Article Archive
March/April 2018

Enhancing Innovative Cognitive and Brain Networks
By Sandra Chapman, PhD; Molly Keebler, MS, CCC-SLP; and Jennifer Zientz, MS, CCC-SLP
Today's Geriatric Medicine
Vol. 11 No. 2 P. 10

The evidence-based Strategic Memory Advanced Reasoning Training (SMART) cognitive training program for healthy older adults focuses on specific cognitive functions, including strategic attention, integrated reasoning, and innovation.

One of the most striking and surprising things about brain health is that in comparison with other aspects of a healthy body, it has been largely ignored to date, and only limited progress has been made in promoting brain health. While heart health is proactively addressed starting in early adulthood, we address the brain only after something goes wrong. But brain health experts at the Center for BrainHealth believe that limited efforts and progress to date have been inadequate in extending the brain health span to match the significantly increased life span.

Declining cognitive function is a leading health concern and challenge, moving ahead of cancer and heart disease for the first time ever. For many decades physicians, nurse practitioners, and other clinical professionals failed to realize steps could be taken to alter the progressive decline that has been well documented in normal aging.

In clinical care, attention to brain concerns is typically initiated only after something goes wrong, such as a stroke, concussion, residual effects of general anesthesia, chemobrain, or concerns related to Alzheimer's disease. When cognitive functions are appraised, these domains are commonly evaluated using well validated simplistic measures. Whereas screening measures are sensitive to dementia, they fail to capture the early cognitive vulnerabilities in normal age-related changes that may be mitigated. Questions are now being asked about whether higher-level cognitive processes in aging, such as innovation, complex reasoning, and strategic control of attention, can be readily measured, monitored, and strengthened.

"Thanks to major breakthroughs in neuroplasticity (ie, the brain's inherent capacity to be modified), evidence is revealing ways adults across the lifespan can harness their brains' neural systems and cognitive functions to build stronger higher-performing brains," says Sandra Bond Chapman, PhD, a University of Texas at Dallas (UT Dallas) professor and founder and chief director of the Center for BrainHealth.

Noninvasive interventions such as cognitive training and physical exercise are gaining momentum as ways to build cognitive resilience and brain reserve throughout life. One of the most fundamental yet little studied aspects of human cognition is innovative thinking, especially in older adults. Innovative cognition is of particular interest in aging due to its central role in human cognition, intellect, decision making, life achievement, resilience, and psychological well-being.1-5
Innovative thinking is a pivotal cognitive capacity and brain function that allows an individual to respond effectively to challenging and constantly changing life demands and is prerequisite to dealing with our rapidly changing world.6

Researchers at the Center for BrainHealth at UT Dallas have demonstrated in a pilot study that cognitive training improves innovative thinking along with corresponding positive brain changes in healthy adults over the age of 55 when compared with two other groups: aerobic exercise and control groups. The study tested the impact of a specifically designed training program known as the Strategic Memory Advanced Reasoning Training (SMART) cognitive training program.

Cognitive Training Program
The SMART cognitive training program is an evidence-based manualized program focused on enhancing top-down executive functioning. Designed by cognitive neuroscientists and clinicians at the Center for BrainHealth and based on more than 25 years of scientific study, SMART provides learning strategies that foster attention, reasoning, and broad-based perspective-taking. SMART focuses on specific cognitive functions, including the following:

• Strategic attention training enables an improved ability to focus without interruptions on major projects and provides practical tips to restore mental energy. It helps in prioritizing mental effort on the critical and achievable daily tasks, blocking distractions, intentionally single tasking, and scheduling regular mental breaks during the day.

• Integrated reasoning calibrates the brain resources between critical details and broader perspectives and offers actionable steps to improve deeper-level thinking, flexible exchange of ideas, and problem solving. Strategies for integrated reasoning exert cognitive control to ''zoom in'' on the important details or steps of a goal, then rapidly ''zooming out'' to synthesize and abstract big picture ideas/goals, followed by ''zooming deep and wide'' to construct generalized application of derived ideas, interpretations, or goals. It is a skill that allows an individual to make more carefully weighed medical, legal, or financial decisions and solve problems in dynamic and demanding environments.

• Innovation teaches how to flexibly update ideas and perspectives to understand complexities and nuances of information and improve problem identification. The strategies of innovation encourage continual seeking of ways to improve everyday tasks and a reframing of negative experiences and obstacles into possibilities and ways forward.

These three core strategies were trained in the first three weeks of in-person group meetings so that participants could understand the basics.

Adults were screened in a multistage screening process comprising online, telephone, and in-person questionnaires as well as physical examinations to ensure good health. Adult participants ranged in age from 56 to 75 and were right-handed native English speakers with at least a high school diploma, no history of psychiatric or neurological conditions, and no history of medication changes or surgery entailing general anesthesia within three months.

Because one of the control groups was aerobic exercise, the authors selected participants who would be most likely to benefit from physical training. Therefore, screened participants represented those who had previously engaged in no more than 20 minutes of aerobic activity, twice per week.

The online questionnaire was followed by a telephone interview to answer questions about the study, verify online responses, and screen for cognitive status. The third stage comprised in-person IQ testing, mood disorders screening, and cognitive assessment. Finally, in the fourth stage a physician examined each participant's physical ability to comply with the study's exercise requirements through an in-person physical assessment of height, weight, waist circumference, body mass index, hypertension screen, basic blood test, and graded stress test. Specifically, participants underwent a maximal oxygen consumption exercise stress test to assess maximal exercise capacity as well as blood pressure/ECG responses, and rating of perceived exertion. This rigorous assessment was carried out before, during, and following the training.

Study Design
To investigate changes in innovation and brain function in healthy older adults, 58 cognitively normal individuals were randomly assigned to three groups: a higher-order cognitive training, wait-listed control, or physical exercise active control groups. The cognitive training group utilized the SMART program developed at the Center for BrainHealth at The University of Texas at Dallas.7 Because aerobic exercise has been shown to lead to improvements in cognition and functional changes within frontal and other brain regions, it was included as one of the study arms.

The cognitive training was conducted in 60-minute sessions one time per week over the course of 12 weeks. Participants also completed personally selected homework assignments related to each session, which involved two additional 60-minute solo practice sessions per week. Participants in the active control physical exercise program met physical activity guidelines of 150 minutes per week of moderate exercise. Training consisted of three aerobic exercise training sessions per week of 60 minutes each over 12 weeks. Participants were assessed to confirm that their target heart rate was reached at each session.

For treatment fidelity, the sessions for all participants in the cognitive training group were led by the same clinician, whose three-stage training process included reviewing literature on the program, observing other trained clinicians, and leading nonstudy SMART training groups under the supervision of a trained clinician.

This is one of the first studies to show gains in innovative cognition and corresponding neural networks following short-term cognitive training in older adults at the beginning (baseline), middle, and end of the study. In contrast, neither the aerobic exercise nor control groups showed significant changes over time.

Specific results revealed significant gains in innovation as measured by the ability to synthesize complex information and generate as many novel high-level interpretations as possible. The participants in the cognitive training group (SMART) showed significant pre- to posttraining gains in high-quality innovation performance, improving their performance by an average of 27% from baseline to mid- and posttraining periods on innovative cognition measures. The physical exercise and control groups failed to show improvement.

Using functional MRI, researchers measured changes in resting-state cerebral blood flow and functional connectivity in two key neural networks previously linked to innovative cognition. These two networks were the central executive network (ie, the focused, goal-oriented network) and the default mode network (ie, the creative, spontaneously generative network for viable ideas, options, and solutions). Researchers identified cognitive training-induced increases in cerebral blood flow in major nodes in the default mode network, suggesting healthier neural function. Even more interesting was the corresponding improvement in innovation performance and the connectivity of the central executive network (positive correlation) and the default mode network (negative correlation) in the cognitive training group only.

Innovative cognition, the kind of thinking that reinforces and preserves complex decision making, intellect, and psychological well-being, does not need to decline with age. The study demonstrated that the SMART cognitive training program enhanced innovation and the underlying neural mechanisms in healthy adults. In many cases, middle-aged to older adults can reverse decline and improve innovative thinking. This study reveals that cognitive training fostering complex mental activity may help enhance cognitive capacities and build resilience against decline in healthy older adults.

Whereas further research is needed to establish how to ensure the benefit persists, these findings suggest that staying mentally active has the potential to restore creative thinking, which typically diminishes with advancing age.

Preserving brain health is one of our greatest health challenges. Given the expanding number of aging adults predicted in the coming years, there is a sense of urgency to explore promising ways to mitigate the widely accepted but now avoidable cognitive declines that accumulate with increasing age.

The Center for BrainHealth's team at UT Dallas is developing online measures and training protocols so that in the near future people around the world will be able to take advantage of evidence-based monitoring and trainings to fortify their brain performance and to inoculate against decline. The authors envision a future where people's best brain years can lie ahead of them rather than in the past, given that individuals become empowered and motivated to attend to their brain health.

— Sandra Chapman, PhD, is the founder and chief director of the Center for BrainHealth at The University of Texas at Dallas, Dee Wyly Distinguished University Professor, and author of Make Your Brain Smarter, and is committed to enhancing human cognitive capacity across the entire lifespan. A cognitive neuroscientist with more than 40 funded research grants and author of more than 200 publications, her scientific discoveries elucidate and deploy novel approaches to advance creative and critical reasoning, strengthen healthy brain development, and expand innovative thinking throughout life (

— Molly Keebler, MS, CCC-SLP, is head of community programs at the Center for BrainHealth.

— Jennifer Zientz, MS, CCC-SLP, is head of clinical services at the Center for BrainHealth.

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2. Beaty RE, Benedek M, Silvia PJ, Schacter DL. Creative cognition and brain network dynamics. Trends Cogn Sci. 2016;20(2):87-95.

3. McFadden SH, Basting AD. Healthy aging persons and their brains: promoting resilience through creative engagement. Clin Geriatr Med. 2010;26(1):149-161.

4. Heilman KM. Possible brain mechanisms of creativity. Arch Clin Neuropsychol. 2016;31(4):285-296.

5. Palmiero M, Nori R, Piccardi L. Verbal and visual divergent thinking in aging. Exp Brain Res. 2017;235(4):1021-1029.

6. Saggar M, Quintin EM, Bott NT, et al. Changes in brain activation associated with spontaneous improvization and figural creativity after design-thinking-based training: a longitudinal fMRI study. Cereb Cortex. 2017;27(7):3542-3552.

7. Chapman SB, Spence JS, Aslan S, Keebler MW. Enhancing innovation and underlying neural mechanisms via cognitive training in healthy older adults. Front Aging Neurosci. 2017;9:314.