What Is Cognition, and What Can It Tell Us?
At ViewMind, we’re finding new and better ways to diagnose and measure neurocognitive health. As part of this mission, we’ve been working to demystify the workings of cognition itself.
Derived from the Latin cognoscere (get to know), the term cognition lacks a single, straightforward definition. Rather, it’s an umbrella term for the numerous mental functions that help us learn and retain information, perform daily functions, and understand our environment.
The DSM-5 divides cognition into six domains: perceptual-motor function, language, executive function, learning, memory, complex attention, and social cognition, with each area further divided into subdomains. We can think of cognition as the human operating system, that runs on the physical brain, enabling us to navigate our world in a myriad of ways.
Cognitive processes operate through an incredibly complex network among more than 100 billion neurons or nerve cells in our brains. Each of these neurons can have up to 15,000 connections with other neurons via synapses. It has been estimated that the brain of a three-year-old child has about 10¹⁵ synapses (1 quadrillion), so it is not surprising humans develop such unique personalities. Many of these processes are as automatic as breathing, while others require concentrated effort. The sheer intricacy and diversity of cognitive activity have made understanding cognition—and the reasons for cognitive decline—a formidable task.
The gap between cognitive and physical health assessment
Whereas the average person routinely undergoes check-ups for physical health at least annually—including procedures to catch the early pathology of specific diseases such as breast and colon cancer—no such measures are currently in place to proactively assess cognitive health.
As neurocognitive disease progresses, the brain loses synapses that cannot be recovered. In the early stages, the brain has enough excess capacity and plasticity to overcome the loss. But eventually, the cognitive reserve is depleted to a point where it can’t compensate and symptoms manifest. Finding a way to arrest the progression of a neurodegenerative disease before it turns this corner is critical.
There’s an old adage about housekeeping: nobody notices it until you stop doing it. The same goes for cognition: medically, it gets short shrift until we see unequivocal signs that it’s not working. At ViewMind, we believe that needs to change.
Not only does cognition comprise the processes that enable us to navigate everyday life; it is also often the first indicator of a disease, providing us with a means to detect subclinical alterations. The onus is thus on researchers to develop cognitive assessments that are more precise, specific to particular brain regions and cognitive domains and easier to routinely implement than those on which medical science has traditionally relied.
The evolution of cognitive assessments
Over the past century, a variety of methods have been used to detect cognitive impairment. Until recently, initial tests have consisted almost exclusively of verbal questionnaires, pen-and-paper exercises related to memory, sets of tasks such as identifying objects or recalling a short list of words and skilled assessors.
Such assessments, which include the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Exam (MMSE), and the Mini-Cog, have been useful in determining whether a patient may have cognitive impairment. While they are an important first step in evaluation, these measures are extremely limited, providing neither a concrete nor a specific diagnosis. Results from these tests may also be compromised by inter-rater reliability issues or recording errors.
Digitally adapted assessments
Recent digital adaptations of pen-and-paper tests have alleviated the risk of inaccuracies due to human subjectivity or error, but their diagnostic ability remains limited. The digital assessments aren’t sensitive enough to detect the all-important subclinical changes that occur during early stages of cognitive decline; nor can they measure the effects of therapeutic or medical implants. The potential value of such interventions must therefore be evaluated through trial and error, a lengthy and cumbersome process.
If initial tests reveal that a patient may have cognitive impairment, an assessor will likely schedule further testing for the patient in the form of brain imaging (MRI, CT, or PET scan) or a lumbar puncture that can test for the presence of proteins associated with various forms of dementia.
Unfortunately, in our current healthcare system, doctors cannot order these invasive and expensive procedures until other diagnostic methods have already been exhausted. By this point, it’s likely that the disease has advanced past the point where interventions could make a meaningful difference for the patient.
The ViewMind solution
Recognizing that superior methods for early diagnosis are key to combatting a wide range of neurocognitive disorders, we’ve developed a precise diagnostic using visual stimulus, eye-tracking and AI that precisely measures the preservation of different brain regions and cognitive domains on-demand.
Leveraging virtual reality headsets and AI software, our assessment has high subclinical sensitivity, allowing us to put our ear to the mind’s tracks to hear the very first rumblings of disease. Our results have been validated through extensive longitudinal research that has found a near-perfect correlation with results from fluid biomarkers, neuro-imaging, EEG scans, and fine motor assessments. Further, ViewMind’s method is sensitive enough to measure cognitive alterations that result from therapeutic or medical device implantation.
Our 15-minute test is non-invasive and easily scalable in a variety of environments. The ability to provide physicians and researchers with data revealing cognitive alterations in the initial stages of the pathology augurs great promise for a sea change in assessment methods for cognitive health for pharmaceutical therapeutic development and healthcare. By listening closely to what biomarkers like eye movement have to tell us, we can crack the mysteries of brain health and cognition for a better future.