is Head Stakeholder Liaison Alzheimer disease at Biogen.

Antonella Santuccione Chadha, MD

Violence against women, which often results in 

 (TBI) and other acquired brain injuries (ABIs), has intensified during the COVID pandemic. Violence against women is a clear violation of human rights and a legal and moral failure of society. It likewise contributes to the brain health gap as well as presents as a major economic problem. As the world struggles to emerge from COVID-induced health and economic decline, women are a major key to the economic recovery. A comprehensive and long-term strategy is required to shed light on and address this dire issue and to ensure the mental well-being women as well as unlock the power of women to drive the economic recovery.

During July 2021, social media influencer Gabby Petito, aged 22, and her fiancé Brian Laundrie, aged 23, embarked from New York on a cross-country road trip captured on Instagram and YouTube.

 In September, Brian returned early from the trip—and alone. Weeks later, Gabby’s remains were found. It was determined that Gabby died from strangulation, and her case opened a national conversation about 

Tragically, Gabby’s case is just one of many. There has been an increase in IPV, illuminating a shadow pandemic within the COVID-19 pandemic.

, 1 in 3 women (approximately 1.27 billion individuals out of the 3.82 billion women in the world) are estimated to have experienced IPV.

 Further, more than one-third (30,000) of the women killed in 2017 were killed by their current or former intimate partner.

 COVID-19 has escalated the rates of IPV. Calls to helplines have increased five-fold in some countries in 2020.4In numerous countries, there has been a 300% increase in police reports of IPV, likely fueled by COVID-19 mitigation strategies.

 UN Women had projected that an additional 15 million women would be affected by IPV for every 3 months of lockdown.

Although this increase in violence will have multipronged effects, the neurological effects and IPV-related acquired brain injury (ABI), including Traumatic Brain Injury (TBI), is particularly devastating. Despite the increasing attention in the last 10 years paid to sports-related TBI, little attention has been paid to TBI resulting from IPV.

 Up to 90% of survivors of IPV report head, neck, and face injuries, many of which result in TBI.

 One study examining brain injury in women who experienced IPV found that 74% of the women sustained at least one IPV-related TBI and 51% sustained repetitive IPV-related TBIs.11 Moreover, the study found a higher brain injury score from IPV was negatively associated with memory, learning, and cognitive flexibility and positively associated with a number of measures of psychological distress.

IPV-related ABI also includes nontraumatic brain injuries. Research has shown that 1 out of 10 women have been strangled by an intimate partner,

 which can cause a multitude of neurological problems, including hypoxic-anoxic brain injury, with long-term implications. As Gabby’s case emphasized, strangulation can result not just in hypoxic-anoxic brain injury but also in death. Indeed, prior non-fatal strangulation has been found to be associated with greater than 6-fold odds of becoming a victim of attempted homicide, and more than 7-fold odds of becoming a victim of completed homicide.

 The high-profile fatal strangulation murder of Gabby underscores femicide in IPV, which devastatingly remains commonplace.

In addition to TBI, hypoxic-anoxic brain injury, and other forms of acquired brain injury, women who experience IPV also are more likely to suffer from anxiety, depression, posttraumatic stress disorder, suicidal ideation, and many other health problems that can last even after the violence has ended, potentially detaching them from the labor market.

There is also a growing concern that women who experience repeated TBIs from IPV may develop chronic traumatic encephalopathy (CTE), a progressive and fatal neurodegenerative disease that cannot be diagnosed until postmortem.

 Unfortunately, the literature tells their tales. For instance, a report from 1990 identified a case of a women who apparently developed CTE from partner abuse.

 In 2021, during a postmortem examination of a woman aged 29 who died following a domestic violence incident, immunohistochemical staining for phosphor-tau revealed evidence of CTE-type pathology.

 This marked the first case of CTE pathology in a young woman who experienced IPV. However, there remains a lack of research investigating the long-term neurological consequences for women who have experienced IPV; research is needed to understand the potential for misdiagnosis, nondiagnosis, or the development of dementia and Alzheimer disease as a result of IPV.

 The latter is especially important since TBI has been identified as a modifiable risk factor for dementia.

 Thus, more research is needed to evaluate IPV as a potential risk factor for dementia.

The neurological effects of IPV extend to the entire family and remain under researched. A recent Brain Injury Australia report of the country’s first research into domestic and family violence (DFV) and ABI found that, out of the 16,000 survivors of family violence attending Victoria hospitals over a decade’s time, 2 in every 5 survivors had sustained brain injury.

 Further, nearly 1 in 3 of the survivors of family violence were children and, of those, 1 in every 4 had sustained a brain injury. Because this was not a study of IPV but instead a study of hospitalizations, it likely represents the tip of the iceberg. Similarly, a study of more than 100 clients of 5 domestic abuse shelters in Arizona found 9 in every 10 individuals reported a head injury with loss of consciousness from family violence in the preceding 12 months.24 Of those, 9 in every 10 reported “too many head injuries to quantify.” Yet only 1 in every 5 ever sought medical attention. Thus, community rates of IPV ABI remain radically under researched.

Currently, most domestic violence shelters and emergency department settings do not assess for TBI, non-fatal strangulation, or other brain injuries from IPV, despite the significant number of studies that demonstrate brain trauma among IPV survivors as well as those that show non-fatal strangulation as an important risk factor for homicide of women.

 Additionally, many women do not seek medical care for their IPV-related ABI.

 However, even when women do interact with social workers, physicians, or domestic violence advocates and shelter staff, there is a lack of training in these professions to adequately screen for and address IPV-related ABI.

Further, when developing criminal justice policy, histories of abuse and brain injury should be addressed. A study of women in prison found that 78% had significant head injury; 84% of these women had experienced repeated head injury largely as a result of domestic abuse that had occurred over many years.

 Yet screening and care for brain injury is not adequately accounted for in criminal justice. The staggering statistics of the number of women who have experienced abuse and are now in prison also further necessitates the development of a trauma-informed criminal justice system.

IPV-related ABI add yet another injustice to the Brain Health Gap, which highlights and frames the sex and gender gap in outcomes for brain health disorders across the lifespan, with strikingly negative outcomes for women.

 To address the Brain Health Gap, research institutions are calling for more women participants in preclinical development of medications, clinical trials, and clinical practice, as well as the expansion of research designed to focus on culturally relevant experiences specific to individuals who identify as female. This will enable more robust and representative data to be collected. Big data, real world evidence, and precision medicine approaches should be the tools used to respond to the call to action above. Furthermore, investing in leaders in health care and public health efforts is imperative to translate these data and perspectives into action. Women remain underrepresented in health care leadership, underlining the lack of gendered consideration in care. These efforts and initiatives are especially important for research, clinical care, and training related to IPV. The Brain Health Gap must address issues related to IPV-related ABIs.

Likewise, we have previously noted that the world is suffering a global brain capital collapse.

Brain Capital is a novel econometric asset that puts a premium on brain health and brain skills in our brain economy.

form of capital relevant to a complex, interconnected, and fragile global economy. Brain Capital needs to be integral to a new narrative of growth and progress that puts people and their well-being, health, interaction with others, and psychological resilience at the center of our economic system. Female empowerment—which includes preventing and addressing violence against women and better identifying and caring for the neurological effects in survivors—is a public and brain health imperative as well as the most effective way to build Brain Capital globally.

Addressing gendered violence and related ABIs can be remedied by integrating the social, medical, political, policy, and diplomatic levels. Taking sex and gender into account—including structural and social determinants—is critical for equality in brain health and precision medicine. The 

Organisation for Economic Co-Operation and Development 

Unit’s Neuroscience-inspired Policy Initiative

 We aim to find new ways to reconceptualize and revitalize the economy and how it works, laying the groundwork to identify relevant metrics while building a transdisciplinary network of stakeholders. The effort draws on experts from medicine, neuroscience, gender analysis, economic policy, philanthropy, and business. The Initiative will rapidly refine and advance women’s brain health via a series of research projects, seminars, and clear policy analyses and recommendations. In doing so, we hope to address the Brain Health Gap, leading to greater health justice for all people and a new era of innovation and progress. We hope to help build a future where both men and women are equipped with the support, resources, and care they need to thrive and in turn build more a resilient society and world.

 is an Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute (GBHI) (at the University of California, San Francisco (UCSF) and Trinity College Dublin), a Thiel Fellow at Stanford University and Steering Committee member for NIPI ( OECD, Meadows Mental Health Policy Institute (MMHPI) and the PRODEO Institute).

is an associate professor in psychiatry at Harvard Medical School and a research scientist at Massachusetts General Hospital. 

is head stakeholder, Engagement Alzheimer's disease at Biogen and Pro Bono CEO and Co-founder of the Women's Brain Project.

is head of the OECD New Approaches to Economic Challenges Unit, Senior Advisor to the OECD Secretary General and co-lead of OECD NIPI.

is advisor to the chief of staff and gender advisor at OECD.

 is a Senior Clinical Advisor for Cohen Veterans Bioscience’s Trauma Research Programs. She serves as Strategic Advisor co-leading CVB’s Suicide Strategy Initiative. 

 is co-lead of OECD NIPI, strategic advisor to the HEKA Fund (Newfund Capital and Fondation FondaMental), steering committee member for the Brain Health Nexus at Cohen Veterans Bioscience, and holds adjuncts roles with IMPACT at Deakin University, GBHI and Baylor College of Medicine.

How the case of Gabrielle Petito galvanized the internet

October 20, 2021. Accessed November 20, 2021. https://www.nytimes.com/2021/09/20/style/gabby-petito-case-tiktok-social-media.html

Gabby Petito was strangled. Experts say such an assault is a red flag for intimate partner homicides

 October 12, 2021. Accessed November 20, 2021. https://www.usatoday.com/story/news/nation/2021/10/12/gabby-petito-strangled-experts-say-its-common-intimate-partner-violence/8426282002/

A Pandemic within a Pandemic - Intimate Partner Violence during Covid-19

When pandemics clash: Gendered violence-related traumatic brain injuries in women since COVID-19.

5. Breiding MJ, Smith SG, Basile KC, et al. 

Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization--national intimate partner and sexual violence survey

6.United Nations Office on Drugs and Crime. 

Global study on homicide: Gender-related killing of women and girls

. 2018. Accessed November 20, 2021. https://www.unodc.org/documents/data-and-analysis/GSH2018/GSH18_Gender-related_killing_of_women_and_girls.pdf

Gender-based violence: We must flatten the curve of this shadow pandemic

. November-December 2020. Accessed November 20, 2021. https://www.un.org/africarenewal/magazine/november-december-2020/gender-based-violence-we-must-flatten-curve-shadow-pandemic

Concussion in sport: Domestic violence victims show same brain injury trauma as athletes with CTE

Intimate Partner Violence and Traumatic Brain Injury: State of the Science and Next Steps

10.Liu LY, Bush WS, Koyutürk M, Karakurt G. 

Interplay between traumatic brain injury and intimate partner violence: data driven analysis utilizing electronic health records.

12.Monahan, K., A. Purushotham, and A. Biegon, 

Neurological implications of nonfatal strangulation and intimate partner violence

13. Glass N, Laughon K, Campbell J, et al. 

Non-fatal strangulation is an important risk factor for homicide of women

Adult experience of mental health outcomes as a result of intimate partner violence victimisation: a systematic review

. 2014;5:10.3402/ejpt.v5.24794. Published 2014 Sep 12.

Intimate Partner Violence, Traumatic Brain Injury, and Social Work: Moving Forward

Intimate partner violence and traumatic brain injury: a public health issue

17. Stern RA, Daneshvar DH, Baugh CM, et al. 

Clinical presentation of chronic traumatic encephalopathy

18. Baugh CM, Stamm JM, Riley DO, et al. 

Chronic traumatic encephalopathy: neurodegeneration following repetitive concussive and subconcussive brain trauma. 

19. Roberts GW, Whitwell HL, Acland PR, Bruton CJ. 

20. Danielsen T, Hauch C, Kelly L, White CL. 

Chronic Traumatic Encephalopathy (CTE)-Type Neuropathology in a Young Victim of Domestic Abuse

21. Livingston G, Huntley J, Sommerlad A, et al. Dementia

 prevention, intervention, and care: 2020 report of the Lancet Commission

Evaluating spousal abuse as a potential risk factor for Alzheimer's disease: rationale, needs and challenges

The prevalence of acquired brain injury among victims and perpetrators of family violence

. 2018. Accessed November 20, 2021. https://www.braininjuryaustralia.org.au/wp-content/uploads/BRAININJURYAUSTRALIAfamilyviolencebraininjuryFINAL.pdf

Traumatic Brain Injury in Domestic Violence Victims: A Retrospective Study at the Barrow Neurological Institute

Head Trauma in a Community-Based Sample of Victims of Intimate Partner Violence: Prevalence, Mechanisms of Injury and Symptom Presentation 

[published online ahead of print, 2021 May 15]. 

. Brain injury in women experiencing intimate partner-violence: neural mechanistic evidence of an "invisible" trauma

27. McMillan TM, Aslam H, Crowe E, et al. 

Associations between significant head injury and persisting disability and violent crime in women in prison in Scotland, UK: a cross-sectional study

28. Aragam GG, Kawaguchi N, Hynes W, et al, Highlighting brain-based inequalities for women: from bedside and boardroom to policy. 

. May 5, 2021. Accessed November 20, 2021. https://www.psychiatrictimes.com/view/brain-based-inequalities-women

29. Smith E, Kawaguchi N, Chapman SB, et al. 

Closing the brain health gap: addressing women’s inequalities

. Oxford University Press Blog. August 21, 2021. Accessed November 20, 2021. https://blog.oup.com/2021/08/closing-the-brain-health-gap-addressing-womens-inequalities/

30. Smith E, Ali D, Wilkerson B, et al. A Brain Capital Grand Strategy: toward economic reimagination. 

31. Eyre HA, Ayadi R, Ellsworth W, et al. 

32.Ellsworth W, Smith E, Champman SB, et al. 

Move over data, brain capital is the new oil

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. January 13, 2021. Accessed November 20, 2021. https://www.oecd.org/naec/brain-capital/

Articles

In honor of the International Day for the Elimination of Violence against Women on November 25, 2021, let’s consider the impact of IPV on the neuropsychiatric health of women. 

Shedding Light on the Shadow Brain Pandemic: The Devastating Effects of Gendered Violence-Related Acquired Brain Injury

“Brain health conditions are a key contributor to the global burden of disease and disability. The devastating impact of these conditions is even more apparent as the world faces global challenges such as the COVID-19 pandemic, climate change, societal inequity, and more. To make progress, we need a fundamental shift in our approach. Convergence Brain Health deftly makes the case that a convergence approach is urgently needed to tackle the global brain health crisis and provides a roadmap for change.”

— Victor Dzau MD, President, National Academy of Medicine

Even before the COVID-19 pandemic, the world was in the midst of an escalating global brain health crisis with severe physical, social, and economic ramifications. According to a recent World Health Organization report, around 450 million individuals were suffering from mental health conditions, marking mental health disorders among the leading causes of ill-health and disability worldwide.

 The Organisation for Economic Co-operation and Development (OECD) estimates that the consequences of mental ill health cost up to 

Due to social and physical distancing, unemployment and underemployment, stress and other factors, there have been significant increases in issues such as depression, anxiety, social isolation, substance abuse, loneliness, and cognitive decline in older adults.

 In addition, as observed after the SARS pandemic, it is expected that COVID-19 survivors may endure long term cognitive and psychiatric consequences, including suicide, posttraumatic stress disorders, and depression.

 Furthermore, brain health is a prototypical 

 in that it is extremely complex and textured by innumerable variables from biology, sociology, genetics, psychology, and the natural environment to economics and beyond.

 Compounding these issues are challenges at all levels of innovation around brain health, listed in 

Table 1. Challenges and Opportunities for the Brain Health Field

Progress in the 21st century will be molded by our collective response to the global brain health crisis.

 Fortunately, beacons of hope are beginning to shine. Stigma has been reduced in high-income country settings, allowing individuals to overcome the barriers to seeking care.

 The COVID-19 pandemic has—in a positive sense—lowered the perceived and actual barriers to technology adoption, ushering in a new era of technology-driven brain health care. Some governments are beginning to increase spending on brain health, and venture capital funding for brain health start-ups has never been more in vogue. PitchBook data shows that 146 deals generated nearly $1.6 billion in venture capital investments as of December 10th, 2020. A decade ago, there were only 3 deals, worth $6.6 million, whereas last year saw a total of 

However, these advances on their own cannot solve the myriad global challenges posed by the brain health emergency. A paradigm shift is needed to address the unprecedented complexities associated with the current global brain health crisis—a crisis now inextricably linked to concurrent interacting crises surrounding discrimination and inequality, mass misinformation, environmental catastrophes, accelerated climate change, entrenched economic models, population displacements and immigrant status, and more.

 Governments, employers, and healthcare systems around the world need to acknowledge the scope of the problem and embrace solutions to empower consumers to take charge of their own brain health and to protect existing levels of health, well-being, and social inclusion.

In response to the evolving issues, convergence science integrates knowledge, tools, and thought strategies from diverse fields to address challenges that exist at the interface of 

 Convergence science not only recognizes the need to respond to apparent societal problems, but also emphasizes approaches which allow us to consider a myriad of the known unknowns and improves the odds of us quickly adapting to newly identified gaps.

 Acknowledging the serendipity of accidentally obtained knowledge permits 

 Taking these approaches when investigating solutions to brain health challenges permits greater flexibility and utility when unforeseen challenges are inevitably met.

Brains are the indispensable drivers of human progress. Why not invest more heavily in them? There are currently 

 allocated to Environment, Sustainability, and Governance investing around the world.

 If only a portion of this amount were invested in brain health, we could produce major improvements for our society.

 note that this present moment is a clarion call for the philanthropic community, which is uniquely positioned to lead an approach in 2 distinct ways. In the short term, the immediate mental health crisis can be mitigated by supporting interventions for the most vulnerable, the development and deployment of rapidly available mental health tools and technologies, and research to drive evidence-based responses to COVID-19-related mental health challenges. Much work is needed to address the long-term mental health impacts caused by the pandemic. There is an ongoing and urgent need for targeted investment in research to better understand and treat mental health conditions, build capacity and diversity within the mental health system, and advocate for social and policy solutions to improve the ecosystem of mental health care.

Given the critical need to nurture healthier, more resilient, and increasingly flexible brains worldwide, we have introduced the concept of Brain Capital—broadly defined as a form of capital which prioritizes brain skills and brain health.

The OECD Neuroscience-inspired Policy Initiative seeks to place Brain Capital at the center of a new narrative to fuel societal resilience in mitigating economic shocks, and to create preparedness should future societies fundamentally transform, for instance through irreversible damage to the environment. The OECD’s New Approaches to Economic Challenges Unit has created the Neuroscience-inspired Policy Initiative. This initiative seeks to reconceptualize and revitalize the economy, laying the groundwork to identify relevant metrics while building a transdisciplinary network of stakeholders. The initiative will rapidly refine and advance the concept of Brain Capital via a series of research projects, economic modelling, seminars, and clear policy analyses and recommendations.

In this context, our Brain Capital Grand Strategy supports the focus of the OECD initiative. The Grand Strategy has 3 main components: considering Brain Capital in all policies, developing a comprehensive investment plan to support Brain Capital, and generating a Brain Capital Index.

Brain health issues should be addressed in the context of improving performance within the fields of innovation and entrepreneurship. Because most 

 are created by firms less than 5 years old,

 creative and innovative entrepreneurs are needed to drive social and economic growth at the regional and national levels. In many ways, together with unprecedented government investment in many countries, entrepreneurs stand as a critical firewall against recession and deprivation. They serve as economic first responders when (exogenous) catastrophic events produce national and global economic shocks. 

In the United States, deaths due to suicide, opioid overdoses, and other addictions and poisonings (deaths of despair) are a barrier to complete economic recovery from COVID-19.

 Approximately 20% of prime-aged males who have dropped out of the labor force are 

 in these deaths, and many of them will not take up jobs even when available due to the severity of their addiction.

A senior economist at The Brookings Institution is leading an initiative to coordinate the many efforts to deal with this crisis. An important role for the task force would be to coordinate with the many burgeoning local level efforts to address addiction and despair, and these local organizations could greatly benefit from ties to a federal-level coordinating agency. Among other things, this agency could serve as an 

 Without addressing the linked issues of mental health and labor market drop-out simultaneously, it will be difficult to solve the tragic mental health crisis or achieve the goal of widely shared economic prosperity.

It is also essential that, given the complexity of the challenges being addressed, freedom to fail is offered liberally. Flat organizational structures, which are agile and empower individuals to make decisions in their specific areas and roles without need to constantly consult with managers at higher levels, are important. However, these decisions should be aligned with the mission and not deviate from the already traced goals and strategy. In 

, we provide examples of organizations and buildings which foster Convergence Brain Health activities.

Table 2. Infusing Convergence Brain Health Practices Into Various Levels of Innovation

Existing models of innovation are not adequate—suffering from siloing and a lack of speed. There are now a number of more contemporary models which may propel the brain health field forward more quickly and effectively. 

For example, The Davos Alzheimer Collaborative (DAC) is a public-private partnership committed to a collective global response against the challenges Alzheimer disease presents to millions of families around the world.

 The DAC aims to raise around USD $700 million for a 6-year plan to accelerate and diversify innovation in Alzheimer disease research. The 3 main components of DAC include a global cohort developed to identify new targets for potential treatments, a global clinical trial support platform to reduce the cost and time to bring new treatments to market, and a healthcare system prepared to get new treatments to patients. The DAC project will enable novel biomarker development, connect global researchers using the data platform provided by the Alzheimer Disease Data Initiative, and keep individuals with the lived experience of Alzheimer disease at the center of its efforts.

The first big data wave occurred over a decade ago, fueled by the reduced cost of -omics techniques (eg, genomics, transcriptomics), increased access to neuroimaging equipment, and the transition to electronic medical records. Insights from this data, however, have not translated into dramatically improved outcomes for patients. Diagnostic clarity is often elusive and treatment selection remains primarily trial-and-error. A second wave of big data proliferation is already underway with the increased implementation of mobile applications and wearable devices.

 Solutions are desperately needed to resolve current bottlenecks in transforming data into insights and action. 

Furthermore, according to economist Klaus Schwab, PhD, we are on the verge of the Fourth Industrial Revolution, which will see a rise in cyber-physical systems that blur “the lines between the physical, digital, and biological spheres.”

 Virtual reality environments, brain-computer interfaces, wearable or implantable devices, and mobile applications will continue to contribute to the current data explosion. Artificial intelligence integrates knowledge from a myriad of disciplines, including computer science, data science, mathematics, engineering, physics, statistics, linguistics, signal processing, ethics, and philosophy. Artificial intelligence is no longer a novelty, but a requisite set of convergence tools for navigating the future.

As psychological disorders are mediated by complex interactions between genetic and environmental factors it will be imperative to dedicate significant effort to understanding the modifiable risk factors emerging from the environment.

 Since the environment includes biological, psychosocial, and ecological components, it is likely to be more complex than the genes, proteins, and metabolites that are currently analyzed by a variety of tools. Therefore, within the framework of convergence brain health it will be necessary to develop highly powerful and complex tools that record, measure, and analyze the myriad environmental factors. This effort will be pursued as it has been with the omics technologies but with a much larger scope, ranging from psychophysiological data collected from millions of individual smartphones to satellite tracking of air pollution in big cities. Important ethical issues, however, will have to be addressed with some urgency.

Operationalizing a convergent clinical framework will require effective direction and utilization of the continuing data explosion.

 The role of digital clinical operating systems is therefore critical for allowing effective patient care, as well as ongoing research. These clinical operating systems house data from clinical encounters, imaging, pathology, personal medical devices, wearables, and finance. Analytics methods include the use of mathematical and algorithmic-based processing of data resources, including subfields of artificial intelligence, such as machine learning, natural language processing, and visual analytics to generate descriptive, predictive, and prescriptive models to analyze and derive insight from data. Machine learning has been utilized in predictive risk assessment, clinical decision support, home health monitoring, finance, and resource allocation.

Convergent approaches often require consideration of many different data types. Data harmonization involves creating a single consistent macro-data source from multiple, potentially disparate micro-datasets. Contributing datasets are structured to remove inconsistencies, creating harmony, such that the final dataset provides a cohesive view of a subject from many different perspectives. Machine learning enables automatization of this process, permitting integration of clinical, behavioral, -omic, imaging, neurosignals, and other datatypes for data mining and predictive modelling. Deep learning in combination with multidimensional biological data (eg, genomics, proteomics) enables examination of the impact of genetic variation or other system disturbances on transcription, translation, signaling, and resultant phenotypic variation. 

Perioperative brain health is an emerging example of the need for a convergence approach in brain health science. The average individual undergoes 9 surgical procedures in his or her lifetime, typically at an older age when the brain is more vulnerable to perioperative insults such as stress, illness, and immobility.

 As such, the perioperative period is a very high-risk period for older adults, and brain health impairments are abundant with considerable negative impacts. For example, the US National Health and Aging Trends Study found clinically significant depressive and anxiety symptoms in 39% and 24% older adults in rehabilitation facilities, respectively, in older adults recently in rehabilitation facilities (vs. 10% and 9% for older adults in the community).

Similarly, a study in the UK of postoperative Intensive Care Unit patients found rates of 40% and 46%, respectively.

 Depression and anxiety are connected to poor postoperative outcomes, including persistent pain, delirium, longer hospital stays, poor functional recovery, lower quality of life, and increased chance of both falls and rehospitalization.

A new field of perioperative mental health is responding to the need to integrate mental and cognitive healthcare with surgical and postsurgical care. The increasing number of older adults undergoing surgery creates high demand for this innovation, so that care can move beyond an emphasis only on surgical success and anesthetic safety, to a convergent brain health view of outcomes, such as improved functional recovery, reduced rehospitalization, and decreased long-term morbidity. These innovations are further driven by bundled care models, which include preoperative optimization, in-hospital care, and postoperative rehabilitation. With the recent genesis of the Center for Perioperative Mental Health, funded by the National Institute of Mental Health (P50MH122351), surgeons, anesthesiologists, nurses, physical and occupational therapists, and surgical patients will work together with psychiatrists in an accelerated laboratory for translating scientific advances to practical clinical care that improves the lives of older adults.

With the emergence of so many digital innovations, care providers are presented with more tools than ever. However, such a crowd of novel options adds complexity and uncertainty. To be clinically useful, such point solutions must first be vetted and then clustered into symphonies shown to play well together to optimize collective benefit for specific conditions. In the dementia field, for example, it is encouraging to see multidomain interventions being deployed.39 In the future, a therapeutic guidance system may make sense, similar to those used to advance precision medicine, such as oncology and neurosurgery.

To develop a workforce that can harness and deploy a convergence brain health framework, increased inclusion and empowerment of women and other traditionally under-represented populations is required. Building institutions that are both inclusive and meritocratic is health promoting in its own right. But more importantly, it is a powerful mechanism for producing the additional talent, fresh perspectives, and new ideas that are needed.

Meanwhile, certain behavioral characteristics among individual innovators should be cultivated. MacRae and Furnham

 articulated 3 dimensions of a high-potential individual suited to convergent teamwork building on Silzer and Church’s model of potential.

 There are 3 core dimensions: foundational, growth, and career dimensions. These dimensions explain how personality traits are foundational to potential because they represent fundamental and stable individual differences. Personality traits, especially conscientiousness and adjustment, contribute to success in nearly any type of work and have, “higher predictive ability of potential in roles that are more complex, challenging, and demanding such as that of the convergence practitioner.”

Career dimensions are the unique and specific skills, expertise, and occupational knowledge required for success in a specific career or role: “Convergence practice requires sublimating one’s own objectives into the vision and the objectives of the team.”

 MacRae and Furnham explain in detail how personality traits fit within a model of convergence practitioner potential and expand on 10 behaviors that are related to career dimensions of potential.

 These behavioral and workplace cultural characteristics allow us to formulate screening criteria for potential new entrants into convergent brain health work, identify those who are high potential convergence practitioners, as well as consider training approaches for those within our existing brain health structures.

Leaders must assume a critical role in optimizing transdisciplinary collaboration and facilitating the emergence of discoveries from these endeavors.

 Gray outlined 3 responsibilities of transdisciplinary leaders: cognitive leadership, structural leadership, and processual leadership:

. Effective cognitive leadership provides a vision that links and motivates transdisciplinary researchers to step beyond their disciplinary lens, relax old assumptions, and search for creative frame-breaking solutions.

. Effective structural leadership adds value by creating bridges and links among unconnected individuals, labs, groups, or departments.

- Processual Leadership: Effective processual leadership encourages trust and turns conflict into constructive interactions.

These leadership approaches should be kept in mind when fostering Convergence Brain Health within an organization. Other 

 of a convergence workplace include a flat organizational structure with minimal discipline silos, a culture of trust and mutual respect, and an open acceptance of the need to respectfully challenge entrenched ways of thinking.

 Teams should be humble in acknowledging that nobody has cracked the many complex problems to date, and likely never will due to unsolvable uncertainty. However, being open to novel and seemingly eccentric ideas may help navigate such problems and identify ways for their best possible management.

Teams in a convergence workplace must embrace the three somehow radical tenets outlined in Jim Dator, PhD’s 

: 1) The future cannot be predicted because the future does not exist; 2) Any useful idea about the future should appear to be ridiculous; and 3) We shape our tools and thereafter our tools shape us.

 An optimal convergence science environment should have a strong guiding vision, will be capable of identifying myriad possible alternative futures, and better guide the organization toward the desired future.

Convergence Brain Health provides direction for transformational change in how teams could work and how organizations need to be built and operated. As we embark on building the new normal of our post-COVID-19 world, Convergence Brain Health will play a key role in this rapidly unfolding change. Indeed, Convergence Brain Health provides an opportunity to grow global Brain Capital and enter a new era of innovation and progress, leading to greater health justice for all people and preparing for the unprecedented brain health challenges of the 21st century.

is cofounder of the PRODEO Institute, adjunct associate professor with IMPACT at Deakin University, instructor in brain health diplomacy at the Global Brain Health Institute, and co-lead of the OECD Neuroscience-inspired Policy Initiative.

is Director of Innovation at a major mental health association and expert in residence at Georgetown University, and the author of Wired This Way.

is an associate with the PRODEO Institute and Thiel Fellow at Stanford University.

is a professor of psychiatry at University of California in Los Angeles (UCLA).

is Distinguished and Emeritus Professor of Psychiatry, University of Pittsburgh, Pittsburgh, PA.

is the global head of Science for Minds at Johnson & Johnson.

is a health policy researcher at the Global Brain Health Institute.

is a social gerontologist at the Global Brain Health Institute.

is a research professor and Director of Chambers-Grundy Center for Transformative Neuroscience at the University of Nevada, Las Vegas.

is a venture partner at Alsop Louie Partners.

is professor and vice chair of Psychiatry & Behavioral Services at Baylor College of Medicine.

is special advisor to the OECD secretary general and head of the OECD New Approaches to Economic Challenges Unit.

is the Wallace & Lucille Renard Professor of Psychiatry and the Director of the Healthy Mind Lab at Washington University School of Medicine in St. Louis, Missouri.

is head of strategic projects and alliances at Delix Therapeutics.

is a professor in the department of Integrative Structural and Computational Biology at Scripps Research Institute.

is a professor of Law and Health Sciences at the University of Surrey School of Law and adjunct assistant professor of Medicine at the David Geffen School of Medicine at UCLA.

is the founding director of the Center for Brain Health at UT Dallas.

is a T. Boone Pickens Distinguished Scientist at the Center for BrainHealth, a co- director at Global Brain Health Institute, professor emeritus at Trinity College Dublin, and founding director of its Institute of Neuroscience.

is the Leo Pasvolsky Senior Fellow at the Brookings Institution, a College Park Professor at the University of Maryland, and a Senior Scientist at Gallup.

is a postdoctoral researcher, Center for Precision Health School of Biomedical Informatics at the University of Texas Health Science Center at Houston.

is Researcher at the Department of Aquatic Sciences and Assessment; Section for Ecology and Biodiversity at the Sveriges lantbruksuniversitet.

is Assistant Clinical Professor of Psychiatry and Biobehavioral Sciences at David Geffen School of Medicine at UCLA and UCLA Olive View Medical Center. 

is a neuroscientist at the Global Brain Health Institute.

How can we face the current pandemic while addressing the brain health crisis?  

Antonella Santuccione Chadha, MD

Articles

Shedding Light on the Shadow Brain Pandemic: The Devastating Effects of Gendered Violence-Related Acquired Brain Injury

Boosting Brain Health After COVID-19: A Convergence Solution