Today he has increasing reasons for optimism. Psychiatry professors Bruce Wexler, at Yale University, and Sophia Vinogradov, at UCSF, have independently found in randomized, controlled trials that people with schizophrenia have shown marked improvement after intensive and progressive cognitive training. Wexler’s studies, begun in the mid-1990s, have shown the improvements to be lasting—up to 12 months—and capable of affecting real-life work performance. Patients with schizophrenia have long been known to have major problems with auditory processing, working memory, and language, similar in some ways to what happens to a brain ravaged by age, Wexler explains. Just like an elderly person who learns bad habits while attempting to cope with a decline in ability, a person with schizophrenia frequently slides from bad to worse. A potentially aggravating factor is that the severe memory problems accompanying the disorder mean that much of what happens to a person with schizophrenia seems surprising. A constant state of surprise triggers surges of the neurotransmitters dopamine and norepinephrine, which gradually poison the brain, according to Merzenich.
Merzenich is currently supervising clinical trials of his program for schizophrenia, conducted by Vinogradov and Wexler at UCSF and Yale. Pending the results, he plans to apply for approval of this use from the Food and Drug Administration. Merzenich is hopeful that the right kind of training could ultimately free people with schizophrenia from drugs. Although Wexler suspects that this goal is overly ambitious, he does believe the training could greatly improve patients’ lives. Scientists who specialize in schizophrenia also agree that Merzenich’s regimen could have a great impact on prodromals, high-risk adolescents who have yet to have a psychotic break. Vinogradov has been awarded a grant by the Stanley Foundation to test Merzenich’s programs on young people at this stage. The hope is that such intervention could prevent the first psychotic episode.
For now, the Brain Fitness Program remains Posit Science’s main and most profitable focus. It got a major vote of confidence last summer, when Humana, the big insurance company, made it available either for no cost or for a reduced price to its Medicare-eligible plan members. Yet despite the enthusiastic testimony I heard from senior citizens who have tried the program, there are no formal studies published in peer-reviewed journals that demonstrate the program’s effects. In their report in Proceedings of the National Academy of Sciences, Merzenich and his coauthors say Brain Fitness Program users in controlled studies showed an average improvement roughly equal to 10 years of memory performance, as assessed with a standardized test for memory and cognition known as RBANS (Repeatable Battery for the Assessment of Neuropsychological Status).
Posit Science is now sponsoring additional evaluations by outsiders, including a team at the Mayo Clinic. Glenn Smith, the principal investigator on that project, declined to comment on the work. But one of Smith’s colleagues, Ron Petersen, director of the clinic’s Alzheimer’s Disease Research Center, called Merzenich’s theory “enticing,” then added: “Would I bet the farm on it? Not right now.” Among a list of caveats, Petersen questioned the suitability of the control method in Posit Science’s study, in which a group of age-matched subjects watched educational DVDs on computers. That relatively passive activity, he pointed out, matches up poorly with the interactive program, which would be much more stimulating, especially for someone without a lot of computer experience. “Why didn’t they at least play Donkey Kong for eight weeks?” he asked.
Merzenich counters that Posit Science tested subjects in an unpublished study with video games that he says would be a more useful comparison than Donkey Kong. He says those subjects saw no improvement.
Petersen also questioned whether the RBANS test represents a meaningful improvement in real-world functioning and noted that the Posit Science team had not tested the longevity of the improvements past three months. “Cautious optimism is probably appropriate,” he said. “But I’d bet they’re being a lot more enthusiastic than that in their marketing materials.” He is right about that. Posit Science’s Web site last fall featured a photo of an attractive, smiling, white-haired couple on a motorcycle and enjoined visitors to “Be sharp. Stay sharp. For a vibrant life.”
A second considerable hurdle for the Brain Fitness Program is the time and devotion it demands: an hour a day, five days a week, for eight weeks, of often tedious, repetitive drills. (Booster sessions are also recommended to keep the connections between neurons toned.) “As it stands, this is a barrier,” acknowledges Avram Miller, a financial guru and adviser to Posit Science. “But I think the time it takes could be reduced significantly.”
Hearing this, Merzenich frowns and shakes his head. Cutting back on the hours is not in his plans. “It takes time to change the brain,” he says. “You’ve got to think of it like going to a regular gym.”
