MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Millions of Americans are visiting online sites to play brain-training games. Companies like Lumosity, PositScience, and Cogmed offer puzzles and complex memory exercises that promise to exercise your brain and improve memory function. But critics say there's little scientific evidence that playing these games can translate into real life benefits.

MS. DIANE REHMJoining me in the studio to talk about the science behind the games and whether they actually work: Dr. Majid Fotuhi of the NeurExpand Brain Center, science journalist and author Dan Hurley, and Dr. Barry Gordon of the Johns Hopkins Medical Institutions. You're welcome as always to be part of the program. Give us a call at 800-433-8850. Send us your email to drshow@wamu.org. Follow us on Facebook or send us a tweet. And welcome to all of you.

DR. MAJID FOTUHIThank you.

MR. DAN HURLEYThank you. Very pleased to be here.

DR. BARRY GORDONThank you very much.

REHMGood to have you all here. Dan Hurley, I'll start with you. Give us an idea of the breadth of these kinds of website learning states and how many there are, how many people are using them.

HURLEYSo, you know, I spent three years researching this. I visited many of these leading companies. I visited Lumosity, PositScience. I've met with the founder of Cogmed. And basically these businesses came out of a bunch of psychological tests that were developed over the past 20, 30 years to measure important cognitive abilities. And what happened was that researchers started saying, hey, maybe you can train on these very tests that we developed to measure your ability.

HURLEYAnd they -- and many studies, so there's, you know, a couple hundred studies have been published at this point showing that training on these tasks improve -- you get better at them, of course, because we all get better -- practice makes perfect.

REHMWhen you practice, yeah.

HURLEYBut there is a lot of studies showing that they transfer to improved abilities outside of the ones that you trained on. Now, as to whether they have true value in real life, there are dozens of studies that have gone so far as to look at real life benefits. And they show some. The real question at this point is how much they benefit you, in whom do they benefit, and what is the best one.

REHMHmm.

HURLEYSo it's early days, but I think, from my point of view as a journalist, what I was surprised to find was when these sites claim, based on real neuroscience, they actually are based on real neuroscience. It's reasonable to believe that a person might benefit. There's certainly more proven benefits to these than, say, a lot of dietary supplements that people take every day.

REHMHmm. So do we have any idea of how many people are using them now?

HURLEYWell, Lumosity says they have 80 million members, which is extraordinary. Most of the other companies are far smaller. Lumosity is built on sort of a, like a Facebook model. They're based in San Francisco. It was developed by people that were involved in -- some of them were neuroscientists, but one of the founders was involved in, you know, private equity funding of new ventures. So there is -- there are easily tens of millions of people involved with this stuff. And, you know, that's why I wrote this book "Smarter" to see what's really going on there.

REHMIt's interesting, for example, that a company like Rosetta Stone, which had originally been used to help people learn languages, has not gotten into this kind of learning.

HURLEYMajor learning companies are involved in this. Pearson, which is the largest educational company in the world, they are now owners of Cogmed which was developed by Swedish psychologists. So there is serious money involved.

REHMHmm.

HURLEYThere's serious research going on. And, you know, when my friends and family ask me about these things, I really say, it's reasonable. This is not kooky...

REHMAre you doing it yourself?

HURLEYI did it. I mean, for research on my book, I spent three and a half months. I worked on Lumosity and dramatically increased my scores on every game I played. I did lots of other things, you know. There's a lot of ways to improve cognitive abilities.

REHMDan Hurley is science journalist. He's a contributor to The New York Times, The Washington Post, and Discover. He's the author of the book, "Smarter: The New Science of Building Brain Power." And that brings me to you, Dr. Fotuhi. Talk about how the brain actually works and the idea of elasticity. We used to think that the brain was there in your skull when we were born, and that was it. That was the brain capacity you would have. All this seems to be changing that notion.

FOTUHIYes. Obviously, the way the brain the works is complicated. But to put it simply in sort of terms that I would teach to elementary school student is that you can think of brain as a pairs of fruits, like pairs of apples and oranges and bananas, and then put on top of bowl. The bowl would be called cortex. This is the part of the brain that's extremely important for many of higher brain function, such as attention, concentration, mood, and inside that bowl, the different fruits -- a pair of them, called the bananas, the two bananas -- and they're particularly important for short-term memory.

FOTUHIIt's called hippocampus. Now, hippocampus and cortex are quite unique because these are parts of the brain that have highest amount of plasticity. And as you said, this plasticity does not stop when you are a teenager or, you know, midlife. It continues throughout life. And this is also the part of brain that gets affected with Alzheimer's disease. So these parts of the brain are both -- have a high degree of plasticity, which means they can improve and expand, but unfortunately they're also vulnerable to many things that happen in our lives, such as stress, high blood pressure, diabetes, and so forth.

REHMSo what do these sites -- how might they affect, for example, protection from something like Alzheimer's?

FOTUHIThey do not, absolutely do not. And, Diane, this is very important. I think this industry has grown, has exploded because millions of people are worrying about Alzheimer disease. If you worry about Alzheimer disease and want to do these games to prevent it, you're wasting your time. You need to know why you have memory loss.

FOTUHIIf you forget names, if you forget conversations, you need a medical workup. Because just like if someone has a chest pain, they need to see a doctor and find out why they have a chest pain. When someone has a memory loss, it could be because of depression. It could be because of obesity. It could be diabetes.

REHMBut don't we all, as we age, lose a little bit of that memory as a natural part of the aging process?

FOTUHIWell, yes, and no. I mean, it does happen, but it shouldn't happen. Because, as I said, brain has plasticity. And the rate of decline with aging is in part because of accumulation of many medical issues. Vitamin D deficiency, vitamin B12 deficiency, even high glucose without diabetes all are things -- these are things that affect your brain.

FOTUHISo in order for you to have a fit brain, there are many things you could do on a daily basis. And as shrinkage that happen in the brain, which, by the way, is about .5 percent per year in some studies, in hippocampus and cortex, can be slowed down. This is something that can happen. And there are, like, five, six things that can be done. The number six on that list would be brain training with memory tests.

REHMDr. Majid Fotuhi, he's founder and chief medical officer of NeurExpand Brain Center and author of "Boost Your Brain: The New (sic) Art and Science behind Enhanced Brain Performance." I wonder how you see it, Dr. Gordon. You're a professor of neurology and cognitive science at Johns Hopkins. Do you define the brain and its abilities in quite the same way as Dr. Fotuhi?

GORDONWell, as Dr. Fotuhi mentioned, he was giving you the elementary school version of the brain. I would like to say, in order to understand some of these things better, the next level we have to go to the graduate school version or the post-doctoral level. For example, one of the things that happens with aging is not that your brain necessarily gets worse, but you remember more. You have more to know. And, as you can imagine a file cabinet that gets stuffed with more material, of course it's harder to find things in there.

GORDONI mean, when I was young, I may knew one Diane. Now I know many more Dianes. And so one of the things from my perspective, as a clinician and researcher, is the answer's not quite that simple. For example, with respect to the brain-training games, people like me might be called optimistic skeptics. Of course the brain is plastic now.

GORDONWe know that it's plastic throughout life. We know that there are many reasons the human brain has to keep changing if it has to. We also know that, of course, practicing some function can improve your ability in that function. The real question is, how much does that generalize to other functions? And how much will that help you in everyday life? And it's the -- and then, do the brain-training games that people have out now actually do that?

REHMAnd those are the questions we're going to be dealing with in this hour. Dr. Barry Gordon is professor of neurology and cognitive science at The Johns Hopkins Medical Institutions. Short break. We'll be right back.

REHMAnd welcome back. We're talking about the online sites that millions of Americans are visiting to play brain-training games. Companies like Luminosity, Posit Science, Cogmed and we also, I gather, have many others joining that. For example, Rosetta Stone, which has acquired a company, let's see, what is it called? Another brain-training…

HURLEYFit, F-I-T.

GORDONFit Brain.

REHMAh, interesting. Okay. So just before the brake, Dr. Gordon, you were saying that you somewhat disagree with the version that Dr. Fotuhi has put forward.

GORDONI disagree only because it's not inappropriate to have a first pass or first approximation idea of how these things work. And I think Dr. Fotuhi is correct in that actually if you see somebody who has memory problems, real memory problems…

REHMReal memory problems.

GORDON…then you look for -- by the way. I emphasize real memory problems because, you know, normal human memory is not perfect by any means.

REHMSure.

GORDONI'd like to emphasize that to my family members, by the way.

REHMRight, right.

GORDONAnd we normally -- the nature of our memory is it's simply cannot be as good as that we have in our smartphones. It just is a different kind of memory altogether. But if you truly have real memory problems, then you look for correctable reasons why they're there. And they can be problems at any age, like, depression, hypertension, heart disease, stroke, you name it. You look for those things and you try to fix them.

GORDONSleep deprivation is a big thing these days. Lack of aerobic fitness is a big problem. What I'm -- going beyond that, what I'm saying is, is that actually we have good plausible scientific reasons to think that some kind of training can improve mental functions. And it might even improve mental functions that generalize to other ones. The question is whether the online games do it or not.

REHMThat is the question. Dan Hurley, you say you spent months doing the…

HURLEYI did it myself and I, you know, I've read basically every study in the field. I would just like to point out that we do know two ways that have a big effect on the risk of Alzheimer's. Education, the more educated you are, the more years you went to school, actually lowers your risk somewhat of developing Alzheimer's, or at least puts it back further. And intelligence is actually -- is well associated with the risk of developing Alzheimer's.

HURLEYSo there are reasons to believe that things that you do, like schooling, can have a real impact and go beyond just the things that you learned.

REHMOkay. But the question here is whether these games -- which I gather people are paying for -- will train you beyond what you are actually training for with these games? Will they take that learning that you perhaps memorize and memorize, will they take you beyond? What do you think, Dr. Fotuhi?

FOTUHII think that if you have difficulty remembering names, you should practice memorizing names.

REHMOkay.

FOTUHIAnd so one of the things we do in our Brain Center is to focus on the deficits that the patient has. As Dr. Gordon mentioned, a lot of times people say they have a memory problems, but the real problem is really depression. And so what they need is gaining confidence in their memory. And what we do in our center is, for example, to teach them how to memorize 50 items or even 100 items forwards and backwards. That gives them confidence that their memory is actually good. And then when they go out, they feel more confident.

REHMBut, Dan Hurley, your book is titled "Smarter."

HURLEYYes.

REHMSmarter is different from, well, let me memorize names.

HURLEYAbsolutely. So intelligence has more to do -- is very closely related with something called working memory. This is your ability to play with the information that you have. Instead of spitting back a phone number, give it to me backwards. Give me the first numbers -- and there are dozens, if not hundreds of studies showing that working memory training, which is the basis of Cogmed, does have real-life benefits.

HURLEYThere have been studies of children with Down syndrome, kids with pediatric cancer…

REHMHow about critics? What do you hear from critics of these games?

HURLEYSo there are credible critics. There are a small group, I would say, of people that simply don't believe the design of these studies, finds flaws in how they're designed. And I look at this -- you know, just because there's a small group of critics and skeptics, doesn't mean it's all a bunch of nonsense. There's not a field of medicine. There's not a drug out there that you can't find academic, serious academic skeptics.

REHMDr. Gordon, do you believe that these websites can actually help people to be smarter?

GORDONWell, it partly depends on what you mean by smarter.

REHMExactly.

GORDONAnd, for example, if you want to remember a phone number backwards, be my guest. But it's not going to really help you much in dialing the phone number. By the way, saying that, for example, in my group we're actually trying to improve working memory. And actually looking at it in part by specialized scans as we give people electric current through their head. So it's not like I'm not involved in this.

GORDONBut the fact is I do think the critics have a point. And in fact, in science we have to listen to the critics carefully because you want to be careful of your own biases. You want to make sure that you've dotted every "I" and looked for every possibility that could have explained the experimental results you get. And one of the typical problems with these experiments that have been done is that they're relatively small and they've been hard to replicate, if replicated at all.

GORDONAnd that's the gold standard in science. And as you know, there have been attempts to replicate some of these things and some have worked to some extent and some haven't. So my position on the games would be, fine, if you treat them as something better than say, over-the-counter multivitamins, that's great. But don't treat them as the -- I don't know -- the Golden Fleece that's going to help you.

REHMAll right. And joining us now from Santa Rosa, Calif., is Dr. Michael Merzenich. He's founder and chief scientific officer of Posit Science. And that is an online website. He's also author of the book, "Soft Wired: How the New Science of Brain Plasticity Can Change Your Life." And welcome to you, Dr. Merzenich. I'm glad you could join us.

DR. MICHAEL MERZENICHIt's nice to be with you, Diane.

REHMTell us about the company you founded, Posit Science. I gather it is a brain-training website. How does it work?

MERZENICHIt is, Diane. The website is actually called Brain HQ, for Brain Headquarters. And it actually comes not from a -- as Dan described -- it doesn't come from a reconfiguration of tests of cognitive ability, it actually stems from neural science. I mean I am a neuroscientist who studied issues of plasticity in brains. And basically, what it's designed to do is to drive the brain in a strengthening or corrective direction.

MERZENICHIt's not really -- the target is not just behavior. The target is also brain function. We want a brain that's operating with greater accuracy, operating at higher speed, operating with greater fluency. And basically the training programs that we've constructed are designed to do that.

REHMI gather you began with students who were struggling in schools.

MERZENICHRight, Diane. In another company that I've co-founded, called Scientific Learning Corporation, we developed programs to train students in school. And we've -- largely children that struggled to read or children that struggled to understand or follow what's happening in classrooms and schools. And we've trained about five million children in the United States and across the world. And most of those children have been very substantially advantaged.

MERZENICHIn that case you can show in their school records that when they're trained they do better. They better in the next -- in the subsequent period. And it's a big change. And the majority of children that initiate such training with the inability to read, after they're trained effectively initiate reading.

REHMSo how did you adapt what you had focused on for students to adult learning?

MERZENICHWell, Diane, the principles of brain plasticity apply. They're not really different in adults, as compared with school-aged children. The same principles are in play. And plasticity is contributing both to, you know, is defined in our historic life, the limits of our abilities. And at any point, in any brain, you can engage the brain and drive it in an improving direction to a significant extent. And if you do it appropriately you can drive it in a way that recovers or strengthens the function of a system.

REHMAll right. So if I go to your website…

MERZENICHRight.

REHM…what am I going to see? What am I going to do?

MERZENICHWell, you're going to see exercises. We don't call them games, but, you know, commonly they are called games. You go to exercises and you're going to initiate -- you can be guided to a program. You can ask for help there with identifying your specific needs or problems as you identify them. And then you can take off in training. And you can train for 10 or 15 or 20 or 30 or 40 minutes a day. And what you're doing is working in progressive exercises where the program is quickly defined.

MERZENICHYou could say your neurological and behavioral limits, whatever you're trying to improve. And then the whole idea is to ratchet you up, minute by minute, hour by hour, day by day, so that ultimately the functionality of the brain process in play is improved progressively across time by what you do. And you commonly -- you have to do that for multiple skills or abilities to actually drive the correction in the system that accounts for a general class of skills.

REHMSo what makes your site, Posit Science, different from sites like Luminosity?

MERZENICHWell, to a large extent they are training to a skill, let's say like remembering. So they might focus heavily on practice remembering. And you can practice remembering like Dr. Fotuhi suggests. But the recent you can't remember is not because you've lost the ability to remember to the -- our skill of memory -- the reason you can't remember in general is because the information the brain is struggling to record in an enduring way, is in a poor form.

MERZENICHSo you actually have to work in more fundamental forms of exercise to sharpen the way the brain is representing the information it's trying to record. So I would say the primary difference is that our approach is substantially more neurological. We're actually trying to change the neurology at every level in the systems of the brain that account for something, something like remembering.

REHMDr. Michael Merzenich. And you're listening to "The Diane Rehm Show." So, Dr. Merzenich, how much am I going to be charged when I come to your website for say a trial or perhaps an entire course?

MERZENICHWell, it's on the order of about $10 a month. And so it depends a little bit on whether you're going to adopt this as a lifestyle change. It's roughly -- in the neighborhood of $100 a year. Or whether you have a specific need in which you would address over a more limited time. So it's of that order. It's of the order of about $10 a month.

REHMAnd just before the break we were talking about skeptics and those who say that these games, these exercises don't really have lasting results.

MERZENICHRight.

REHMHow do you respond?

MERZENICHWell, first of all, there are -- you can design brain games that have relatively limited impact. And that have relatively limited extension past the benefits of the exercise itself. And a lot of the brain exercises out there are of that nature. But actually we have constructed exercises and evaluated them in thousands of subjects, in Grade A, you know, FDA-level outcome trials.

MERZENICHAnd as a rule we've demonstrated not just the fact, of course, that you drive improvements of what you train people to, but you also drive improvements in general ability, that powerfully impact everyday life.

REHMLike what?

MERZENICHNow, I might say, Diane, it's -- I'll talk about that in a minute. I'd say that's not true of all brain game websites, you know. And there's sort of an inverse relationship between the most successful websites and the actual amount of science that has been conducted. But what are those general benefits? Well, you can train a person in ways that do not relate to memory at all and demonstrate substantial improvements of memory, in a general sense, of all aspects of memory.

MERZENICHYou can train a person for 10 hours, in an appropriate way, and cut their driving accident rates in half. You can train a person for -- which is -- represents the use of the brain, you could say, as it relates to very complex and elaborate skills and abilities and levels of control. You can train a brain in a relatively simple way and five years later demonstrate 35 to 40 percent fewer incidents of onset of depression.

REHMI would…

MERZENICHNow, those are just a few really simple examples…

REHMSure.

MERZENICH…of sort of exaggerated impacts that have been recorded. But there are clearly impacts that generalize to real life.

REHMAll right. Dr. Gordon, I would think that the extent to which someone has previously suffered from depression and does the work on these sites, that would vary tremendously, wouldn't it?

GORDONWell, I think, as Dr. Merzenich points out, and as Dr. Fotuhi, of course, first of all, you're going to get a lot of variation in those things.

REHMSure.

GORDONAnd they're going to influence how you respond. I'll just make a comment, by the way, that the kind of process of task exercise construction the Dr. Merzenich was referring to and that other people are trying to -- for example, Dr. John Krakauer at Hopkins is trying this -- is trying to build what we'll call a game from the ground up, to try to benefit people, as oppose to adopt tasks that happen to be convenient. And that, I think, has a much better scientific basis than just adopting tasks that happen to be lying around.

REHMCan the sites be adapted to an individual or are they simply created for the entire population?

GORDONI -- well, without knowing all the sites involved, I thought that actually is one of their selling points.

REHMAll right. Dr. Barry Gordon, Dr. Merzenich, they'll all be here to answer your questions. Stay with us.

REHMAnd it's time to open the phones as we talk about websites for training the brain, what works, what may not work and for whom it may work best. Let's go first to David. He's in Santa Rosa Beach, Fla. You're on the air. David, are you there?

DAVIDI am here. Can you hear me?

REHMOkay, sir. Go right ahead.

DAVIDThank you. My question has to do with ADHD. We have a 14-year-old son who takes Ritalin for ADHD and it's a focus issue at school. So my question is, do we think that any of these computer-based brain training games is effective for attention deficit as part of ADHD?

REHMAll right, sir. Thanks for calling. David Hurley -- Dan, I'm sorry.

DAVIDSo Cogmed was actually developed to treat ADHD. And they have dozens of studies showing benefits by improving working memory, improving your ability to attend and focus, that it does show benefits in people with ADHD. And I've met people that feel that they've benefitted. I've visited with psychologists. I am considering using it for a member of my own family.

REHMInteresting.

HURLEYYeah, it definitely...

REHMAnd that was Lumosity.

HURLEYNo, that's Cogmed.

REHMCogmed.

HURLEYSo Cogmed, and one of the real interesting benefits of it is that it's offered only through psychologists. So you have to go find a psychologist. If you search for Cogmed you find...

REHMBut then that means you're going to have to pay a fee to the psychologist.

HURLEYYeah, so Cogmed is far and away the more expensive option. It's going to be about $1800...

REHMWow.

HURLEY...for a -- for the whole thing. You do it mostly in your own home but a psychologist first sits with you and like either a parent or partner and helps makes sure that you both know, and then kind of holds your feet to the fire, which is really great for people...

REHMBut Dan, is anybody checking as to whether these things actually work?

HURLEYWell, again, so they have dozens of randomized placebo-controlled trials in major scientific journals. Now there are people that continue to question it. Of course there are people that continue to question the benefits of all sorts of FDA-approved medications. So we know that controversy is nothing unusual in medicine. But it's -- there are certainly a lot of good scientific published trials to make people believe that this can benefit.

REHMDr. Gordon.

GORDONI'll just -- I'll make a general comment and a specific one. One of the problems with good scientific trials is that in science I think people generally recognize that even a good trial isn't proof of anything. So even though it's the best we have to go on and as a clinician I might use it too, it doesn't meant that next year somebody's not going to disprove it or find a fatal flaw.

GORDONBut on the other hand there is both -- in terms of treating conditions like ADHD and memory loss, etcetera, there's both plausible reasons, and maybe even more evidence, that brain training can help in the sense that you might be able to more optimize an individual who has problems to begin with rather than somebody who's already at a more optimal or their normal level of functioning. The data is very hard to interpret, I have to confess.

REHMAll right. Here's an email from --

MERZENICHDiane, could I comment on that?

REHMSure, Dr…

MERZENICHActually, it's been shown very compellingly that with the training that we've applied in school-aged children, not one aspect of ADHD, and that's the inattentiveness, it's completely neurologically correct, you actually have to train the normal controlled population in a beautifully controlled trial to drive the neurology in the normal kids to be now as alert and attentive as the children. And this is without drugs. This is without taking any medicine.

MERZENICHBut the other part -- and this is also true of Cogmed -- this is the aspect of ADHD that's repaired. The other side of ADHD which is the hyperactivity, the problem with the pressing distracters has been more difficult to deal with. But actually we have conducted trials in the last year, the primary trials that are being conducted in Asia, in which we've shown that we can actually overcome hyperactivity by training.

MERZENICHSo you're going to see very highly effective training programs that are applied or actually designed to recover or to restore the neurology in children with ADHD.

REHMAll right.

MERZENICHSo it's not quite here yet because the trials are still underway in Asia.

REHMOkay. We've got an email from Nichole in Dallas, Texas who says, "There as a recent study at the University of Texas, Dallas that showed the best cognitive results in aging brains age 60 to 90 were achieved not by doing puzzles or word games, but by engaging in ongoing learning projects such as learning to quilt, taking a digital photograph course. Do any of these sites allow users to engage learning new skills in a comparable way," Dr. Fotuhi.

FOTUHII fully agree with that statement. I think if you have an hour and you want to do something about your brain, you want to do something that gives you the most benefit, and by taking new hobbies that challenge different parts of your brain and also involve engagement with other people, you can really enhance your brain function. I think the one thing we need to focus on is each program needs to be designed for a specific person but there are things that work for most people.

FOTUHIFor example, Diane, if you want to improve your brain function you can take on a dance class because with dancing you exercise. The one thing that everybody unanimously agrees is that exercise is the single best thing for your brain. The second thing you probably can do is meditation because stress is really bad for the brain. Several studies have shown that stress, anxiety, depression cause some shrinkage in the brain. And then you can pay attention to a healthy diet.

FOTUHIAnd then you can do things like a dance class because socializing is really good for the brain. We don't have the specific science for it but engaging with people, learning new things from people. So for one hour of dance class that you go to, you really simulate different parts of your brain at the same time.

REHMAll right. But are you suggesting that the things you've just talked about, taking a photography class, learning to dance, exercising, that they are at least as valuable and useful as the kind of brain websites we're talking about?

FOTUHII would put the brain training with websites at the bottom of the list.

REHMReally?

FOTUHIYes, because you already spend a lot of time in front of computers. Most of us are, you know, doing things in front of computers most of the day anyway. And so if you have one hour and you want to do something for your brain health, you better get out. You better go do something that engages you, that makes you happy, that makes you smile.

REHMProbably going to be a lot less expensive, Dan.

HURLEYWell, I mean, when I -- for my book I tried -- I learned a new musical instrument. I learned to play the renaissance lute.

REHMGood for you.

HURLEYI did take up a boot camp exercise class. I did try mindfulness meditation. But, you know, combining that with these games, I increased, you know, my own score in terms of a, you know, person who's already doing pretty well. My fluid intelligence increased 16 percent after three-and-a-half months.

REHMAnd how did you measure that?

HURLEYThere's something called the ravens advanced progressive matrices which is the -- this basic test. It's considered the gold standard of fluid intelligence measures. Basically you're trying to detect patterns in a small grid and figure it out.

REHMDo you know about this, Dr. Gordon?

GORDONOh certainly. Certainly. Oh use it clinically. The -- part of the issue is is that there's lots of different kinds of intelligence. And even what we call, for example, working memory, it's not one kind of memory. It's many different kinds of memory probably. What we call visual intelligence is many different kinds of intelligences. And I think Dr. Merzenich made a point that may have not quite come out -- or rather been picked up on. Namely you're talking about different people and different problems.

GORDONSo on the one hand, a child with ADHD and a particular kind of inattentiveness may benefit from a brain training game that -- I'll pick an 80-year-old, may not need anymore and may want to do something else. And so the dance class may be better for the 80-year-old while the ADHD attentiveness training may be better for the 16-year-old.

REHMAll right. Let's go to Concord, N.H. Hi there, William.

WILLIAMHello.

REHMHi.

WILLIAMHi. I was wondering -- thank you for taking my call.

REHMSure.

WILLIAMI was wondering if they would discuss the relationship between low rates of Alzheimer's and people that are multilingual. And I wondered if they thought that maybe learning languages would also be helpful to the brain.

REHMDr. Fotuhi.

FOTUHIYes, Diane. As I mentioned to you hippocampus, which is the part of the brain that's very important for memory, has a tenancy to shrink or expand. And one of the things that's been shown to increase the size of hippocampus is actually learning a new language. You can do this with intensive language training for three months. And you can see that before and after MRIs show a significant increase in the size of hippocampus.

FOTUHIAnd again, hippocampus is a substrate, is a brain tissue that's involved and it's very important for memory along with the cortex. And these parts of the brain do change. Now there are always skeptics that say, you know, there is somebody who knows three languages who still has Alzheimer's disease. And I think it's important to realize that when you do things, you literally change the biology of your brain. You increase the number of synapses, you increase the number of blood vessels.

FOTUHIHippocampus actually has the capacity to grow new neurons. When you exercise you actually make new neurons. When you learn new things your hippocampus grows. And this is also the same part of the brain that shrinks. So although we don't have any evidence that these things actually delay the onset of Alzheimer's, we know that these things definitely improve your brain health and brain size so much so that we can actually see it on MRIs.

MERZENICHDiane, can I comment about this? This is...

REHMSurely.

MERZENICHDr. Fotuhi said earlier that there's no evidence that he did not believe that you could delay the onset of Alzheimer's disease by brain training. But in fact, you change the brain physically and functionally as you acquire ability, as you improve the functionality of the brain. And of course you do that whether you do that by working at a progressive brain exercise that's appropriately designed on a computer just as much as you do if you're dancing and one of the things or -- and any other new learning activity, learning a new language for example.

MERZENICHAnd this has been shown over and over and over again. You change the physical brain of course. That's the basis of the improvement. That's what's changing. You're actually driving the brain to change in a positive direction. And that's what all of this -- that's what our form of brain training is based on. It's based upon actually driving the brain correctively in ways that would rejuvenate it.

REHMAll right. But...

MERZENICHAnd it does do that.

REHMAll right. Let me raise the question of whether, for example, simply spending an hour reading a good book couldn't do something of the same.

MERZENICHIt's relatively inefficient...

REHMAll right, Dr. Merzenich. I've directed this to Dr. Gordon.

GORDONYou couldn't see the gesture, Mike. The -- it depends on what you're trying to do. If you want to get better at dancing, then you have to dance. Reading a book about dancing isn't going to help you do that, not much, although it will do some. But I, for example, recommend that people do something they enjoy doing because, first of all, then they will do it and they'll immerse themselves in it much more.

GORDONAnd second of all, they will lead to those expansions, as Mike has pointed out, in brain regions and brain functions. They'll strengthen things and they'll strengthen in areas they want.

REHMDr. Barry Gordon. He is with the Johns Hopkins University Medical Institutions. And you're listening to "The Diane Rehm Show." And now let's go to Morton in Boston, Mass. Hi, you're on the air.

MORTON...involves activities of the brain that sort of simulate tool-making activities where you're using gross motor skills and fine motor skills and sequence of events to make a tool or a weapon or something that the -- you know, has been in process by human society over 100,000 years. And the brain developed with these. And you have say -- who is it -- Einstein used to play the violin occasionally. And that has gross motor skills and sequence of events and fine motor skills.

MORTONAnd that may, you know, sort of tune up the brain, like you take the car out to run on the highway to tune it up, keep the battery charged. This is something that has been, you know, in society for tens of thousands of years. And it causes all the neuro transmitters to get to the right levels and the right supply of chemicals to adjust themselves as you're doing it, as if you were making a tool. And it could be just doing the Rubik's Cube or playing a few tunes on the violin, that sort of thing.

REHMAll right. Dr. Fotuhi.

FOTUHIYes, I think that's a great idea. And I must say I fully agree with Dr. Gordon here in that you have to do things you enjoy. And if you enjoy making a chair or making a table, go ahead, do it. It does increase your attention. It does get your mind off of the other things you do. It is relaxing. But if it's not something you enjoy, don't suffer through it.

HURLEYI would say though that one thing that's really interesting about these brain games is people often ask, you know, what about doing crossword puzzles that I do?

REHMYeah, of course, sure.

HURLEYSo these kinds of interventions with these games have definitely been shown to be superior to that kind of thing. And I think what ties all of these together is that it has to be something progressive. You have to be working at something that's getting more challenging as you get better at it. That's why many of these games are believed to have benefits and why learning any new skill, you know, whether music or dancing or whatever, something new that you can progress at.

REHMSo give me a quick example of what I'm likely see if I go to Lumosity for example.

HURLEYSo you look at an object in the middle of your screen. And while you're trying to keep track of it there's another object way at the edge of the screen. And apposite science has a very similar brain HQ that you have to keep track of multiple things, especially on the periphery. And there's -- ten-year results were recently published showing significant benefits that lasted after just ten hours of training.

REHMDan Hurley. He's science journalist and author of "Smarter: The New Science of Building Brain Power." Dr. Majid Fotuhi. He's founder and chief medical officer at NeurExpand Brain Center, author of "Boost Your Brain: The New Art and Science Behind Enhanced Brain Performance." Dr. Barry Gordon, professor of neurology at the Johns Hopkins Medical Institutions, co-author of "Intelligent Memory: Improve the Memory that Makes You Smarter."

REHMAnd Dr. Michael Merzenich. He's founder and CEO of PositScience. He's also neuroscientist and author of "Soft-Wired." Thank you all so much. And thanks for listening all. I'm Diane Rehm.