Computerized Cognitive Training Annotated Research Bibliography
1) A study currently
underway at Duke University which is attempting to assess the
impact of computerized attention training and computerized
instruction on measures of student attention, academic
achievement, academic productivity, and student behavior.
Link to Article
2) A study conducted at the Center
for the Study of Special Populations (See note below.) was
designed to evaluate the effectiveness of commercially available
computerized cognitive training (Captain's Log) and
neurofeedback (EEG brain wave biofeedback) treatment in helping
to improve the functioning of children diagnosed as having an
ADHD disorder. A total of 71 participants (85% males) between
the ages of 8 and 11, and diagnosed by either a physician or a
psychologist as having ADHD, completed the study. The volunteers
were randomly assigned to the following three groups: 1)
Cognitive Training, 2) Neurofeedback or 3) No Treatment. Each
person in the two treatment groups was provided 20 half- hour
sessions over a 10 week period. A battery of tests and parent
rating scales were administered at the beginning and end of the
study using test examiners who were "blind" to group
affiliation.
These tests supported the efficacy
of the Captain's Log computerized cognitive training system in
helping to significantly improve the ability to focus and
sustain attention, to encode and retrieve visual and auditory
information and to increase the speed of mental processing.
Cognitive training also significantly improved emotional and
psychological functioning by apparently decreasing ADHD
symptoms. One test rating scale of Hyperactivity also showed
significant decreases in ADHD symptoms. On another scale of
Hyperactivity no decreases were observed, possibly because this
group's mean scale score to start was already below the clinical
cut-off level for Impulsive-Hyperactive behaviors.
Neurofeedback treatment was found
to be more specific in its benefits, and the evidence indicates
that this treatment helped to reduce impulsive, hyperactive, and
off-task behaviors for individuals who initially presented as
significantly more impaired than the other two treatment groups
in terms of Impulsive-Hyperactive behaviors. At the end of
treatment for this group of individuals, the mean score, which
was initially clinically elevated based on the Conner's
Impulsive- Hyperactive scale, decreased to below the clinical
cut-off level. However, only the one area of memory related to
an increased ability for immediate auditory recall showed
improvement, and verbal recall of a story significantly
declined. Thus, the neurofeedback treatment did not seem as
reliable or broadly effective in improving attention,
concentration and memory skills as cognitive training. While our
understanding of who will best benefit from cognitive training
and neurofeedback and how these new techniques may best be used
is limited at this time, it is hoped that these findings will
encourage further controlled research in these areas.
Finally, of great interest is the
surprising finding of this study that no treatment at all for
children with ADHD during the summertime led to a pervasive
worsening of their emotional and behavioral problems. The No
Treatment group also showed no gains whatsoever in cognitive
functioning on the objective tests. It is not clear to this
researcher what kind of activities (e.g., camp, day care, summer
school, vacations, etc.) these children participated in during
the summer. However, the lack of regular tasks and
exercises demanding focused attention, concentration, sitting
still and increasing response inhibition clearly appears to be
detrimental to the mental health and well being of ADHD
children.
Based on this research, these new
techniques show great promise as components in the multi-modal
treatment of ADHD. It may prove beneficial to combine cognitive
training and neurofeedback for some individuals. The traditional
approaches of psychotherapy, behavior modification, school
modifications, family therapy and parent education can all be
integrated and combined with these new approaches. While our
understanding of who will best benefit from cognitive training
and neurofeedback and how these new techniques may best be used
is limited at this time, it is hoped that these findings will
encourage further controlled research in these areas.
Note:
This analysis is based on independently conducted research
completed during the Summer of 1993 at the Center for the Study
of Special Populations, California State Polytechnic University,
Pomona, California, by Drs. Aubrey Fine and Larry Goldman. The
interpretation and views expressed in this analysis of the
study's findings are those solely of Dr. Sandford who has the
other authors' permission to disseminate their findings and his
own analysis of the results.
3) A therapeutic experiment
was conducted to investigate the influence of Captain’s Log. The behavior and
cognitive abilities of 4 severely
emotionally disturbed children with (ADHD), ages 7 to 11 over a 16-week
period using 64 training sessions.. Children were assessed using
behavioral scales, spectral electroencephalograms, and
intelligence and performance tests both pre- and post-treatment.
Results support the expectation that children who were most
successful in the training would demonstrate the highest levels
of generalization of those skills that were the focus of
treatment.
Ref: Slate S., E., Meyer T., L., Burns W., J., Montgomery
D., D. “Computerized Cognitive Training for Severely Emotionally
Disturbed Children with ADHD.” Behavior Modification. 1998 Jul;
22(3): 415-37.
4) Patients with chronic psychiatric
disorders have been found to have neuropsychological deficits.
This study examined the effectiveness of computer administered
cognitive rehabilitation on 69 inpatients diagnosed with
psychotic disorders at a V.A. Medical Center. The treatment
group (N = 40) showed significant improvement on most memory
subtests of the Wechsler Memory Scale, as well as on the
Trailmaking Test (Parts A and B), and reported significantly
fewer cognitive complaints. Control subjects (N = 29) showed no
changes on these variables. These results indicate that
psychiatric patients can productively work with computers, and
that computer-assisted cognitive rehabilitation can produce
short-term improvements in psychiatric inpatients' cognitive
performance.
Ref: Burda, P.C.,
Starkey, T.W., Dominguez, F., & Vera, V. "Computer-Assisted
Cognitive Rehabilitation of Chronic Psychiatric Inpatients."
Computers in Human Behavior. 1994 10(3): 359-368.
5) Adults diagnosed with mild
traumatic brain injury (mTBI) or Attention Deficit Hyperactivity
Disorder (ADHD) were treated with EEG Biofeedback and cognitive
training. Psychological and neuropsychological tests were
completed at pre-treatment and post-treatment and compared to a
normal control group that did not receive training, but was
tested on two occasions. The results showed significant
improvement on full scale attention and full scale response
control score on the IVA Continuous Performance Test. in the
mTBI and ADHD groups compared to the control group. Errors on a
problem solving task decreased only in the mTBI group.
Ref:
Tinius, T., & Tinius, K.A. "Changes After EEG Biofeedback
and Cognitive Retraining in Adults with Mild Traumatic Brain
Injury and Attention Deficit Hyperactivity Disorder." Journal of
Neurotherapy. 2000-2001; 4(2) 27.
6) This case study was one of the
first to find cognitive training to be an effective non-drug
treatment approach for individuals with ADHD. This research
involved a 13-year-old Caucasian male who was diagnosed with
ADHD. The researchers used the Captain’s Log®
cognitive training system to systematically train the subject
for a total of 35 sessions. Informal verbal reports from the
parents and teacher of the youth indicated that this
individual’s behavior had significantly improved. According to
his teacher, he was able to stay on task longer and was less
disruptive in class. His grades also significantly improved from
failing grades to above average performance. His mother noticed
that she did not have to spend as much time monitoring his
behavior.
These researchers reported that
computerized cognitive training was well received by this young
man. He enjoyed the tasks and liked the intrinsic rewards that
were associated with completing the tasks. In addition, the
researchers stated that computer-assisted cognitive training
programs such as Captain’s Log® can be easily adapted
into classroom settings, since most school systems make
computers available to pupils.
For this individual the
traditional treatments used to treat ADHD, which included
medication, along with individual and group therapy, had not
proven to be helpful. Cognitive training did lead to
improvements in school and home functioning. These improvements
were generally maintained seven months after the treatment was
concluded. Sufficient functional improvement was obtained that
it was possible to successfully mainstream this student. On
followup he was still in regular classes and was reported by his
mother to be coping well and meeting the demands of his
schoolwork.
Ref: Kotwal, D.B., Burns, W.J., &
Montgomery, D.D. "Computer-assisted cognitive training for
ADHD." Behavior Modification. 1996; 20. 85-96.
7) Due to a traumatic brain injury,
this 31 year old patient required a bilateral temporal lobectomy.
At 4 months post surgery testing revealed poor immediate and
delayed recall. Following a four month intervention using a
computer-assisted cognitive retraining program (Captain's Log)
to supplement traditional rehabilitation, a dramatic increase in
visual memory was documented. Except for this dramatic
improvement, other functional abilities were found to show only
expected recovery patterns. This study suggests that patients
with bilateral temporal lobectomy may be more amenable to
intervention than was previously believed and offers some
evidence for the effectiveness of computer-assisted cognitive
retraining.
Ref:
Steinhardt, M., Montgomery, D., Burns, W., Bat-Ami, M., &
DiCowden, M. "Cognitive Rehabilitation of a 31 Year Old
Bitemporal Lobectomy Patient." Distributed by permission of the
authors. Pre-publication, please do not cite.
8)
An experiment was conducted to investigate the influence of
Captain’s Log (a computerized cognitive-training system) on the
behaviors and performance capabilities of 4 severely emotionally
disturbed children with Attention Deficit Hyperactivity Disorder
(ADHD), ages 7 to 11. Behavioral scales, spectral
electroencephalograms, and intelligence and performance tests
were assessed pre- and post-treatment. A behavioral point system
and monitoring of progress on computer tasks were used
throughout treatment to evaluate ongoing improvements. There
were 64 training sessions administered over a 16-week period.
Outcome of treatment was determined by computer advancement,
changes in behavioral points, and pre- and post-measures.
Results support the expectation that children who were most
successful in the training would demonstrate the highest levels
of generalization of those skills that were the focus of
treatment.
Ref: Slate, S.E., Meyer, T.L., Burns, W.J.,
Montgomery, D.D. "Computerized Cognitive Training for Severely
Emotionally Disturbed Children with ADHD." Behavior
Modification. 1998 July; 22(3) 415-437.
Generalized Cognitive Training Research
1) Cognitive
training when combined with medication for children with ADHD
was
found to significantly decrease impulsivity when compared to a
control group that received medication only and to another
control group that was treated using behavior modification
techniques. The impulsivity was assessed using the Gordon CPT.
Ref: Hall, C.W., Kataria, S., “Effects of Two Treatment
Techniques on Delay and Vigilance Tasks with Attention Deficit
Hyperactive Disorder (ADHD) Children.” The Journal of
Psychology. 1992 January. 126(1): 17-25.
Link to Article
2) This is a well-controlled
study demonstrating that computerized cognitive training can be
used to improve working memory and that participants were able
to retain the
improvements three months after training was completed.
Ref: Klingberg T., Fernell E., Olesen PJ., Johnson M.,
Gustafsson P., Dahlstrom K., Gillberg CG., Forssberg H.,
Westerberg H. “Computerized Training of Working Memory in
Children with ADHD--A Randomized, Controlled Trial.” Journal of
the American Academy of Child and Adolescent Psychiatry. 2005
Feb; 44(2): 177-86.
Link to Article
3) This study showed that
working memory skills which underlie complex reasoning could be
trained in children with ADHD and in adolescents without any
diagnosed psychiatric disorders. The study used a control group
and also found that cognitive training of working memory
generalized to other cognitive skills that were assessed. The
cognitive training treatment also led to the reduction of
excessive hyperactive motor activity.
Ref: Klingberg, T., Forssberg, H., Westerberg, H.,
“Training of Working Memory in Children with ADHD.” Journal of
Clinical and Experimental Neuropsychology. 2002 Sep; 24(6):
781-91.
Link to Article
4) An article from APA
discussing the potential of helping children with ADHD by
training their working memory skills. It also contains a brief
review of the importance and limitations of working memory
capacity.
Link to Article
5) This article in
Scientific American discusses how training the brain for many
children with ADHD may be just as effective as the traditional
medication treatment approach albeit requiring more patience and
effort on the part of parents, teachers, and therapists.
Ref: Sinha, G. “Training The Brain: Cognitive Therapy as
an Alternative to ADHD Drugs.” Scientific American. July 11,
2005.
Link to Article
6) The results of this
study found that cognitive training specifically designed to
promote the generalization of classroom tasks improved both the
classroom behavior and the academic achievement of hyperactive
children.
Ref: Cameron, M.I., Robinson, V.M. “Effects of Cognitive
Training on Academic and On-Task Behavior of Hyperactive
Children.” Journal of Abnormal Child Psychology. 1980 Sep; 8(3):
405-19.
Link to Article
7) The intensive training
of visual tracking and scanning skills using computer games was
found to improve these specific skills. This improvement was found in
those participants with attentional difficulties and it did not
matter if they also had other cognitive dysfunctions.
Individuals with only attention problems and those with both
attention difficulties and cognitive dysfunction improved
equally well.
Ref: Larose, S., Gagnon, S., Ferland, C., Pepin, M.
“Psychology of Computers: XIV. Cognitive Rehabilitation Through
Computer Games.” Perceptual and Motor Skills. 1989 Dec; 69(3 Pt
1): 851-8.
Link to Article
8) This study indicated
that home-based cognitive training can improve some attentional
and memory functions and can also facilitate the learning of
cognitive strategies.
Ref: Boman, L., Lindstedt, M., Hemmingsson, H., Bartfai,
A. “Cognitive Training in Home Environment.” Brain Injury. 2004
Oct; 18(10): 985-995.
9) Three studies were
found that supported the effectiveness of cognitive
rehabilitation in improving the functioning of individuals with
Multiple Sclerosis and are discussed in this review paper.
Ref: Thomas P. W., Thomas, S., Hillier, C., Galvin, K.,
Baker, R. “Psychological Interventions for Multiple Sclerosis.”
Cochrane Database of Systematic Reviews. 2006 Jan
25;(1):CD004431.
Link to Article
10) This study
showed significant improvement in the cognitive functioning of
80 patients with Schizophrenia who received computerized
cognitive training. The study was completed in Germany.
Ref: Bender, S., Thienel, R., Dittman-Balcar, A.,
Tackenberg, A., Gastpar, M. “Training Effects of Computer-based
Cognitive Training in Patients with Schizophrenia”. University
of Essen. Clinic for Psychiatry and Psychotherapy, Germany.
Link to Article
11) This is a study
demonstrated the effectiveness of Cognitive Rehabilitation for
Schizophrenia and that it resulted in specific improvements in
cognitive flexibility and memory when compared to a traditional
occupational therapy treatment program. Also, the results indicated
that psychosocial skills were
improved; supporting the generalization of the cognitive
rehabilitation treatment.
Ref: Wykes, T., Reeder, C., Corner, J., Williams, C.,
Everitt, B. “The Effects of Neurocognitive Remediation on
Executive Processing in Patients with Schizophrenia.”
Schizophrenia Bulletin. 1999; 25(2): 291-307.
Link to Article
12) This study shows that
specific cognitive training exercises combined with work therapy
for schizophrenic patients led to an increase in working memory
when compared to a treatment group that received only work
therapy.
It also showed that the cognitive training effects endured for 6
months.
Ref: Bell, M., Bryson, G., Wexler, B.E., “Cognitive
Remediation of Working Memory Deficits: Durability of Training Effects in Severely Impaired and Less
Severely Impaired Schizophrenia.” Acta Psychiatrica Scandinavica.
2003 Aug; 108(2): 101-109(9).
13) Improvements in verbal
memory for individuals with Schizophrenia were found after
cognitive training involving auditory processing. The control
group did not show any improvement.
Ref: Fiszdon, J. M.; Whelahan, H., Bryson, G. J.; Wexler,
B. E., Bell, M. D. “Cognitive Training of Verbal Memory using a
Dichotic Listening Paradigm: Impact on Symptoms and Cognition.”
Acta Psychiatrica Scandinavica. 2005 Sep; 112(3): 87-193(7).
14) This study addressed
the potential problems that computerized cognitive training
could have for individuals with Schizophrenia. The concern was
that computer-assisted cognitive training might create feelings
of anxiety for those individuals with Schizophrenia. After 5
weeks of training these researchers found that the patients
reported a significant increase in self-esteem and feelings of
well-being. Also, there was a significant decrease in computer
anxiety, which was not initially high. The trainees reported
that the training was fun and that they perceived that their
cognitive abilities were improved by it. Thus, only positive
emotional effects were found for computerized cognitive training
by individuals suffering from Schizophrenia. Online Article
(text is in German)
15) This study found that
after cognitive training 52% of schizophrenia patients who were
impaired on at least one of the memory tasks normalized their
performance on at least one of those tasks. The researchers
concluded that clinically meaningful improvement may be possible
using cognitive rehabilitation and that the preponderance of the
clinical research supports improvements in cognitive skills
through cognitive training for patients with schizophrenia. This study was
important in that it used a community based, non-psychiatric
control for comparison of the effectiveness of cognitive
training.
Ref: Bell, M., Fiszdon, J., Bryson, G., Wexler, B.
“Effects of Neurocognitive Enhancement Therapy in Schizophrenia:
Normalisation of Memory Performance.” Cognitive Neuropsychiatry.
2004; 9(3). 199-211.
16) The
Veteran's Administration Hospital treatment guidelines for
Stroke recommends cognitive rehabilitation. Online Article.
Link to Article
17) This study showed that
cognitive rehabilitation can be used to improve memory in stroke
patients.
Ref: Cuesta, G.M., “Cognitive Rehabilitation of Memory
Following Stroke. Theory, Practice, and Outcome.” Advances in
Neurology. 2003; 92: 415-21.
Link to Article
18) While EEG Biofeedback apparently
constitutes a direct way of normalizing one’s EEG, computerized
cognitive rehabilitation achieves the same results, but in a
more indirect way. The purpose of this study is to test the
relationship between cognitive rehabilitation and changes in the
EEG patterns in TBI patients with attention deficits.
Participants were five individuals with TBI, out of medication
and at least one year post-injury. Post-testing demonstrated
improvement in attention (mainly in sustained, alternating and
selective attention) following cognitive training, and
correlated with self-reports. EEG changes accompanied these
improvements. Further analysis of the EEG changes are underway.
These findings need to be replicated in a larger study.
Ref:
Stathopoulou S., & Lubar J.F. "EEG Changes on TBI Patients
During Cognitive Tasks after Cognitive Rehabilitation."
Presented at the ISNR Convention. Monterey, CA., 2001.
19) A computerized
cognitive rehabilitation approach for memory enhancement with
TBI patients was found to be similar in its effectiveness when
compared to a
therapist directed cognitive rehabilitation memory training
program. Both treatment approaches showed a significant
improvement in memory skills after training when compared to a
no treatment control group.
Ref: Dou, Z.L., Man, D.W., Ou, H.N., Zheng, J.L., Tam,
S.F. “Computerized Errorless Learning-based Memory
Rehabilitation for Chinese Patients with Brain Injury: A
Preliminary Quasi-experimental Clinical Design Study.” Brain
Injury. 2006 Mar; 20(3): 219-25.
Link to Article
20) This study looked at
TBI patients with working memory problems and used a cognitive
rehabilitation treatment program to specifically train them to
improve their working memory skills. The treatment group was
compared to other TBI patients who had processing speed problems
but did not have problems with their working memory abilities.
The control group did not show any improvement in
memory skills after undergoing the cognitive remediation
therapy.
Ref: Serino, A., Ciaramelli, E., Di Santantonio, A.,
Ladavas, E., “A Rehabilitative Program for Central Executive
Deficits after Traumatic Brain Injury.” Brain and Cognition.
2006 Mar; 60(2): 213-4.
Link to Article
21) Adolescents and
children with attention and memory deficits after acquired brain
injury were treated for about 3 hours per week for 17 weeks
using cognitive training exercises. The control group
participate in a freely chosen interactive activity for the same
amount of time. Pre- and post-training assessments were made
using a neuropsychological test battery. Improvements in
sustained and selective attention as well as in memory
performance were shown in the treatment group as compared to
control group.
Ref: Van't Hoogt, I., Andersson, K., Bergman, B.,
Sejersen, T., von Wendt, L., Bartfai, A. “Beneficial Effect from
a Cognitive Training Programme on Children with Acquired Brain
Injuries Demonstrated in a Controlled Study.” Brain Injury. 2005
Jul; 19(7) 511-518.
22)
Over 95% of rehabilitation facilities who serve individuals with
brain injuries and strokes provide cognitive rehabilitation.
This landmark, meta-analysis study, which reviewed 171 published
articles, found compelling evidence of the effectiveness of
cognitive rehabilitation for the remediation of attention,
memory, functional communication and higher level executive
skills. The article provides specific, evidence-based
recommendations for cognitive rehabilitation to help guide
clinicians in their work.
Ref:
Cicerone, K.D., Dahlberg, C.,
Kalmar, K., Langenbahn, D.M., Malec, J.F., Bergquist, T.F.,
Felicetti, T., Giacino, J.T., Harley, J.P., Harrington, D.E.,
Herzog., J., Kneipp, S., Laatsch, L., Morse, P.A. "Evidence
Based Cognitive Rehabilitation: Recommendations for Clinical
Practice. Archives of Physical Medicine and Rehabilitation.
2000; 81(12) 1596-1615.
23) This study found that specific cognitive
rehabilitation training is needed to improve executive, higher
level mental functioning in Parkinson's patients. Half of the
patients were randomly assigned to the cognitive rehabilitation
treatment group and the other half received the standard medical
treatment for Parkinson's disease. The cognitive training group
significantly improved on two measures of executive functioning
and no improvement was found in the standard treatment group.
Ref: Sammer, G., Reuter, I., Hullmann, K., Kaps, M.,
Vaitl, D. “Training of Executive Functions in Parkinson's
Disease.” Journal of Neurological Sciences. 2006 Jun 8.
Prepublication.
Link to Article
24) A meta-analysis
review of cognitive training for Alzheimer's patients found that
it was effective for the restoration of learning, memory,
executive functioning, activities of daily living and general
cognitive problems.
Ref: Sitzer, D.I., Twamley, E.W., Jeste, D.V. “Cognitive
Training in Alzheimer's Disease: A Meta-analysis of the
Literature.” Acta Psychiatrica Scandinavica. 2006 Aug; 114(2):
75-90.
25) This study showed that
in older people computerized cognitive training led to
improvements in working memory, processing speed, learning
skills and the ability to not be effected by interference when
learning. Some of these abilities were able to be maintained 5
months after training was completed. The researchers concluded
that computerized cognitive training is an effective way to
treat declines in cognitive functioning that often occur as people age.
Ref: Gunther, V.K., Schafer, P. Holzner, B.J., Kemmler,
G.W. “Long-term Improvements in Cognitive Performance through
Computer-assisted Cognitive Training: A Pilot Study in a
Residential Home for Older People.” Aging and Mental Health.
2003 May; 7(3): 200-206.
26) This review of the
literature suggests that cognitive decline is neither universal,
pervasive, or irreversible. It also identified research studies
which demonstrated that older
adults can benefit from cognitive training.
Ref: Thompson, G., Foth, D. “Cognitive-Training Programs
for Older Adults: What Are they and Can they Enhance Mental
Fitness?” Educational Gerontology. 2005 Sep; 31(8): 603-626.
27) A collaborative
approach involving cognitive training resulted in the maintenance of
its benefits when compared in their
working individually.
Ref: Saczynski, J., Margrett, J., Willis, S. “Older
Adults' Strategic Behavior: Effects of Individual versus
Collaborative Cognitive Training.” Educational Gerontology. 2004
Aug; 30(7): 587-610.
Link to Article
28) Based on
single-case designs and small group studies these researchers were positive
about the benefits and value of cognitive training for
early-onset Alzheimer's disease.
Ref: Clare, L., Woods, R., “Cognitive Training and
Cognitive Rehabilitation for People with Early-stage Alzheimer's
disease: A Review.” Neuropsychological Rehabilitation. 2004 Sep;
14(4): 385-401.
29) This book which
discusses the NIH funded research with Nuns that shows how
stimulating and using your brain is the one of the best ways to
prevent the development of Alzheimer's disease. The Nun Study is
a longitudinal study of aging and Alzheimer's disease funded by
the National Institute on Aging. Participants were 678 American
members of the School Sisters of Notre Dame religious
congregation who were 75 to 106 years of age.
Ref: Snowdon, D., “Aging with Grace: What the Nun Study
Teaches Us about Leading Longer, Healthier, and More Meaningful
Lives.” 2001.
Link to Article
30) In fact, there is now
enough research supporting the effectiveness of cognitive
training that the Alzheimer’s Association is offering free
classes around the country to teach people — of any age, but
especially baby boomers — just how to do it. They call it
“maintain your brain.” More information is provided in an online
article that discusses how training your brain helps you to keep
it alive throughout your life.
Link to Article
31) An article related to
how to keep your brain young called: 11 Steps to a better Brain.
Link to Article
32) Maintain your brain
using recommendations from the Alzheimer's Association.
Link to Article
33) An article that discussing
ways to keep your brain mentally active.
Link to Article
34) What the AARP says
about improving your brain.
Link to Article
35) How the brain works in
simple language from the AARP website.
Link to Article
36) Staying sharp using an
AARP program.
Link to Article
37) A website for the
latest breaking “Brain News.”
Link to Article
38) This online article
discusses that researchers found the most compelling convincing
evidence to date that complex mental activity across people's
lives significantly reduces the risk of dementia. The
researchers found that "exercising" the brain almost halves the incidence
of dementia.
Link to Article
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