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The Digitisation of Neuroscience: Democratising Brain Health for Our Populations
Our brain is the most complex organ in the body, yet its true value to businesses and economies has yet to be fully realised. Are digital neuroscience solutions the key to ensuring our knowledge-based economies continue to thrive in the post-pandemic normal?

by Nav Vij and Dr Prem Pillay

The final and most difficult frontier of medical science has been progress in the area of applied neuroscience and solutions for improving brain health and curing brain diseases.

When we think of physical health, we often tend to forget the organ that controls all others – the brain. In today’s knowledge-based economies, where we increasingly rely on complex thinking and decision-making coupled with strong interpersonal communication skills to drive our businesses, good brain health is more important than ever.

Brain Health is at Risk

The World Health Organization (WHO) defines brain health as “the state of brain functioning across cognitive, sensory, social-emotional, behavioural and motor domains, allowing a person to realise their full potential over the life course, irrespective of the presence and absence of disorders”. Brain health disorders like anxiety, depression, and neurodegeneration cost the global economy trillions of dollars each year in lost productivity.1

Unfortunately, brain health is at greater risk than it’s ever been, meaning this cost could skyrocket. Even before COVID, mild cognitive decline could start in people in their 30s. The gradual decline of an ageing brain can be accelerated by physical illnesses such as diabetes or hypertension. These effects can be further aggravated by persistent negative emotional states—with anxiety, depression, stress and, increasingly, loneliness, impacting brain health.

Mild cognitive impairment (MCI), which affects people who can still carry out most everyday tasks independently, is an early stage of memory loss or other cognitive ability loss (such as language or visual/spatial perception). Alzheimer’s disease, dementia, and strokes are conditions that can later develop in MCI patients.

The causes of Mild Cognitive Decline (MCI) are multifactorial and include chronic illnesses, stress, smoking, drugs, age, family history, and neurogenerative disease. The environment (e.g. air pollution, chemicals, pesticides) may also play a contributing role to MCI. Early detection of MCI and early intervention are key to alleviating outcomes.

The WHO estimated in 2019 that 1 in 8 people – 970 million people – were living with a mental health disorder.2 People living with anxiety and major depressive disorders rose by 26 per cent and 28 per cent respectively in just one year at the start of the pandemic.3 This type of strain on our cognition and mental wellbeing can very easily result in productivity loss for businesses.1

The impact of these disorders reaches far beyond the individual. One study estimated that the global cost of improving treatment coverage for anxiety and depression between 2016–2030 was around US$147billion (in 2016 dollars), yet the return on investment was equivalent to 43 million extra years of healthy life, with an economic value in the region of US$310 billion.4 These numbers are conservative as they account only for the value to the workforce, with no consideration of the knock-on effects on general health and well-being.

Social isolation has also increased. A study in Japan found that social isolation increased by roughly 7 per cent between January (before the pandemic) and August 2020.5 Social isolation and loneliness can have a significant detrimental effect on physical and brain health, increasing the risk of premature death from all causes at a rate that rivals obesity, physical inactivity, and smoking.6,7 Moreover, social isolation was also associated with a 50 per cent increased risk of dementia.8

This is cause for concern as the number of people in the Asia-Pacific with dementia is expected to triple—to a massive 71 million people—by 2050; the global number is expected to reach 139 million people. This is coupled with the two-fold effect of dementia being an expensive disease to manage— already the estimated annual worldwide cost of the disease is US$1.3 trillion. By 2030, it is forecasted to reach US$2.8 trillion.9

All these problems have been exacerbated by COVID-19, which has dealt a huge blow to brain health. According to research by the University of Michigan, more than half of COVID-19 patients who are hospitalised and 43 per cent of patients who are COVID-19 positive also have Long COVID.10 Another meta-analysis study revealed that up to seven months after the infection, COVID-19 survivors had worse general cognition than healthy controls.11

Patients who have had COVID-19 also experience significantly more changes and deterioration to their brain structure and cognitive abilities than those who have not experienced the virus.12 To compound this effect, alternative studies have also found that non-severe COVID-19 was linked to a 1.71 times increased risk of early-onset cognitive deterioration.13

The Role of Neuroscience in Modern Health

As our populations continue to skew ever older and as cognitive decline becomes more widespread, coupled with the rising burden of diseases such as dementia, it is clear neuroscience has an important role to play in global health. Maintaining good brain health is essential – for individuals, societies, and businesses that depend on workers operating at maximum productivity levels.

One of the greatest contributions neuroscience can make is identifying cognitive issues early enough for them to be treatable or manageable. However, traditional “pen and paper” methods of testing are a considerable bottleneck. These methods are limited in accessibility and scalability and require highly trained specialists. As with all scarce resources, this leads to the tests being prohibitively expensive for the populations that would most benefit from them. Limiting testing to those that can afford it results in skewed data, reducing available insights into the wider population, and making holistic treatments challenging.

Digital Neuroscience Can Pave the Way for Solutions

Unfortunately, early attempts to bring neuroscience into the digital space have been met with mixed success. The focus on “digital mobile health applications without medical grade evidence”, for example, has done more harm than good for this nascent field.

The increasing scrutiny on digital brain health applications by governing health bodies has also dealt a blow to the new-age neuroscience space. As a result of popular mobile health applications engaging in misleading advertising and being unable to supplement claims with medical evidence, credibility issues, and concerns around the impact of the “training effect” on the results of digital brain health applications have risen. This has slowed the rate of progress, reducing the perceived value of serious neuroscience tools that are following the same regulatory guidelines required by drug products and medical devices.

Initiatives such as OECD’s “Recommendation of the Council on Responsible Innovation in Neurotechnology” are helping to reverse the course, providing innovators with much-needed guidance on the social, legal, and ethical issues raised by novel neurotechnologies.14 OECD’s recommendations centre around nine core principles which, together, help ensure innovations develop in line with appropriate oversight and advisory bodies to mitigate the risks or unintended consequences of novel technologies.

Against this backdrop of robust and responsible innovation, digitised neuroscience has near-boundless potential for improving and enhancing the brain health not just of individuals, but entire populations.

The Potential of Digital Neuroscience

Removing the bottlenecks in testing is imperative. Uncoupling cognitive tests from the “pen and paper” model and moving them into the digital arena allows for greatly improved accessibility and scalability and, importantly, lower prices for patients. Digital access to testing also removes the geographical barriers often faced by non-urban populations in developing countries. Ultimately, this creates a virtuous cycle of improvement—more widespread testing allows for richer data, greater understanding, and more holistic treatment protocols.

The traditional forms of Neuropsychological testing are a great example of where digitisation can democratise brain health. These tests are expensive (S$6-12,000 each), time-consuming (8-10 hours per person over the course of three days) and understaffed by the neuro-psychology specialists required to analyse the results. A digital brain test, such as Neurowyzr’s Digital Brain Function Screen, on the other hand, can be completed online in as little as 15-20 minutes, with the potential for same-day consultations and action plans. A digital test doesn’t rely on access to rare (and expensive) specialist resources or equipment, which allows for scalability at a cost of just 5-10 per cent of traditional tests.

Digitising neuroscience also facilitates the shift toward a more preventative approach to managing brain health. Advances in cloud computing, AI, and machine learning make it possible to bring “big data” and continuously learning algorithms together to improve patient outcomes.

As with any preventative model, the key is early and accurate benchmarking to capture and address abnormal decline as soon as possible. The benefits are innumerable. Digital solutions provide better access to healthcare for patients, while greatly relieving the pressure on healthcare professionals. Making more accurate diagnoses ahead of the curve improves the potential for good patient outcomes.

These benefits also extend to the workplace and promise to improve outcomes for employees and employers. Lockdowns and work-from-home initiatives have greatly reduced person-to-person interactions for workers. Given that most people of working age used to spend two-thirds of their day in the office, this leads to increased social isolation and exacerbates issues such as anxiety and depression, particularly among at-risk groups such as younger workers and minority groups. Medical-grade digital tools help to analyse, assess, and benchmark employee cognitive functions, identifying warning signs before it is too late and reducing the costs of both absenteeism and presenteeism.

Such tools have broader applications too, from helping build resilient talent pools to measuring focus levels in employees with attention-critical roles. These tools work best when combined with specialised staff training. Leadership, for example, can often benefit from more active self-reflection, as well as a deeper understanding of science-backed strategies for building the workplace of the future. Developing mental health ambassadors supported by these digital tools and special training to actively implement these strategies, and providing meaningful long-term support for colleagues is another important step in creating a sustainable path to peak performance in the workplace.

With safe, supportive workplaces and reliable, affordable, and early access to evidence-based digital neuroscience tools, good brain health becomes available to all. Improving brain health is good for the economy, good for society, and good for individuals.

While it’s tempting to put a dollar value on just how “good” it is, when we consider the potential of a wide-ranging and global reduction in suffering that better brain health would bring, the value it holds is incalculable.

We envisage a future where comprehensive brain health care is achieved through digital screening and monitoring to allow proactive interventions, where digital brain therapeutics work hand in hand with pharma-based medications and medical technology devices to provide the full spectrum of brain treatments for all.

References

  1. New Approaches to Economic Challenges. OECD. (n.d.). Retrieved August 18, 2022, from https://www.oecd.org/naec/brain-capital/
  2. World Health Organization. (n.d.). Mental disorders. World Health Organization. Retrieved August 18, 2022, from https://www.who.int/news-room/fact-sheets/detail/mental-disorders
  3. World Health Organization. (n.d.). Mental health and covid-19: Early evidence of the pandemic’s impact: Scientific brief, 2 March 2022. World Health Organization. Retrieved August 18, 2022, from https://www.who.int/publications/i/item/WHO-2019-nCoV-Sci_Brief-Mental_health-2022.1
  4. Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-up treatment of depression and anxiety: a global return on investment analysis. The lancet. Psychiatry, 3(5), 415–424. https://doi.org/10.1016/S2215-0366(16)30024-4
  5. Murayama, H., Okubo, R., & Tabuchi, T. (2021). Increase in Social Isolation during the COVID-19 Pandemic and Its Association with Mental Health: Findings from the JACSIS 2020 Study. International journal of environmental research and public health, 18(16), 8238. https://doi.org/10.3390/ijerph18168238
  6. Holt-Lunstad, J., Robles, T. F., & Sbarra, D. A. (2017). Advancing social connection as a public health priority in the United States. The American psychologist, 72(6), 517–530. https://doi.org/10.1037/amp0000103
  7. Peçanha, T., Goessler, K. F., Roschel, H., & Gualano, B. (2020). Social isolation during the COVID-19 pandemic can increase physical inactivity and the global burden of cardiovascular disease. American journal of physiology. Heart and circulatory physiology, 318(6), H1441–H1446. https://doi.org/10.1152/ajpheart.00268.2020
  8. National Academies of Sciences, Engineering, and Medicine. (2020). Social isolation and loneliness in older adults: Opportunities for the health care system. National Academies Press.
  9. Dementia Statistics. Alzheimer’s Disease International (ADI). (n.d.). Retrieved August 18, 2022, from https://www.alzint.org/about/dementia-facts-figures/dementia-statistics/
  10. Chen, C., Haupert, S. R., Zimmermann, L., Shi, X., Fritsche, L. G., & Mukherjee, B. (2022). Global Prevalence of Post COVID-19 Condition or Long COVID: A Meta-Analysis and Systematic Review. The Journal of infectious diseases, jiac136. Advance online publication. https://doi.org/10.1093/infdis/jiac136
  11. Crivelli, L., Palmer, K., Calandri, I., Guekht, A., Beghi, E., Carroll, W., Frontera, J., García-Azorín, D., Westenberg, E., Winkler, A. S., Mangialasche, F., Allegri, R. F., & Kivipelto, M. (2022). Changes in cognitive functioning after COVID-19: A systematic review and meta-analysis. Alzheimer’s & dementia : the journal of the Alzheimer’s Association, 18(5), 1047–1066. https://doi.org/10.1002/alz.12644
  12. Douaud, G., Lee, S., Alfaro-Almagro, F., Arthofer, C., Wang, C., McCarthy, P., ... & Smith, S. M. (2022). SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Nature, 604(7907), 697-707.
  13. Liu, Y. H., Chen, Y., Wang, Q. H., Wang, L. R., Jiang, L., Yang, Y., ... & Wang, Y. J. (2022). One-year trajectory of cognitive changes in older survivors of COVID-19 in Wuhan, China: a longitudinal cohort study. JAMA neurology, 79(5), 509-517.
  14. OECD, Recommendation of the Council on Responsible Innovation in Neurotechnology, OECD/LEGAL/0457
About the Authors

Nav Vij
Nav Vij is the Co-founder and Chief Digital Neuroscientist of local brain health startup Neurowyzr. Nav holds a degree in Neuroscience from the University of Melbourne and more than 15 years of experience in the fields of digital health and human capital, and is dedicated to making a difference in peoples’ lives through neuroscientific practice and technological advancement.

Dr Prem Pillay Dr Prem Pillay is Chief Medical Adviser at local brain health start-up Neurowyzr. Trained at the MD Anderson Cancer Center and Cleveland Clinic Foundation in the USA, Dr Prem was Chief Resident Neurosurgeon at Cleveland Clinic before returning to Singapore to become Co-Director of the Brain Centre and Head of Neurosurgery at Singapore General Hospital. He is currently Medical Director at the Singapore Brain-Spine-Nerves Centre.

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