What If the Best Brain Exercise Has Nothing to Do With Your Brain?

This article is based on my conversation with neuroscientist Julie Fratantoni, PhD, author of the Better Brain by Dr. Julie Substack, as part of the first-ever Brain Health Substack Summit hosted by The Habit Healers.Click here to join tomorrow for Brain Health Substack Summit Day 2 with Annie Fenn, MD.In the late 1990s, I was sitting in a pharmacology lecture during my first weeks of medical school, staring at a stack of handouts thick enough to be mistaken for a semester’s worth of reading. It was two weeks of material. I had three children at home. My youngest was ten months old.So I started drawing cartoons.I drew a Pepsi bottle to represent peptidoglycans, a class of molecules in bacterial cell walls. Then I drew a little van driving across the Pepsi bottle for vancomycin, the antibiotic that targets those molecules. I colored the van red, because vancomycin can cause a flushing reaction known as “Red Man Syndrome.” When test day came, I didn’t need to scramble for facts. I could see the picture in my head. The van. The Pepsi bottle. The red.My classmates noticed. They started borrowing my cartoons, which forced me to explain the drawings out loud, which meant I had to think even harder about what the relationships between the drug classes actually were. Nearly thirty years later, I still remember pharmacology details I probably have no business remembering. My daughter later went to medical school and adopted the same method. We published books about it called Visual Mnemonics.I did not know it at the time, but I had stumbled into something neuroscience now has a very clear explanation for. And it is not what most people think of when they hear the words “brain exercise.”That is exactly what I wanted to explore when I sat down with Julie Fratantoni, PhD, for the opening conversation of our Brain Health Substack Summit. Julie is a neuroscientist, the author of the Better Brain Substack, and someone who works directly with clients on cognitive performance. I expected her to talk about brain-training apps and puzzles. Instead, she dismantled almost everything I thought I knew about what it means to exercise your brain.The Basketball ProblemJulie likes to use basketball to explain two very different approaches to brain training.Imagine you are coaching a youth basketball team. You run drills: dribbling, passing, shooting. Each skill gets practiced on its own. This is what researchers call bottom-up training. You are building individual abilities one at a time, rep by rep. My husband coached our youngest’s basketball team, so I know this routine well. You drill the fundamentals first, because no strategy in the world matters if you cannot get the basics right.Now imagine game day. Suddenly your players need to decide when to pass, when to shoot, how to coordinate with teammates, how to adjust when the other team changes formation. That is top-down training. It requires the prefrontal cortex, the part of your brain right behind your forehead, which handles planning, problem-solving, decision-making, and the ability to pull separate pieces of information together into something useful.The same split exists in cognitive training. Bottom-up brain exercises target single skills like working memory (the ability to hold information in mind temporarily), attention, or processing speed (how fast your brain takes in and responds to information). Top-down exercises challenge your prefrontal cortex to do the harder work of organizing, judging, and thinking critically.Here is where things get interesting. Most commercial brain-training apps focus on bottom-up skills. And the majority of research shows that getting better at those games does not translate into real-life improvement. You get better at the game. That is about it.Julie was blunt about this during our live conversation. The majority of research shows that these games do not generalize to real life, she said, and she wanted to say it loud and clear because it is the question she gets asked more than almost any other.The 23-Hour ExperimentThere is, however, one notable exception, and it comes from one of the largest cognitive training studies ever conducted.The ACTIVE study enrolled about 3,000 adults aged 65 and older and assigned them to one of three types of cognitive training: speed training, memory training, or reasoning training. A fourth group served as a control and received no training at all. The participants trained over a period of three years and were then followed for two decades.The result that caught everyone’s attention was this: the speed training group showed a 25 percent reduction in the risk of developing dementia, including Alzheimer’s disease. The memory and reasoning groups did not show that same protective effect.But Julie pointed out something most people overlook when they read about this study. The speed training was adaptive, meaning it automatically adjusted its difficulty based on how each person performed...