Published in February 2012
Prepared by: Alvaro Fernandez1, Luc P. Beaudoin2, Muki Hansteen-Izora3, Margaret E. Morris4, Joshua R. Steinerman5, Peter J. Whitehouse6
1 SharpBrains, Washington, DC 20008
2 Simon Fraser University, Burnaby, British Columbia
3 Intel Labs, Intel Corporation, Hillsboro, OR 97124
4 Intel Labs, Intel Corporation, Hillsboro, OR 97124
5 ProGevity Neuroscience, Merion Station, PA 19066
6 Department of Cognitive Science, Case Western Reserve University, Cleveland, Ohio 44106
The 2011 SharpBrains Virtual Summit brought together more than 260 research, technology and industry innovators in 17 countries for 3 days to discuss the rapidly evolving developments in science, technology and policy relevant to brain health across the lifespan. A number of important themes emerged from the talks and discussions, including potential approaches to developing a rich digital toolkit to monitor and maintain cognitive and emotional health, the need for innovative cross-sector partnerships and the urgency of scaling up solution to address growing societal needs. Also discussed were required scientific frameworks, marketing standards, analysis of latent consumer demands, and methods to disseminate and discuss timely information and analysis – such as virtual conferences to bring together multiple stakeholders to enable cross-sector collaboration and foster innovation. Global priorities such as optimizing cognitive and emotional health across the lifespan provide a compelling reason to innovate about the process of innovation itself, pooling the efforts of hundreds of pioneers across the traditional silos of geography, sector and profession. Virtual conferences can enable successful distributed collaboration when they focus on appropriate use of the digital medium, deliver a clear value proposition to participants and prioritize ease of technical access.
The 2011 SharpBrains Virtual Summit: Retooling Brain Health for the 21st Century (March 30th — April 1st, 2011) brought to the (virtual) table more than 260 research, technology and industry participants for 3 days to discuss the ways in which neuroscience, cognitive science and non-invasive technologies can potentially be employed to improve cognitive, emotional and behavioral functions and capabilities across the lifespan.
As Dr. Brenda Dann-Messier, Assistant Secretary for Vocational and Adult Education of the U.S. Department of Educated, highlighted in her opening remarks, we need to sharpen our questions and to envision specific ways in which we can collaborate, innovate, and make significant progress in years to come, given longer lives and a much faster-moving and complex society and labor market today than only 100 years ago. How will we retool our schools, universities, community colleges, workplaces, health systems and retirement policies to ensure they support, rather than hinder, citizens’ abilities to thrive in the 21st century?
Participants in 17 countries attended this wholly online conference in order to learn from and converse with more than 40 scientists, executives, entrepreneurs and policy makers (1). Topics encompassed cognitive neuroscience and neuroplasticity research, consumer, regulatory and policy trends, and newly available technology-based platforms, products and services. Summit participants represented the innovation spectrum, from researchers to technology developers to users and their associations, bringing diverse perspectives on how emerging science and tools can best help develop and maintain the critical mental capacities to optimize quality of life, workplace productivity and delay disease.
Most of the 11 Summit panel sessions featured a cross-sector and cross-geography roster of speakers, allowing, as a representative example, a conversation between a Silicon Valley researcher and technologist, a UK psychiatrist and an American insurance executive, moderated by a Canadian life sciences investor.
Key themes relating to public perceptions, policy priorities, assessment options and ways to put research into practice surfaced in the Summit’s opening panel. Nigel Smith, Director of Strategy at AARP, framed the conversation by sharing that 80% of the 38,000 adults over 50 surveyed in the 2010 AARP Member Opinion Survey indicated “Staying Mentally Sharp” as their top ranked interest and concern—above other important concerns such as Social Security and Medicare (2), which raises the need to define, measure and promote the concept of “staying mentally sharp” through the early assessment and prevention of brain-based problems, the optimization of cognitive functioning in daily life (e.g., working, socializing, driving) across the full lifespan, and the maintenance of independent living among older adults. Prof. Cary Cooper, Chair of the UK’s Academy of Social Sciences introduced the main findings from The Foresight Project for Mental Capital and Wellbeing, a colossal endeavor marshalling hundreds of neuroscientists under the auspices of the UK government in 2009, which coined the term “Mental Capital” as encompassing “the totality of a person’s cognitive and emotional resources. It includes their cognitive ability, how flexible and efficient they are at learning, and their “emotional intelligence”, such as their social skills and resilience in the face of stress” (3). Dr. Kenneth Kosik, Director of the Neuroscience Research Institute at UC Santa Barbara, added that “we need to demedicalize cognition” if we are to find ways to apply cognitive and neuroscience findings to practical lifelong solutions for an aging population— away from a disease-based and often pharmacologically driven medical agenda.
SUMMARY OF MAIN TAKE-AWAYS
One of the major messages from the conference was the need to devote sufficient attention and resources to preventive brain health strategies across the whole lifespan (4) and the need to bring to market a new generation of reliable and inexpensive assessment and monitoring strategies of cognitive and emotional health – in order to target and deliver those preventive strategies in efficient ways. There was consensus that repeated, frequent, assessment over time (i.e., monitoring) with the use of consumer-facing technologies is preferable to a single assessment. Several speakers identified intra-individual change as a powerful marker of risk, diagnosis, and response to intervention. That is, an idiographic approach, comparing a person’s current performance to his or her previous measures, could be more informative than comparing that individual to norms derived from the population at large (e.g., inflections can be detected). In the past, logistical and technical considerations made repeated assessment too burdensome or expensive; however, new technologies enable one to unobtrusively obtain repeated measures (whose reliability can be assessed) within digital games, cognitive training programs, other software, or naturalistic environments, and allow for sophisticated statistical and computational techniques to be applied.
Dr. Molly Wagster presented tasks from the NIH Toolbox for the Assessment of Neurological and Behavioral Function, to be released in September 2012, as a possible “common currency” which could be used in a range of clinical and research applications throughout the lifespan. Cognitive domains covered include executive function, episodic memory, language, processing speed, attention, and working memory. Commercial batteries featuring technology-enabled cognitive tests in these domains were also presented by multiple developers. Non-cognitive and behavioral measures which could be sampled passively or unobtrusively may also be useful markers of changes in brain function which correspond to or even precede changes in cognitive performance. Examples include metrics of motor performance (walking, typing) or everyday function (medication adherence). The maturing of analytical tools and passive methods for in vivo behavioral assessment may offer promise for uncovering clinically significant correlations between the activities of daily living and cognitive function. Standardizing outcomes for research, clinical and consumer-facing applications in order to enable meaningful comparative analysis was identified as a major barrier to innovation and to adoption of emerging interventions.
The view was expressed that the growing range of tests, products and services in the expanding marketplace creates a number of new requirements. All parties (consumers, organizations, clinicians, educational professionals, etc.) need transparent, practical and evidence-based information about the effectiveness of these products. Health systems administrators will need to decide how to integrate lifestyle and non-invasive interventions to enhance cognitive and emotional functioning. Existing clinical and regulatory infrastructure for distribution and reimbursement of validated clinical bio-medical interventions will also need to be adapted to these new classes of preventive and therapeutic products. A number of Summit participants expressed a need for coalescing and training a cohort of “brain fitness” professionals equipped to educate the public and to integrate non-invasive programs in community environments. These workers could be drawn from several disciplines (including psychology, occupational and speech therapy, special education and social services). Resulting frameworks for training and certification could contribute, it was suggested, to public education efforts driven, for example, by a growing interest in an “annual mental check-up” (5).
While the primary focus of the conference was innovation for cognitive and emotional health given extended longevity, there were multiple presentations and discussions about how research in disabling medical conditions, ranging from schizophrenia to stroke and brain injury, may lead to promising behavioral health and therapy applications for a wider array of people with impaired cognitive functioning. New types of non-pharmacological, neuroplasticity-driven interventions might augment or even supersede choice pharmacological agents and purely compensation-driven approaches in remediating cognitive deficits associated with these conditions. Engaging the wider healthcare community and embedding these applications in standard clinical settings will require partnerships, extensive education of clinicians and validation from clinical effectiveness bodies and policy-makers.
EMERGING THEMES AND IMPLICATIONS
Here is a brief distillation of key themes and implications from the conference’s 40+ presentations and discussions.
1. A lifelong, holistic, integrative approach to brain health is required. Whatever the nomenclature, brain health starts at birth and encounters an array of challenges over one’s lifetime. Given extended longevity trends, an evolving approach that is sensitive to individual, environmental and life-cycle needs is required. That means tailored programs of assessment, exercise and socialization to improve brain health. Ethical quandaries around data collection and use and early diagnosis of cognitive impairments will require further debate and policy developments.
2. Innovative, collaborative and economical research strategies are needed in industry, government and academia. Once the assessment and monitoring strategies discussed above are in place, data processing requirements will push the boundaries of traditional statistical analyses in psychology and neuroscience in significant ways. They may lead to major developments in the gathering and analysis of data at the intersection of computer science, psychometrics, mathematics and artificial intelligence. Platforms that organically gather large data pools are gaining traction and attracting interest from research communities. BRAINnet database of brain, cognitive, genomic and clinical data, and Lumosity.com’s vast database of consumer interactions performed via its web and mobile platforms are allowing researchers to pose new meaningful questions. Validated tools that mitigate research duplication and help answer emerging research questions would enhance information yield and reduce research costs.
3. New funding mechanisms are needed to support research, product development and marketing of research-based non-traditional products and services. The cost of new solutions and services can be distributed among different parties who have a stake in the user’s mental capabilities and overall brain health. The specific points below highlight potential financial conflicts related to adoption and development of new tools:
- Some presenters recognized that credible cognitive training products are currently too expensive for widespread adoption. Dr. Henry Mahncke, CEO of Posit Science, suggested that consumers could reasonably be paid to use these products in specific contexts. For example, insurance companies could provide discounts to customers who voluntarily complete interventions that demonstrably lower accident rates. Tom Warden at Allstate shared positive internal data on an ongoing major pilot test which suggests they may be following that route in the future.
- A number of companies, such as Nationwide, now issue wellness credits to employees for using select online brain wellness platforms.
- Baycrest stated that over 50% of their funding for new cognitive technologies comes from public sources.
- Dr. Walter Greenleaf, of virtual reality-based cognitive therapies Virtually Better, suggested specific challenges and strategies that startups should consider in bringing products to new markets, such as pursuing contract-based work with major players who already have defined distribution channels.
It was noted that this industry is not the first or the last to need to find ways to spread the costs of research and development.
4. A flexible, customizable and personalized approach is required to address emerging challenges and opportunities. For example, not all lifestyle guidelines, talk therapies, meditation techniques, cognitive training programs or drugs have the same effects on all people. Speakers emphasized that, as a general rule, transfer to measurable real-life outcomes is hard to obtain. But it was reported to be possible when basic “conditions for transfer” are met, such as proper identification of deficit in target population and sufficient training “dose” (6;7). Several speakers confessed to be “shocked” by the strength of the negative claims made by the “BBC brain training” Nature paper (8) in spite of the “homeopathic dosing” of the intervention. Dr. Bavelier presented research suggesting that some action programs enhance many users’ executive control and selective attention (with broad transfer) whereas software games that do not present competing attentional targets did not. Dr. Jerri Edwards (of University of South Florida’s School of Aging Studies) and Dr. Sophia Vinogradov (of UCSF Department of Psychiatry ) showed how specific cognitive training can yield driving safety and mental health benefits. More research is required to precisely characterize the mapping between characteristics of interventions and classes of significant real world outcomes, especially given the protective role of physical exercise, cognitive engagement, and cognitive training (9;10). Further, an objective and reliable assessment-based system will be required to personalize interventions based on the user’s needs, including the identification of medical co-morbidities that can impair cognitive function.
5. A rich digital toolkit for cognitive, social and emotional health is called for. As the range and variety of presentations illustrated, there are ongoing initiatives to develop and deploy tools in each of the following categories: computerized assessment for myriad cognitive, psychological and neurological concerns; data analysis and recommendation systems; interventions for manifold clinical and non-clinical problems; measurement of the effectiveness of interventions; and dynamic feedback and intervention adjustment. Increasingly, smart devices and environments will allow seamless capture of cognitive and emotional health data, permitting longitudinal, in vivo assessment of brain functioning. Screenings will be conducted through smart phones and other novel embedded technologies in the home and ambient settings. Interoperability of applications with Electronic Medical Records (EMRs) will be required to drive applications in healthcare settings.
6. Models and best practices for scale up are a must — and diverse options are at hand. Given the scale of the challenges ahead, innovation will need to include varied approaches to reach consumers, patients and professionals, whether through digital platforms, teams of professionals, or retail formulas comprised of enjoyable products and educational customer service. Who will train the trainers to ensure standardized interventions across different sites and populations? With new web platforms, community screening of “at risk” populations can be inexpensive on a per capita basis. Repeated intra-individual cognitive testing may be able to reveal individual changes in cognitive decline rather than traditional comparisons with population norms.
7. The field and marketplace are in their infancy — with associated opportunities and challenges. Robin Klaus from Club One noted that it in the 1960’s, it was strange to see people jogging. He proposed that people who are already actively interested in their health will form the leading edge of adoption of emerging programs for “brain fitness”. Other speakers proposed that people whose livelihoods are predicated on their cognitive performance, i.e., knowledge workers, will also be early adopters. Dr. Martha Farah and Michael Valenzuela, among others, emphasized the need for ethical and meaningful frameworks to help interested parties negotiate a growing range of options for brain enhancement (11).
To help identify and address these concerns, the Summit discussion included topics such as scientific frameworks, marketing standards, analysis of latent consumer demands, and new ways to disseminate and discuss timely information and analysis – such as virtual conferences to bring together multiple stakeholders to enable cross-sector collaboration and foster innovation. Global priorities such as optimizing cognitive and emotional health across the lifespan provide a compelling reason to improve the process of innovation itself, devising new ways to pool the efforts of hundreds of pioneers across the traditional silos of geography, sector and profession.
A WORD ABOUT THE FORMAT: THE ROLE OF VIRTUAL CONFERENCES
Virtual conferences as a method for convening a multidisciplinary cohort of 260 participants from 17 countries distributed around the world emerged from our dialogue as a topic worthy of reflection and investigation. No single speaker or participant had to travel to partake in the 2011 SharpBrains Summit. This means: no airports, airplanes, security, etc. Speakers gave their talks online, participants asked their questions online, and moderators guided the conversations online. Everyone had the opportunity to mingle in a private online platform before the conference, during the breaks, and after the conference. In the chat rooms, a large number of participants expressed gratitude that they could obtain the benefits of such a conference from their homes or offices.
Traditional conferences are excellent as a medium for gathering groups of people around a topic or theme in which they share a collective interest. Face to face dialogue between people is the optimal way to connect, communicate, and establish mutual understanding. However, there are limitations to this format. The primary drawback of course is geography. Travel is expensive and burdensome. Coordination of a multitude of presenters and participants across both time and space can be a logistical nightmare. The time and expense of traditional conferences often precludes or limits participation to geographically and professionally convenient audiences. It can be difficult to encourage participants outside of the primary audience to overcome the travel burden required to attend. For events seeking to foster multidisciplinary collaboration this can be a significant challenge. We believe that, based on our experience during the 2011 SharpBrains Summit, virtual conferences can play an important role in enriching and enhancing cross-sector, global collaboration when they follow these guidelines:
1) Identify an unserved need. While any topic can potentially justify a virtual conference, we suggest not competing with existing events but to select a nascent topic which is just starting to draw significant public attention and where science and technology are key components of the solution. Fields where relevant data, findings, technologies and market developments evolve rapidly will probably see the most benefit from attempting to organize virtual events.
2) Build on industry practices for global collaboration. In organizations at the nexus of science and technology, be they for-profit multinational companies or non-profit universities, global distributed collaboration is already part of the culture, and virtual interactions are already an integral part of doing business, from web-based training to conference calls to remote workers.
3) Explain the format to sponsors, allies and participants as a way to reduce “friction” among stakeholders who should meet more often. Virtual conferences can enable additional information sharing and communications during the year, building incremental conversations and relationships with ease of joining and less “friction” in terms of time and cost. Seamless cross-sector and global interactions can provide a much more holistic diagnosis of opportunities and challenges, including exposure to non-familiar data and perspectives. The weak connections across sectors and geographies can turn into esteemed relationships and partnerships that otherwise would have been established.
4) Prioritize technical simplicity and ease of access. A temptation which is hard but important to resist, given the constant influx of new virtual platforms, is to deploy the latest and visually richest technologies including for example real-time video livestream and 3D visual environments. We would suggest the selection of appropriate technology in alignment with the needs of the topic and participants and prioritization of simplicity and ease of technical access. Complex features that may work well in controlled tests can easily prove too complex for hundreds of participants that have varying degrees of technical sophistication. High bandwidth, video-intensive systems offer some advantages; but they can pose unnecessary barriers to entry and can drive participants away.
5) Facilitate an inclusive yet well-curated exchange. Virtual meeting technologies can enable dozens of speakers and moderators and hundreds of participants, each of them in their own location, to share up-to-date information with participants. This enables a potentially unlimited number of presentations and discussions, and a very diverse speaker roster. Speakers cannot count on a “captive audience” – any participant who is not interested in the ongoing proceedings can simply go back to his or her daily work by opening other computer programs or making a phone call. This might actually improve the quality of presentations and facilitate in depth dialogue and discussion
6) Facilitate local connections: local hosts can facilitate physical and virtual local meetings. including co-located participation for those in the same organization or city. They can also facilitate preparatory and follow up meetings.
7) Foster a sense of community. Creating conference-specific groups in a professional social platform such as LinkedIn enables participants to connect with each other and to maintain discussions before, during and after the conference, fostering a sense of community. Conference proceedings can also be integrated with social media and with partner organizations’ communication channels to facilitate communications among existing participants and to engage new ones.
While virtual conferences offer numerous benefits and advantages over traditional co-located conferences, there are also disadvantages. Traditional conferences are an established method for convening a group of stakeholders around a given theme, market, or discipline. Face to face contact is an essential component of learning, sharing and developing relationships. We consider virtual conferences as a supplemental and alternative format that can enhance and support the ability of a diverse group of stakeholders with a common interest to convene and collaborate in an effective and efficient manner.
Given growing broadband Internet access, innovative video-based communication platforms and richer virtual environments, we believe the role of virtual conferences can only increase over time. A key open question, both regarding the field of lifelong brain health and the role of virtual conferences, is: How can innovation be best integrated into existing practices to augment the realm of what is possible and practical?
The major message from the 2011 SharpBrains Summit was the need to devote sufficient attention and resources to preventive and capacity-building brain health strategies across the lifespan, and that a new generation of reliable and inexpensive assessment and monitoring strategies of cognitive and emotional health are essential and attainable components of such strategies. Education, health care, medical, insurance and neurotechnology models will need to adapt to better serve societal needs in this emerging scenario. There is a need to reduce the traditional dependence on invasive drugs and devices driven by disease-based models. Participants expressed optimism, with which we agree, about the potential of rigorous new research and innovation and a resulting marketplace founded on concepts of cognitive reserve and neuroplasticity.
To meet growing demands, the process of innovation process must be accelerated. Virtual international conferences greatly facilitate knowledge sharing and networking in a way that is responsive to tight travel budgets and the rapid advances in technology and science. Virtual events can help to critically evaluate emerging requirements, research and products. They can promote the development of inter-personal relationships that are important for applying and advancing knowledge and technologies beyond traditional silos. The success of these conferences is predicated on their organizers understanding the participants’ needs, especially that of technical simplicity.
The 2011 SharpBrains Summit was supported by Summit Sponsors Intel Corporation, Lumos Labs, Arrowsmith Program, Posit Science, Cogmed, UCLA Center on Aging, Baycrest, Brain Resource, and CogniFit, and by Summit Partners The Alzheimer’s Research and Prevention Foundation (ARPF), The Berenson-Allen Center for Noninvasive Brain Stimulation (CNBS), The Brain Injury Association of Canada, Brain World Magazine, Center for Brain Health at the University of Texas at Dallas, The Center for Information Technology Research in the Interest of Society (CITRIS), The Center for Technology and Aging, Global Pharma Consultancy, The International Council on Active Aging® (ICAA), MaRS Discovery District, National Health Charities Canada, The Neuroleadership Institute, OLLI @ Berkeley, SmartSilvers, TrainingCampus.com, The Gazzaley Lab @ UCSF, and The UNCG Gerontology Research Network.
We also acknowledge Ashoka: Innovators for the Public, for physically hosting the SharpBrains team during the Summit in their Arlington, VA office, and the following individuals for commenting on previous iterations of this meeting report: Luc P. Beaudoin, PhD (Simon Fraser University), Katherine Sullivan (Walter Reed Army Medical Center), Steve Zanon (ProActive Ageing).
Disclaimer and Competing Interests
Claims above constitute the opinion of the Authors, and the Authors alone; they do not represent the views and opinions of the Author’s employers, supervisors, nor do they represent the view of organizations, businesses or institutions the Author is a part of. This manuscript has not been directly subsidized and/or contracted by a private or commercial enterprise. The authors declare that they have no competing interests other than those noted in their affiliations.
(1) SharpBrains. 2011. “2011 SharpBrains Summit: Retooling Brain Health for the 21st Century.” www.sharpbrains.com/summit/. Retrieved April 21, 2011.
(2) Dinger, E. 2010. Listening to the Member: The 2010 AARP Member Opinion Survey. AARP Research & Strategic Analysis. Washington, D.C.: AARP.
(3) The Government Office for Science. 2008. Foresight Mental Capital and Wellbeing Project: Final Project Report (Executive Summary). London, U.K.: The Government Office for Science.
(4) Olshansky, J., et al. 2011. “The Global Agenda Council on the Ageing Society: Policy Principles.” Global Policy 2: 97–105.
(5) ASA-Metlife Foundation. 2006. Attitudes and Awareness of Brain Health Poll. San Francisco, CA.: American Society on Aging.
(6) Willis et al. 2006. Long-term Effects of Cognitive Training on Everyday Functional Outcomes in Older Adults. JAMA, 23: 2805– 2813.
(7) Edwards, J.D. et al. 2009. Cognitive speed of processing training delays driving cessation. Journals of Gerontology: Medical Sciences, 64: 1262–1267.
(8) Owen et al. 2010. Putting brain training to the test. Nature, 465, 775–778.
(9) Jaeggi, S. M., Buschkuehl, M., Jonides, J., & Shah, P. 2011. Short– and long-term benefits of cognitive training. Proceedings of the National Academy of Sciences of the United States of America, 2011, 2–7.
(10) Agency for Healthcare Research and Quality (AHRQ). 2010. Alzheimer’s Disease and Cognitive Decline, Structured Abstract. April 2010. Agency for Healthcare Research and Quality, Rockville, Md.
(11) Valenzuela, M., and Sachdev, P. 2009. “Can Cognitive Exercise Prevent the Onset of Dementia? A Systematic Review of Clinical Trials with Longitudinal Follow Up.” American Journal of Geriatric Psychiatry 17:179−87.
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2012 SharpBrains Virtual Summit:
Optimizing Health through Neuroplasticity & Digital Innovation
Pre-Summit Workshops: May 31st- June 1st, 2012
Summit: June 7–8th, 2012
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Confirmed Speakers @ 2012 SharpBrains Summit include:
Dr. Tracy Alloway, Assistant Professor, University of North Florida; author of AWMA assessment
Dr. Gregory Bayer, CEO, Brain Resource
Dr. Robert Bilder, Chief of Medical Psychology-Neuropsychology, UCLA Semel Institute for Neuroscience
Alvaro Fernandez, CEO, SharpBrains
Dr. Sheryl Flynn, CEO, Blue Marble Game Co
Dr. Adam Gazzaley, Director Neuroscience Imaging Center, UCSF
Dr. Elkhonon Goldberg, author, scientist, neuropsychologist
Eric Gordon, CEO, Atentiv
Dr. Evian Gordon, Executive Chairman, Brain Resource
Jonas Jendi, GM and VP, Cogmed/ Pearson
Dr. Holly Jimison, Associate Professor, Dept of Medical Informatics &Clinical Epidemiology, Oregon Health & Science University
Dr. C. Shawn Green, Assistant Professor, University of Wisconsin-Madison
Dr. Dharma Singh Khalsa, President, Alzheimer’s Research and Prevention Foundation
Dr. Kenneth Kosik, Director, UCSB Neuroscience Institute; Founder, CFIT
Dr. Paul Nussbaum, clinical neuropsychologist
Dr. Michael Posner, Professor Emeritus, University of Oregon
Dr. Bill Reichman, CEO, Baycrest
Dr. David Rock, Co-Founder, NeuroLeadership Institute
Dr. Yaakov Stern, Head Cognitive Neuroscience Division of the Taub Institute, Columbia University
Kate Sullivan, Director Brain Fitness Center, Walter Reed Army Medical Center
Dr. Yi-Yuan Tang, Director, Texas Tech Neuroimaging Institute
Dr. Peter Whitehouse, Professor, Case Western Reserve University