San Francisco-based Posit Science Corporation, an early pioneer in the nascent brain fitness sector, is focused on advancing the science of brain plasticity in order to build its consumer base, attract high-profile partners, and propel its business. To date, more than 140 peer-reviewed papers have published on the efficacy of the company’s brain exercises and assessments, and Posit Science says more than 200 additional studies are currently underway. Those studies show many benefits, including gains in standard measures of cognition (e.g., speed, attention, memory), in standard measures of quality of life (e.g., mood, confidence, health-related quality of life) and in real-world activities (e.g., balance, gait, driving).
Its flagship product is the cloud-based BrainHQ platform – a freemium and paid subscription-based service, accessible online at BrainHQ.com and through the BrainHQ iOS and Android apps. Users of BrainHQ range from young Wall Street traders to aging great grandparents – people looking for a cognitive edge and those looking to avoid going over the edge.
Posit Science is primarily following a direct-to-consumer strategy but notes that about a third of its users now come in through strategic partnerships. Brain training is a rapidly expanding sector that has experienced growing pains – some competitors have been fined for unsubstantiated product claims – but the company says that its commitment to good science has helped it attract an increasing number of well-known distribution partners. That includes the AAA auto clubs, the Bigger Faster Stronger school sports program, Easter Seals cognitive disability programs, food giant Nestle, Tufts Health Plan, and Tom Brady’s sports training venture TB12 Sports. In early 2018, the list expanded to include the US Army, Navy, Air Force and Marines.
The broad sweep of partners gives a hint as to the range of verticals that Posit Science believes can benefit from its technology, and plans to pursue. And, that does not include its FDA pipeline poised to emerge from its R&D efforts – and more than 60 published papers – in clinical indications.
What makes BrainHQ unique in the field of brain training is that it uses a bottom-up approach, focusing on improving the elemental building blocks of perceptual speed and attention as foundational to gains in higher cognitive functions, such as memory and decision-making. BrainHQ has dozens of computerized exercises that target every major system of the brain.
BrainHQ quickly personalizes, using smart algorithms to adjust stimuli based upon prior performance data, for each user. The exercises get harder when you are having a good day, and ease up when you are having a bad day, in order to help you push through new levels of your “personal best.”
How They Got Started
Posit Science co-founder and Chairman Jeff Zimman previously worked as a Venture Partner for VSP Capital, a Partner and Managing Director at Lazard and Partner at the Cooley law firm. And he received a JD and MBA from Stanford.
The idea for Posit Science came together over a dinner Zimman had with neuroscientist Dr. Mike Merzenich. Dr. Merzenich is one of the leading authorities on brain plasticity — which is the brain’s ability to change chemically, physically and functionally based on responses to sensory and other inputs.
Merzenich explained what was going on in his lab and other labs around the world to harness brain plasticity to address cognitive decline. Both men were caregivers to family members undergoing such decline at the time. They talked about how to get the science out of the lab and into the world.
“For a scientist, Mike is a really good closer, Zimman recalled. “As we finished dinner, he extended me an offer to start the company with him, and said: ‘You know, it would be criminal if you didn’t come help me do this?’”
What became Posit Science was the third company to spin out of the Merzenich Lab at UCSF. All had their roots in the relatively new science of brain plasticity.
Thirty years ago, scientists believed that the brain was plastic – capable of chemical, structural and functional change – only in childhood. By the time a person reached adulthood, the brain was hard-wired and destined to wear out.
Dr. Merzenich (and colleagues) did the seminal experiments that led to the discovery that plasticity is a lifelong phenomenon and that it is present throughout the brain – from the cellular level up into major brain systems. Dr. Merzenich recognized that the brain could be driven into a positive direction if it was given the right inputs.
After discovering lifelong plasticity, Dr. Merzenich began to focus on how to harness plasticity. He became the first to apply plasticity to improve the human condition through his co-invention of the cochlear implant — which provided the brain with new electrical inputs from sound waves in order to restore hearing to hundreds of thousands of people.
Dr. Merzenich next turned to how computers might be used to measure brain function, deliver the right stimuli and drive the brain in a positive direction. The early efforts in brain training resulted in a company to help children with language learning and reading. But, there were so many other parts of life that could be improved by plasticity, that Posit Science became the vehicle for all those efforts.
Their first hire at Posit Science was Dr. Henry Mahncke, who had gotten his Ph.D. while a UCSF student in the Merzenich Lab. Dr. Mahncke ended up taking an odd turn for a new doctor of neuroscientist by taking a job as a consultant at McKinsey.
“At first, I focused on medical devices, given my science background, and then became instrumental in launching the video game practice at McKinsey, following my lifelong love of games,” Dr. Mahncke recalled. “Consulting demands a lot of travel, and when we had our first child, I became a Vice Consul for Science & Technology to the government of United Kingdom, based in San Francisco.”
“I was walking to work one day when Mike called to tell me about the new company he and Jeff were starting. I became their first hire, and I was put in charge of operationalizing the science — building out the internal team and the global team. I always was vocal in my opinions, and in 2011, Mike and Jeff asked me to become CEO and run the company.
Launch Of BrainHQ
When they started, the Internet was not fast, accurate or reliable enough for the millisecond and other micro-adjustments required in their exercises. At first, they had to deliver the exercises on CD-ROM, and later by online downloads, to get the exercises on the computer’s desktop, where they could access the computer’s full speed and power to run the applications. By 2011, the Internet was fast and accurate enough to run the exercises online — which is when BrainHQ was launched.
While developing BrainHQ, they reworked the training experience so that people could work on exercises for whatever time period fit into their day whether it was 1 or 2 minutes or 1 or 2 hours and anything in between. And they learned from online casual games what was engaging and kept people coming back.
Fixing the Underlying Problems
In an interview, Dr. Mahncke noted that people often come up with compensatory strategies to address cognitive deficits. But these strategies typically fail to address the underlying issues and may even make things worse. For example, a common compensatory strategy is to turn up the volume when someone is having increasing trouble hearing or following TV shows. However, the problem may have nothing to do with volume — it could be that the brain’s auditory system no longer has the speed and accuracy needed to hear the fast speech amidst noise that is common on TV. That person may be able to zero-in on the signal a bit more easily by increasing the volume, but over time the brain is being adjusted to require louder signals.
Another common compensatory strategy was noted in a common reaction to falls. “An older person falls, and we typically react by suggesting that person needs a walker,” Dr. Mahncke observed. “However, a part of that person’s increasing fall risk is because their visual processing system is slowing down, so it doesn’t tell the brain that a fall is beginning as quickly as it used to. When a person starts using a walker, they no longer stand up straight – they tend to walk looking down, rather than ahead. So again, a walker may be necessary, but it’s not solving a core part of the problem – brain speed in the visual system.”
Dr. Mahncke cited two studies out of Chicago that looked at people on the cusp of high fall risk and showed that visual BrainHQ training improved their balance, likely by improving the speed and accuracy of information from their visual system as an input to the brain’s fall detection systems.
Milestones
When asked about what some of Posit Science’s biggest milestones have been, Zimman said the most important milestone was building a global team of university-based scientists willing to help design, test, refine and validate brain exercises.
“We had dozens signed up when we started, and that team has grown to hundreds of scientists at leading universities and institutes all over the world,” Zimman said. “We went open source with research studies from the start. By that I mean, we are willing to help any academic team with a well-designed study, and we exercise no control over their publication of results. Most companies would think it crazy to take that risk, but we truly believe in the power of science to reveal the truth.”
Zimman noted that each study publication is a significant milestone and requires thousands of hours of work from researchers and volunteer participants. Zimman noted that the first few papers were exciting, especially when those results were replicated in the 486-person IMPACT Study led by researchers at the Mayo Clinic and the University of Southern California.
“That was really exciting because you no longer had to take just our word on the efficacy of our approach,” Zimman said. “That study showed that people improved in speed and attention, those gains generalized to gains in memory, and the participants noticed that improved cognition in everyday activities. When unblended to the results, one of the lead scientists exclaimed ‘we hit the trifecta!’”
Another milestone was when they met scientists behind the speed training that had been used in the ACTIVE Study. Each of the teams discovered there were others on the planet who shared their view on how cognition is improved. They also took an exclusive license on their technology and started working with them closely. The ACTIVE Study tracked 2,800 older adults for 10 years between the average age 74 to 84. There was a control group and three different intervention groups doing different types of cognitive training: 1) memory strategy training, 2) reasoning strategy training, and 3) the computerized speed of processing training they eventually licensed.
In November, the ACTIVE Study published their 10-year results on the impact of different types of training on the incidence of dementia. This was a real milestone because it was the first time ever in a randomized controlled trial that researchers found an intervention that significantly reduced reported incidence of dementia. Only the speed training had a significant effect and the reduction in risk was at 29-48% depending on how many hours of training, and which definition of dementia, was used.
And of course, meeting Tom Brady was a big milestone. “Tom’s experience made us focus on data we already had that showed we could improve the performance of even peak performers. That’s important because it says brain exercise is like physical exercise – it’s for everyone,” Zimman said.
The ACTIVE Study also tracked older adults driving records for five years and saw a 48% reduction in at-fault car crashes in those who trained with the BrainHQ exercises. In other studies, as a result of training, older drivers were shown to drive more frequently and to be less put off by challenging conditions. “Studies also show less driving cessation, and that’s a good thing, because in our society, for most people, giving up driving is throwing in the towel — it leads to higher rates of illness and death,” Zimman noted.
“I mention the driving results, because when a quarterback tells us that he can see things more quickly, see more, and make better decisions faster, we don’t have a randomized controlled trial on quarterback performance; however, it is quite consistent with the driving results, which are backed by multiple randomized controlled trials, Zimman said. “And, when we get an email – as we have on more than one occasion — from a user telling us that ‘BrainHQ saved my life’ and then describing how a traffic accident was averted, we can observe that is consistent with data from studies. It is also consistent with a large field trial run by AAA in Southern California. As a result of that field trial, AAA is now expanding the number of states in which they offer their insured a free subset of our exercises targeting driving, and AAA participants get a discount on their AAA automobile insurance for completing 7 to 10 hours of training.”
In 2016, the company entered into a special arrangement with library supplier Demco, so that BrainHQ is now offered without charge to patrons at hundreds of libraries.
Sports
As mentioned earlier, one of the most high-profile users of Posit’s software is New England Patriots quarterback Tom Brady. Brady uses cognitive training as a way to get split-second advantages on the field. After Brady started using Posit Science’s BrainHQ training software four years ago, he led his team to four division championship games and his third Super Bowl earlier this year.
Posit Science developed a special sports version of BrainHQ for Brady’s training organization, TB12 Sports at tb12.brainhq.com. Here is a special version of the BrainHQ Hawk Eye exercise that was developed for Brady when he was preparing for the Super Bowl:
Hawk Eye targets a user’s abilities in visual speed, visual search, visual acuity, and useful field of view.
There is a time gap between when an athlete receives sensory information and acts on it. That gap is what most people think of as “reaction time,” and it has both a mental and physical component. At Posit Science, they break reaction time into four mental steps and a final physical step. A player (1) recognizes something happened, (2) attends to what happened, (3) decides how to react, (4) activates a signal from the brain to the body to move in reaction, and (5) reacts physically. The split seconds spent in the mental process can take longer than the physical act.
In the area of sports, the mantra at Posit Science is that “if you think slow, you play slow.”
Even though players are ranked for being faster if they can out-run others by tenths of a second, up until recently little was done for measuring and improving brain speed. BrainHQ exercises focus on improving the mental components of reaction.
The company says there is a growing recognition among coaches and players that cognitive conditioning is as important as physical conditioning.
Military Adoption
BrainHQ is used at dozens of military and veterans medical centers and facilities in treatment and research. In early 2018, the Department of Defense contracted for BrainHQ to be made available to every soldier, airman, sailor and marine.
Posit Science has received grant funding from the National Institutes of Health (NIH) and the Department of Defense. The NIH supported studies in aging and in disorders and diseases associated with cognitive impairment. The funding from the Department of Defense initially was for research in addressing brain injuries, which have been the signature form of injuries in recent conflicts. Posit Science’s work with the military and the veterans’ administration expanded over time.
“Posit is now working under a DARPA (Defense Advanced Research Projects Agency) grant in developing an app that monitors a service members mood and mental state several times a day, to provide health professionals with more accurate and timely information, and to measure whether that might improve mental health and career longevity in the military” Zimman said. “Results of that research have begun to publish.”
“While our initial focus was on addressing brain injuries (such as, traumatic brain injuries, concussions, blast exposures, and PTSD), more recently there has been interest in using brain exercises to improve job performance,” Zimman added. “The military has a concept of unit readiness — there’s even a measure of a unit’s dental readiness — so we are exploring what mental readiness might look like. We believe the military can use cognitive assessments to better screen recruits and cognitive training to raise ability levels overall, as well as in each military occupational specialty.”
Customer Experience
When asked if he could share a story about a customer that used their service, Zimman provided an emotional response.
“My most memorable experience with a user came when we wrapped up an early small study at a retirement community,” Zimman said. “I was interviewing participants in their apartments to see what we could learn about the user experience.”
“I asked a participant if she had noticed any changes,” Zimman recalled. “She replied that she could now remember phone numbers. I had heard that from quite a few people, and I asked, ‘Anything else?’ She looked at me with a mixture of contempt and pity and said, “You just don’t get it.” I admitted I didn’t, and I asked her to explain. She said something like: ‘Aging is filled with daily small indignities. I couldn’t remember a phone number long enough to dial it after I looked it up. If you weren’t on speed dial, we didn’t talk. Now, I remember phone numbers — to me that’s a big deal. I am more like my old self. And, I’ll tell you another thing, you see that china and crystal in that china cabinet. I stopped using it, because every time I did dishes my hand would slip and I’d chip or break a piece. Look in my kitchen and you’ll see nothing but acrylic glasses and plates. But, last week, when I hosted bridge, I used the good stuff, and when I almost dropped a glass, I was able to recover it.’”
“I finished that interview, and then sat for 10 minutes in my car and cried,” Zimman said.
What’s Next?
What are Posit’s future company goals?
“First, we are working on new features, so that you can easily and continuously engage in lifelong monitoring of your brain health,” Zimman said. “We think this will be as normal as tracking physical health.
“Second, we are working with regulatory agencies with the objective of getting exercise sets shown effective in studies of populations coping with diseases and disorders cleared for the medical marketplace,” Zimman added.
“Third, we continue to expand our network of partnerships,” Zimman concluded. “While most BrainHQ users come to us directly, about a third come through partners. We’ve mentioned some of those — for example, with AAA, Nestle, TB12 Sports, libraries and the military.”