Jul 14, 2008
By: Alvaro Fernandez
You know your weight. And your physical fitness. And a variety of health-related metrics.
What about your brain fitness?
Two recent announcements bring out how the assessment of cognitive abilities, or brain functions, is increasingly being done thanks to new computerized options:
1) Last week, OptumHealth announced an exclusive 3-year agreement (estimated at $18m) with the Australian company Brain Resource. OptumHealth will be embedding the Brain Resource platform into their overall Behavioral Solutions program.
- OptumHealth Behavioral Solutions will work with Brain Resource to provide clinicians with a Web-based assessment that measures general cognition (how people process information) and social cognition (how people manage their emotions). This 40-minute assessment is based on well-known and validated tests of memory, attention, executive function, and response speed, and mood, social skills and emotional resilience.
- When used by trained clinicians as a tool that is part of the total spectrum of health care, this unique information can be helpful in the treatment decision-making process in several ways.
2) A few weeks ago, we read that U.S. Troops To Get Cognitive Screening
- The military will begin giving cognitive tests this summer to troops heading to war, in an effort to get a baseline measure of their reaction time, memory, concentration and other brain functions, which could be referenced in case they are injured.
– Assistant Defense Secretary S. Ward Casscells recently directed military leaders to begin pre-deployment screening of troops by late-July, using a computer-based test known as the Automated Neuropsychological Assessment Metrics, or ANAM, a Department of Defense spokeswoman confirmed in written responses to The Courant.
- The testing, which takes about 15 to 20 minutes, will “allow for greater levels of accuracy when making assessments following injury,” said the spokeswoman, Cynthia Smith.
– Smith said the new testing is not intended as a diagnostic tool for mild traumatic brain injury, but instead would enable clinicians “to compare a person to their own ‘norms’ or baseline scores” in the event of an injury.
I see these instruments as a critical part in the brain fitness puzzle. Neuroimaging techniques such as MRI and fMRI are very important to support clinical and research work, but are not mature/ scalable enough to help measure brain functions in millions of healthy individuals. Neuropsychological testing is still today often done with pen and paper, administered by a trained expert, and very resource-intensive.
Computerized cognitive assessments can start offering value in many contexts that neither neuroimaging nor traditional neuropsychological testing can reach.
The media is starting to take note. We recently reviewed a recent article that explained,
- “Cognitive Drug Research is one a handful of businesses, most of them outside of the U.S., that work with pharmaceutical companies to test how new drugs for everything from nicotine addiction to Alzheimer’s disease affect the mind’s ability to remember things, make decisions, and analyze information.”
- “Cognitive tests have been around for a century as examinations taken with paper and pencil. In the 1970s and ‘80s the tests shifted to computers, Cognitive Drug Research founder Keith Wesnes says.
In fact, one of the key highlights from the market report we released in March was that “Large-scale, fully-automated cognitive assessments are being used in a growing number of clinical trials. This opens the way for the development of inexpensive consumer-facing, baseline cognitive assessments.” And we profiled a few leading companies in the space: Brain Resource Company, Cognitive Drug Research, CNS Vital Signs and CogState.
Brain scientists don´t recognize one overall “brain age” or “intelligence”. We can view our brain functions or cognitive abilities as a variety of skills, some more perception-related, some more memory-related, some more language-related, some more visual, some more abstract-thinking and planning oriented. There is no general “brain age” that can be measured or trained in a meaningful way.
We explored this in more detail in our market report, saying that
-“A major bottleneck in the use and refinement of cognitive training tools for the appropriate groups today and in the future is the time and economic investment involved in mostly manual neuropsychological assessments.
- “Potentially, these (new, computerized) assessments could be repurposed to help establish a cognitive baseline, assess mental functioning before and after clinical conditions, track the consequences of aging, indentify priorities for cognitive training, and measure progress independent from the training itself”
Now, the use of these new technologies also raises concerns, nd not just about their reliability and validity.
John Moore of Chilmark Research just commented on the Brain Resource-OptumHealth announcement in his post Will a Mental Evaluation be a Part of Your Next HRA?, pointing out that “it is fairly well-known that many chronic diseases have a high comorbidity factor with mental health, OptumHealth’s partnership with Brain Resource, and its success (or lack thereof) will be an interesting one to follow. And while I applaud this effort, it also raises some pretty scary privacy concerns. How will these assessments be used beyond the confines of the clinician’s office?, What access will OptumHealth have to the data? And what about the employers who have OptumHealth’s parent, United Health Group as an insurer for their employees? Will employers have access to this data, particularly if they start embedding it within HealthAtoZ?”.
These are excellent questions. Humana, a health insurance company, recently announced that they were discontinuing their agreement with Posit Science under which they had been offering the Posit Science Brain Fitness Program to their Medicare members. Whereas a number of reasons were offered for that decision (ranging from low uptake rates of the promotions given the legal complexities of reaching out to Medicare users, to low utilization of the product), another concern was mentioned to us during a set of interviews with Humana members: they were concerned about whether a program that had been given to them for free by their insurance company would somehow transmit data back on the mental performance of the user.
Furthermore, we can expect clear public policy implications in this area. Art Kramer recently explained that “the NIH is preparing an NIH Toolbox to provide valid, reliable instruments to researchers and clinicians, to solve the problem that exists today, namely, the lack of uniformity among many measures used. The initiative was launched in 2006, and it is a 5-year effort, so we’ll need to wait to see results”.
As with any new tool, we´ll need the define the rules of the road.
1) First of all, we´ll need to make sure it measures what it is supposed to, and with high degrees of reliability.
2) Second, there need to be clear policies in place as to whom can access which data and for which purpose.
3) Finally, we expect the assessments will lead into actionable personalized recommendations to improve if not help maintain cognitive functions.
We will continue to pay close attention to this emerging, and very promising, field.