Dr. Henry Mahncke is a leading expert in the field of cognitive neuroscience and the CEO of BrainHQ, a groundbreaking brain training program. With over two decades of experience in the field, Dr. Mahncke has dedicated his career to understanding and enhancing human brain function. In this exclusive interview, we delve into the world of BrainHQ and its impact on cognitive health.
BrainHQ is a scientifically designed brain training platform that leverages the principles of neuroplasticity to improve cognitive skills such as attention, memory, and processing speed. Driven by a team of neuroscientists and experts, BrainHQ offers a diverse range of exercises and challenges tailored to individual needs, making it accessible to people of all ages.
In this interview, Dr. Mahncke shares his insights into the research behind BrainHQ, its proven efficacy, and its potential to improve brain health across various populations. We discuss the importance of cognitive training in maintaining mental sharpness, combating cognitive decline, and optimizing brain performance. Join us as we explore the fascinating world of BrainHQ and its transformative impact on cognitive well-being.
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Can you just tell me really quickly about your background and how you got interested in the field of cognitive training?
My background is as a neuroscientist, I originally came out to San Francisco to do my PhD in Neuroscience at UC San Francisco. I worked in a very interesting lab that studied brain plasticity, how the brain rewires itself through learning and experience and training. That idea may seem obvious now, but you know, if you were to rewind the clock 20 years ago, 30 years ago, 40 years ago, most neuroscientists believed that the adult brain couldn’t change, that the wiring was fixed.
The belief was that the brain functions like a computer chip. It has wires, processes information, uses electricity, and much like a computer chip, it wears out or breaks over time. There seems to be nothing that can be done about it. When I was in graduate school, we were informed that neurons gradually died one by one as we aged, and there was no solution for it. However, the lab where I worked challenged this notion. We now acknowledge, as it’s widely accepted and stated in textbooks, that the adult brain is plastic. It undergoes changes, reorganizes, and rewires as we use it.
I was interested in harnessing the basic science of brain plasticity and transitioning it from the lab to real-world application. The objective was to create a scientifically grounded, clinically validated brain training program. This program would be equipped with Computerized Adaptive brain training exercises that were demonstrably effective at leveraging the power of brain plasticity to rewire the brain. The aim was to facilitate healthier brains, improved cognition, and consequently, better lives. This was a deeply personal issue for me, given my personal experience—my grandfather passed away from what we now recognize as Alzheimer’s disease.
When I was around nine or ten years old, our understanding of the brain was quite limited. We simply assumed that people’s brains aged and wore out, with dementia being seen as the inevitable final stage. However, we now understand that this isn’t accurate.
The idea of starting a company and working daily on something that could potentially improve the lives of people in such situations, and possibly many others, provided a compelling reason to come to work every day.
How has the program evolved over the years?
Initially, when we built the program, we constructed a core set of exercises focusing on the auditory system to enhance memory and cognition related to speech. We opted for this focus due to our extensive knowledge about brain plasticity in the auditory system. The program was actually a CD-ROM; you would purchase it, receive a box in the mail, and insert the CD-ROM into your computer. However, once installed, the program could not be altered – what you installed was what you got. At best, we could update it every few years or so. Over time, just about everything has changed.
We’ve since moved beyond those initial six exercises and developed numerous more; there are now about 29 brain training exercises in Brain HQ. Naturally, it has transitioned from a CD-ROM program to an online program, accessible via your phone or tablet. It has also incorporated a personal trainer feature. Now, Brain HQ can analyze your entire history of brain training and determine the next best exercise for you. Our understanding of how to help people track their progress through the brain training program has evolved significantly. There is now a wealth of information available to help you monitor your progress.
I believe one of the exciting aspects of the intersection between software and healthcare is the iterative potential. While the core mechanics must remain consistent—since they are proven to work and scientific efficacy is incredibly important to us—there is ample room for enhancing the user experience. We can make it truly compelling, something that integrates smoothly into everyone’s daily lives. That aspect is genuinely enjoyable.
Would you say that the development of technology initially placed limitations on what BrainHQ could achieve?
Absolutely. You could rewind the clock even further when all of this was still basic science about brain training. The development of personal computers, which dates me a bit, was a breakthrough. To drive effective brain change and stimulate brain plasticity, you really have to train with systems that are adaptive. As you improve, the systems need to increase in difficulty. The brain rewires itself when challenged at the appropriate level. I believe we all intuitively understand that if we’re doing something too easy, we’re not going to improve at it because there’s no need – our brains are working perfectly well. On the other hand, if you’re doing something too challenging, you’re also not going to improve because your brain can’t even begin to grasp it.
Therefore, when we consider brain training programs, being able to construct adaptive computerized systems using sophisticated algorithms that can adjust on a millisecond basis becomes incredibly important to facilitate genuine brain change.
For instance, when we build visual exercises to enhance visual speed and attention, we need to control what’s on the screen, frame by frame, much like how a video game works. We need to know, for instance, whether an image is on the screen for 16 milliseconds or 32 milliseconds.
If we’re training the auditory system to process speech more accurately and swiftly, so you remember it better or to hear more clearly in a noisy environment, we need to adjust that speech on a millisecond basis because that’s how the brain functions.
None of this was possible until reasonably advanced PCs became available. The reason we first developed this program for CD-ROM was that the web couldn’t handle these tasks. You couldn’t achieve frame-by-frame accuracy on the web, nor could you control audio down to the millisecond. As web technologies advanced, our ability to take this proven science and apply it to these modern technology platforms eventually evolved as well.
How does brain HQ differ from other brain training programs on the market? What makes it unique?
We make a clear distinction between a brain training program, which has been scientifically proven to work, and brain games. There are countless brain games available – you can simply open your phone and find endless options. The major difference between us and those programs lies in scientific efficacy.
We have deep roots in neuroscience. When we developed the first set of brain training exercises, we didn’t want to simply claim that these exercises were scientifically sensible and thus should be used – even though they are scientifically sensible and should indeed be used. We wanted to prove that they improved generalized cognitive function. To do so, we had to conduct extensive, time-consuming, technically challenging, gold-standard randomized controlled trials.
After we initially built the exercises, we collaborated with the Mayo Clinic and USC. We ran the first large-scale, multi-site, randomized, prospective, parallel-arm control trial and convincingly demonstrated that participants assigned to do Brain HQ exercises showed much greater improvements in memory than those who did a control activity, which in this case was adult education delivered via DVD-ROM videos. This was a breakthrough. People hadn’t done that before. This scientific lead solidified our reputation as an effective program – no need to just take our word for it – and it sparked its own revolution.
Over 200 papers have now been published showing that Brain HQ exercises specifically improve cognitive function and also enhance real-world function. They help people maintain independent living skills and even reduce fall risk, among other benefits. That’s the crucial difference between us and the other brain games available, which is to say, our program has been proven to work, and that’s significant.
Can you just elaborate a little further on the scientific research behind brain HQ and how it’s been validated?
I mentioned the initial study briefly, but I’d like to elaborate further. You’re likely wondering if brain training really works. That’s a fair question. Numerous brain games out there claim to be science-based. But how can we truly know they’re effective? We verify their effectiveness the same way we do for a new drug or medical device. We gather a fairly large group of individuals and randomize them into two groups. One group undertakes the new brain training program, and the other does something that seems like it might improve cognitive function but probably doesn’t.
You may be aware that in drug studies, the comparison is often between a drug and a placebo, like a sugar pill. We employ a similar concept in brain training programs. For instance, if you take a brain health test twice, your scores might improve randomly, not necessarily due to improved cognitive function. Therefore, we need to compare the brain training program to a control. That’s the kind of study we carry out.
We use standardized neurocognitive measures in these studies. Neuropsychologists have developed a variety of tests for cognitive function over the years. For instance, you might take an auditory verbal learning task where someone reads you a list of 15 words. You are then asked to immediately repeat them and again after half an hour to test your recall. You might also take a working memory test, wherein you’re shown a sequence of lights on a board, similar to tic-tac-toe, and you have to repeat the sequence in reverse. There are numerous standard tests of this nature.
The crucial point is that these are not the exercises you practice during the brain training program. If you merely practice the aforementioned tic-tac-toe game, you will certainly get better at it, but that’s not the goal. What we need to demonstrate is that you’re using the brain training program and improving on similar tests.
This was our approach in our initial research, which we refer to as the Impact Study. We provided evidence that our program improves performance on standardized cognitive function measures that any neurologist or neuropsychologist would use, and we demonstrated significant improvement.
In that first study, conducted with individuals aged 65 and older, we found that the memory improvements were equivalent to about 10 years of cognitive functioning. People in their 70s were performing more like those in their 60s, while those in their 60s were performing more like individuals in their 50s, and so forth. Subsequent studies have gone further. Not only are we enhancing cognitive function, which is of course significant – people naturally desire to maintain sharp cognitive abilities – but other studies have also shown that we’re improving real-world function.
For example, I referenced a study on fall risk. This study, funded by the National Institutes of Health, examined over 2,800 older adults. It was discovered that participants who were at high risk for falls, meaning they had already experienced a fall, significantly reduced their risk of falling over the next decade by 30% through the use of this brain training exercise. This was compared to a group that did not partake in the brain training program, providing a useful control. We essentially apply the tools of science, in this case, clinical trial tools that have been thoroughly refined in evidence-based medicine. We’re doing, frankly, what everyone should be doing.
I must say, I find it quite absurd that one can launch a brain game on the market, hinting at its ability to improve brain health and memory, without conducting a clinical trial to prove it. In my opinion, such products shouldn’t be available. They’re a waste of time and money, and they’re deceptive. Several of these brain game companies have been rightly penalized by regulatory authorities for making false claims. I believe that’s appropriate. People deserve to know that what they’re using has been proven to work.
There’s a 2017 review – I’m sure you’re aware of it – that questioned the effectiveness of various brain tests. They concluded that there was “little evidence that training enhances performance on disability related tasks, improves everyday cognitive function.” Can you discuss this?
As you might imagine, I am, of course, quite familiar with that analysis. It struck me as odd because they meticulously read numerous published papers, including some of my own. The approach they took involved finding a single fault with each paper. After identifying these faults, they collectively dismissed the entire body of work, saying, “Well, each of these papers has at least one aspect we don’t like. So, I suppose there’s no evidence here.” This doesn’t align with a scientific approach.
One of the first lessons in graduate school is that every scientific paper will have elements you don’t agree with. That’s the nature of science; it’s challenging. For instance, I recall one instance – because I’ve extensively reviewed the paper in question – where they criticized one of the studies I was involved with. They argued that we had analyzed many measures, and they would have preferred if we had analyzed a single, unified measure. Their criticism was peculiar since we did have a unified cognitive function measure in that study; they were factually incorrect. This critique underscores my concerns about their approach.
A more commonly used method, employed by many other scientists, is called a meta-analysis. This involves compiling all the published studies and averaging them. Yes, any single study might have aspects we don’t agree with, but by averaging all of them, if there truly is no effect, it should be apparent when averaged. Yet, virtually every modern meta-analysis conducted on cognitive or brain training has shown that it works. When all these studies are averaged together, they reveal statistically significant improvements in cognitive measures and, indeed, real-world measures as well.
For instance, a study was conducted at UT Dallas, led by Basak, and published in 2022. This analysis examined well over 100 cognitive training studies and demonstrated that, on average, there were significant improvements not only on neurocognitive measures but also in generalization to real-world measures.
The paper you mentioned seems flawed to me. I believe any first-year graduate student can review 100 papers and identify problems. Such an exercise isn’t particularly valuable. I find this in stark contrast to modern meta-analyses, which demonstrate tangible real-world and functional benefits. While I can appreciate the effort, I must emphasize that the field of science has already progressed beyond this point.
How does BrainHQ customize training programs to meet the needs of different users in different areas. If you can just compare and contrast let’s say how you cater to the sports industry, and how you cater to let’s say the military how are they similar? How are they different? How does that work?
I’ll speak broadly about BrainHQ first and then address those two domains. BrainHQ is highly adaptive to users. When you begin any BrainHQ exercise, the difficulty adjusts in real-time. If you succeed, it becomes more challenging within mere seconds. If you struggle to keep up, it becomes easier to find the appropriate level for you. Therefore, if a top-performing athlete and a person experiencing the initial stages of cognitive decline that might precede dementia were to use BrainHQ, you would observe differing levels of difficulty. The athlete would correctly answer trial after trial, and the exercise would progressively increase in complexity. On the other hand, a person dealing with memory loss might answer one question correctly, then miss the next, causing the difficulty to decrease. Very rapidly, they’d be performing at different levels, but each one would be correctly answering about 80% of the trials at their respective level. This adaptivity we’ve discussed earlier is designed to challenge each individual’s brain in the most suitable way, facilitating effective brain rewiring.
Furthermore, we offer 29 exercises, each containing dozens of brain training levels of varying difficulty. A high-performing individual will swiftly progress to the more demanding levels due to an internal algorithm in BrainHQ and the personal trainer. However, someone in the early stages of memory loss will keep practicing at the initial levels, ensuring their brain receives ample opportunity for reinforcement. In this sense, we can use the same program but, thanks to these sophisticated adaptive tools, it can rapidly customize itself for individuals with different cognitive abilities and needs.
Interestingly, you mentioned the military and sports. When we first started developing this, we mainly thought about older individuals experiencing memory loss. It’s a process we all inevitably face; our attention span decreases and our memory isn’t as good as it used to be.
What happened next was quite unexpected. We received a call out of the blue one day, and the person on the line said, “Hey, do you know Tom Brady is using BrainHQ?” Truthfully, we didn’t. We subsequently spoke to his team and discovered he had a neuroscience team while he was with the Patriots in Foxborough. We met with him, his trainer, and his neuroscience team, and learned he was performing these exercises at an incredibly high level, because they had adapted to him.
This interaction broadened our perspective on what we could be doing. We realized we didn’t have to focus solely on aiding brains that weren’t functioning optimally. We could potentially help improve any brain, regardless of its initial state. We started to approach brain training the same way we view physical exercise. Physical exercise, of course, benefits those who are out of shape; it improves heart health, lowers cholesterol, increases strength and builds endurance. But, let’s not forget, exercise is also extremely beneficial for those in good shape. People in good physical condition often maintain and improve their fitness through regular exercise. We shouldn’t view exercise as exclusively for those in poor physical shape. Regardless of your current physical condition, the right exercise program will likely improve your fitness.
The same principle applies to the brain. Whether you are on the cusp of memory loss or you’re at peak cognitive performance, you can enhance and maintain your brain health through appropriately designed brain training exercises. This realization encouraged us to consider working with individuals in high-performance situations.
We began working with TB12, a renowned sports training organization, which was truly exciting. Numerous individual NFL players started using BrainHQ independently, opening doors for us to start collaborating with the military.
We’ve worked with SOCOM, for instance, the United States Special Forces, where they use BrainHQ to hone the mental acuity of individuals who are already exceptionally sharp. Their perspective is, “If we have a Special Forces operator, a Navy SEAL who’s already in the 95th percentile, we want to push them to the 99th percentile to tackle the world’s most demanding tasks.” We’re capable of supporting that kind of endeavor.
Similarly, we’ve started working with law enforcement groups. These groups consist of police officers who, on the whole, are quite astute. However, law enforcement is a demanding job that requires a brain capable of making important decisions with split-second accuracy in challenging situations. We can assist in enhancing these capabilities.
This work has significantly changed our perspective on brain health. We’ve learned we can support individuals in a variety of situations. Depending on the group, we might use a slightly different combination of cognitive training exercises. For instance, with law enforcement, we often focus a lot on executive function: how to make the correct decision in a very short period of time. This is crucial for law enforcement officers. In sports and the military, we often work a lot on decision-making speed, attention, and overall processing speed. They simply need to be faster. When you breach a door, you need to be the first person to react upon entering the room. We can customize our program accordingly.
Consider it analogous to a gym. When you go to a gym, there’s a plethora of equipment available. You might not use all of it, but if you have a personal trainer, they’ll pick the right set of exercises to tailor your physical fitness to your specific needs, whether that’s for basketball, football, patrolling as a law enforcement officer, and so forth.
We also just did this wonderful pilot study with NASA where they came to us and said, Hey, we got astronauts and again, people doing a very challenging very demanding job, typically already operating an incredibly high levels of cognitive performance, but they want them to be sharper. The are also worried that they’re going to put these men and women in space for quite some time – a mission to the moon, eventually a mission to Mars – where they might be out there for months, and have the same way we need to think about their physical conditioning when they’re in space for extended period. We need to think about their brain health and their brain conditioning when they’re in space for an extended period of time.
They ran an exciting pilot study where they took a number of people who weren’t astronauts, but were pretty much very similar to astronauts as a first step and actually generalized to NASA standard high performance cognitive battery, showing that on that test, we improve their scores by about 90%. So again, one more piece of evidence that just about everyone is going to benefit from better brain health and better brain training.
So what role will cognitive training play in the future of healthcare and in particular aging?
That’s a great question. It’s indeed intriguing how, when we consider healthcare and aging, it seems as though we believe the body begins at the neck and extends downwards. We currently dedicate a great deal of effort to maintain the health of our bodies below the neck. We understand the significance of exercise, we appreciate the role of diet and nutrition, and we constantly ponder physical health in various ways.
Yet, there seems to be this lingering, outdated belief that the brain will take care of itself and that there’s nothing we can do about it. Obviously, the brain is part of the body. The health of the brain can be maintained in the same way that heart cells or the liver’s health can be preserved. The question then arises, “What can we do to maintain the health of the brain?” The answer is, actually, quite a lot of things. I happen to work in a brain training company, so I see it firsthand.
Physical exercise, diet, and nutrition play vital roles in brain health. Sleep and stress reduction also have important roles. The use of hearing aids and glasses becomes crucial as our senses start to wane. Additionally, maintaining social connections certainly plays a significant role in brain health.
Of course, brain training plays a crucial role as well, right? After all, engaging in cognitive activity is the primary function of the brain. I believe we are in the early stages of recognizing that we need to proactively maintain the health of our brain, not passively or automatically letting things unfold, but in the same way we consider actively maintaining our physical health.
This recognition carries many implications. For instance, I’m 53 years old. When I visit my doctor, irrespective of the reason for my appointment, they invariably start with a blood pressure check. Why? Because we acknowledge the importance of heart health. And my doctor never fails to discuss it. I foresee a time in the near future when every doctor’s visit will include a quick assessment of your brain health. They’ll check things like your processing speed and the internal noise level in your brain, which we now know are the earliest indicators of brain aging. Your doctor will then advise on activities to help maintain your brain health, including brain training and physical exercise.
Just as we have classes designed to prevent diabetes, teaching participants how to live a healthier lifestyle to reduce their metabolic risk and prevent type 2 diabetes, we will soon see community health centers offering classes on brain health. These classes will incorporate physical exercise, diet, brain training, and sleep into their curriculums. In fact, we’ve received funding from the NIH to develop a program like this in collaboration with the YMCA here in San Francisco. We plan to launch it in the near future.
The key takeaway is that we need to take care of our bodies, not just below the neck, but above it as well. By doing so, our brain span can keep pace with our lifespan.
It’s exciting because we’re in the early stages of a brain health revolution. In the future, we will look back on this day and consider our past practices as somewhat ludicrous. We used to allow people to age, believing that it was acceptable for them to just sit on the sofa and catch up on TV reruns. But in reality, this is a terrible activity for brain health. Similarly, we will think it unfathomable that we had veterans returning from war with repetitive IED exposure, PTSD, and mild traumatic brain injuries, yet we simply told them to adapt to civilian life, find a job, or go back to school.
Such a response is absurd, right? We should have helped these individuals improve their brain health. We will view severe mental illnesses like schizophrenia and bipolar disorder and marvel at our past ignorance, realizing that we neglected to acknowledge the importance of improving brain function to enhance the quality of life for these individuals.
So, on the one hand, it can be disheartening to look around and wonder how we remained so profoundly ignorant about the most critical part of our body. On the other hand, we can adopt an optimistic perspective and acknowledge that we are starting to figure this out. The landscape will eventually change. We will realize that we need to work on improving and maintaining brain health across every aspect of our lives, communities, and health conditions.
How will you continue innovating and improving BrainHQ in the years to come?
There are many ways in which we are pushing the boundaries. First and foremost, we have ongoing investment in basic science and innovation, where we are inventing new exercises and conducting clinical trials. We are testing these exercises with various groups. As mentioned earlier, we received funding from the NIH to develop an in-person brain health program in collaboration with the YMCA.
We have also initiated a study where participants are using Apple Watches to monitor their mobility. The goal is to investigate whether brain training can enhance their daily mobility and decrease their risk of falls. Additionally, we are testing BrainHQ in diverse clinical conditions. While I can’t reveal all of our ongoing projects, the National Cancer Institute has funded a large study.
In numerous studies, BrainHQ is being used with various clinical conditions to investigate whether we can aid individuals. This kind of scientific exploration is constantly ongoing. But we also strive to improve BrainHQ as a consumer app. Like any consumer app, we regularly engage with our users to understand what they find compelling or less appealing.
One key aspect of brain training, like any wellness initiative whether it’s exercise or diet, is consistency. Users need to stick with it for some time to reap the benefits. Thus, we ask our users: What aspects of the app did you find engaging? What helped you form a habit? If you took a break, what would remind you to return to the app? By addressing these questions from a consumer behavior perspective, we are better equipped to transform brain training into an enjoyable routine, much like how some people fall in love with exercising or healthy eating. This approach is part of our user experience and consumer design perspective, representing innovation in the field of brain health.
IMAGE CREDIT: Posit Science.