Torkel Klingberg: More than just a computer game

Ahead of the wave: Torkel Klingberg.

Healthcare professionals naturally concentrate their efforts on patients and their afflictions. Few medical researchers have the lateral thinking it takes to see opportunities for their work in other applications, let alone to see those ideas through to commercialisation. Harriet Wallberg-Henriksson, president of Sweden’s Karolinska Institutet, singles out Torkel Klingberg as an exception.

Klingberg, professor of cognitive neuroscience at the Karolinska, works in a hot area of science, understanding how the brain works. He may not know it yet, but, by merging cognitive science and computers, he also surfs ahead of the wave dubbed converging technologies, the idea that many of tomorrow’s new products and services will come from the merger of previously disparate areas of science.

In particular, Klingberg’s group at the Karolinska is trying to understand the neural basis for cognitive development during childhood and early adulthood. The team uses one of the latest tools for brain research, functional magnetic resonance imaging (fMRI), to image and measure brain activity. In this way, they “read the minds” of young people with, for example, attention deficit hyperactivity disorder (ADHD).

Working with memory

A major part of the group’s work is on the development and plasticity of working memory and attention. Plasticity is the brain’s ability to adapt, to reorganise neural pathways as we encounter new experiences. Working memory is what you would expect from the label. Like the volatile “random access memory” in a computer, working memory is a temporary store that processes information “on the fly”.

Working memory typically holds information for a few seconds. We use working memory to, for example, remember instructions, solve problems, control impulses and focus attention. Deficient working memory shows up as an array of symptoms, including inattention.

Klingberg’s group uses fMRI to study what is going on physiologically in the brain. The technique, which is revolutionising cognitive science, allows researchers to investigate how memory develops in young people and to compare this with how memory works in adults. It turns out that youngsters with ADHD, and some people born prematurely, have deficits in working memory. In the course of its research, the Karolinska group found that it is possible to train working memory. “I thought that working memory might be possible to improve, just like any other skill,” says Klingberg.

In one set of experiments, the researchers worked with healthy adults. Over five weeks, the volunteers practised various working memory tasks. The fMRI showed that this really did lead to changes in the areas of the brain associated with working memory.

No option but to form a company

Not content with adding to the growing body of knowledge on the subject – something that the group has done with numerous peer reviewed papers – in 2001 Klingberg set up a company, Cogmed, with backing from the Karolinska’s development fund and venture capital investors, to sell software it calls Cogmed Working Memory Training.

Klingberg didn't set out to start a new business to exploit his ideas. At first he considered licensing the idea but he soon found that using computerised training for a medical condition was such a new idea that it was difficult to find a company that could take it on. The same issue came up when Cogmed was looking for funds. “The fact that we did not really belong to any particular category, such as IT or pharma, made it more difficult,” Klingberg explains.

Wallberg-Henriksson likes Cogmed because, she says, “It is not a fancy molecule or a new drug, but based on an observation.” Instead, Cogmed trains the memory with tricks borrowed from computer games.

“The computer was a good tool for doing the training,” Klingberg explains. “It allowed interactive adjustment of difficulty level, and reduced the need for psychologist/assistant for supervising the training. In addition, we could make the training programmes more attractive by having design and rewards similar to computer games. All this together made it possible with intensive training, for several days a week, for several weeks.”

The company says that its computerised training, which requires the involvement of a qualified coach, is “designed to help people with serious attention deficits,” providing them with, “an effective means to improve their attention, impulse control and problem solving skills.”

Children participate in exercises through a software programme called RoboMemo. For about 30 minutes every weekday for five weeks, RoboMemo guides the child through different exercises that are says Cogmed, “designed to train both the visuo-spatial and verbal working memory. The level of difficulty continually adjusts based on the real-time performance of the participant.”

More than 1,400 children and adults have been through the training in Europe. Clinical trials have shown that more than 80 per cent of children who have completed Cogmed’s programme have, “dramatic and lasting improvements to their attention, impulse control and problem solving skills”.

“Parents often report that their children perform better in school and are able to keep up a coherent conversation more easily after training,” Klingberg said recently. “Being able to hold back impulses, such as anger outbursts, and keeping better track of one’s things are other every-day life benefits.

With between 3 and 5 per cent of school-age children in the US estimated to have ADHD, Cogmed clearly has a large potential market. Earlier this year the company opened an office in the US and more than 25 practices now offer Cogmed Working Memory Training.

Drug-free solution

While there are drug treatments for ADHD, these are controversial, causing adverse side effects in some patients. Nor are drugs suitable for some of the other attention issues that Klingberg has investigated.

RoboMemo is not only for ADHD, says Klingberg. It is also “a tool for improving working memory and attention for anyone with an impairment”.

Other groups with attention deficits include victims of stroke or traumatic brain injury. Earlier this year, Klingberg’s group published a paper showing that stroke victims who undertook the training reported that they were “less easily distracted, less likely to daydream and less likely to lose focus when reading”.

RoboMemo could even help us to counter the effects of ageing. The capacity of our working memory also slowly goes down as we get older, “as much as 8 per cent per decade, starting when we are 30,” says Klingberg. “Many older persons might therefore want to use this as a way to stay sharp as they age.” Perhaps computer games have something to teach older people after all.