PositScience's Brain Fitness software requires users to play different games. In one called Listen and Do, the user hears a set of instructions, such as moving the above characters around in a certain order, and must then follow them. (Courtesy PositScience)

Greg Robinson used to have problems getting into his home because he couldn't manoeuvre his keys into the keyhole. After living with HIV for 25 years, his brain capacity had declined to the point where simple motor functions were a challenge.

Cognitive decline is a common symptom in people who are HIV positive, and it's one of the main inhibitors to their living normal lives. One of the symptoms of the virus is that it accelerates the effects of aging on the brain, which can affect functions such as memory, motor skills and speech.

Robinson, 53, worked as an epidemiologist in Toronto, but he had to go on disability insurance because his memory was failing him.

"I couldn't even find the word for doorknob, so I'd just say, 'You know, the thing you grab with your hand and open it up,' " he says. "I worked with numbers all the time. I was a statistician and I couldn't put them together. I was transposing numbers wrong, I was forgetting things."

Four years ago, his friend and fellow HIV patient Maggie Atkinson turned him on to Brain Fitness, or software developed by San Franciso-based PositScience that promised to reverse his cognitive decline.

Robinson was skeptical, but Atkinson said it worked wonders for her and her father, who had suffered a stroke.

Both Robinson and Atkinson were patients of psychologist Sean Rourke, executive director of the Ontario HIV Treatment Network, and after consulting him, the trio devised a plan.

Robinson underwent a battery of neurocognitive tests that gauged capabilities such as memory, mental speed and sharpness. He scored below average in all measures and poorly in others.

He then started the Brain Fitness program, which comes on discs sold through PositScience's website. The program requires users to perform numerous exercises and play mini-games, such as differentiating between sounds and identifying similar images that flash on screen.

Unlike other brain teaser games, however, the software has been designed by neuroscientists to take advantage of a concept called brain plasticity, which suggests the brain can actually be reprogrammed to overcome the effects of aging or disease.

"Our brains get so used to processing things in a similar way. One aspect of this is that you're activating other neural networks that are dormant, not connected or peripherally involved," Rourke says. "You're activating them to recruit them to overcome what that person is experiencing. You're teaching the brain to rewire itself."

Clinical tests

PositScience was founded in 2003 by Michael Merzenich, a neuroscientist at the University of California at San Francisco who had been studying brain plasticity for more than 30 years. Merzenich paired PhD scientists with game designers and project managers from Silicon Valley to come up with the games in Brain Fitness.

Along with the Mayo Clinic in Minnesota, PositScience conducted clinical tests and partnered with auto insurance companies in the United States to test the software's effects on drivers.

The results have been positive and the company is now starting a push into attracting consumers to the software.

'It's not teaching you knowledge. It's changing the way the brain is responding to information.'—PositScience CEO Steven Aldrich

Chief executive Steven Aldrich stresses that Brain Fitness, and its vision-related cohort called InSight, are different from mnemonic tools because they deal with the core issues that cause cognitive decline.

"If you don't exercise physically in ways that challenge your body, you're not going to see an improvement physically. With the right input, you can drive the brain to improve itself," he says.

"It's not teaching you knowledge. It's changing the way the brain is responding to information. It literally changes the physical structure of the brain and the chemistry of the brain."

Aldrich says users start to see real-world effects, such as improved memory, after about 10 hours of playing the games. The recommended "dosage" is two or three sessions a week, which usually last an hour each.

Atkinson, who first heard of the software when it was mentioned on TVO's The Agenda a few years ago, says she noticed effects, including improved handwriting, after about 10 days of use.

Her memory started deteriorating in 2004, to the point where she couldn't remember friends' names or the word for "toaster."

Like Robinson, Atkinson is a well-educated, highly trained professional. She is a lawyer, but found herself withdrawing from meetings at work whenever she had to speak. She ordered the software from PositScience's website and convinced her father to join her in trying it out.

'Gruelling' games

The games, some of which were "gruelling" because of their difficulty and repetitiveness, have made a massive difference for both of them, and Atkinson now recommends it to everyone she knows, not just fellow HIV patients.

"In my case, I found that it really did turn back the clock," says Atkinson, 48.

She admits, though, that her case was anecdotal, which is why Rourke decided to put Robinson through a series of before-and-after tests.

After completing the recommended Brain Fitness session, Robinson saw huge differences in his scores on the neurocognitive tests. In some categories, such as memory, he saw improvements of 50 per cent, and he could again fit pegs into a peg board — something he could not do before, which translated into his problems with using keys.

"I can zip through it now no problem," he says. "It transposes itself into measurable differences in your life. If there was some sort of rote memory that was being cultured and sustained here, it wouldn't be generalizable to other areas of your life."

Both Robinson and Atkinson have done refresher courses on the software. Atkinson says that after two years, she found her memory slipping again, so she went through another round and saw similar improvements. Robinson says he has done a "dose" every summer for the past four years, and he feels his mental skills have continued to improve.

He also says further trials need to be done on people with HIV in order to make the treatments more widely accessible. While he and Atkinson are in good financial positions and can afford the computers required and the software's $395 price tag, the majority of people suffering from HIV and AIDS cannot, he says.

PositScience is working on a downloadable version of the software, which will lower its price tag and make it more widely available. Rourke, who is planning wider tests among the 600 HIV patients he works with, says the games are an important step toward understanding how the brain works.

"They're really on to something here, because it is actually fundamentally getting at the root of what you need to do to show any kind of physiological change in the brain."