Forgetfulness. Uncertainty. Confusion. We’re just beginning to understand the pervasive effects of COVID-19 on the whole person.
The isolation and inactivity rendered by sudden and prolonged sheltering-in and social distancing have affected both physical and cognitive health, with many people describing feeling, for the first time, a “brain fog.” They’re having trouble thinking clearly, remembering and making decisions like their old selves, and are wondering when the cognitive murk will clear.
Their fear is that it won’t, leading them to pay attention to the issues of long-term brain health and what can be done to combat the emerging possibility of decline. Chances are the brain fog is not dense enough to sound an Alzheimer’s horn—there’s a world of difference between malaise and dementia. But there are contributing factors and remedies that are common to both.
For starters, to remain healthy, the brain, as with our other major organs, must be regularly checked.
COVID-19 and telemedicine
The sheltering-in needed to combat the virus has also thrust telemedicine into the spotlight. Remote consultation, counseling, diagnosis and treatment are changing the way that healthcare is delivered, accessed and paid for. With an explosion of people utilizing technology for digital medicine during the crisis, telemedicine services have increased by nearly 4,000%.
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That’s not a typo. Speaking about the impact of the pandemic on technology in general, Microsoft CEO Satya Nadella said, “We’ve seen two years of digital transformation in two months.”
Given how slowly change happens in healthcare, I would purport that the transformation is orders of magnitude greater in this sector. Digital testing and intervention have emerged as game changers for conditions as varied as cancer screening and pain management.
For cognitive illnesses such as Alzheimer’s disease and other forms of dementia, there’s a similar transformation occurring.
What the eyes tell us
When it comes to cognitive health, the eyes are the window to the brain.
Advances in digital testing for Alzheimer’s now provide the ability for individuals to see their cognitive engine at work and for doctors to keep their eyes on the patient. Digital medicine enables people to conveniently assess their cognition—that is, one’s memory, something seemingly elusive to measure; as well as brain processing speed, the speed at which a person is able to process new information, executive function and attention. By doing “brain checkups” at home, using an ordinary smart device or computer, an individual can measure and monitor the vital signs of their cognitive engine.
Their responses to a series of screen prompts provide data that is the basis for the test’s results, tracking eye movement to determine cognitive strength or the signals of decline, separating something like temporary brain fog from more serious markers. Because the camera is rolling during the assessment, the face of the patient is shared with a doctor along with the test results, replicating the in-office assessment at home, and even improving on it. With the traditional cognitive tests, a person is required to sit for several hours responding to prompts recorded by a doctor.
The technology behind digital testing is able to capture more information, such as executive function and response rate, and process it much faster. A series of tests can be completed in as little as 30 minutes, with the results delivered immediately.
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What can you do about the results? Even with the old test methods, that’s always been the sticking point. Though Alzheimer’s disease is widely understood to be the number one fear as people age, only 16% get tested for the disease, and, frequently, only after symptoms of decline begin to appear.
Low levels of testing are primarily the result of a lack of access to cognitive testing—most primary care doctors don’t have proper tools or time to administer the tests, and there are only 2,300 neurologists in the U.S.—but, often, the bigger issue is the fear of the result. Telemedicine has solved the first challenge—digital testing allows people to assess their cognitive health whenever and wherever they would like.
The second—fear of the result—has been the more vexing challenge. “What can I do about Alzheimer’s?” may be the most frightening words a person could imagine having to say. Aside from inaccessibility, people avoid testing because they’d rather not know about something that seems hopeless. Digital medicine can provide an answer.
The benefits of lifestyle intervention
Testing is the first step toward preventing Alzheimer’s. The second is therapy targeted toward strengthening cognitive health, treating the brain like we would treat our heart or lungs—clinically and for the long haul. The digital brain-checkup results can help a doctor or health coach map out an individualized lifestyle therapy, such as the proper diet, exercise, sleep, intellectual stimulation and social interaction, that will preserve cognitive strength and reduce the risk of Alzheimer's.
Several groundbreaking studies, pioneered by the 2014 FINGER protocol (The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability), have shown that Alzheimer’s can be prevented through changes in lifestyle behaviors. Further studies, such as one led by Dr. Richard Isaacson at Weill Cornell Medicine, have reached the same conclusion, and current research on lifestyle intervention is being supported by the Alzheimer’s Association and the World Health Organization.
The studies have shown that issues of stress and inactivity—contributors to COVID brain fog—are among the factors that can have negative implications for long-term brain health. It’s essential to consider how lifestyle changes started now can strengthen cognitive health over time.
Perhaps the concerns triggered by the crisis and the innovations of digital healthcare can awaken people to the available choices for taking care of their brain health. As people in the post-COVID world will surely continue much of the telemedicine they’ve come to value, the benefits of digital brain checkups—convenience, standardized testing, objective results, a path to prevention—can help eliminate the challenges of cognitive testing and help to end Alzheimer’s.
Elli Kaplan is the CEO of Neurotrack, a digital health company that aims to transform the measurement and management of cognition and memory loss.