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Thursday, April 29, 2010

Can Brain Training Improve Cognitive Performance?



Readers,

A recent paper published in the journal Nature looked at whether six weeks of online brain training would improve the cognitive performance of 11,430 healthy adults. What’s intriguing about this paper, besides the sheer size of the study, is that it was published in such a prestigious journal despite essentially having a null result.

To examine the effects of brain training on cognitive functioning, Owen Adrian of the Medical Research Council in the United Kingdom and his collaborators conducted a massive clinical trial online. At the start, 52,617 subjects, recruited through the British Broadcasting Corporation science show Bang Goes the Theory, signed up to participate. Ranging in age from 18 to 60, they were instructed to perform certain cognitive tasks for at least 10 minutes a day, three times per week, for six weeks. To do so, they logged on to the show’s website.

The study randomly assigned subjects to either one of two brain-training groups or to a control group. The two training groups differed in the kind of training they received: one practiced tasks designed to improve reasoning, planning, and problem-solving, while the other received training more like that involved in many commercial brain-training programs. For instance, they practiced tests assessing a wide range of cognitive functions, including short-term memory, attention, visuospatial processing, and math. A third group consisted of control subjects whose task involved finding answers to “obscure questions” using any online resources they could find.

To detect cognitive gains, the researchers administered a neuropsychological battery at baseline and six weeks later. It consisted of four tests that assessed verbal short-term memory, spatial working memory, paired-associates learning, and reasoning. The change in scores from pre-test to post-test served as the main outcome measure and an indicator of generalized cognitive improvement. Analyses focused on the 11,430 subjects who had completed at least two training sessions during the six-week period, as well as the neuropsychological test battery before and after that time. Not surprisingly, the training improved performance on the trained tasks. But, the control group also improved, with similar effect sizes. The critical comparison was whether the experimental groups showed greater improvements in performance post-training than the control group did. And the answer, generally speaking, was no. That is, when the researchers directly compared the performance of the three groups across all four tests, they found that all improved, but only slightly, but with no statistically significant differences.

Further studies will be done, including follow up of subjects who continue to participate in the online training for the next year, to see if any significant differences can be teased out.

A.M. Owen, A. Hampshire, J.A. Grahn, R. Stenton, S. Dajani, A.S. Burns, R.J. Howard, & C.G. Gallard (2010). Putting brain training to the test. Nature

Michael Rafii, MD, PhD
Associate Medical Director of the ADCS

 
Author: Michael Rafii MD, PhD at 8:53 AM 0 Comments

Monday, April 19, 2010

IGIV Phase II Study Results


Readers,

As promised, I want to share some findings presented at the Annual American Academy of Neurology meeting held last week in Toronto, Canada. The is the major meeting for clinical neurologists in this country; it is huge and hectic. And while in recent years there has been a tendency for new data related to Alzheimer’s disease to be presented at conferences devoted entirely to AD (eg, the International Confernece on Alzheimer’s Disease, ICAD), there are always notable reports at AAN.

This year, there was a paper delivered by Dr. Norm Relkin from Cornell on the continuing results from his Phase II trial of pooled human immunoglobulin therapy (called IVIG or sometimes IGIV) for people with AD. For the first time, he was able to describe the results after 18 months of treatment. It is a very small trial, with a total of 24 participants, with 16 initially randomized to receive IGIV and the other 8 randomized to receive an identical placebo. After 6 months of such treatment, all subjects received active IGIV. Of the initial group of 24, 21 are still being followed, 14 from the original active group, and 7 from the group that received placebo for 6 months followed by active treatment.

Norm has reported before that active treatment was associated with better cognitive and clinical results during the six-month placebo controlled phase, and that the benefits persisted even after the placebo group started active treatment. At AAN, he presented data from the 18 month time point, and showed rather dramatic cognitive benefit in the subjects treated with IGIV from the start compared to those starting 6 months later. Further, he showed that MRI scans revealed a reduction in brain atrophy in those on treatment for the full 18 months.

These results are encouraging, as they are consistent with an important clinical benefit related to this treatment. But caution is necessary. The study is very small indeed. While the findings are statistically significant, they could be influenced by unexpectedly poor performance in the very small group originally on placebo.

But that said, the results do provide further support for the theory that delivery of naturally-occurring anti-amyloid antibodies contained in pooled human immunoglobulin may be an effective therapy for AD. The multicenter Phase III trial under way now, a collaboration between the ADCS and Baxter, could provide a definitive answer.

Thanks for reading,
Paul Aisen
 
Author: Paul Aisen MD at 4:46 PM 0 Comments

Tuesday, April 06, 2010

Useful Websites


Readers,

Still in an introductory mode, I would like to point you to some of the most valuable and reliable web sites for information related to Alzheimer’s disease (in addition, of course, to our own: www.adcs.org).

First is ADEAR, the Alzheimer’s Disease Education and Referral site managed by the National Institute on Aging, a branch of NIH and our primary source of funds. The ADEAR web address is www.nia.nih.gov/alzheimers. ADEAR is an authoritative source of articles on the disease, caregiving and research, with an emphasis on government-funded activities including the Alzheimer’s Disease Centers around the country and the ADCS.

Next is the Alzheimer’s Association web site, www.alz.org. You undoubtedly know that the Alzheimer’s Association is the leading non-profit organization supporting Alzheimer’s research and care. The web site is outstanding, with up-to-date reports on the demographics and science of AD, including risk factors, diagnosis, treatments, research and financial/legal/insurance issues.

Last, but definitely not least, is the Alzforum site, www.alzforum.org. This is the leading web address for scientists working in the field. It provides links to the huge number of AD-related research papers published in scientific journals (typically over a hundred new papers each week), articles summarizing the latest developments, and various tools that support collaborative research. While much of the material is technical, it provides a fascinating look at the disease from the perspective of the research community, and is an incredibly useful resource.

Remember that the internet as a whole provides a near-infinite amount of information on AD, but most of it is simply wrong. The enormous need for support and hope generates an outpouring of information, some of it well-intentioned but inaccurate, some of it fraudulent. Please be skeptical. I believe that virtually all important information for families dealing with AD can be found on the sites described above, where it will be presented in a fair and objective manner.

Next week is the annual meeting of the American Academy of Neurology in Toronto. We should have some interesting news to report.

Thanks for reading,
Paul Aisen, MD
 
Author: Paul Aisen MD at 2:15 PM 0 Comments

Friday, April 02, 2010

Welcome to the ADCS Blog


Welcome to the first entry in the ADCS blog. I hope that our readers have had a chance to explore the ADCS web site and have a clear idea of who we are and what we do. In brief, we are a consortium of clinical investigators from around the continent funded by the National Institute of Aging (a branch of NIH) to conduct therapeutic research in Alzheimer’s disease. It is our mission to speed the development of new treatment options by improving clinical trial methods and by conducting studies of promising agents. We collaborate with academic investigators and companies from all over the world.

What is the purpose of this blog? We aim to provide updates on research in AD written in language accessible to all. In particular, we intend to comment on media reports that many of you read; our perspective on such reports is often quite different from that presented by the journalists. Our goal is to accurately review research developments in a broad context, with recommendations on how our readers should (or more often should not) be influenced by the findings. People sometimes get the impression that there are major breakthroughs in the treatment of AD on a monthly basis.

While there has been much progress in understanding the disease and many promising treatments are under investigation, developing therapies that are effective and safe takes an enormous amount of time. The bad news is that we have not had a new treatment for AD approved since 2003. The good news is that incremental advances occur every week, and there are dozens of new treatments in the various phases of clinical testing.

Please let us know the topics and questions you would like addressed in this blog. While we will not be able to respond to all questions, we will post entries on the topics of greatest interest to our readers.

Thanks for reading.

Paul Aisen, MD
Director, ADCS
 
Author: Paul Aisen MD at 11:40 AM 2 Comments

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About Us

The Alzheimer's Disease Cooperative Study (ADCS) was formed in 1991 as a cooperative agreement between the National Institute on Aging (NIA) and the University of California, San Diego. The ADCS is a major initiative for Alzheimer's disease (AD) clinical studies in the Federal government, addressing treatments for both cognitive and behavioral symptoms. This is part of the NIA Division of Neuroscience's effort to facilitate the discovery, development and testing of new drugs for the treatment of AD and also is part of the Alzheimer's Disease Prevention Initiative.

The ADCS was developed in response to a perceived need to advance research in the development of drugs that might be useful for treating patients with Alzheimer's disease (AD), particularly drugs that might not be developed by industry.