I sat down with my grandmother-in-law shortly after my youngest baby’s birth. We marveled about the differences in our childbirth experiences. She had her children in the 50’s and 60’s in NY, when women were routinely anesthetized, and I had my children, over the last ten years, in a process involving prenatal testing, stem cell banking, and careful selection of medication based on my own genetic and environmental profile.
It’s not really a secret anymore that technology and data are revolutionizing the way we understand health and treat disease. We’re evolving from a one-size fits all approach to one where our individual biomarkers can inform our prognoses and treatment decisions.
This is personalized medicine and it’s exploding. The Personalized Medical Coalition had found 13 examples of personalized medicine 10 years ago in 2006. By 2011, that number was at 72, a five-fold increase. And here we are today, with 113 examples, another 50% increase.
While times have certainly changed, for my grandmother-in-law as caregiver they have not. In her current experience helping her husband navigate the tricky waters of dementia and memory care, she wants to know why, if we can do all this amazing personalized medicine in the fields of genetics, cancer, childbirth and more, why is dementia so behind the times?
For a couple of reasons. First, it’s because dementia is not one thing. It is a collection of symptoms with many different underlying causes and just about everything about it varies from person to person.
In another example close to me, my grandmother, my father’s mother, lost her ability to speak in English, which she had been speaking in America, her adopted country, for 40 years. With my grandfather, my mother’s father, his cognition remained intact, so he was pretty sharp as his memory declined. He was fond of public speaking and would repeat himself, which we all thought was funny until it wasn’t and we realized what was going on. The point is that as scientists, we have not figured out how to fully classify “dementia” into all of the different things that it really is.
A second challenge stems from the fact that we tend to seek out the doctor only when things are very wrong. Full blown dementia in its advanced stages is obvious. The condition that precedes it, however, called Mild Cognitive Impairment, or MCI – the middle stage between normal forgetfulness and true dementia – is notoriously difficult to detect by a physician, and is often dependent on recognizing subtle changes in yourself or someone you know well. Because early detection of dementia is a diagnostic challenge, patients participating in dementia research studies and clinical drug trials are often so far along in their disease progression, past the point of no return perhaps, that these research efforts have had little chance to succeed.
I’m clearly affected by dementia in my family. I wish I could say that this is unique, but actually having 2 out of 4 grandparents getting dementia is about what we can expect as we live into our 80’s, 90’s and beyond. Most of us will be touched by this at some point in our lives.
As a neuroscientist, physicist, and entrepreneur, I’m on a mission, to help catch up our understanding of this mysterious, complex, and completely individualized disease state. We have a ways to go but a giant first step and much of what we need to get there is already in our pockets.
Neurocognitive testing. Traditionally administered by a neuropsychologist, neurocognitive testing is a way for us to peek under the hood and measure brain function non invasively. The tests are effective and deceptively simple. They assess important capabilities such as attention, memory, language, reaction time, visual processing, cognitive processing, and so on — essentially the dynamic features of our brain functioning. We can adapt these traditional tests to mobile, allowing us to take a snapshot of our brains terms of our neurocognitive capabilities.
Let me show you some examples on our app called BrainCheck.
This is one of our tests called the Flanker Task. It says “which way does the center arrow point” and the user has to respond as quickly and accurately as possible. When the arrows are all in the same direction (the congruent case) it is easier to answer than when they’re in different directions (the incongruent case). The difference in response time between the two cases is a measure of executive function – the ability to squelch distractors and pay attention to the salient inputs – something that is difficult to do in general, but especially when you have cognitive impairment.
In this second example, called the Trail Making Task, the user has to tap 1-A-2-B-3-C, etc. This measures visual processing. And this is the Digit-Symbol-Substitution Task (interestingly also part of an IQ test). The symbol matches the #9, which you key in.
Classically, these tests have strong predictive value for dementia, and when a collection of tests is given, the results can be taken together to show which cognitive domains are impaired.
We can also take this a step further. We can take advantage of recent advances in mobile technology and obtain a high-resolution digital signature of scores to obtain an amazingly detailed pattern of cognitive performance. I will call this signature of scores a neurocognitive fingerprint. It’s like a real fingerprint, or a genetic fingerprint – to borrow the analogy for what has led to much of the revolution in personalized medicine. It can quantify an individual’s cognitive state in ways that have previously remained subtle and qualitative.
In addition to richer data, which we can now obtain, we also need lots of it. Lots of rich multi-dimensional data on a population size that scientists have never had access to. Imagine a clinical trial for the whole world.
By tapping into the mobile and wearable device revolution we can check our brain health in real-time, not just on once a year trips to the doctor and we can do so in respect to other dimensions of our health – eating, sleeping, and exercise, and also what medications we’re on, and the status of any other health conditions. You don’t need an appointment, you can take neurocognitive tests at home and get a detailed readout of how your brain is functioning. This gives your doctor tools to assess what’s happening if results start to deviate from your baseline.
Cognitive health is as important as physical health. If everybody were monitoring their cognitive health we would have a massive database of neurocognitive profiles or fingerprints. Neuroscientists and data scientists can then begin to understand the relationship between fingerprints and disease states with a kind of high definition that just hasn’t been possible before.
This means we can create the proper classifications. When we understand what we’re working with better, doctors will be able to give very personal prognoses. And for all of us, this means we can begin to customize treatment in ever increasingly targeted and accurate ways.
We are all governed by our brains. Our brains are the most complex machines in the world and they’re responsible for creating our realities. So much of who we are and what we do are the result of our neurocognitive capabilities. I want my children and grandchildren to live into old age, have a continuous track of cognitive changes, and as soon as they occur have a personalized intervention that halts them, so they can take full advantage of a long life.