Neuro-fitness, neuro-coaching… be careful, not everything that glitters is ‘neuro’

Neuro is in fashion! Or so it might seem from the profusion of neologisms that begin with the prefix neuro: neuro-training, neuro-learning, neuro-coaching, neuro-fitness… Neuroscientists who work in our laboratories to understand how the brain works would love for Neuroscience to be more popular among the public agencies that fund our research. However, the reality is that today many of these terms are frequently used in a spurious manner as mere ‘marketing’ tools to sell products or treatments without a scientific basis.

It is difficult for consumers to separate the wheat from the chaff, the scammers from the honest professionals, because the former often use and abuse scientific language to give themselves a veneer of reliability. Their websites are loaded with technical terminology that seems to evoke a deep knowledge of how the brain works, such as neuroplasticity, cerebral hemispheres, neuronal connectivity, or neurolinguistic programming. These terms generate a feeling of trust in the average consumer, who in most cases does not have the training to know whether they are being sold smoke or the cure for all their ills. This is the usual procedure for pseudotherapies, that is, for treatments whose effectiveness has not been scientifically proven.

Scientific proof that a treatment is effective is called a clinical trial, a term that will be familiar to you from the time of the pandemic. A clinical trial consists of comparing two or more groups of people, each with a specific treatment, with their symptoms monitored over time, and with a powerful statistical analysis that shows whether there are differences between the groups, that is, whether the proposed new treatment is effective. The power of the clinical trial depends on whether the effect of the treatment is measured using objective parameters or subjective reports from the patients themselves, on the number of people recruited and representing both men and women and of different ages, social strata, etc., among many other variables. In addition, the results of these clinical trials will have to be reported in scientific journals to be endorsed by other experts.

If the new therapy, however ‘groundbreaking’ it may be, does not have the backing of the scientific community because no publications are provided to prove it, we are probably dealing with a pseudotherapy. It is also common that its proponents are not scientists but marketing experts, who abuse scientific jargon and make the content incomprehensible. Unfortunately, there is very little legislation regarding pseudotherapies, although the Ministry of Health has the coNprueba initiative underway to inform about them.

Neuropromises and brain function

The 19th century French writer Georges Sand said that nothing is more like an honest man than a rogue who knows his trade. And indeed, many of these pseudo-therapies are based on real concepts of Neuroscience, but they distort them.

One term that comes up frequently is ‘neuroplasticity’, a well-documented phenomenon in the scientific literature, occurring in everything from humans to sea slugs, whereby the brain is able to modify the strength of the connections between its neurons. When we learn something new, some neural connections are strengthened, while when we forget, others are lost. It is a concept analogous to walking in the woods: if the path is well-travelled, the footsteps reinforce the trail, while if there are no visitors, the path is forgotten and eventually eaten up by weeds.

Neuroplasticity is an intrinsic property of neurons and is exercised every time we learn something, whether it is a new language, how to play music, how to paint, or how to read a book. It is well established that keeping the brain active is the best way to prevent the loss of cognitive abilities associated with age. Recent studies in laboratory mice genetically modified to express human mutations associated with Alzheimer’s disease showed that the ability of these mice to recognize novel objects or to exit a maze was not lost when they reached advanced ages if they had been trained during their adult life. However, the damage produced by these mutations in the brains of these mice (similar to the damage in patients with Alzheimer’s, including the presence of amyloid protein plaques), was not affected by cognitive training.

These results may explain why people with a higher level of education have a lower risk of developing Alzheimer’s. Perhaps it’s not just that having a bachelor’s degree or doctorate prevents the brain damage associated with Alzheimer’s, but that a brain that has been trained throughout life is able to continue making new connections even as neurons are lost with age or disease. Returning to our mountain metaphor, a trained brain would be like an expert mountaineer who, after a landslide, is able to go around the fallen rocks and open a new path to reach his destination.

Despite the clear protective effect of keeping the brain active against brain ageing, evidence that specific cognitive training therapies are beneficial is inconsistent. For example, a recent study found that a specific type of computerised cognitive training did improve how well dementia patients performed on some memory tests, although it did not study whether there were improvements in their daily lives. In contrast, the effect of playing computer games that promise to slow ageing in healthy people led to significant litigation in the US a decade ago, because it was not based on scientific evidence.

The consensus from a recent “meta-study” (a compilation of published clinical trials) is that if you train yourself in a specific activity, you will get better at that activity in the short term (1-2 years), but it is not clear that there will be an overall cognitive improvement or reduction in the development of dementia in the long term (5 years). That is, if you only do puzzles, you will be better at puzzles, but that will not prevent you from developing Alzheimer’s. On the other hand, if you keep your brain active with a variety of activities and stimuli, it is more likely that it will continue to function effectively in later life.

Another concept that frequently appears in this field is that of ‘neuro-linguistic programming’, a therapy that proposes creating or strengthening a connection between the brain, language and our behaviour. In simple terms, it means modifying our brain and our behaviour through words to treat illnesses such as anxiety or depression, or to improve academic or professional success. On paper, the concept is very nice, and there are many companies that continue to sell it, when the reality is that for more than 10 years the consensus of the scientific community is that it is all talk. The concept of neuro-linguistic programming is so abandoned that even scientific articles on it have stopped being published.

The effect of mindfulness therapies is somewhat more doubtful, as it has been less studied. A recently published clinical trial involving 276 people diagnosed with anxiety found similar beneficial effects when comparing mindfulness with the drug commonly used to treat anxiety, escitalopram. However, it is a small study and has the limitation that the analysis of the patients was not done using objective measures but rather a self-questionnaire filled out by the patients themselves. Much clearer is the lack of effect of this therapy as a treatment for cancer, although it may help improve the emotional well-being of those who suffer from it. In any case, robust clinical trials are needed to determine the therapeutic potential of mindfulness.

The take-home message is that not all that glitters is ‘neuro’. Before you decide to spend money on one of these shiny new therapies, it’s probably worth investing a little time in researching whether their efficacy has been proven.