22 May BrainHQ Computerized Training Program Improved Cognitive Parameters after Mild TBI

MedicalResearch.com Interview with:

Dr. Mahncke

Dr. Henry W. Mahncke PhD
Research neuroscientist
CEO of Posit Science Corporation 

MedicalResearch.com: What makes this study newsworthy? 

Response: Mild Traumatic Brain Injury (mTBI) is a complex condition to treat. Patients can report many symptoms (e.g., cognitive deficits, depression, anxiety, stress, fatigue, pain, sleep difficulties, disorientation, emotional issues). Prior to this study, conducted at five military and veterans’ medical centers, there has been no highly-scalable intervention to treat the cognitive deficits associated with mTBI. This study showed that a plasticity-based, computerized, brain-training app can drive statistically and clinically significant gains in overall cognitive performance. Given the number of service members and vets with persistent cognitive deficits from TBIs, that’s a big deal.

MedicalResearch.com: What can you tell us about the medical condition (mild TBI) investigated in this study?  

Response: Nearly 400,000 members of the US armed forces have been diagnosed with one or more TBIs. More than 82 percent of those injuries are classified as “mild” TBIs (commonly from concussion or blast exposure and often referred to as “mTBIs”). In most cases, service members can experience a full recovery from a “mild” TBI – but for those that do not, cognitive consequences can persist for years with life-altering results. This risk is notably higher for service members returning from the Iraq and Afghan conflicts than for civilians – and as a result, this injury has been called the “signature injury” of those conflicts. 

MedicalResearch.com: How was the study organized?

Response: The Department of Defense (DoD) funded the BRAVE Study to determine whether a plasticity-based, computerized, brain-training intervention could be broadly and remotely applied and could produce significant improvements in persistent cognitive deficits across a diverse mTBI population. No computerized cognitive training has previously been shown effective in a Class 1 study (as defined by the American Academy of Neurology).

BRAVE enrolled 83 participants with a history of mTBI and diagnosed with cognitive impairment. Typically, participants had been deployed to combat areas, and, on average, had their most recent mTBI more than seven years earlier. Their average age was 33, and 81% were male. Before training, they tested, on average, about two standard deviations below normal on the ANAM (a cognitive test used by the military to screen for cognitive impairment).

The participants were randomized into a treatment group (BrainHQ) and an active control group (computer games). Both activities were plausibly expected to have some positive impact due to their demands on cognitive realms, such as attention, memory, and reasoning. Each group self-administered training in their own homes (with telephone supervision from trained coaches) and were asked to train for 1 hour per day, 5 days per week, over twelve weeks. Comprehensive cognitive assessments were performed before training, after training, and after a twelve-week, no-training, follow-up period.

The study was conducted through a nationwide network of five military and veterans’ medical centers (NICoE/Walter Reed National Military Medical Center in Bethesda; Schofield Barracks/Tripler Army Medical Center in Honolulu; Baylor/Michael E. DeBakey VA Medical Center in Houston; Yale/VA Connecticut Healthcare System in West Haven; and Harvard/VA Boston Healthcare System in Boston); with Posit Science in San Francisco as the study coordination center. 

MedicalResearch.com: What makes this study newsworthy?

Response: Mild Traumatic Brain Injury (mTBI) is a complex condition to treat. Patients can report many symptoms (e.g., cognitive deficits, depression, anxiety, stress, fatigue, pain, sleep difficulties, disorientation, emotional issues). Prior to this study, conducted at five military and veterans’ medical centers, there has been no highly-scalable intervention to treat the cognitive deficits associated with mTBI. This study showed that a plasticity-based, computerized, brain-training app can drive statistically and clinically significant gains in overall cognitive performance. Given the number of service members and vets with persistent cognitive deficits from TBIs, that’s a big deal. 

MedicalResearch.com: What can you tell us about the medical condition (mild TBI) investigated in this study?

Response: Nearly 400,000 members of the US armed forces have been diagnosed with one or more TBIs. More than 82 percent of those injuries are classified as “mild” TBIs (commonly from concussion or blast exposure and often referred to as “mTBIs”). In most cases, service members can experience a full recovery from a “mild” TBI – but for those that do not, cognitive consequences can persist for years with life-altering results. This risk is notably higher for service members returning from the Iraq and Afghan conflicts than for civilians – and as a result, this injury has been called the “signature injury” of those conflicts.

MedicalResearch.com: How was the study organized?

Response: The Department of Defense (DoD) funded the BRAVE Study to determine whether a plasticity-based, computerized, brain-training intervention could be broadly and remotely applied and could produce significant improvements in persistent cognitive deficits across a diverse mTBI population. No computerized cognitive training has previously been shown effective in a Class 1 study (as defined by the American Academy of Neurology).

BRAVE enrolled 83 participants with a history of mTBI and diagnosed with cognitive impairment. Typically, participants had been deployed to combat areas, and, on average, had their most recent mTBI more than seven years earlier. Their average age was 33, and 81% were male. Before training, they tested, on average, about two standard deviations below normal on the ANAM (a cognitive test used by the military to screen for cognitive impairment).

The participants were randomized into a treatment group (BrainHQ) and an active control group (computer games). Both activities were plausibly expected to have some positive impact due to their demands on cognitive realms, such as attention, memory, and reasoning. Each group self-administered training in their own homes (with telephone supervision from trained coaches) and were asked to train for 1 hour per day, 5 days per week, over twelve weeks. Comprehensive cognitive assessments were performed before training, after training, and after a twelve-week, no-training, follow-up period.

The study was conducted through a nationwide network of five military and veterans’ medical centers (NICoE/Walter Reed National Military Medical Center in Bethesda; Schofield Barracks/Tripler Army Medical Center in Honolulu; Baylor/Michael E. DeBakey VA Medical Center in Houston; Yale/VA Connecticut Healthcare System in West Haven; and Harvard/VA Boston Healthcare System in Boston); with Posit Science in San Francisco as the study coordination center.

MedicalResearch.com: What are the main findings?

Response: Researchers found the BrainHQ group showed a statistically and clinically significant improvement on overall cognitive function (compared to the computer games group), and this benefit persisted for at least twelve weeks after training completed. Cognitive function improvements were 3.9 times larger in the BrainHQ group than the control (as measured immediately following training) and grew to 4.9 times larger (when measured again 12 weeks after training ended)

On average, participants in the BrainHQ group improved on the cognitive performance composite measure by 24 percentile ranks – as though they went from the 50^th percentile to the 74^th percentile.

While results on the primary cognitive measure were significant, analysis of functional and self-report measures did not show significant between group differences. However, on many measures both groups showed improvement, suggesting general benefits of cognitive engagement and study inclusion.

MedicalResearch.com: What should readers take away from your report?

Response: There is now Class 1 evidence that cognitive deficits from mTBI can be effectively treated with a plasticity-based, computerized, brain-training app, even if patients are in a remote location.

MedicalResearch.com: What can you tell us about the computerized training as compared to more traditional cognitive rehabilitation?

Response: Current treatments focus on in-person, 1:1 cognitive rehabilitation (e.g., training a person to use a calendar to make up for lapses in memory) – approaches that can be helpful, but are difficult to scale to all service members and veterans, and to all the places where they live.

TBI patients receiving top quality care have a range of treatments within their individual evidence-based plans in order to address their full range of needs. For example, pain might be addressed with a course of physical therapy or pain-killers, or depression might be addressed with a course of psycho-therapy or anti-depressants. There’s not been a lot of options when it comes to evidence-based programs for cognitive deficits. This study presents Class 1 evidence of a highly-scalable intervention, that quickly personalizes to each individual and that can be delivered remotely.

MedicalResearch.com: How does BrainHQ work?

Response: BrainHQ is a new type of computerized brain training program, directly-based on decades of National Institutes of Health (NIH)-funded scientific research into brain plasticity – the discovery that the adult brain can rewire itself structurally, functionally, and chemically in response to experience and learning.

The exercises in BrainHQ focus on elemental cognitive abilities, such as the speed and accuracy with which a person processes sensory information (primarily hearing and vision). Improving that speed and accuracy, lays the foundation for better working memory, which is the key building block of all higher cognitive function – such as other forms of memory, planning, reasoning, decision-making and social cognition.

There are now more than 150 peer-reviewed articles on the benefits of the exercises and assessments in BrainHQ. That includes gains in standard measures of cognition (e.g., speed, attention, memory, executive function); in standard measures of quality of life (e.g., mood, confidence, control, health-related quality of life); and at real world activities (e.g., balance, gait, driving, skills needed to live independently).

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We are engaged in ongoing research on brain injuries of different type. One area we are looking at now is a demonstration that cognitive conditioning can make a person more resilient, just a physical conditioning can. We’re also very interested in research looking into the common causes of cognitive impairment across a wide variety of conditions – from mTBI to chemobrain to multiple sclerosis to HIV-associated neurocognitive impairment. Even though these conditions have very different origins, they look like the put the brain in a similar “noisy” information processing state – suggested to us that there may be common ways to improve cognitive function across these disparate conditions.

MedicalResearch.com: Is there anything else you would like to add? 

Response: Many of us believe we are entering a new era in which treatment alternatives will be more easily accessible, and can be more quickly personalized, by being delivered digitally. That version of the future requires solid studies and changes in our healthcare delivery, payment, and regulatory systems. This study is another foundation stone in building the case for that version of 21^st century medicine.

Any disclosures? Dr. Henry Mahncke and other supporting members of the research team from Posit Science are employed by, and have equity in, Posit Science, the maker of BrainHQ (used as the intervention in the study). The researchers at the five military and veterans’ sites, who administered the study and collected the data, have no financial interest in Posit Science and no conflicts to declare. 

The study results were presented at the 9^th Annual Traumatic Brain Injury Conference in Washington DC. The intervention studied was the brain training app BrainHQ, made by Posit Science.

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Last Updated on May 22, 2019 by Marie Benz MD FAAD