Synergistic Brain-Training

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Let The Games Begin (But It Matters What Kind)

Exercise is good for brain health; we’ve written about this before, for example:

How To Reduce Your Alzheimer’s Risk ← there are many advices here, but exercise, especially cardiovascular exercise in this case, is an important item on the list!

Today it’s Psychology Sunday though, and we’re going to talk about looking after brain health by means of brain-training, via games.

“Brain-training” gets a lot of hype and flak:

  • Hype: do sudoku every day and soon you will have an IQ of 200 and still have a sharp wit at the age of 120
  • Flak: brain-training is usually training only one kind of cognitive function, with limited transferability to the rest of life

The reality is somewhere between the two. Brain training really does improve not just outwardly measurable cognitive function, but also internally measurable improvements visible on brain scans, for example:

But what about the transferability?

Let us play

This is where game-based brain-training comes in. And, the more complex the game, the better the benefits, because there is more chance of applicability to life, e.g:

  • Sudoku: very limited applicability
  • Crosswords: language faculties
  • Chess: spatial reasoning, critical path analysis, planning, memory, focus (also unlike the previous two, chess tends to be social for most people, and also involve a lot of reading, if one is keen)
  • Computer games: wildly varied depending on the game. While an arcade-style “shoot-em-up” may do little for the brain, there is a lot of potential for a lot of much more relevant brain-training in other kinds of games: it could be planning, problem-solving, social dynamics, economics, things that mirror the day-to-day challenges of running a household, even, or a business.
    • It’s not that the skills are useful, by the way. Playing “Stardew Valley” will not qualify you to run a real farm, nor will playing “Civilization” qualify you to run a country. But the brain functions used and trained? Those are important.

It becomes easily explicable, then, why these two research reviews with very similar titles got very different results:

The first review found that game-based brain-training had negligible actual use. The “games” they looked at? BrainGymmer, BrainHQ, CogMed, CogniFit, Dakim, Lumosity, and MyBrainTrainer. In other words, made-for-purpose brain-trainers, not actual computer games per se.

The second reviewfound that game-based training was very beneficial. The games they looked at? They didn’t name them, but based on the descriptions, they were actual multiplayer online turn-based computer games, not made-for-purpose brain-trainers.

To summarize the above in few words: multiplayer online turn-based computer games outperform made-for-purpose brain-trainers for cognitive improvement.

Bringing synergy

However, before you order that expensive gaming-chair for marathon gaming sessions (research suggests a tail-off in usefulness after about an hour of continuous gaming per session, by the way), be aware that cognitive training and (physical) exercise training combined, performed close in time to each other or simultaneously, perform better than the sum of either alone:

Comparing the effect of cognitive vs. exercise training on brain MRI outcomes in healthy older adults: A systematic review

See also:

Simultaneous training was the most efficacious approach for cognition, followed by sequential combinations and cognitive training alone, and significantly better than physical exercise.

Our findings suggest that simultaneously and sequentially combined interventions are efficacious for promoting cognitive alongside physical health in older adults, and therefore should be preferred over implementation of single-domain training

~ Dr. Hanna Malmberg Gavelin et al.

Source: Combined physical and cognitive training for older adults with and without cognitive impairment: A systematic review and network meta-analysis of randomized controlled trials

Take care!

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  • The Lupus Encyclopedia – by Dr. Donald Thomas

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    First, a note on the authorship: while this is broadly by Donald E. Thomas Jr. MD FACP FACR, there were more contributors, namely:

    Jemima Albayda, MD; Divya Angra, MD; Alan N. Baer, MD; Sasha Bernatsky, MD, PhD; George Bertsias, MD, PhD; Ashira D. Blazer, MD; Ian Bruce, MD; Jill Buyon, MD; Yashaar Chaichian, MD; Maria Chou, MD; Sharon Christie, Esq; Angelique N. Collamer, MD; Ashté Collins, MD; Caitlin O. Cruz, MD; Mark M. Cruz, MD; Dana DiRenzo, MD; Jess D. Edison, MD; Titilola Falasinnu, PhD; Andrea Fava, MD; Cheri Frey, MD; Neda F. Gould, PhD; Nishant Gupta, MD; Sarthak Gupta, MD; Sarfaraz Hasni, MD; David Hunt, MD; Mariana J. Kaplan, MD; Alfred Kim, MD; Deborah Lyu Kim, DO; Rukmini Konatalapalli, MD; Fotios Koumpouras, MD; Vasileios C. Kyttaris, MD; Jerik Leung, MPH; Hector A. Medina, MD; Timothy Niewold, MD; Julie Nusbaum, MD; Ginette Okoye, MD; Sarah L. Patterson, MD; Ziv Paz, MD; Darryn Potosky, MD; Rachel C. Robbins, MD; Neha S. Shah, MD; Matthew A. Sherman, MD; Yevgeniy Sheyn, MD; Julia F. Simard, ScD; Jonathan Solomon, MD; Rodger Stitt, MD; George Stojan, MD; Sangeeta Sule, MD; Barbara Taylor, CPPM, CRHC; George Tsokos, MD; Ian Ward, MD; Emma Weeding, MD; Arthur Weinstein, MD; Sean A. Whelton, MD

    The reason we mention this is to render it clear that this isn’t one man’s opinions (as happens with many books about certain topics), but rather, a panel of that many doctors all agreeing that this is correct and good, evidence-based, up-to-date (as of the publication of this latest revised edition last year) information.

    And if you have lupus, you’ll be aware there are a lot of doctors who don’t know a tremendous amount about it, hence the value of this “…for patients and healthcare providers” tome.

    It is what it claims to be: a very comprehensive guide. It’s not light reading, and it is 848 pages of information-dense text and diagrams. If you want to know something, anything, about lupus, then if science knows it, then chances are it is in this book, or this book will at least point you directly to a paper you can read about your specific query.

    The style is, nevertheless, about as readable for the layperson as possible, which is quite an achievement for a book with this amount of dense scientific information. For that, the author thanks his husband, for being the non-doctor beta-reader to screen it for readability—quite a service, with all those doctors writing!

    Bottom line: if you or someone you love has lupus, this book should absolutely be in your collection.

    Click here to check out The Lupus Encyclopedia, and have everything at your fingertips!

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  • The Miracle of Flexibility – by Miranda Esmonde-White

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We’ve reviewed books about stretching before, so what makes this one different?

    Mostly, it’s that this one takes a holistic approach, making the argument for looking after all parts of flexibility (even parts that might seem useless) because if one bit of us isn’t flexible, the others will start to suffer in compensation because of how that affects our posture, or movement, or in many cases our lack of movement.

    Esmonde-White’s “flexibility, from your toes to your shoulders” approach is very consistent with her background as a professional ballet dancer, and now she brings it into her profession as a coach.

    The book’s not just about stretching, though. It looks at problems and what can go wrong with posture and the body’s “musculoskeletal trifecta”, and also shares daily training routines that are tailored for specific sporting interests, and/or for those with specific chronic conditions and/or chronic pain. Working around what needs to be worked around, but also looking at strengthening what can be strengthened and fixing what can be fixed along the way.

    Bottom line: if your flexibility needs an overhaul, this book is a very good “one-stop shop” for that.

    Click here to check out The Miracle Of Flexibility, and discover what you can do!

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  • Lychees vs Kumquats – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing lychees to kumquats, we picked the kumquats.

    Why?

    In terms of macros, everything is comparable except for fiber, of which kumquats have 5–6x as much fiber, which means a very significant win for kumquats in this category.

    When it comes to vitamins, lychees have slightly more of vitamins B3, B6, C, and K, while kumquats have a lot more of vitamins A and B1, and moderately more vitamins B2, B9, E, and choline. A fair win for kumquats here.

    In the category of minerals, lychees have a little more copper, phosphorus, and selenium, while kumquats have 11x as much calcium, as well as a 2–3x more iron, magnesium, manganese and zinc. An easy win for kumquats.

    Both fruits have great phenolic profiles, being both rich in antioxidants.

    All in all, enjoy both, but if you’re going to pick one, kumquats easily win the day!

    Want to learn more?

    You might like to read:

    Take care!

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Related Posts

  • What’s Your Ikigai?
  • Dealing With Back Acne

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? We love to hear from you!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small 😎

    ❝Lately I’ve increasingly been getting zits on my back, I don’t think my shower habits have changed at all, is this just an age thing or is there something I can do about it?❞

    Well, we cannot diagnose from afar, so definitely consider seeing a dermatologist if it persists and/or it’s more than a small nuisance to you, but…

    Yes and no, with regard to age.

    Rather, it’s not really about age, but (in most cases, anyway) hormonal fluctuations. That’s why teenagers often get it; it’s also why acne breakouts can occur during pregnancy, and it can happen again in perimenopause, menopause, or in the postmenopause climb-down, due to imbalanced hormones during the change, and while it’s less likely for men undergoing the andropause (the noticeable drop of testosterone levels after a certain age), it can absolutely occur if taking certain androgenic supplements, including simply taking testosterone (or conversely, if taking something to dial down antagonistic hormones). It can also happen if you’re taking something that throws out your free testosterone to DHT ratio.

    See also: Prevalence and Demographics of Truncal Involvement Among Acne Patients: Survey Data and a Review of the Literature

    As for what to do in this case? The usual process is: just wait it out. At some point your hormones will become stable again (nature loves equilibrium, and the body is mostly a self-righting system if given what it needs to do that), and your skin will return to normal. To be clear: the acne occurs because of the change, not necessarily the end place. So whatever hormone levels you have, be they medicated or otherwise, you just need to keep them stable now (assuming the levels are fine; if not, get them fine, and then keep them stable—speak to an endocrinologist for that) in order to come out the other side acne-free.

    However, that’s “the usual process”, and obviously we cannot guarantee it’s not something else. It can also be caused by stress:

    The Impact of Pyschological Stress on Acne ← teehee, a typo made it into the publication title

    …in which case, of course, simply manage your stress (we know, often easier said than done, but the point is, that’s the remedy in this case).

    See also: How To Reduce Chronic Stress

    Diet is not the cause (or cure), but enjoying an anti-inflammatory diet will be beneficial, and consuming inflammatory things, exacerbatory:

    Effects of Diet on Acne and Its Response to Treatment

    Hygiene is also rarely to blame, but it can make a difference, so: do wash gently, wear clean clothes, and wash your bedsheets more often than you think necessary. And about that showering:

    Body Scrubs: Benefits, Risks, and Guidance

    Take care!

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  • Hearing voices is common and can be distressing. Virtual reality might help us meet and ‘treat’ them

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Have you ever heard something that others cannot – such as your name being called? Hearing voices or other noises that aren’t there is very common. About 10% of people report experiencing auditory hallucinations at some point in their life.

    The experience of hearing voices can be very different from person to person, and can change over time. They might be the voice of someone familiar or unknown. There might be many voices, or just one or two. They can be loud or quiet like a whisper.

    For some people these experiences are positive. They might represent a spiritual or supernatural experience they welcome or a comforting presence. But for others these experiences are distressing. Voices can be intrusive, negative, critical or threatening. Difficult voices can make a person feel worried, frightened, embarrassed or frustrated. They can also make it hard to concentrate, be around other people and get in the way of day-to-day activities.

    Although not everyone who hears voices has a mental health problem, these experiences are much more common in people who do. They have been considered a hallmark symptom of schizophrenia, which affects about 24 million people worldwide.

    However, such experiences are also common in other mental health problems, particularly in mood- and trauma-related disorders (such as bipolar disorder or depression and post-traumatic stress disorder) where as many as half of people may experience them.

    Rawpixel/Shutterstock

    Why do people hear voices?

    It is unclear exactly why people hear voices but exposure to prolonged stress, trauma or depression can increase the chances.

    Some research suggests people who hear voices might have brains that are “wired” differently, particularly between the hearing and speaking parts of the brain. This may mean parts of our inner speech can be experienced as external voices. So, having the thought “you are useless” when something goes wrong might be experienced as an external person speaking the words.

    Other research suggests it may relate to how our brains use past experiences as a template to make sense of and make predictions about the world. Sometimes those templates can be so strong they lead to errors in how we experience what is going on around us, including hearing things our brain is “expecting” rather than what is really happening.

    What is clear is that when people tell us they are hearing voices, they really are! Their brain perceives voice experiences as if someone were talking in the room. We could think of this “mistake” as working a bit like being susceptible to common optical tricks or visual illusions.

    man's head with image of brain scan superimposed
    There may be differences in the brains of people who hear voices. Triff/Shutterstock

    Coping with hearing voices

    When hearing voices is getting in the way of life, treatment guidelines recommend the use of medications. But roughly a third of people will experience ongoing distress. As such, treatment guidelines also recommend the use of psychological therapies such as cognitive behavioural therapy.

    The next generation of psychological therapies are beginning to use digital technologies and virtual reality offers a promising new medium.

    Avatar therapy allows a person to create a virtual representation of the voice or voices, which looks and sounds like what they are experiencing. This can help people regain power in the “relationship” as they interact with the voice character, supported by a therapist.

    Jason’s experience

    Aged 53, Jason (not his real name) had struggled with persistent voices since his early 20s. Antipsychotic medication had helped him to some extent over the years, but he was still living with distressing voices. Jason tried out avatar therapy as part of a research trial.

    He was initially unable to stand up to the voices, but he slowly gained confidence and tested out different ways of responding to the avatar and voices with his therapist’s support.

    Jason became more able to set boundaries, such as not listening to them for periods throughout the day. He also felt more able to challenge what they said and make his own choices.

    Over a couple of months, Jason started to experience some breaks from the voices each day and his relationship with them started to change. They were no longer like bullies, but more like critical friends pointing out things he could consider or be aware of.

    A digital image of a man's face with settings to right to shape voice characteristics
    A screenshot from HekaVR, the software used in the Australian AMETHYST trial. HekaVR, CC BY-ND

    Gaining recognition

    Following promising results overseas and its recommendation by the United Kingdom’s National Institute for Health and Care Excellence, our team has begun adapting the therapy for an Australian context.

    We are trialling delivering avatar therapy from our specialist voices clinic via telehealth. We are also testing whether avatar therapy is more effective than the current standard therapy for hearing voices, based on cognitive behavioural therapy.

    As only a minority of people with psychosis receive specialist psychological therapy for hearing voices, we hope our trial will support scaling up these new treatments to be available more routinely across the country.

    We would like to acknowledge the advice and input of Dr Nadine Keen (consultant clinical psychologist at South London and Maudsley NHS Foundation Trust, UK) on this article.

    Leila Jameel, Trial Co-ordinator and Research Therapist, Swinburne University of Technology; Imogen Bell, Senior Research Fellow and Psychologist, The University of Melbourne; Neil Thomas, Professor of Clinical Psychology, Swinburne University of Technology, and Rachel Brand, Senior Lecturer in Clinical Psychology, University of the Sunshine Coast

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Health Insurers Limit Coverage of Prosthetic Limbs, Questioning Their Medical Necessity

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    When Michael Adams was researching health insurance options in 2023, he had one very specific requirement: coverage for prosthetic limbs.

    Adams, 51, lost his right leg to cancer 40 years ago, and he has worn out more legs than he can count. He picked a gold plan on the Colorado health insurance marketplace that covered prosthetics, including microprocessor-controlled knees like the one he has used for many years. That function adds stability and helps prevent falls.

    But when his leg needed replacing last January after about five years of everyday use, his new marketplace health plan wouldn’t authorize it. The roughly $50,000 leg with the electronically controlled knee wasn’t medically necessary, the insurer said, even though Colorado law leaves that determination up to the patient’s doctor, and his has prescribed a version of that leg for many years, starting when he had employer-sponsored coverage.

    “The electronic prosthetic knee is life-changing,” said Adams, who lives in Lafayette, Colorado, with his wife and two kids. Without it, “it would be like going back to having a wooden leg like I did when I was a kid.” The microprocessor in the knee responds to different surfaces and inclines, stiffening up if it detects movement that indicates its user is falling.

    People who need surgery to replace a joint typically don’t encounter similar coverage roadblocks. In 2021, 1.5 million knee or hip joint replacements were performed in United States hospitals and hospital-owned ambulatory facilities, according to the federal Agency for Healthcare Research and Quality, or AHRQ. The median price for a total hip or knee replacement without complications at top orthopedic hospitals was just over $68,000 in 2020, according to one analysis, though health plans often negotiate lower rates.

    To people in the amputee community, the coverage disparity amounts to discrimination.

    “Insurance covers a knee replacement if it’s covered with skin, but if it’s covered with plastic, it’s not going to cover it,” said Jeffrey Cain, a family physician and former chair of the board of the Amputee Coalition, an advocacy group. Cain wears two prosthetic legs, having lost his after an airplane accident nearly 30 years ago.

    AHIP, a trade group for health plans, said health plans generally provide coverage when the prosthetic is determined to be medically necessary, such as to replace a body part or function for walking and day-to-day activity. In practice, though, prosthetic coverage by private health plans varies tremendously, said Ashlie White, chief strategy and programs officer at the Amputee Coalition. Even though coverage for basic prostheses may be included in a plan, “often insurance companies will put caps on the devices and restrictions on the types of devices approved,” White said.

    An estimated 2.3 million people are living with limb loss in the U.S., according to an analysis by Avalere, a health care consulting company. That number is expected to as much as double in coming years as people age and a growing number lose limbs to diabetes, trauma, and other medical problems.

    Fewer than half of people with limb loss have been prescribed a prosthesis, according to a report by the AHRQ. Plans may deny coverage for prosthetic limbs by claiming they aren’t medically necessary or are experimental devices, even though microprocessor-controlled knees like Adams’ have been in use for decades.

    Cain was instrumental in getting passed a 2000 Colorado law that requires insurers to cover prosthetic arms and legs at parity with Medicare, which requires coverage with a 20% coinsurance payment. Since that measure was enacted, about half of states have passed “insurance fairness” laws that require prosthetic coverage on par with other covered medical services in a plan or laws that require coverage of prostheses that enable people to do sports. But these laws apply only to plans regulated by the state. Over half of people with private coverage are in plans not governed by state law.

    The Medicare program’s 80% coverage of prosthetic limbs mirrors its coverage for other services. Still, an October report by the Government Accountability Office found that only 30% of beneficiaries who lost a limb in 2016 received a prosthesis in the following three years.

    Cost is a factor for many people.

    “No matter your coverage, most people have to pay something on that device,” White said. As a result, “many people will be on a payment plan for their device,” she said. Some may take out loans.

    The federal Consumer Financial Protection Bureau has proposed a rule that would prohibit lenders from repossessing medical devices such as wheelchairs and prosthetic limbs if people can’t repay their loans.

    “It is a replacement limb,” said White, whose organization has heard of several cases in which lenders have repossessed wheelchairs or prostheses. Repossession is “literally a punishment to the individual.”

    Adams ultimately owed a coinsurance payment of about $4,000 for his new leg, which reflected his portion of the insurer’s negotiated rate for the knee and foot portion of the leg but did not include the costly part that fits around his stump, which didn’t need replacing. The insurer approved the prosthetic leg on appeal, claiming it had made an administrative error, Adams said.

    “We’re fortunate that we’re able to afford that 20%,” said Adams, who is a self-employed leadership consultant.

    Leah Kaplan doesn’t have that financial flexibility. Born without a left hand, she did not have a prosthetic limb until a few years ago.

    Growing up, “I didn’t want more reasons to be stared at,” said Kaplan, 32, of her decision not to use a prosthesis. A few years ago, the cycling enthusiast got a prosthetic hand specially designed for use with her bike. That device was covered under the health plan she has through her county government job in Spokane, Washington, helping developmentally disabled people transition from school to work.

    But when she tried to get approval for a prosthetic hand to use for everyday activities, her health plan turned her down. The myoelectric hand she requested would respond to electrical impulses in her arm that would move the hand to perform certain actions. Without insurance coverage, the hand would cost her just over $46,000, which she said she can’t afford.

    Working with her doctor, she has appealed the decision to her insurer and been denied three times. Kaplan said she’s still not sure exactly what the rationale is, except that the insurer has questioned the medical necessity of the prosthetic hand. The next step is to file an appeal with an independent review organization certified by the state insurance commissioner’s office.

    A prosthetic hand is not a luxury device, Kaplan said. The prosthetic clinic has ordered the hand and made the customized socket that will fit around the end of her arm. But until insurance coverage is sorted out, she can’t use it.

    At this point she feels defeated. “I’ve been waiting for this for so long,” Kaplan said.

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

    This article first appeared on KFF Health News and is republished here under a Creative Commons license.

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