INSIGHT, A Comprehensive, Multidisciplinary Brain Training System
Condition: Cognitive Ability, General
Study type: Interventional

Summary: 
      Adaptive reasoning and problem-solving are critical skills that allow for accurate decisions
      to be made based on varying levels of information. In many situations these decisions must be
      made and communicated under stressful, time-sensitive conditions. In such contexts, an
      ability to apply inductive and deductive reasoning to complex, ambiguous, and/or novel
      problems is critical. The objective of the INSIGHT project is to establish a comprehensive
      and rigorous brain training protocol to significantly improve adaptive reasoning and problem
      solving. We will examine a variety of interventions (cognitive training, physical fitness
      training, physiological stimulation, , and combinations thereof) to assess their ability to
      improve adaptive reasoning and problem solving abilities. Multimodal interventions are
      hypothesized to act synergistically to significantly enhance fluid intelligence (Gf) and
      underlying brain structure and function.
    

Detailed description: 
      Recent innovations in cognitive neuroscience have advanced understanding of the
      neurobiological foundations of fluid intelligence (Gf) and adaptive reasoning and problem
      solving (ARP). Rather than engaging a single brain structure (e.g., prefrontal cortex) or
      operating at a fixed level of performance throughout adulthood, emerging neuroscience
      evidence indicates that Gf and ARP are mediated by a distributed neural system whose
      functions can be significantly enhanced by specific types of interventions, including
      cognitive training, high-definition transcranial direct-current brain stimulation (HD-tDCS),
      and physical fitness training. The main objective of the INSIGHT project is to establish and
      validate a comprehensive and rigorous brain training protocol that incorporates the best
      available interventions for the enhancement of Gf and ARP.

      The project was divided into two phases, with the first occurring in February -November 2014
      and the second occurring February - December 2015. The two phases were similar in structure
      and goals/hypotheses, but had several methodological differences in terms of interventions,
      arms, and outcome measures. This document contains information pertinent to only the 2014
      phase, which examined the relative contributions of physical fitness intervention, video-game
      based training, and high-definition transcranial direct-current brain stimulation (HD-tDCS)
      to the improvement of Gf/ARP, executive function, working memory, relational memory, physical
      fitness level, and brain structure/function.

      Arms/groups completed 1 week of testing to establish baseline measurements of cognitive
      abilities, physical fitness, and brain structure/function. 16 weeks of various intervention
      protocols. These protocols could include single or multiple intervention type(s) with varying
      schedules. Three 70-min training sessions were completed per week, so all arms completed 56
      hours of training, total. Following completion of the intervention period was 1 week of
      post-assessment to measure changes in cognitive abilities, physical fitness, and brain
      structure/function.

      Technical Justification for Physical Fitness Intervention: The beneficial effects of physical
      fitness on cognitive performance and brain health have been documented in many studies. For
      example, this literature suggests that increased exercise leads to the birth of new neurons
      in the hippocampus (a key brain region underlying Gf), increased connections among neurons
      throughout the brain, the development of new vasculature structure, increased production of
      neurotrophic proteins, enhanced learning and memory, and enhanced executive control including
      attention and inhibition, working memory, mental flexibility, and action monitoring. In
      particular, (1) exercise effects are largest for tasks that involve executive control
      functions for working memory, planning, and problem solving - abilities that are essential
      for Gf and ARP; and (2) aerobic exercise training, when combined with strength and
      flexibility training, had a greater positive effect on cognition compared to exercise
      training programs that included only aerobic components. Such findings provide important
      justification for the physical activity intervention proposed here. Hence, the proposed
      fitness intervention employs a combined aerobic/resistance training program to further
      enhance the benefits of cognitive training on Gf and ARP.

      Technical Justification for Video Game-Based Training: Training on five cognitive skills -
      (1) processing speed, (2) attention, (3) working memory, (4) relational memory, and (5)
      cognitive flexibility - has been shown to provide promising transfer results to Gf and other
      relevant constructs. This training regime is the basis for the design of the Mind Frontiers
      software platform. Mind Frontiers includes an integrated suite of mini-games that are
      designed to train these five core cognitive skills. The mechanics, as abstractions of the
      cognitive exercises, ensure that the scientific integrity and the training effect of the
      exercises are preserved, but the exercises are implemented as games with motivational
      features and adaptive difficulty.

      Technical justification for HD-tDCS: It has been hypothesized that Gf and ARP are critically
      dependent on a fronto-parietal brain network, and thus that bilateral, specific stimulation
      of the frontal cortex with high definition transcranial direct current stimulation (HD-tDCS)
      would have an excitatory effect on neurons within that network, making them more likely to
      fire, and thereby enabling faster learning and facilitating transfer to Gf.

      Technical Justification for Active Control: Change detection and visual search tasks were
      selected as the active control tasks because previous work had indicated that training
      low-level perceptual abilities did not transfer to Gf and ARP.
    

Intervention name(s): Cognitive Training - 48 sessions; Fitness; Active Control; active tDCS; sham tDCS; Cognitive Training - 20 sessions
Intervention type(s): Behavioral; Behavioral; Behavioral; Device; Device; Behavioral
Intervention description(s): Mind Frontiers cognitive training software (Aptima Inc.) is a Wild West-themed Android application played on Nexus 10 tablets. This intervention includes 20 70-min sessions (23.33 hrs) completed over 12 weeks: 1/wk weeks 5-8, 2/wk weeks 9-16. The 6 mini-games, played in random order for 10 min each session, are Ante Up (Tower of London, executive functioning); Irrigator (visuospatial reasoning); Pen 'Em Up (dual task switching, executive function); Supply Run (Keep Track, working memory updating); Riding Shotgun (visuospatial working memory); and Sentry Duty (dual n-back, working memory). There is also a meta-game in which players build a town using resources earned from the mini-games, played for 5 min each session.; Based on high intensity cardiovascular resistance training (HICRT), this intervention includes a combination of aerobic and strength training. Sessions are conducted in a group of ≤20 participants per class, with ≤5 participants per trainer. This intervention includes 28 70-min sessions (32.67 hrs) completed over 16 weeks: 3/wk weeks 1-4, 2/wk weeks 5-8, 1/wk weeks 9-16. At the first and last session, participants complete the Army Physical Readiness Test. All other sessions consist of: Warm-up; Walk/Run; 2 HICRT circuits with 3 sets of 3-4 exercises; 1-2 min jump rope and 4-min power series between HICRT segments; Drills & Skills; and Cool-down/stretch.; The active control condition consists of 2 tasks (change detection and visual search) with 3 variants each. This intervention includes 48 70-min sessions (56 hrs) completed over 16 weeks: 3/wk. The 6 tasks are played in random order for 10 min each session.; Active HD-tDCS is administered during the first 30 minutes of each Mind Frontiers session. Therefore, the schedule is 20 30-min sessions (10 hrs) completed over 12 weeks: 1/wk weeks 5-8, 2/wk weeks 9-16. The HD-tDCS devices are Soterix Medical 2x2 models, using 4 electrodes (2 anodal and 2 cathodal). Electrodes are held in place with custom, 3D-printed electrode holders inserted into EEG caps, using EEG gel. Participants receive 2.0 mA current for 30 min, split over the 2 anodal electrodes, each drawing ≤1.0 mA. Stimulation is ramped up and ramped down over 30 sec at the beginning and end of the 30-min stimulation period.; Sham HD-tDCS is administered during the first 30 minutes of each Mind Frontiers session. Therefore, the schedule is 20 30-min sessions (10 hrs) completed over 12 weeks: 1/wk weeks 5-8, 2/wk weeks 9-16. The HD-tDCS devices are Soterix Medical 2x2 models, using 4 electrodes (2 anodal and 2 cathodal). Electrodes are held in place with custom, 3D-printed electrode holders inserted into EEG caps, using EEG gel. Participants do not receive sustained stimulation; it is ramped up and ramped down over 30 sec at the beginning and end of the 30-min stimulation period to elicit the sensation of simulation and make the sham condition more convincing.; Mind Frontiers cognitive training software (Aptima Inc.) is a Wild West-themed Android application played on Nexus 10 tablets. This intervention includes 20 70-min sessions (23.33 hrs) completed over 12 weeks: 1/wk weeks 5-8, 2/wk weeks 9-16. The 6 mini-games, played in random order for 10 min each session, are Ante Up (Tower of London, executive functioning); Irrigator (visuospatial reasoning); Pen 'Em Up (dual task switching, executive function); Supply Run (Keep Track, working memory updating); Riding Shotgun (visuospatial working memory); and Sentry Duty (dual n-back, working memory). There is also a meta-game in which players build a town using resources earned from the mini-games, played for 5 min each session.
Other intervention name(s): Mind Frontiers adaptive cognitive training - 48 sessions; high intensity cardiovascular resistance training; aerobic and strength training; Adaptive Visual Search/Change Detection; active high-def transcranial direct current stimulation; sham high-definition transcranial direct current stimulation; Mind Frontiers adaptive cognitive training - 20 sessions
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Keywords: Psychological Tests; Neuropsychological Tests; Transcranial Direct Current Stimulation; Exercise; Circuit-Based Exercise; Video Games; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Cognition; Executive Function; Learning; Problem Solving; Transfer (Psychology); Decision Making; Brain; Gray Matter; White Matter