Trans­form­ing Brain Health with Dig­i­tal Tools to Assess, Enhance and Treat Cog­ni­tion across the Lifes­pan: The State of the Brain Fit­ness Mar­ket 2010

We are only begin­ning to grasp the impli­ca­tions of life­long brain plas­tic­ity, includ­ing how dig­i­tal tech­nolo­gies can effi­ciently assess, enhance and treat cog­ni­tion across the lifes­pan. The con­ver­gence of demo­graphic and pol­icy trends with cog­ni­tive neu­ro­science dis­cov­er­ies and dig­i­tal toolk­its is giv­ing birth to a nascent mar­ket­place that can fun­da­men­tally trans­form what brain health is, how it is mea­sured, and how it is done.

Neu­ro­sci­en­tist San­ti­ago Ramon y Cajal once said that Every man can, if he so desires, become the sculp­tor of his own brain. That desire is becom­ing main­stream, fueled by baby boomers hit­ting their 60s and by the com­pa­nies and providers cater­ing to their needs, in a quest to enhance brain fit­ness — the brain-based func­tion­al­ity required to remain active and productive.

Meet­ing that grow­ing desire, dig­i­tal tech­nol­ogy can be used to present spe­cific task demands to indi­vid­u­als in a form that is inten­sive, repeat­able, adap­tive, and highly tar­geted. This can enable con­sumers and insti­tu­tions serv­ing them to assess, enhance, and treat cog­ni­tion in ways that can eas­ily scale, open­ing up a wealth of new infor­ma­tion to inform pre­ven­tive and clin­i­cal brain care.

2009 wit­nessed a sig­nif­i­cant trans­for­ma­tion in the brain health and fit­ness mar­ket­place, dri­ven by a grow­ing num­ber of inno­v­a­tive pro­fes­sional (vs. con­sumer) appli­ca­tions. This is a great sign in itself that the mar­ket is likely to evolve in a more ratio­nal, struc­tured man­ner than over the last cou­ple of years, and that cur­rent con­fu­sion in the con­sumer seg­ment may well be a tem­po­rary phenomenon.

We esti­mate that the size of the world­wide dig­i­tal brain health and fit­ness soft­ware mar­ket in 2009 was $295M “35% growth since 2008, and rep­re­sent­ing an annu­al­ized growth rate of 31% since 2005. As you can see in Fig­ure 1.2, we break down the mar­ket into four main cus­tomer seg­ments, based on who makes the purchase.

While healthy aging is the main value propo­si­tion dri­ving growth today, we also see sig­nif­i­cant growth fueled by a gen­eral desire to enhance brain health and per­for­mance at any age, as evi­denced in the range of Final­ists in the 2010 Brain Fit­ness Inno­va­tion Awards pre­sented in Chap­ter 4, where we include ten case stud­ies of inno­va­tion aimed at enhanc­ing per­for­mance in a vari­ety of real-world con­texts: aca­d­e­mic per­for­mance, sports per­for­mance, work­place pro­duc­tiv­ity, dri­ving safety, qual­ity of life among older adults and clin­i­cal populations.

These trends reflect the core long-term rec­om­men­da­tion of the Fore­sight Project on Men­tal Cap­i­tal and Well­be­ing (an influ­en­tial research and pol­icy effort spon­sored by the UK gov­ern­ment), to pro­mote opti­mal men­tal cap­i­tal tra­jec­to­ries through life for the gen­eral pop­u­la­tion, since

the idea of a tra­jec­tory nat­u­rally lends itself to think­ing in terms of max­imis­ing the “area under the curve as a mea­sure of suc­cess. This pro­vides a straight­for­ward form of weight­ing across the age range in terms of the gains to be made; the higher the tra­jec­tory rises in the ini­tial stages, the greater will be the area under the curve across the whole life­course. Many would see that this places an appro­pri­ate empha­sis on the for­ma­tive phases of life. How­ever, the age at which the tra­jec­tory peaks and the rate of sub­se­quent decline will also make size­able con­tri­bu­tions to the area under the curve. Thus, all phases of the life­course have impor­tant impacts on the aggre­gate mea­sure of success.

The poten­tial of this emerg­ing mar­ket­place — and the essence of this report — is appar­ent in Fig­ure 1.6, which shows how and why diverse ini­tia­tives, ven­dors and tech­nolo­gies cov­ered in this report belong to the same con­tin­uum of brain care, from cra­dle to grave.

The Y-axis rep­re­sents Brain Fit­ness. Next to it we fea­ture the Inno­va­tion process that needs to take place to cap­ture the opportunity.

• Cul­ture of pri­or­i­ties, beliefs and habits (Chap­ter 2): Close to 2,000 decision-makers and early-adopters pri­or­i­tize (brain func­tions required to thrive per­son­ally and pro­fes­sion­ally in the XXI) It is inter­est­ing to con­trast the top 2 ranked func­tions (Abil­ity to man­age stress­ful sit­u­a­tions, Con­cen­tra­tion power to avoid dis­trac­tions) with the bot­tom 2 (Abil­ity to multi-task, Remem­ber­ing faces and names). Lev­els of cus­tomer sat­is­fac­tion are sig­nif­i­cantly higher among buy­ers of dig­i­tal prod­ucts than among buy­ers of paper-based ones, and among buy­ers of evidence-based prod­ucts than among buy­ers of evidence-free
  ones.
• Ven­dors (Chap­ter 3): In 2009 the com­pet­i­tive land­scape started to become more clearly defined, in terms of end users, dis­tri­b­u­tion chan­nels, busi­ness mod­els and com­pet­i­tive dif­fer­en­ti­a­tion. The Inter­net is becom­ing the pri­mary dis­tri­b­u­tion vehi­cle, while some ven­dors still rely on CD-Rom pack­ages, and a few have already suc­cess­fully devel­oped tight online/ mobile plat­forms. Our pro­pri­etary Mar­ket and Research Momen­tum Matrix analy­sis resulted in the cat­e­go­riza­tion of twenty tech­nol­ogy ven­dors, out of over 100, into four quad­rants to bet­ter pre­dict their long-term suc­cess. Seven com­pa­nies emerged as Cat­e­gory Lead­ers, due to their Higher Mar­ket and Research Momen­tum: Brain Resource, Cog­niFit, Lumos Labs, Posit Sci­ence, Ultra­sis, United BioSource (CDR), Sci­en­tifi c Learn­ing. Five com­pa­nies were High Poten­tials, five Wait & See, two Cross­words 2.0. Addi­tion­ally, a num­ber of inno­v­a­tive service-based mod­els and star­tups start to fill the gaps in the brain fit­ness puz­zle, and we ana­lyze twelve of the most promising.
• Pio­neers (Chap­ter 4): In 2010 Sharp­Brains launched the first annual Brain Fit­ness Inno­va­tion Awards designed to cel­e­brate out­stand­ing pio­neers who are apply­ing neuroplasticity-based research and tools in the real world. A dis­tin­guished Judg­ing Panel selected Three Win­ners out of the Top Ten Final­ists (and forty entries over­all.) This chap­ter fea­tures case stud­ies on each of the Top 10 Final­ists, includ­ing what they are doing and why, results and lessons learned. The Three Win­ners were USA Hockey, All­state, and Nation­wide. Remain­ing Final­ists were: Arrow­smith School, Uni­ver­sity Behav­ioral Health­Care, AAA Foun­da­tion for Traf­fic Safety, Saint Luke’s Brain and Stroke Insti­tute, Oak­land Uni­fied School Dis­trict, Men­tal Health Asso­ci­a­tion of Rock­land County, and SCAN Health Plan.
• Research & Devel­op­ment (Chap­ter 5): Twenty-four lead­ing sci­en­tists exam­ine recent cog­ni­tive neu­ro­science find­ings on the value and lim­i­ta­tions of a wide vari­ety of non-invasive brain health tools, and dis­cuss their impli­ca­tions for brain care across the lifes­pan. An emerg­ing chal­lenge is going to be how to stan­dard­ize, inte­grate and per­son­al­ize these emerg­ing tools.

The X-axis in Fig­ure 1.6 above rep­re­sents the lifes­pan, divided into the insti­tu­tions whose job it is to enhance/ main­tain brain fit­ness dur­ing each stage.

• Schools (Chap­ter 6): 2009 proved to be a good year for devel­op­ers of education-focused cog­ni­tive train­ing pro­grams, thanks to a new fed­eral fund and to rapidly grow­ing research link­ing cog­ni­tive and self-regulation capac­i­ties to aca­d­e­mic per­for­mance over time.
• Employ­ers (Chap­ter 7): Sev­eral trends we iden­ti­fied last year, includ­ing brain-based assess­ments and train­ing to mon­i­tor and enhance cog­ni­tion and men­tal well­ness, con­tin­ued and grew sig­nif­i­cantly in 2009. Sports teams and the mil­i­tary have tra­di­tion­ally led the way — but Cor­po­rate Amer­ica is also join­ing in, given Mature Work­force and science/ tech­nol­ogy drivers.
• Con­sumers (Chap­ter 8): Adults over fifty are adopt­ing brain fit­ness as a main­stream aspi­ra­tion and lifestyle. They want use­ful tools to pro­tect cog­ni­tive health and per­for­mance (not nec­es­sar­ily to reverse aging). They are find­ing a grow­ing but noisy mar­ket­place. The first consumer-facing val­i­dated assess­ments are becom­ing available.
• Providers (Chap­ter 9): The con­ver­gence of pol­icy dri­vers with scientific/ med­ical dis­cov­er­ies, new tech­nol­ogy plat­forms and evidence-based inter­ven­tions is fun­da­men­tally reshap­ing cog­ni­tive and men­tal health care frame­works and toolk­its. Mul­ti­ple insur­ers, health plans, and senior liv­ing chains are deploy­ing and test­ing a new gen­er­a­tion of dig­i­tal brain health & fit­ness tools, mak­ing this the largest cus­tomer seg­ment as of today. The first brain-based Clin­i­cal Deci­sion Sup­port Sys­tems are becom­ing avail­able and inte­grated into Elec­tronic Health Records; adop­tion of com­put­er­ized Cog­ni­tive Behav­ioral Ther­apy is grow­ing sig­nif­i­cantly through the NHS in the UK; and cog­ni­tive train­ing (a sub­set of cog­ni­tive engage­ment) was iden­ti­fied, in a recent NIH-sponsored report, as the only pro­tec­tive fac­tor against cog­ni­tive decline sup­ported by the high­est degree of evi­dence. Cog­ni­tive neu­ro­science meets telemed­i­cine may well result into Per­son­al­ized Cog­ni­tive Med­i­cine in years to come.

The com­bi­na­tion of the Men­tal Par­ity Law and US health reform may well lead to an explo­sion of reim­bursable brain assess­ments, ser­vices and evidence-based non-invasive inter­ven­tions. Bet­ter assess­ments, tax­onomies, deci­sion sup­port sys­tems and inte­grated research efforts will enable the field to mature and inte­grate into main­stream care a new gen­er­a­tion of dig­i­tal tools to assess, enhance, and treat cog­ni­tion. For the time being there are no magic pills or gen­eral solu­tions to brain health, but there is a toolkit of grow­ing value when used appropriately.

We con­tinue to pre­dict that between now and 2015 brain fit­ness will become a main­stream con­cept –hope­fully sup­ported by a brain-based framework-, that con­sumers and insti­tu­tions will have access to much enhanced dig­i­tal toolk­its and plat­forms, and that a grow­ing ecosys­tem will enable this growth.

Unfor­tu­nately, all the ground­break­ing research and inno­va­tion has been occur­ring with­out a par­al­lel growth of qual­ity con­sumer edu­ca­tion (and pro­fes­sional devel­op­ment, in many cases). Cog­ni­tion remains an elu­sive con­cept in pop­u­lar cul­ture, which lim­its the abil­ity of con­sumers and pro­fes­sion­als to make informed deci­sions. This may well be the major bot­tle­neck lim­it­ing the field’s poten­tial to deliver real-world ben­e­fits and move up the curve fea­tured in Fig­ure 1.6. In our view, only informed demand will ulti­mately ensure the devel­op­ment of a ratio­nal and struc­tured marketplace.

Inno­v­a­tive part­ner­ships will be required to chan­nel the grow­ing amount of inter­est, research, tools and, yes, con­tro­versy, into a bet­ter struc­tured and sus­tain­able mar­ket­place. We fore­cast the world­wide mar­ket to range between $2 bil­lion to $8 bil­lion by 2015, depend­ing on how impor­tant cat­e­gory bot­tle­necks are addressed. This presents sig­nif­i­cant oppor­tu­ni­ties for inno­va­tion, invest­ment, busi­ness devel­op­ment and, ulti­mately, enhanced brain health and fit­ness of an aging society.

• Exec­u­tive Summary
• Table of Contents
• List of Figures
• In-Depth Ven­dor Profiles

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