You know your weight. And your physical fitness. And a variety of health-related metrics. What about your brain fitness? In years to come, we can expect a growing number of assessments to help each of us address that precise question, using tools that today are only available to researchers and clinicians, raising both opportunities and concerns. Two recent announcements bring out important events in that direction: 1) Last week, OptumHealth announced an exclusive 3-year agreement (estimated at $18m) with the Australian company Brain Resource. Quote: "OptumHealth Behavioral Solutions will work with Brain Resource to provide clinicians with a Web-based assessment that measures general cognition (how people process information) and social cognition (how people manage their emotions). This 40-minute assessment is based on well-known and validated tests of memory, attention, executive function, and response speed, and mood, social skills and emotional resilience." 2) A few weeks ago, we could read that U.S. Troops To Get Cognitive Screening Quote: "The military will begin giving cognitive tests this summer to troops heading to war, in an effort to get a baseline measure of their reaction time, memory, concentration and other brain functions, which could be referenced in case they are injured." I see these instruments as a critical part in the brain fitness puzzle. Neuroimaging techniques such as MRI and fMRI are very important to support clinical and research work, but are not mature or scalable enough to help measure brain functions in millions of healthy individuals. Neuropsychological testing is still today often done with pen and paper, administered by a trained expert, and very resource-intensive. Brain scientists don´t recognize one overall "brain age" or "intelligence". We can view our brain functions or cognitive abilities as a variety of skills, some more perception-related, some more memory-related, some more language-related, some more visual, some more abstract-thinking and planning oriented. There is no general "brain age" that can be measured or trained in a meaningful way. Now, the use of these new technologies also raises concerns, and not just about their reliability and validity. John Moore of Chilmark Research just commented on the Brain Resource-OptumHealth announcement, pointing out that "it is fairly well-known that many chronic diseases have a high comorbidity factor with mental health, OptumHealth's partnership with Brain Resource, and its success (or lack thereof) will be an interesting one to follow. And while I applaud this effort, it also raises some pretty scary privacy concerns. How will these assessments be used beyond the confines of the clinician's office?, What access will OptumHealth have to the data? And what about the employers who have OptumHealth's parent, United Health Group as an insurer for their employees? Will employers have access to this data, particularly if they start embedding it within HealthAtoZ?" These are excellent questions. Humana, a health insurance company, recently announced that they were discontinuing their agreement with Posit Science under which they had been offering the Posit Science Brain Fitness Program to their Medicare members. Whereas a number of reasons were offered for that decision (ranging from low uptake rates of the promotions given the legal complexities of reaching out to Medicare users, to low utilization of the product), another concern was mentioned to us during a set of interviews with Humana members: they were concerned about whether a program that had been given to them for free by their insurance company would somehow transmit data back on the mental performance of the user. Furthermore, we can expect clear public policy implications in this area. Art Kramer recently explained that "the NIH is preparing an "NIH Toolbox" to provide valid, reliable instruments to researchers and clinicians, to solve the problem that exists today, namely, the lack of uniformity among many measures used. The initiative was launched in 2006, and it is a 5-year effort, so we'll need to wait to see results". A with any new tool, we´ll need the define the rules of the road. 1) First of all, we´ll need to make sure it measures what it is supposed to, and with high degrees of reliability. 2) Second, there need to be clear policies in place as to whom can access which data and for which purpose. 3) Finally, we expect the assessments will lead into actionable personalized recommendations to improve if not help maintain cognitive functions. The question, "Are You Ready to Measure Your Brain Fitness", may become relevant earlier than we expect. Copyright (c) 2008 SharpBrains
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