Digital Solutions for Cognitive Health

Revolutionizing the delivery of cognitive health assessment and intervention with innovative and scalable digital technology

With rapidly aging populations worldwide, the prevalence of Alzheimer's disease (AD) is expected to triple from 47 million in 2015 to 131 million in 2050. Dementia has historically received less attention than other conditions in developing nations, but this is changing as the financial burden continues to grow. Total costs of dementia in developing countries are estimated to be US$72.6 billion annually, of which $2.9 billion are in Africa alone. The prognosis for AD is generally dismal, as the disease is often at a neurobiologically advanced stage by the time symptoms appear. Worse yet, the life expectancy for people with dementia in developing countries is 2-7 years shorter than those in developed regions. While none of the available pharmacological treatments can alter disease progression, there is hope in the form of behavioral interventions that prevent or delay AD onset. A growing body of research supports the efficacy of a multidomain lifestyle intervention that addresses diet, exercise, cognitive activity, and vascular risk factors for improving and maintaining cognitive function in individuals who are at risk for dementia.

Neurotrack addresses the growing AD epidemic in two distinct ways through the innovative use of technology: 1. By facilitating the detection of subtle signs of cognitive decline before symptoms are present, and 2. By providing an actionable, evidence-based solution for the prevention or delay of AD onset. First, our cognitive assessments use eye tracking technology to measure cognitive health, which has been shown to reliably detect early signs of decline. The tests can be taken with any webcam-enabled device, including computers, smartphones, and tablets, making them widely accessible to dispersed populations. Second, our multidomain virtual lifestyle intervention (Memory Health Program) includes educational material, tracking tools, and a health coach to guide participants through changes in diet, exercise, cognitive training, and vascular risk factor management. Based on the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) protocol, our intervention addresses modifiable risk factors for AD and aims to preserve or improve cognitive function in at-risk individuals.

We will change the world by delaying or even preventing the onset of dementia in millions of people through the widespread digital dissemination of evidence-based tests and solutions that measure and preserve cognitive health. The combination of our cognitive assessments and virtual lifestyle intervention empowers people to take control of their AD risk before it is too late. The only technology needed is an internet-connected device with a webcam, making our products widely reachable to remote areas where neuropsychological care is often difficult to obtain. We also plan to explore broader applications of our technology in the years to come, expanding into conditions like Parkinson’s disease, multiple sclerosis, depression, anxiety, and autism spectrum disorder.

Our products are innovative because they make cognitive assessment and intervention available to people globally. The novel application of webcam technology provides an inexpensive and scalable way to measure cognition outside of clinical settings. The visual tests are language agnostic, only requiring translation of the instructions. The Memory Health Program (MHP) platform is based on innovative software technology that facilitates the adoption of healthy behaviors. MHP is the only available virtual lifestyle intervention aimed at preserving cognitive health. We have experience translating the program into other languages and making appropriate cultural adaptations, which we will continue to do over time.

Webcams are required for the cognitive assessments, which are visual paired-comparison tasks. These tasks are a well established method for assessing memory function by measuring eye movements while subjects view a series of images on a screen. Subjects who spend more time viewing the novel images have better memory function than those who have more equally distributed viewing times between novel and familiar images. Internet-enabled devices, like smartphones, computers, or tablets are necessary for the delivery of the virtual lifestyle intervention, which includes health behavior tracking, curriculum, cognitive training exercises, and support from a health coach and peers.

Our two main goals are to:

1. Expand the reach of our webcam-based cognitive assessments. With targeted DTC marketing and new B2B contracts, we expect to have an additional 300,000 people take the tests within the next year. Our main focus this year is on establishing a strong international market.

2. Further develop and deploy the updated version of the Memory Health Program. This involves continuing to build the platform, conducting user insights research, and launching a second clinical trial to further assess efficacy. We strive to enroll 10,000 people in the program this year.

Our broader vision is to empower millions of people of all ages to gain actionable insights into their cognitive function. We will develop additional digital assessments and interventions for various conditions, such as depression, anxiety, and autism. We strive to reach 5 million people within the next three years.

Five years from now, we will have a wide range of assessments and interventions for various chronic conditions. We strive to reach 50 million people with our digital products. We plan to secure widespread coverage by health insurers, life insurers, and employers, and also recruit users through online advertisements and marketing.

All products are deployed electronically. Users need access to an internet-enabled device with a webcam but do not necessarily need to own one. People who do not own these devices can often use them at libraries and community centers.

The MHP is an engaging and interactive program designed to retain participants. The program is personalized for each user, driven by a machine learning algorithm that can identify the most impactful program features for each individual. Many people inherently value their cognitive health and are motivated to complete the program. The ability to longitudinally monitor cognitive status also increases engagement.

Over 50,000 people from 165 countries have taken the cognitive assessments to date. Most these users were recruited through online advertisements and marketing. Our main business operations are in the US and Japan, but people from across the globe have opted to take the test through our website.

The MHP is still in development and has primarily been a tool on the website to date. Results from a study on the first MHP version demonstrate improvements in cognitive function after 12 months of program participation. We are working towards developing and studying a more robust version of the MHP.

We have two different pipelines, since our products are in different stages of development. For the cognitive assessments, we expect to be serving 500,000 people in one year and 5 million in three years. For the interventions, we expect to be serving 20,000 people in one year and 500,000 in three years. These estimates are based on international B2B deals currently in the pipeline, the B2B deals we plan to have in the pipeline over the next few years, and projected enrollments through DTC channels.

Neurotrack is led by CEO Elli Kaplan, who holds an MBA from Harvard and whose career spans two decades in both the public and private sectors, including the White House, AIG Capital Partners, and Goldman Sachs. CSO Nick Bott, Psy.D. is a clinical neuropsychologist and research scientist at Stanford University who specializes in older adult populations. VP of Clinical Development Jordan Glenn, PhD is a behavior change expert with experience in digital health. This combination of scientific and business expertise uniquely positions us to succeed in the complicated insurance and healthcare ecosystems.

Neurotrack collects revenue from both DTC and B2B channels. Currently, our revenue is primarily based on test administrations because the MHP is still in development. Through the DTC model, users pay for the assessment online through our website. Users create an account and pay separately for each test they take over time. Our B2B partners offer the test to their customers as part of their aging services. The B2B model has gained traction in Asia, where we have conducted multiple proof-of-concept studies. Asia is experiencing the effects of an aging population acutely and is interested in products that prevent cognitive decline and dementia, which is why our early adopters are located there.

We also continue to develop additional distribution channels and partners in the clinical and research realms. A select group of physicians in California, Florida, Denver, and New York are using our test in their clinics where the test is being covered by health insurance. The MHP will generate additional revenue from both DTC and B2B channels once it is fully developed and operational in December 2018. We plan to offer various payment models for both the tests and intervention.

We feel strong alignment with Solve’s mission to address complex problems through open innovation and partnerships. Our innovative solutions can greatly reduce the burden of dementia, one of the most devastating conditions in the world. However, we cannot effectively tackle this problem alone. Solve can facilitate the formation of connections and partnerships needed to make our solutions and others available to older adults worldwide, especially those in underserved areas. As we expand into other conditions, the recognition we gain and the connections we form through Solve will help advance our mission of increasing access to neuropsychological assessment and intervention.

The biggest barrier we face is reaching underserved populations in both developed and developing countries. We believe strongly that socioeconomic status should not limit access to our products, but this presents challenges for our technology-based solutions. In areas where smart device ownership is low or where internet connection is poor, we will have to come up with creative solutions to reach people. Solve can help us form critical connections with organizations that have experience working with underserved populations to enable broader access.