Brain Work-Outs and You - The Bipolar Connection

Patient Expert

Last week, I posted a short piece on brain work-outs. This followed from a conversation I had with a friend who informed me he was doing daily exercises via a site called Lumosity.

I also came across a similar site called PositScience. Both sites involve paid subscriptions. The subscriptions provide access to daily brain exercises. These exercises challenge the user's performance across a variety of "executive function" domains, such as working memory, attention, responding to stimuli, and processing information. As you improve, the exercises grow more challenging.

We all know the value of keeping our brains active. For instance, here is the opening to a 2009 Mayo Clinic press release:

A new Mayo Clinic study found that engaging in cognitive activities like reading books, playing games or crafting in middle age or later life are associated with a decreased risk of mild cognitive impairment.

Basically, the Mayo Clinic is encouraging people, particularly those in the aging population, to pursue hobbies. But is that enough? Or do we need to be giving our brains real work-outs? In dealing with bipolar, we have a lot more to worry about than trying to remember where we left our car keys.

In 2004, I attended the American Psychiatric Association's annual meeting. There, I heard Deborah Yurgelin-Todd (then at Harvard), describe a study she had published earlier that year. She and her colleagues scanned the brains of 11 subjects with bipolar (symptom-free) and 10 controls as they performed the Stroop Color-Word Task.

The Stroop involves flashing the words, "Blue," Red," and so on. But the word, "Blue," may be colored red or green, and "Red" may be colored yellow. The subject's task is to sort out the conflicting information and come up with the right answer almost instantly.

The study found that those with bipolar experienced significant delays in their responses and that they had to work their brains harder to perform the task. Cognitive deficits, Dr Yurgelin-Todd told her audience at the APA, should be regarded as a core feature of bipolar.

Dr Yurgelin-Todd estimates one-third of those with bipolar suffer cognitive deficits, but throw stress and impulse-control into the mix and we probably have everyone covered. At the 2011 Ninth International Bipolar Conference, I heard Stephen Strakowski of the University of Cincinnati describe how those with bipolar typically have to work their cortical areas much harder to compensate for their tendency to get stressed or their urge to jump right in.

In one study, for instance, the ones who did best (the control group, of course), actually slowed down their reaction times. This allowed them to wait that precious micro-second or two for the thinking part of their brain to kick in and produce a correct response.

The bipolar group, of course, couldn't wait.

We are not referring to specific areas of the brain, as such. Rather, whether in regulating emotions or in processing information, we are talking about how different brain networks talk to each other. If one network is shouting while the other is merely whispering, we are going to have problems.

Two years earlier, at the International Congress on Schizophrenia, I heard Michael Merzenich of UCSF report on his pioneering work in drilling patients with schizophrenia in routine cognitive tasks. His colleague, Sophia Vinogradov, reported they were seeing enduring changes in their patients six months later.

Okay, this is how naive I am. At the 2011 Bipolar Conference, Dr Strakowski was part of a panel that included leading bipolar researchers. These researchers proposed various tweaks to standard cognitive therapy. At question time, I got up and asked about Dr Merzenich's work. I couldn't recall Dr Merzenich's name, so I had to laboriously describe the conference session and what I got out of it.

No one on the panel had a clue. They had no idea what I was talking about. At last, a very distinguished researcher from Oxford gave me a ridiculously patronizing answer that illustrated his complete ignorance, together with his complete inability to listen. I politely took my seat, taking great care to suppress any eye-rolling/smacking-my hand-against-my-head behavior. I also stifled my urge to call the guy a pompous twit.

At the coffee break after the session, a young researcher approached me. He had understood my question. He had heard of Dr Merzenich's work. We both agreed that schizophrenia research was at least five years ahead of bipolar research. If bipolar researchers were smart, they would be listening to the schizophrenia researchers. They don't. Well, maybe the younger ones do.

Moving on ...

I briefly mentioned Dr Merzenich in my previous piece. This was in support of the proposition that brain work-outs have some scientific validity. After I posted my piece, I came across the PositScience site. Lo and behold, Dr Merzenich is PositScience's co-founder.

So - we have heavyweight endorsement for brain work-outs. Against this, we must consider Dr Merzenich's direct financial interest. He is no longer speaking as a disinterested party.

Keep in mind, both Lumosity and PositScience are aimed at the general public, the kind of people who are worried about cognitive decline as they age (I guess that's all of us). I am sure there is a direct application for bipolar. I can even imagine the day will come when we will all be doing daily brain work-outs as a matter of course.

In the meantime, real quick, other things we need to consider:

  • Managing stress. Nothing takes the cortical areas off-line faster than stress. Chronic stress may seriously compromise neural networks.
  • Good sleep. A fatigued brain is prone to very bad judgment.
  • Physical exercise. The brain is energized. Brain cell growth is encouraged.
  • Social interactions. Time-outs are good, but we need social stimulus to stay mentally sharp.
  • Good diet. We are what we eat. Various nutrients appear to enhance brain function or offer protection against normal wear and tear.

Much more to come ...