Check-engine-light for the Brain: Part 1

Tools for Independent Living: Explorations

We are trying an experiment over the next few months in how we communicate our research with you. We are doing a series of deep-dive explorations of topics relating to “Tools for Independent Living” and we will be sharing them in installments (as we explore) via emails.

The first topic we are exploring is the “Check Engine Light for the Brain”, see below for an explanation.

Expect to receive emails as we learn things of relevance (frequency of emails will depend on results but will not be more frequent than weekly and likely “every few weeks / monthly” at best).

What is a “Check-engine-light for the Brain”?

Richard Caro described this idea a few years ago (here), in an article about “Gerontech Products we Wish Existed”.

The core concept has two parts:

1. there is some type of ongoing monitoring you can do that gives you a “score”, that relates in some way to “risk” of the thing you are monitoring (in this case cognition or dementia risk for example); and

2. there is some type of ongoing intervention you can do that can impact your score, so you can be proactive about maintaining “wellness”.

While we are still waiting for the “perfect product”, this year we started to think it might be possible to create a sort of Do-it-Yourself (“DIY”) version of the check-engine-light for brain concept by combining some existing products.

Whether or not that is possible is what we will be exploring in this series of posts over the next few months.

Here is the idea (reprinted from our earlier article).

Cognition Monitor + History Over Time (+ Intervention?)

It's not news that Alzheimers and other forms of dementia are all too common, and big economic and clinical societal challenges. And for older adults facing the realities of growing older, the concern that something could happen to your mind is "a big deal". (See our "Topic Hub": Brain, Memory, Dementia Tech for background on this topic).

Of course, one can wait until one has dementia, and hope someone has come up with a "cure" by then. But for the more proactive, a preferred approach would be to try and "avoid it" — or reduce the risk of it happening to you.

There are two problems, which is where we see the opportunity for a new innovation.

Piece 1: Cognition Monitor

While not everyone wants something like this, there is a significant fraction of our explorer community who are interested in the idea of a "device" that could measure their level of cognition, and then track it over time.

And, if there was a proven intervention that could slow the decline of cognition, then the number of people interested in this would be much bigger.

An important aspect of this concept is that it would start to be used long before any cognitive decline manifested itself. In other words, it is a bit like an "engine warning light". It doesn't replace the visit to the doctor. It helps you remain "well" longer.

This "cognition monitor" would satisfy some specific criteria (see below).

Here are some critical features.

• It does not need to be perfect, or absolute, although those would be good attributes. But it needs to measure and track a proxy for cognition or dementia risk over time. And tell you something about where you stand compared to some metric of "goodness or badness".

• The cognition score needs to be given to you, as the older adult (ie you are in charge, not "the system") — with educational tools so you know what it means. It might need to involve a family member as well, or even instead, if there is signficant cognitive impairment.

• And ideally this would all happen at home, and not require a trip to see some type of healthcare person.

• And it would be up to the older adult to decide who was allowed to see the cognition score, and what they would do about it (perhaps with pre-agreed involvement of a family member at certain score levels?).

• And it would track changes over time. Because often it would be changes over time that would trigger a desire to "do something" rather than an absolute number.

• And the score would need some peer-reviewed validation.

• Especially important: the score would need to cover all the relevant aspects of cognition. It should not be limited to just one aspect (eg memory) if there are other aspects of cognition that matter for measuring dementia and cognition impairment.

• In an actual product, maybe "cognition score" is the wrong terminology. This would need thought.

We note that clinicians today have some tools that let them measure aspects of cognition (they use these to help diagnose dementia, for example). These do not satisfy all the criteria above, but are an obvious starting point for this exploration.

Piece 2: The Intervention

First, the facts about whether there are interventions that can reduce dementia risk or slow down decline of cognition, and what they are, are hard to come by. The lay press is full of competing opinions. And many older adults are unclear.

So, some clear and credible education would be an important part of this "solution".

Second, we believe that some of the interventions, like diet and exercise, would be more widely adopted if coupled with a metric that showed where one stood on the "cognition" ladder, and whether or not it was declining (and how fast).

As with the fall risk intervention above, we think the ideal product/solution would go far beyond saying "visit your physician". There would ideally be some type of connected service to help decide what sort of intervention you needed, and ideally some type of motivational reinforcement, such as is common in the emerging field of digital therapeutics.

This Exploration: Next Steps

We are exploring the extent to which the product concept above either already exists or can be assembled from various existing products that do some of the above.

Over the next few months we will be sharing what we learned.

• View Part 2

• View Part 3

• View BrainHQ Explorer Report.

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Please Share Your Opinions and Ideas

Some of you may well have opinions on this topic. We welcome your comments and suggestions in the comments (button below).

We are especially interested if you know of a product or service that does some or all of what we describe above. We would like to learn more about it, especially if you have personal experience with it.

To short circuit some of the likely comments:

• we will definitely be including the opinions of experts (such as neurologists and geriatricians) in our exploration. If you are such a person and would like to help, please send us an email (or reply to this email);

• we understand that many people have their own views on the perfect diets or supplements or exercise regimens to maintain or improve cognition. If you have peer-reviewed literature on this topic to share, we welcome your inputs. If you just want to tell us how “supplement x” is great, we are less interested, unless you have some evidence to share;

• please don’t post comments that are infomercials or affiliate links or other marketing material. They will be blocked.

• If possible, please use the comments rather than sending us an email, so others can benefit from your opinions too.