One Brain's journey

I have mentioned several times in past posts that I do marketing work for Cogmed in Canada but this simple description does not really do the relationship justice and I thought it timely to revisit the topic. I chose Cogmed. I went looking for them. That journey began when my most skeptical friend who works for Psychological Services for one of the largest school boards in the country first told me about Cogmed with an enthusiasm he rarely displays and I thought we might together acquire a license. From my first contact with their head office in Stockholm, to my first visit with a practice in Canada I was impressed with their professionalism and integrity.

We didn’t meet Cogmed’s fairly strict requirements for a license and so I decided to offer my services to build their brand in Canada and to further public understanding of the concept of neuroplasticity, which is necessary to understand how Cogmed works or that it should work at all. That is one of the reasons I started this blog. The blog though, as anyone who has been reading it will understand, is very much a personal view. Am I biased towards Cogmed? Yes, is the short answer. I am biased because I know their working memory training does what they say it’s supposed to to. I have a bias towards Cogmed because of their professional and thorough approach to the commercialization of research conducted by the Karolinska Institutet in Stockholm and I am biased towards them because I know their product is backed by solid, ongoing and peer-reviewed, validation studies.

I do work for Cogmed because they pay me to do it but also because I have an intense and personal fascination with the concept of neuroplasticity and the role of working memory in so many mental health issues. For some time I was quite depressed about how my own life had been shaped by what has turned out to be problems with working memory and I was determined that somehow this could be have some meaning if I could make others aware of the role of working memory in mental health disorders and the fact that it can be improved.

Only you the reader can decide whether I have made a dent in that objective. I hope you will post a comment or two on this blog, from time to time, and let me know if you, or someone you know, has problems such as those discussed in the blog and if what is published here has been helpful.

I also hope your journey can be as interesting and exciting as mine has been and continues to be.

A couple of weeks ago, Cogmed, the people I do some work for, released results of study that show that Cogmed Working Memory Training changes the density of dopamine (D1 to be specific) receptors in the brain.

I was quite encouraged by this study, for a number of reasons, for one it would appear that the changes brought about by Cogmed Working Memory Training are probably longer lasting than what might be accomplished by medication. It would also seem to indicate that the process is quite complex and, although this was already more or less established by the researchers at Cogmed, the changes have some permanency.

In an interview on a podcast about the study on the Science site*, Torkel Klingberg, the developer of Cogmed, explained that either too much or too little dopamine is not good. He went on to explain that in many of the subjects the number of dopamine receptors was decreased and in a lesser number there was actually a small increase in the number.

It seems to me that what the training accomplishes is an adjustment in dopamine receptor density, the end result of which is an improvement in working memory. I know from my own reading that dopamine is the neurotransmitter that is made more available by stimulant medication. I take Ritalin to accomplish this. Why Cogmed training would decrease the number of dopamine receptors and end up making things work better is a mystery to me, as it would seem that this would make less dopamine available in the brain.

I do realize though that this thinking is just my response of trying to simplify something that is much more complicated than my self-education allows me to understand.

I will write again as the meaning of this study becomes clearer…

*http://www.sciencemag.org/cgi/content/full/sci;323/5915/800/DC2

When I was diagnosed with Attention Deficit Disorder (ADD) in the summer of 2000 at the age of 56 I was told to educate myself about ADD. I took this advice quite seriously and over the course of the next few years I read almost 40 books on the subject. Looking back on this effort at this point in time I realize that most of the content of those books is now obsolete.

Off the top, let me declare that I sometimes do marketing work in Canada for a Swedish company known as Cogmed.  They have created an on-line training program that improves working memory, a key component of ADD.  Improve working memory and you will improve focus and attention.

I first made contact with Cogmed because a friend told me he had come across their program and that, not only did it appear to work but that it was backed by solid scientific research. My friend works in the psychological services department of a large Canadian school board and spends a large portion of his work time assessing kids who have this disorder. He suggested that he and I together might try to acquire a license to use Cogmed Working Memory Training, and we set about to do that.   The discussions had just begun when I realized that we did not qualify to be a Cogmed practice a license but was asked by Cogmed’s CEO, Jonas Jendi, if I would provide support in Canada for marketing Cogmed.  At the present moment I am not engaged in doing this and have no financial relationship with Cogmed but I still view their organization and their primary service, Cogmed Working Memory Training, with a great deal of respect.

I was intrigued with how and why Cogmed worked.  I learned that Cogmed improves the brain function known as working memory but how does this happen?  I am no expert in medicine but I had thought that if a part of your brain wasn’t functioning properly, you were pretty well stuck with it.  Then I remembered a lecture I had attended at the University of Toronto Faculty of Medicine in a series known as Mini-Med School, a course designed for the public to explain various aspects of modern medical practice.  The lecture I recalled was on stoke rehabilitation and the physician who spoke began by asking the class of more than 200 people, “When was the last time you saw a stroke victim on the street?”

The class seemed a bit confused and so he curled his arm up and limped across the stage the way I had seen lots of stroke victims do in the past but for the life of me, and for that matter most of the people in the lecture hall, I couldn’t remember the last time I had seen someone who looked that way.  A few people raised their hands and then the lecturer asked, “Do you know why you don’t see people like that anymore?’  No one answered and he began his lecture.

He worked at Baycrest Geriatric Hospital in Toronto and headed up the stroke rehabilitation program there.  He said that with a stroke the last function to go is motor control.  The reason stroke victims used to end up apparently paralyzed is not because they couldn’t move their limbs but because the part of the brains that makes them aware of the arm or leg that might be affected is not working.  If you could make them aware of a limb, according to him, they will be able to move it.  This concept is what guides the most advanced stroke rehabilitation today.  This meant that stroke rehabilitation where medical practitioners are painfully moving an arm, or a leg, back and forth hoping to engender some muscle control was a total waste of time.  Instead practitioners, at least those at Baycrest, were doing things like supplying patients with special glasses that shifted a patient’s vision to one side or the other and then after the brain had adjusted, removing the glasses and behold, the patient was aware of the limb and, more importantly, could move the it.

I realized, after some more research, that the concept of neuroplasticity is quite new and absolutely groundbreaking in the world of medicine.  In his bestselling book, The Brain That Changes Itself, Norman Doidge said, “The discovery that thoughts can change the structure and function of our brains—even in old age—is the most important breakthrough in neuroscience in 400 years.”

And so began my journey…