes the process and look to the success of the Lexington program to justify their enthusiasm. Superintendent Rosa Blackwell argues that “decades of research confirm that when parents are more involved, student achievement increases.” Cincinnati schools stand to benefit from those decades of research in creating a program that clearly aligns the activities of parents and teachers in order to make a Cincinnati public school environment that provides the most comprehensive program for students.

Cincinnati schools are relying on a number of local and national partners to implement the program. In addition to the Pritchard Committee, Cincinnati schools will be working with the United Way and Xavier University. These groups hope to create Community Learning Centers where parents can come for training. Cincinnati schools are grateful for the support from business and other community partners in order to fund these Community Learning Centers. Among the grant supporters are the KnowledegeWorks Foundation, the Scripps Howard Foundation and the Kroger Foundation. All of these groups will work in conjunction to make the program as effective as possible for Cincinnati school parents.

To start the program off, a pilot group will begin working under the direction of Zakia McKinney. Ms. McKinney has worked as an Education Director at the Urban League as well as an Executive Director of the Walnut Hills Churches. She has been active in community organizations for many years and looks forward to sharing her experience with Cincinnati schools. She is optimistic of the program’s potential for Cincinnati schools, stating that “The Parent Leadership Institute will play an important part by training parents as informed advocates and willing change agents equipped to engage other parents to work with the schools on solutions for change”