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Computerized Cognitive Assessments: opportunities and concerns

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.

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3 Responses

  1. Dave Pisoni says:

    Hel­lo: This is Dave Pisoni at Indi­ana Uni­ver­si­ty. Have you heard of HVPT–High Vari­abil­i­ty Pho­net­ic Train­ing. More than ten years ago, we showed that you could train Japan­ese lis­ten­ers to per­ceive Eng­lish /r/ and /l/. Up until our stud­ies this was believe to be impos­si­ble because Japan­ese does not have this con­trast. We also showed in a pio­neer­ing study that this learn­ing trans­fers from per­cep­tion to pro­duc­tion. That is, after HVPT in per­cep­tion, our sub­jects also showed bet­ter artic­u­la­tion of this con­trast. Is this work of any inter­est to your read­ers? dbp

  2. Alvaro says:

    Hel­lo Dave, hadn´t heard of it, but sounds inter­est­ing. Will email you to learn more.

  3. Thanks for sub­mit­ting this post to our blog car­ni­val. We just pub­lished the 37th edi­tion of Brain Blog­ging and your arti­cle was fea­tured!

    Thank you.

    Sin­cere­ly,
    Sha­heen

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As seen in The New York Times, The Wall Street Journal, BBC News, CNN, Reuters,  SharpBrains is an independent market research firm tracking how brain science can improve our health and our lives.

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