Cognitive performance through decades of life

Our current era of innovation could be described as widespread disruption, empowered by bold cross-disciplinary experimentation and capabilities like big data, machine learning, and AI. The pandemic has shown us how powerful we can be when we work together. It has thrown a spotlight on the purpose of technology and its democratization, highlighting the importance of allowing technology to fulfill its destiny as an enabler — not just for the few, but for everyone, everywhere.

Yet innovation is complex. It needs collaboration and coordinated effort. I am thrilled to be a part of working this way at Tobii, as we aim to be an innovation enabler for our partners.

This story is about Apeiron Life and what they are doing in the area of cognitive health. How they leverage the digital platform developed by REACT Neuro, why taking care of your brain is as important as taking care of your body, and the role Tobii's eye tracking has to play in achieving that.

Dr. David Martin is chief scientist at Apeiron Life — a Silicon Valley startup that promotes a data-driven approach to health, wellbeing, and fitness. David is one of those genuine souls whose down-to-earth nature makes him a great conversationalist. His depth of experience and lifetime dedication to human performance themes have reaffirmed in my mind the significance of good brain health — to achieve what’s possible on a daily basis, but also for quality of life as we age.

With two decades of experience at the Australian Institute of Sport and several years with the Philadelphia 76ers as the director of performance research, David possesses an unparalleled wealth of knowledge and experience related to human performance. His approach is both scientific and pragmatic — it's all about the data and priorities.

Slowing the decline

We all know that prevention is better than cure and that a plant-based diet, daily exercise, and a good night's sleep are essential ingredients for personal wellbeing and performance. Technology provides us with plenty of devices and applications to track all of these aspects of our lives, helping us to build up a picture of how much we sleep, the quality of our rest, and our average daily steps. We can now easily measure changes in body weight, muscle strength, and exercising heart rate.

Unfortunately, most of us don’t have access to deeper metrics generated by, for example, motion trackers, spirometers, EEG, and thermographic sensors — standard equipment in professional sports training. The high stakes in the world of international sports ensure that any new research, technology, or methodology that might make a difference to athletic performance is usually worth investigating. And that’s good news for people like me who spend a lot of time sitting in front of a screen because the current wellbeing trend will create enough demand so that some of these advanced technologies will trickle down to the mainstream.

But what is driving the current wellbeing trend? Longevity is one factor. Modern medicine is capable of keeping us alive longer than before. But without healthy cognitive performance — which starts to decline from about 50 — longevity may not be matched with a high quality of life.

After the age of 50, neuro processing speed — reflected by some specific neurological tests — declines about 10-20% per decade. More specifically, the test time for TMT-B can increase from 70 to 85 seconds from age 55-65. But research shows that with a healthy diet, good sleep, and frequent exercise, many aspects of cognitive health and performance can be maintained as you age — which is pretty cool, says David.

The question is how to slow the decline and how to measure it?

How Apeiron Life got involved

Founded by Geoff Yang and a few other like-minded folks in 2019, Apeiron Life delivers data-driven wellbeing and fitness solutions to some of the most prominent business leaders and professional sports personalities in the Bay Area.

At the beginning of the startup, David, his colleagues, and some of the members were talking about the different physiological systems and capabilities that begin to decline with age but are responsive to lifestyle changes. Some were interested in aerobic health. For others, it was joint health, body composition, and balance — this last one being vital for surfers and yogis who want to continue practicing as they age. With so many venture capitalists and tech leaders among them, it's probably not surprising that they were keen to gain a better understanding of their cognitive health — not just to perform in the now but to maintain brain wellbeing later on.

So, David and his team spent a couple of months looking around the world to find a suitable technology that would enable them to deliver an efficacious, meaningful assessment of cognitive health. But he warns,

“You have to be really careful how you define cognitive health!”

We accept traditional established definitions of cognitive health while at the same time focus on very practical and relevant features of cognitive health. For instance, it is often important to be able to visually scan and locate things. How your eyes look for things, how your hands reach out and respond when you see something you want — these are the types of capabilities that are important to our members. They need to, for example, be able to rapidly scan a spreadsheet to find specific data items or patterns. Or to be in a crowded space and be able to spot the person they are looking for. People need the search-and-retrieve brain function — neural processing — to work well. Unfortunately, for many, these kinds of capabilities slow down as we get older, says David.

Leveraging established research

David is particularly interested in trail-making tests because they provide an indication of scanning speed and are well-established in the neuropsychological world. Like a kid’s dot-to-dot puzzle, the subject traces a path through a set of randomly organized numbers (or numbers and letters) in the correct order as quickly as possible. Traditionally, trail-making tests are carried out with pen and paper — overseen by a tester. More recently, tests have been computerized. The standard metric is time-to-completion because processing speed is an important indicator of cognitive performance.

In the Cognitive and Brain Health space, we identified many different companies using a variety of different technologies, but we all became really excited when we found REACT Neuro because this company was led by a group of internationally recognized neuroscientists with both MIT and Harvard affiliations.

A not so obvious synergy until you do it

So, let me back up a little and tell you about how David and I got to talking and how Tobii, Apeiron Life, and REACT Neuro are working to measure and then slow cognitive decline.

I'm guessing you already know that Tobii is the world leader in eye tracking. This technology is essential because it’s the only way of capturing the minute aberrations in eye movement that signify cognitive impairment. There are other indicative parameters, but if you want to leverage research based on ocular movements, eye tracking is the way to do it. Plus, it has other advantages in terms of form factor and unobtrusiveness.

REACT Neuro is a Cambridge-based platform developer focusing on evidence-based neurological assessments. What they have done is shift traditional cognitive tests into the VR world. In doing so, they've enabled a multitude of unbiased and previously unavailable metrics. Using a Pico Neo 2 Eye headset to run the tests is ideal because it's, portable, includes Tobii eye tracking, and you don't need to connect it to a computer. The advantage of VR over traditional paper- or computer-based testing is that it cuts out the external influences. With native eye tracking, measurement can be carried out in an unobtrusive way.

I love it when there is synergy between two different types of technology, especially when it is not necessarily obvious. People in elite sports know about Tobii — we've been using Tobii eye tracking glasses for years to see where athletes look before they perform an important movement like taking a shot in basketball. We’ve also known about Pico VR headsets. But when the two of them came together with the Pico Neo 2 Eye, you get something special, and it is easy to wonder, why didn’t I think of that. Suddenly, you've got neuroscientists using VR headsets to do research with sophisticated eye tracking sensors — it just makes sense.

Eye tracking generated metrics

The addition of eye tracking to the mix is significant because this technology makes it possible to record micro-movements, known as fixations and saccades, which reveal how a person’s brain is working to solve a problem. For trail-making tests, eye tracking shows how a person jumps back and forward, how long they dwell on a given spot.

David seemed to like VR too because the interactive nature of the new test environment starts to feel like a game, and given that most of the people he deals with are highly competitive, it’s a fun way for them to be engaged with their cognitive health and monitor their progress.

I am really interested in Pupillary Light Reflex, which, as the name suggests, quantifies how the pupils of the eye respond to light. Researchers have long known that that pupils respond to bright light differently following brain trauma. But it appears that the Pupillary Light Reflex can also be influenced by brain fatigue. Such a test is quite easy to implement in a VR environment with sophisticated eye tracking technology. Without high fidelity and high-tech approaches, it becomes far more difficult to quantify this unique and potentially informational reflex.

What does the future hold?

For now, David and the team at Apeiron Life are working with REACT Neuro and their extended network in Boston to figure out how to best translate data captured by advanced eye tracking within the VR application to refine how they help clients slow cognitive decline. Their long-term goal is to scale and turn science-based performance training mainstream so that more people can take preventive measures to maximize wellbeing — both physical and cognitive.

He points out that if we look at what some of the tech giants are doing, it's pretty clear there's a shift going on. Apple, for example, has publicly announced that they want to make health and wellness one of the company's many great legacies. As sensors and actuators get ever smaller, new kinds of monitoring fabrics and wearables will become mainstream. In the future, we will likely see multiple purposes for many common items that we use every day. For example, a pair of glasses could help you see and protect your eyes from dust. But they will also record your physical activity and cognitive performance — allowing people to monitor their brain performance in the same way they monitor their heart health with blood pressure, waist circumference, and exercising heart rate.

What I see in the Apeiron Life/REACT Neuro collaboration is a recurring pattern — not just among our partners but all over the tech industry. When startups begin using a tool like eye tracking for assessment purposes, they not only solve the problem they set out to fix, they begin to generate data. Over time and with enough tests, you can mine this data for insight. You could, for example, start to create individual recommendations for individuals based on their cognitive load, leading to more personalized programs that not only support current cognitive performance during work and play but also contribute to a lifetime of cognitive health with a decreased risk of early dementia or rapid progression of Alzheimer’s disease.

As a finishing note, I want to extend my gratitude to David for taking the time to talk to us and for inspiring us with his ideas and dedication. If you want to know more about the man behind the science, I recommend this interview on Judocast, where David talks about sports performance with renowned judo player and coach Chuck Jefferson.