Taking your brain vitals: Stories from a techno-optimist inventing the future of human performance

Dr. Cori Lath­an, author of Invent­ing the Future: Sto­ries from a Techno-Optimist

For as long as I can remem­ber, my father loved act­ing. Into his six­ties and ear­ly sev­en­ties, he was quite active in the the­ater. He played Tartuffe in Molière’s Tartuffe, Nick Bot­tom in Shakespeare’s A Mid­sum­mer Night’s Dream, and the Old Man in Steve Martin’s Picas­so at the Lapin Agile. When he won the role of Scrooge in a local pro­duc­tion of Dickens’s A Christ­mas Car­ol, I was so excit­ed for him that I bought tick­ets way before open­ing night. But he was hav­ing trou­ble remem­ber­ing his lines. Even­tu­al­ly, the direc­tor had to let him go.

To find out what was going on, my mom and dad went to his pri­ma­ry care physi­cian, who referred him to a neu­rol­o­gist. After wait­ing a month for that appoint­ment, the neu­rol­o­gist told Dad to see a neu­ropsy­chol­o­gist, who was booked anoth­er three months out. When that appoint­ment arrived, the neu­ropsy­chol­o­gist gave him a vari­ety of cog­ni­tive tests, includ­ing writ­ten, ver­bal, and com­put­er based. After anoth­er month, the neu­rol­o­gist called us back in and told my father, “You have mild cog­ni­tive impairment.”

“No shit, Sher­lock,” I thought. “That’s why we went to see his doc­tor six months ago.” The neu­rol­o­gist then dis­cussed my father’s oth­er health issues with us, which includ­ed car­dio­vas­cu­lar dis­ease, sleep apnea, type 2 dia­betes, and by that point, depres­sion. I then had an inspi­ra­tion. “Dad, when was the last time you used your CPAP machine?” He admit­ted sheep­ish­ly, “I don’t use it. I don’t like it.”

“Dad, if your brain doesn’t get oxy­gen at night, it’s not going to work dur­ing the day.” Prob­lem solved. Well, not total­ly, but it was a start. The real prob­lem was that every­thing my father was going through—from men­tal health to chron­ic ill­ness­es and aging—affects brain health.

In the ear­ly 2000s, brain health took cen­ter stage in the media. With the release by the NFL Play­ers Asso­ci­a­tion of the first study on the long-term impact of head injuries, con­cus­sions became a big top­ic in both pro­fes­sion­al and ama­teur sports. Around the coun­try, par­ents start­ed ques­tion­ing whether they should even let their kids play foot­ball and soc­cer. My own daugh­ters par­tic­i­pat­ed in sports, and I wor­ried par­tic­u­lar­ly about my fourth grad­er, a gym­nast. Iron­i­cal­ly, she got a seri­ous con­cus­sion not from doing a back­flip but from falling off a piece of play­ground equipment.

It took her three months to recov­er. Dur­ing that time, I learned more about con­cus­sion treat­ment than I ever want­ed to know. For some­one who likes to ana­lyze and solve prob­lems, I found it par­tic­u­lar­ly dis­tress­ing that there is no sin­gle diag­nos­tic for a con­cus­sion. No blood test or imag­ing tech­nique. Instead, the diag­no­sis is a sub­jec­tive deter­mi­na­tion based on mul­ti­ple factors:
• Cir­cum­stan­tial (i.e., a recent blow to the head).
• Symp­toms (e.g., a headache).
• Impaired bal­ance (as mea­sured by dizzi­ness or stumbling).
• Impaired cog­ni­tion (as mea­sured by sim­ple ver­bal questioning).

You’ll note the last three cri­te­ria are not very spe­cif­ic to con­cus­sion. If the first cri­te­ri­on isn’t met (that is, if you didn’t recent­ly hit your head), a doc­tor wouldn’t nec­es­sar­i­ly diag­nose con­cus­sion as the cause for your symptoms.

By 2010, it was clear that a new approach to brain health was need­ed. The Navy Bureau of Med­i­cine con­tract­ed Anthro­Tron­ix to devel­op a tool to mea­sure the impact of deploy­ment as a whole—not just blast exposure—on cog­ni­tion. We exam­ined how experts cur­rent­ly mea­sured brain health—like the neu­rol­o­gist who met my dad, gave him some tests, and made a deter­mi­na­tion. No mat­ter how gift­ed the neu­rol­o­gist may be, there was no way for him to know whether my dad’s cog­ni­tion had declined, improved, or stayed the same over the past months or even years. Yet I’d expect­ed that doc­tor to have all the answers.

We pro­posed a new approach. Rather than boil the ocean try­ing to char­ac­ter­ize every aspect of cog­ni­tion, we said, “Let’s track brain health as if it’s a vital sign.” To do this, we need­ed a track­ing tool that was as easy to use as, say, a ther­mome­ter or blood pres­sure cuff. Before you assume this is impos­si­ble, think about the way you actu­al­ly use a ther­mome­ter. The read­out tells you whether your tem­per­a­ture is high or low, which helps you to form a pic­ture of your over­all health. You would nev­er auto­mat­i­cal­ly attribute a high num­ber to a par­tic­u­lar ill­ness, though a fever is cer­tain­ly a sign that some­thing may be severe­ly wrong. With a blood pres­sure cuff, we would nev­er check your pres­sure once—or even twice—to decide whether you have hypertension.

We would need to track it over time so we have a fuller pic­ture. Hav­ing that base­line also helps us deter­mine if a change occurs that is sig­nif­i­cant for you. For exam­ple, I have con­sis­tent­ly low blood pres­sure, so what’s high for me may be nor­mal for you. And if we didn’t have that base­line, a doc­tor might con­sid­er my blood pres­sure to be fine when in fact it’s ele­vat­ed for me.

Just as a ther­mome­ter read­ing doesn’t tell you what’s wrong with you, we wouldn’t expect this tool to diag­nose a sol­dier. But like a ther­mome­ter, it would quick­ly and reli­ably assess mean­ing­ful changes in a soldier’s med­ical sta­tus. Oth­er key aspects of our approach were that the tool must work on any mobile plat­form and be self-admin­is­tered. Our con­cept of oper­a­tions was that a busy medic in the field could give a sol­dier a hand­held device, walk away to do what­ev­er else they need­ed to do, and come back five min­utes lat­er for the answer.

Our team found three tests that met the require­ments. All had been used in research for over twen­ty years, so they were time test­ed and refined. One mea­sured sim­ple reac­tion time: when an object appears in the mid­dle of the screen, touch it as quick­ly as you can. The sec­ond mea­sured choice reac­tion time: when an object appears in the mid­dle of the screen, choose the object below that match­es it. The third, a go/no-go game, mea­sured impul­sive­ness: you are shown an object to tar­get and must touch it as quick­ly as you can when it appears on-screen (go) and do noth­ing when a non­tar­get object appears (no-go).

Sim­ple, right? They are sup­posed to be. You shouldn’t need a col­lege edu­ca­tion to do well; you just need sus­tained atten­tion. Our goal was to mea­sure focus or atten­tion and how quick­ly some­one could respond accu­rate­ly, called pro­cess­ing speed. Atten­tion and pro­cess­ing speed are build­ing blocks for the hard­er stuff our brains have to do, like remem­ber­ing instruc­tions or plan­ning steps to com­plete a task.

Using those three games, we devel­oped an app-based cog­ni­tive assess­ment tool, a “brain vital sign” for mil­i­tary use. We called the app DANA.

As of this writ­ing, we are two years into a study fol­low­ing a cohort of old­er adults with mild cog­ni­tive impair­ment to see if DANA can detect cog­ni­tive changes before a demen­tia diag­no­sis. And our work test­ing the impact of DANA didn’t stop with Alzheimer’s research. We received an addi­tion­al NIH grant to work with the Johns Hop­kins Medicine’s vir­tu­al COVID-19 clin­ic to track recov­er­ing patients who might expe­ri­ence diag­nosed or undi­ag­nosed “long-haul” symp­toms like cog­ni­tive impair­ment. This research is ongo­ing and will doc­u­ment and hope­ful­ly help many peo­ple who are strug­gling with the lin­ger­ing effects of COVID-19.

My vision for DANA has always been that every time you go to the doc­tor, in addi­tion to tak­ing your height, weight, blood pres­sure, and tem­per­a­ture, they will take your DANA brain vital. When mea­sur­ing your brain health becomes sec­ond nature—as com­mon as check­ing your blood pressure—it will empow­er every­one, no mat­ter their age, to spot changes soon­er and take action.

– Dr. Corin­na (Cori) Lath­an is a tech­nol­o­gy entre­pre­neur who has devel­oped robots for kids with dis­abil­i­ties, vir­tu­al real­i­ty tech­nol­o­gy for the space sta­tion, and wear­able sen­sors for train­ing sur­geons and sol­diers. Above is an adapt­ed excerpt from her new book, Invent­ing the Future: Sto­ries from a Tech­no-Opti­mist, which explores the many pos­si­bil­i­ties of tomor­row through Cori’s twen­ty-year jour­ney invent­ing at the edge of tech­nol­o­gy and human performance.