In 2018, psychiatrist Oleguer Plana-Ripoll was wrestling with a puzzling fact about mental disorders. He knew that many individuals have multiple conditions — anxiety and depression, say, or schizophrenia and bipolar disorder. He wanted to know how common it was to have more than one diagnosis, so he got his hands on a database containing the medical details of around 5.9 million Danish citizens.
He was taken aback by what he found. Every single mental disorder predisposed the patient to every other mental disorder — no matter how distinct the symptoms. “We knew that comorbidity was important, but we didn’t expect to find associations for all pairs,” says Plana-Ripoll, who is based at Aarhus University in Denmark.
Since 2010, the SharpBrains Virtual Summit has been bringing together neuroscientists, entrepreneurs, and practitioners with a mission to improve mental healthcare, brain performance and general well-being.
As we get ready to host our next collective brainstorming next week, let us share some key themes from our last Summit, since they helped shape the Agenda for this one.
In 2017, the gathering’s tone was generally optimistic–given the explosion of scientific and technological breakthroughs, start-ups and investments–but important ethical concerns were also widely discussed.
1. The Need is Very Real, Very Large and Largely Unmet
Dr. Tom Insel, a well-known scientist turned policy-maker turned entrepreneur, shared a deep dive into the landscape of healthcare innovation: We have seen $15 Billion invested in Health Tech since 2012, in over a thousand new companies … yet mental healthcare has not truly evolved while brain and mental disorders remain among the costliest conditions in the US, with an annual burden estimated at $200+ Billion.
Same thing regarding aging and brain health: the need is very real and very large, both in developed and in emerging countries. At least there we see stronger signs of advocates and policymakers beginning to take note. For example, Sarah Lenz Lock from AARP spoke about the need for improved digital assessments that are evidence-based and personalized, helping millions of older adults self-monitor their brain health and delay cognitive and memory problems.
A number of researchers shared population-level ways to promote lifelong brain health. For example, Belén Guerra-Carrillo at UC-Berkeley discussed how Big Data coming from new online and mobile platforms can inform policy. Dr. David Bartrés-Faz from the Barcelona Brain Health Initiative described how tracking behaviors–that sustain neural functioning in advanced age—can help personalize interventions, and how they are measuring lifestyle factors in a large, 3,000-subject-strong, randomized trial.
2. Solutions Start with Early Detection and Digital Phenotyping
A very ingenious presentations came from Jan Samzelius of NeuraMetrix, one of the winners of the Brainnovations Pitch Contest. His team, with a background in cybersecurity, discovered a method of assessing typing cadence which could enable early detection of neurodegenerative diseases, from Alzheimer’s Disease to Parkinson’s. The system can run silently (yes, permission and privacy will be issues to address) in the background of a personal computer or smartphone, integrating hundreds of variables in a persons’ keyboard cadence and flagging unusual patterns.
Another great example came from Nancy Briefs of Digital Cognition Technologies, which has adapted a traditional neuropsychological test (the ‘Clock Drawing Task’) and combined it with machine learning to provide fast, affordable, and scalable detection of cognitive changes.
Mindstrong Health has been at the forefront of digital phenotyping. Dr. Tom Insel discussed how ‘digital exhaust’ –data taken from smart phones– can be used to provide objective, continuous, and proactive markers of mood, cognition, and behavior. The firm has found that variables extracted through machine learning are as good at predicting cognitive function as the test-retest reliability of numerous cognitive tests, presenting the opportunity for scalable and noninvasive solutions to detect mental health disorders. Further, the information gained from these methods could be used by clinicians and patients not only to enable early intervention but also to monitor progress over time, something that is rarely done today.
3. And continue with Lifestyle and Digital Health/ Medicine interventions
The upcoming ‘digital cavalry,’ as described by Dr. Oliver Harrison from Telefonica Innovation, will be highly complementary to the early detection and digital phenotyping initiatives outlined above.
For example, Dr. Eddie Martucci of Akili Interactive Labs shared findings from a recently-published randomized controlled trial (RCT) supporting the use of ‘prescription’ video games to target symptoms of attention deficit hyperactivity disorder (ADHD), while representatives at Click Therapeutics, Sincrolab, and MyndYou outlined a new wave of personalized cognitive training/ therapy programs. Going further, researchers at Neuroscape and UCSF presented virtual and augmented reality platforms for multimodal bio-sensing, adaptive evaluation and brain-body training, which could well help upgrade brain healthcare and cognitive rehab in the near term.
Some of the ideas discussed were simple yet highly inspired. Dr. Albert Kwon and colleagues at AugmentX crafted an augmented reality adaptation of mirror box therapy to potentially provide home-based treatment for stroke victims. Emma Yang, the youngest Speaker being just 13-years old, unveiled Timeless — a digital app using artificial intelligence to help persons with Alzheimer’s Disease to remember events, stay connected, and engage with friends and family.
4. Open issues: data security, privacy, equity
While exploring the opportunities, Summit participants also detailed the concerns over data security, privacy, equity, and ethics.
Dr. Simone Schurle at ETH Zurich surveyed biomedical systems for neuro-monitoring and intervention and issued a powerful call for responsible development: new platforms and devices can produce great good in health care, but also have the capacity for misuse and harm.
Dr. Álvaro Pascual-Leone at Harvard Medical School discussed state-of-the-art neuromodulation, which offers a significant and largely untapped opportunity, while Dr. Anna Wexler from University of Pennsylvania highlighted real-world issues experienced by home-based users and championed the need for better ecological research and customer protection, given the onrush of ‘do-it-yourself’ home devices and loosely regulated products.
Multiple speakers discussed major concerns regarding privacy and personal autonomy raised by big data platforms, and potentials way forward.
5. The Time to Engage is Now
Given everything discussed above, now is the prime moment for changemakers, investors, clinicians and allied healthcare professionals to engage with the digital brain health revolution in ways that can benefit all.
Significant advances are coming, have come, and will continue to come. Researchers, innovators and practitioners should work together to direct the flow of the upcoming ‘digital cavalry’ and shape the Future of Brain Health – together we can better recognize needs, provide feedback on implementation, and make sure that those who suffer receive actual benefits.
At the same time, we have a responsibility to identify and preempt ethical concerns and to guide responsible development and appropriate use. If users and professionals pull back from these advances out of propriety concerns, turf war, or feelings of threat, a great opportunity will be lost. Our brain/ mental health care problems will only get worse, not better.
Let’s, together, explore and discuss how to use every available tool in the toolkit to address the very real and very unmet needs of 7+ billion people in the 21st Century.
– Alvaro Fernandez is the CEO & Editor-in-Chief of SharpBrains, and Brandon Frank is a PhD candidate at Fordham University with a concentration in Neuropsychology.
Learn More & Register:
Making Mental Health a Global Priority (The Dana Foundation):
“Who hasn’t felt a sense of loss or detachment from our families, friends, and regular routines, or experienced nervousness and anxiety about changes in our personal and professional lives? [Read more…] about Next: Harnessing information and communications technology (ICT) to address mental health challenges affecting 700 million people today
Exploring Targeted Cognitive Training for Clinical Disorders (Association for Psychological Science):
“Research on the treatment of mental disorders often centers on understanding which treatments work. But knowing that a treatment is effective doesn’t necessarily tell us why the treatment works. A better understanding of the precise mechanisms that [Read more…] about Research series: How, when and why does targeted cognitive training work to promote behavioral and emotional health?
“There are people who think dwelling on their emotions is helpful, viewing it as a kind of wrestling match with their inner demons. But according to psychologists, it’s [Read more…] about Training our brains’ executive control to reduce rumination and improve mood
Transforming Diagnosis (article by Thomas Insel, Director of the NIMH): “In a few weeks, the American Psychiatric Association will release its new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‑5)…While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating [Read more…] about Time to revamp psychiatry and mental health in light of modern neuroscience?