The Scientific Basis of our Brain Fitness and Concussion Recovery Programs
Published in the Journal of Prevention of Alzheimer’s Disease (2016) , about our 12-week Brain Fitness Program
Published in Nature Reviews Neurology (2012), about how we can grow the memory part of our brain
Published in Nature Reviews Neurology (2009) , about how late-life memory loss has many different treatable etiologies
Brain Fitness Program
The program consists of nine important interventions, starting with patient’s sense of “purpose in life” and their desire for peak brain performance in order to achieve a personal goal:
- Setting specific goals for patient’s 12-week program, based on his/her “purpose” in life and brain performance expectations
- Fitness training and close monitoring to ensure progress
- Neurofeedback training
- Stress and anxiety reduction counseling
- Meditation training
- Cognitive Skills Training
- Nutrition counseling for Mediterranean diet and taking omega-3 supplements (e.g. algal-DHA 900 mg/day)
- Medical treatment of insomnia, sleep apnea, vitamin B12 or D deficiency, and depression, as needed
- Emphasis on brain training home assignments (“homework”), with increasing difficulty (e.g. memorizing a list of 100 items)
The Brain Fitness Program consists of a comprehensive brain health assessment followed by a series of interventions designed to optimize memory and overall cognitive performance.
The manuscript with results from patients who completed the Brain Fitness Program was presented at the Alzheimer’s Association International Conference in Washington DC, on July 18th, 2015. Below are the figures from this manuscript. They show that 84% of patients experienced high-impact improvements in their cognitive function, 97% had high-impact or moderate-impact improvements in their brain wave normalization. Among those who had before-and-after brain MRIs, 65% had remarkable reversal of atrophy (12%) or actual growth (53%) in the size of their hippocampus.
The cognitive results in one of the patients who completed the Brain Fitness Program shows remarkable improvements in her executive function, memory, and language.
Patient’s baseline cognitive function is shown as percentile compared to others of her age and gender. Post-program cognitive test showed significant improvements in 9 of the 10 cognitive tests, with regards to executive function, memory, and language. The only cognitive domain that did not improve was list-learning delayed recall (not shown); it remained unchanged from baseline.
Brain mapping (Q-EEG) results in one of the patients who completed the Brain Fitness Program shows significant reduction (reduced red areas) in abnormally slow (theta) brain wave activity.
Q-EEG detects changes in a patient’s brain activity and compares it with a normative set of data. Statistically significant higher than normal or lower than normal EEG activities are shown in red or blue colors, respectively. Post-program Q-EEG (B) in this patient showed significant improvement toward normal (46%) from baseline (A), through a reduction in excessive levels of slow theta waves in her right temporal lobe.
MRI results in one of the patients who completed the Brain Fitness Program shows significant enlargement in the size of hippocampus.
Post-program MRI with NeuroQuant showed an 8.6% growth in the volume of the hippocampus (HC). (A): Baseline Brain MRI. (B): Post-program Brain MRI. (C): Higher magnification of baseline hippocampal volume. (D): Higher magnification of the post-program hippocampal volume.
Concussion Recovery Program
Mild Traumatic Brain Injury (mTBIs), commonly referred to as concussion, can cause dizziness, vertigo, headache, neck pain, sensitivity to light, sensitivity to noise, insomnia, irritability, memory loss, and inability to get things done. Most patients feel they are functioning at 20% to 80% of their usual baseline. Sometimes, these nagging symptoms can last for weeks, months, or even years.
Patients with this condition, called post-concussive syndrome, often receive fragmented treatment for their individual symptoms from different experts, and as a result, they fail to achieve full recovery. At our brain center, you will first meet with Dr. Fotuhi. He has a great deal of experience in taking care of patients with headaches, sensitivity to light/sound, irritability, insomnia, memory loss, vertigo, and fatigue. Having taken care of more than 5,000 patients with variety of such symptoms, he knows well how to care for patients who have post-concussive syndrome. These patients often have the above symptoms for months to years and feel frustrated by their failure to return to their baseline. Dr. Fotuhi feels for them and with the help of his multi-disciplinary program gets back on their way to full recovery.
After your initial visit with Dr. Fotuhi, you will be scheduled to undergo a thorough neurocognitive assessment. We establish which of your brain functions are above average for your age and which ones are below average for your age. We also use questionnaires to gauge your level of insomnia, daytime sleepiness, anxiety, depression, headache, irritability, dizziness, and sensitivity to motion, sound, and/or light. A Brain Mapping qEEG will help us measure the level of electrical activity in different corners of your brain. It uses small sensors similar to the ones used for a hear EKG to reveal if parts of your brain are running too fast or if other parts are running too slow. You may also undergo a brain MRI, blood tests, or fitness testing, depending on your particular clinical issues.
Once you complete your thorough assessment, it becomes clear which parts of your brain need the most amount of training and which aspects of your life need to most amount of improvement and coaching.
The treatment component of your program begins with your meeting with your brain coach. He or she will explain to you the specific component of your 12-week training with us and answer all of your questions. During your subsequent brain coaching sessions, you may receive training and instructions for meditation, memory improvement, better organizational skills, exercising more, brain healthy diet, and stress reduction. You will be assigned specific brain games that are tailored to boost your attention, concentration, processing speed, and recall. Each week, you find yourself getting better and better.
At mid-program, after six weeks, you will repeat the cognitive evaluation and brain mapping qEEG. It will show you how you have improved and which areas of your brain function need further training. Your brain coach will review these results with you and help you become more confident as you impress yourself and your family members with your success stories.
At the end of the program, you will most likely have formed new healthier lifestyle habits such as better exercise regimen, better diet, better sleep pattern, and better organizational skills. Your final cognitive evaluation and qEEG will capture your progress using objective testing. Dr. Fotuhi will review these results with you and answer any questions you may have.
The vast majority of our patients report remarkable improvements in their concussion symptoms and return to full time school or work activities.
In a single-arm intervention trial that was performed, 22 patients with an average age of 32.68 and a diagnosis of post concussion syndrome received brain coaching and neurofeedback over a 12 week period. Upon completing the program, patients on average improved in 10 out of 15 cognitive domains. The post-program cognitive tests showed 68.2% patients had large effect size and improvements in at least 5 of the 15 areas of cognitive function. In addition, 22.7 percent of patients had improvement in two to four areas of cognitive function.
Patient example of improvements in cognitive performance
Graph shows patient’s cognitive testing scores at the beginning, midway, and end of program.
Blue: beginning of program testing scores
Orange: midway testing scores
Purple: end of program scores
Patient example of improvements in qEEG.
First image: EEG at the beginning of the program
Second image: EEG at the end of the program
90% of patients in our concussion recovery program show some level of improvement
Areas of cognitive improvement that showed the most remarkable improvement include cognitive flexibility, executive functioning, complex attention, and working memory.
Cognitive flexibility: the ability to adapt one’s mental strategies to fit varying environmental demands