Helen Lavretsky, MD, MS

(In honor of Women’s History Month, we invited our contributors to write about the women who inspire them.—Ed.)

We always think with gratitude about individuals who inspire us and serve as guiding lights for our careers. One such person was Lissy F. Jarvik, MD, PhD, who became one of my mentors during my fellowship training in geriatric psychiatry at UCLA in 1994-96, with continuing research collaboration for years to come. Jarvik was a trailblazing pioneer in the field of geriatric mental health, and whose work helped guide the field of Alzheimer research and geriatric neuropsychiatry. She died at the age of 97 years in her home in Santa Monica, California, on October 1, 2021.

Lissy F. Jarvik, MD, PhD. Image from the United States National Library of Medicine.

Her career in aging spanned the field from mental changes and psychiatric aspects to genetic changes and chromosomal changes, as well as drug treatment and psychological treatments.

The National Library of Medicine featured her in their interactive “Changing the Face of Medicine” exhibit, describing her as “a pioneer in the field of neuropsychogeriatrics.” For her “distinguished contributions in the general field of psychiatry and mental health,” Jarvik was the first recipient of the American College of Physicians William C. Menninger Memorial Award in 1993. She was also the first woman psychiatrist appointed a distinguished physician by the United States Department of Veterans Affairs (VA), a title she held from 1987 to 1993.

Jarvik was born Lissy Feingold in the Hague, Netherlands, on March 17, 1924. In 1940, she fled the Netherlands, which was overtaken by Nazi Germany, for the United States in a dramatic escape. In 1946, she graduated 

 from Hunter College. She went on to earn her master’s degree and PhD from Columbia University in 1947 and 1950, respectively. While studying for her doctorate at Columbia, she began working on a twin study with her mentor, Franz Josef Kallmann, MD, with whom she traveled around New York state to catalog medical and psychological data on twins.

Her dissertation attempted to “disentangle the whole question of genetics and the environment in aging,” Jarvik followed 134 pairs of identical and fraternal twins who were at least 60 years of age at the study’s outset. Throughout the next 20 years, she continued to follow the twins, documenting changes in mental functioning, survival trends, cancer rates, and general health history. The study’s findings demonstrated a strong genetic component of the aging process and a tie between physical and mental impairments in aging.

After receiving her PhD from Columbia University, Jarvik went on to receive her MD from Case Western Reserve University School of Medicine in 1954. She returned to New York and continued her research at Columbia’s department of psychiatry and at the New York State Psychiatric Institute.

In the early 1970s, Jarvik moved to Los Angeles and became professor of psychiatry and biobehavioral sciences at UCLA, where she established the first inpatient psychogeriatric unit and the first course in behavioral sciences for first-year medical students that involved a large effort of attracting multidisciplinary faculty. She was instrumental in establishing a fellowship in geriatric psychiatry at UCLA, which was one of the first 5 fellowships in geriatric psychiatry in the country, and one of the first to be accredited by the Accreditation Council for Graduate Medical Education (ACGME) with more than 150 fellows trained over the past 41 years. She insisted on forging training, education, and research collaborations among geriatric medicine, geriatric neuropsychology, and behavioral neurology, which has been and continues to be the hallmark of this training program. Graduates of this program have succeeded in academic, research, clinical, and specialty practices.

In 1981, Jarvik hosted the first independent meeting of the American Association for Geriatric Psychiatry (AAGP) that just separated from the American Psychiatric Association (APA) in Los Angeles, where a small group of visionaries met to discuss late-life mental health needs and the field of geriatric psychiatry. Today, the AAGP is an established membership association of nearly 2000 geriatric psychiatrists and other health care professionals in the United States, Canada, and abroad, dedicated to the mental well-being of older adults. Jarvik served as AAGP president from 1984-85. She took a leadership role in testifying before the American Board of Psychiatry and Neurology (together with Jerry Yesavage, MD, and George Grossberg, MD) to convince them to approve geriatric psychiatry as a specialty within the field of psychiatry.

From 1987 to 1993, Jarvik was the first woman psychiatrist, and the second woman ever appointed a “Distinguished Physician” by the Department of Veterans Affairs (VA).

 She traveled throughout the United States in order to meet and interact with physicians in various specialties so that she could heighten their awareness to the needs of older veterans, mostly World War II veterans. She visited more than half of the VA medical centers at least once, and made numerous trips to VA Headquarters in Washington, DC, to consult on strategies and implementation. Through face-to-face meetings, rounds, lectures, seminars, and workshops, she was able increase interest in older veterans and facilitate the start of new training, treatment, and research programs throughout the VA system.

Jarvik was at the forefront in the use of investigational drugs for treating geriatric patients with both Alzheimer disease and major depressive disorders. She was also among the first to emphasize the role of microtubules in the pathogenesis of Alzheimer disease, and to use psychotherapeutic approaches to the treatment of geriatric patients, as well as the role of family caregivers. In 1988, Jarvik coauthored 

Parentcare: A Commonsense Guide for Adult Children

Written for the “sandwich generation”—adults caring for both their children and their parents at the same time—the book was one of the first guides of its kind. “The book came about because I saw in research subjects how involved the children became in their parents’ health care and their parents’ lives,” Jarvik explained. “I learned how they were committed to helping their parents, how they were bewildered by their new unexpected responsibilities, and the unforeseen changes in their relationships with their parents.”

Jarvik lived a long life, and lived it well, improving the lives of countless others, and attracting and inspiring young physicians into the field of geriatric neuropsychiatry and neuroscience of Alzheimer disease. She is an inspiring example for those of us who follow in her footsteps.

is a professor in-residence in the Department of Psychiatry at the University of California, Los Angeles. Her work on geriatric depression and integrative mental health using mind-body interventions has received national attention, and she has won numerous grants supporting that work. A distinguished fellow of the American Psychiatric Association and of the American Association for Geriatric Psychiatry, and a fellow of the American College of Neuropsychopharmacology, she is also on the board of 

1. Dr. Lissy Feingold Jarvik. United States National Library of Medicine. October 14, 2003. Accessed February 1, 2022. 

https://cfmedicine.nlm.nih.gov/physicians/biography_166.html

2. Lissy Jarvik. Wikipedia. Edited December 3, 2021. Accessed February 1, 2022. 

https://en.wikipedia.org/wiki/Lissy_Jarvik

This article has been modified from In Memory of Lissy F. Jarvik, MD, Ph.D.: Reflections on her Life Well Lived, Helen Lavretsky, 

The American Journal of Geriatric Psychiatry

, Volume 30, Issue 2, Pages 259-261, Copyright Elsevier 2022.

Is there a woman who inspires you? Write to us at 

Articles

Remembering Lissy Jarvik, MD, PhD—a pioneer of geriatric neuropsychiatry.

On Women Who Mentor Us

Alzheimer disease (AD) remains one of the most dreaded diagnoses a patient can get. The US Food and Drug Administration (FDA) raised hopes when it approved aducanumab, which promised to be the first disease-modifying drug for AD. But the approval immediately proved controversial. Three FDA board members 

 its patient label, and in mid-July, major hospitals announced that they would not administer the 

, Helen Lavretsky, MD, MS clarifies the issues in the aducanumab debate and offers guidance for clinicians whose patients may ask about it. Going beyond pharmacology, she points out that other treatment options, including mind-body interventions and diet changes, have been shown to slow AD’s progression.

Advice for talking to patients and caregivers about aducanumab and other novel pharmacological options

Mind-body and lifestyle interventions for AD

AD prevention programs, including nutrition, exercise, and stress reduction

Taking care of caregivers, including psychiatrists and other medical professionals

is a professor in-residence in the Department of Psychiatry at the University of California, Los Angeles. Her work on geriatric depression and integrative mental health using mind-body interventions has received national attention, and she has won numerous grants supporting that work. A distinguished fellow of the American Psychiatric Association and a fellow of the American College of Neuropsychopharmacology, she is also on the board of 

Podcasts

Although the new drug aducanumab has grabbed all the headlines, the future of Alzheimer treatment may be just as much about public health campaigns as it is about psychopharmacology. In this episode of Psych Pearls, we find out why.   

What Will the Future of Alzheimer Disease Treatment Look Like? 

The world is in the midst of an unfolding cognition crisis, with devastating personal, societal, and economic implications. The expanding elderly population requires better cognitive care; we are also coming to understand the importance of cognitive interventions and support in early childhood. Furthermore, the COVID-19 pandemic has brought global attention to cognitive issues, with over 50% of individuals recovering from the infection experiencing fatigue and brain fog. Initial studies indicate lasting deficits in executive function, impaired cognitive control, and reduction in global cognition leading to disability or reduced function.

 There are fears that COVID-induced deficits may last for years beyond the infection.

—such as attention, memory, perception, language, and reasoning

—are declining across the whole population. Beyond the effects of COVID-19, there is an alarming increase in the number of individuals around the world with serious cognitive impairments. These impairments co-occur with disorders including depression, anxiety, schizophrenia, autism, posttraumatic stress disorder, dyslexia, obsessive-compulsive disorder, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), addiction, dementias, and more.

 The severity, type, duration, and course of cognitive dysfunction differ between these disorders. The aging world population will heighten the cognition crisis. By 2060, the 

number of individuals aged 65 and older is projected to double

 is often only assessed when there is a specific, subjective complaint from patients, family members, or caregivers. In this context, there are many factors which suboptimize the value. For example, there are lengthy waiting lists to see neuropsychologists or cognitive neurologists, and various modalities used to assess cognitive dysfunction in later life are inaccessible to most (eg, positron emission tomography and advanced magnetic resonance imaging scans). Furthermore, there is no consistent clinical assessment algorithm for how to use cognitive assessment tools (eg, when to use pencil and paper tests, digital, blood-based, or neuroimaging). When there is no specific, subjective cognitive complaint, cognition is not assessed. This means more subtle and slow-onset forms of cognitive dysfunction may be missed. This can delay treatment and mean more progressive brain changes. If cognition is assessed, it is often not addressed, supported, or followed up in the long-term. Further, in many developing countries, cognition is rarely—if ever—screened, resulting in complications such as high rates of undiagnosed dementia.

 across the lifespan, it is critical that cognition is assessed and monitored across disorders and throughout life. Addressing and building cognition is especially crucial during early childhood, when cognitive difficulties can be caught before they have too much detrimental impact on a child’s developmental trajectory.

Examples of Cognitive Decline in Psychiatric Conditions

Consider depression: More than 264 million individuals around the world suffer from depression, making it the 

 and a major contributor to the overall global burden of disease.

 Depression is commonly associated with a lowering of a patient’s mood and energy for long periods of time. Depression also impairs cognition, including affecting attention, memory, information processing, decision-making skills, cognitive flexibility, and executive functioning.

 Indeed, 85 to 94% of individuals with acute depression experience significant cognitive impairments.

 Even when depression has remitted, around 40 to 45% of patients report dysfunction in one cognitive domain.

 Cognitive impairments are not addressed by first-line 

is now proposed as a novel treatment target for depression.

 Cognitive remediation therapy has provided encouraging results for the management of cognitive deficits in major depressive disorder (MDD).

 The incorporation of biobehavioral strategies (eg, exercise) and multimodal treatment approaches (eg, cognitive training, antidepressant therapy, and neuromodulation) is likely to generate therapeutic benefit.

Another example is cancer. It is estimated that at the end of 2020 there were over 70 million cancer survivors worldwide.

 Cognitive impairments—including deficits in visual working memory, sustained attention, new learning, and more—are commonly observed in patients with cancer and those in remission.

 Though cancer- and chemotherapy-related cognitive impairments (eg, confusion, lapses in memory and attention, difficulty concentrating, etc) are often known colloquially as chemo brain or chemo fog, up to 30% of patients with cancer exhibit subtle cognitive impairments prior to treatment, suggesting the body’s physiological response to a tumor (eg, inflammatory processes or vascular changes around the tumor) may be disruptive to cognition.

 Neuroimaging and neuropsychological studies have validated the role of chemotherapy contributing to cognitive issues, with chemotherapy patients having a more difficult time during memory recall than those cancer patients who did not receive the drugs, which suggests that their neural networks had been altered.

 Indeed, 75% of cancer patients have cognitive impairments during treatment, and 35% of survivors have cognitive impairments that continue in the months and years after treatment.

In addition to depression and cancer, there are many other disorders across the lifespan that have been shown to cause cognitive impairments, including ADHD,

 chronic obstructive pulmonary disease (COPD),

 depicts a small subset of disorders with associated cognitive problems.

Figure 1: Subset of Disorders With Associated Cognitive Impairments33

Innovative measurement-based approaches need to be leveraged to better understand and treat the impacts of cognitive impairments from disorders across the lifespan. Measurement-based care can be defined as the practice of basing clinical care on client data collected throughout treatment. Measurement-based cognitive care, therefore, includes ensuring that cognition is assessed and monitored at all stages of the treatment process across a multitude of disorders—not merely Alzheimer disease (AD) and late-life cognitive decline.

For example, with cancer patients, cognition needs to be assessed before treatment begins and then regularly during and after treatment. Cognitive assessments must also be easy for the patient to access. Since these patients will already be saturated with physical and mental health interventions, it is critical that any cognitive assessments and additional interventions are able to fit into their lives as seamlessly as possible.

Regular assessment and monitoring of cognitive health is also critical across the entire spectrum of health, including those who do not have a present health concern. Innovative delivery systems—such as at-home digital technologies—can ensure accessibility and awareness that these assessments exist. Regularly assessing cognition throughout the lifespan will enable cognition to be used as a new vital sign. Further, it will provide the opportunity to establish an individual’s cognitive baseline; identify changes that may suggest prodromal stages of disease and allow for early intervention. Cognitive care will adopt a more proactive, preventative, and personalized approach to one’s cognitive lifespan. Psychometric quality is clearly critical (ie, robust assessments of performance norms, reliability, validity, sensitivity, and specificity).

 Ensuring cognitive assessments include quality of life and activities of daily living is also important. 

New technologies and tools will help make measurement-based cognitive care a reality. New, predictive tools in cognition include 

 Tracking eye-movement has been found to offer a window into cognitive processes and impairments. Preliminary data indicate that eye-tracking tests may detect early stages of AD

; characterize cognitive impairments in patients with other neurological disorders, including amyotrophic lateral sclerosis, Parkinson disease, multiple sclerosis, autism spectrum disorders,

; and identify and access brain dysfunction in patients—including children—with mental health conditions such as depression.

 When implemented in a digital setting, some novel tools have been found to have a myriad of benefits.

For example, Akili Interactive developed the first and only 

 that has been cleared by the US Food and Drug Administration to treat adolescent ADHD and improves attention impairments.

 Akili’s digital therapeutic for adolescent ADHD has been found to improve objectively measured inattention as determined by the Test of Variable Attention Attention Performance Index (API) in adolescent patients with ADHD.

 Other digital therapeutics have been found to reduce cognitive impairments in adults living with MDD

 Tools are also being developed to promote the development of cognitive skills during childhood.

 Some smart phone-based technologies may be deployed worldwide including to low- and middle-income countries, allowing greater equity in cognitive care.

The necessity of validated remote evaluations—enabled by many of these new biomarkers—is apparent, underscored by the recent limitations on in-person visits secondary to the COVID-19 pandemic. Digital technologies are well positioned for a role in remote evaluation to be used synchronously or asynchronously and over telemedicine platforms.

We must re-engineer the modern health care team when moving towards measurement-based cognitive care. Just as genetic counselling was established as a new field in 1969 to help individuals navigate genetic risk and testing, a new field needs to be established to help patients navigate cognitive risk and testing. Many new cognition biomarkers provide a risk score or predictive analytic, which like predictive genetics can bring a host of new questions and worries: What does my score mean? How do you interpret a black-box algorithm? What can I do about my risk for cognitive impairment after chemotherapy? Am I developing AD or am I experiencing cognitive problems due to depression? Will these results create issues for my health or life insurance policies?

Cognition counselors are needed as part of the modern care team to 1) ensure that cognition is addressed in disorders where it is commonly overlooked (eg, postsurgery, cancer, diabetes, depression, etc); 2) help patients navigate the new anxieties and questions that arise from new technologies, cognitive assessment, and risk scores; and 3) discuss and coordinate care options and provide referrals to educational services, advocacy and support groups, novel technologies, other health professionals, and community or state services. Cognition counselors will also help overcome the barriers of implementing digital technology in both a clinical and educational setting, increasing acceptance and compliance. Further, existing care team members—such as clinical neuropsychologists—could also be trained or upskilled to fulfill the role of cognition counselors, helping to rethink and 

To optimize the likelihood that measurement-based cognitive care can be instituted, leveraged tools should be brief (≤ 10 minutes), highly scalable, able to be administered by the patient or trained clinical staff, and able to automatically generate an interpretative report with instant electronic medical record integration.

 To further help realize measurement-based cognitive care, health systems must be prepared to move quickly when a new biomarker is seen to add clinical value. We applaud the work of the 

 for proposed frameworks to accelerate such preparedness.

Finally, design thinking principles must be strictly adhered to in the development of novel biomarkers given these tools can be deployed across disorder type and the lifespan.

 For example, elderly individuals may experience changes and challenges that span disability segments, including visual, cognitive, speech, mobility, and neural impairments. From deterioration in vision to difficulty touching screens to everything in between, novel biomarkers and tools must account for these changes and be designed to be accessible to all. The fields of disability studies and assistive technologies will likely be 

 Further, measures must be taken to mitigate practice effects from repeated use of measurement-based cognitive care tools, ensuring that increasing familiarity and exposure to cognitive tests does not become a confounding factor in scores.

Measurement-based cognitive care is the urgently needed to address to the unfolding cognition crisis. Measurement-based cognitive care will bring an era of medicine where cognition is proactively addressed and better understood for disorders across the lifespan; technologies and tools underpin advancements in cognitive assessment and monitoring; and care teams are equipped to help patients navigate the new uncertainties that arise and receive proper care. In doing so, individuals will be able to improve their quality of life and have their capacity to thrive increased. Placing measurement-based cognitive care as a critical component of medicine will bring widespread personal, medical, and societal benefits.

a member of the Steering Committee of the Organization for Economic Co-operation and Development (OECD)-PRODEO Institute Neuroscience-inspired Policy Initiative, and an Atlantic Fellow for Brain Equity at the Global Brain Health Institute at UC San Francisco (UCSF).

Joy Chambers-Grundy Professor of Brain Science and Director of the Chambers-Grundy Center for Transformative Neuroscience, University of Nevada Las Vegas (UNLV).

is a Professor in Cognitive Neuroscience and Director of Research in the Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia.

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

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

Turner Institute for Brain and Mental Health, Neurodevelopment Program School of Psychological Sciences, Monash University.

is the professor of psychiatry, Director, Late-life Mood, Stress and Wellness, and Integrative Psychiatry research programs UCLA Semel Institute for Neuroscience and Human Behavior.

cofounder of the PRODEO Institute, co-lead of the OECD-PRODEO Institute Neuroscience-inspired Policy Initiative,

instructor in brain health diplomacy at the Global Brain Health Institute. He holds adjunct positions with IMPACT at Deakin University and Baylor College of Medicine.

1. Ortelli P, Ferrazzoli D, Sebastianelli L, et al. Neuropsychological and neurophysiological correlates of fatigue in post-acute patients with neurological manifestations of COVID-19: Insights into a challenging symptom

2. Agadjanyan MG, Petrovsky N, Ghochikyan A. A fresh perspective from immunologists and vaccine researchers: active vaccination strategies to prevent and reverse Alzheimer's disease. Alzheimers Dement. 2015;11(10):1246-1259.

3. Gazzaley A. The Cognition Crisis: The Perils and Promise of Technology and the Brain. Digital Media and Developing Minds National Conference. October 17, 2018. Accessed July 14, 2017. 

https://www.childrenandscreens.com/2018-conference/talks-and-panels/the-cognition-crisis-the-perils-and-promise-of-technology-and-the-brain/

Textbook of Clinical Neurology, Volume 355

The Distracted Mind: Ancient Brains in a High-Tech World

6. ACL Administration for Community Living. 

 April 30, 2018. Accessed July 14, 2021. 

https://acl.gov/news-and-events/announcements/announcing-2017-profile-older-americans

7. Jitapunkul S, Chansirikanjana S, Thamarpirat J. Undiagnosed dementia and value of serial cognitive impairment screening in developing countries: a population‐based study. 

 Depression. January 30, 2020. July 14, 2021. 

https://www.who.int/news-room/fact-sheets/detail/depression

9. McIntyre RS, Xiao HX, Syeda K, et al. The prevalence, measurement, and treatment of the cognitive dimension/domain in major depressive disorder

10. Millan MJ, Agid Y, Brüne M, et al. Cognitive dysfunction in psychiatric disorders: characteristics, causes and the quest for improved therapy. 

11. Perini G, Ramusino MC, Sinforiani E, et al. Cognitive impairment in depression: recent advances and novel treatments. 

12. Conradi HJ, Ormel J, de Jonge P. Presence of individual (residual) symptoms during depressive episodes and periods of remission: a 3-year prospective study. 

13. Advances in Understanding Neurobiological Underpinnings and Treatment Interfaces of Cognition in Depression.

14. Shilyansky C, Williams LM, Gyurak A, et al. Effect of antidepressant treatment on cognitive impairments associated with depression: a randomised longitudinal study

15. Cartreine J. More than sad: depression affects your ability to think. Harvard Health Blog. May 6, 2016. Accessed July 14, 2021. 

https://www.health.harvard.edu/blog/sad-depression-affects-ability-think-201605069551

16. Richardson L, Adams S. Cognitive deficits in patients with depression

17. Carvalho AF, Alves GS, Köhler CA, McIntyre RS. Cognitive enhancement in major depressive disorder

 In Keefe RS, Reichenberg A, Cummings J, eds. 

Cognitive Enhancement in CNS Disorders and Beyond

18. Weiss B. Chemobrain: a translational challenge for neurotoxicology. 

19. Hodgson KD, Hutchinson AD, Wilson CJ, Nettelbeck T. A meta-analysis of the effects of chemotherapy on cognition in patients with cancer. 

20. Janelsins MC, Heckler CE, Peppone LJ, et al. Longitudinal trajectory and characterization of cancer-related cognitive impairment in a nationwide cohort study. 

21. Pendergrass JC, Targum SD, Harrison JE. Cognitive impairment associated with cancer: a brief review

22. Olson B, Marks DL. Pretreatment cancer-related cognitive impairment—mechanisms and outlook. 

23. Palmer C. Cognition and cancer treatment. American Psychological Association. 2020;51(2):42.

24. Kesler SR, Bennett FC, Mahaffey ML, Spiegel D. Regional brain activation during verbal declarative memory in metastatic breast cancer. 

25. Rubia K. Cognitive neuroscience of attention deficit hyperactivity disorder (ADHD) and its clinical translation. 

26. Munshi MN. Cognitive dysfunction in older adults with diabetes: what a clinician needs to know. 

27. Robinson OJ, Vytal K, Cornwell BR, Grillon C. The impact of anxiety upon cognition: perspectives from human threat of shock studies. 

28. Torres-Sánchez I, Rodríguez-Alzueta E, Cabrera-Martos I, et al. Cognitive impairment in COPD: a systematic review.

29. Andrianopoulos V, Gloeckl R, Vogiatzis I, Kenn K. Cognitive impairment in COPD: should cognitive evaluation be part of respiratory assessment? 

31. Sumowski JF, Benedict R, Enzinger C, et al. Cognition in multiple sclerosis: state of the field and priorities for the future. 

32. Benedict RH, Amato MP, DeLuca J, Geurts JJG. Cognitive impairment in multiple sclerosis: clinical management, MRI, and therapeutic avenues. 

33. Aging2.0 OPTIMIZE Conference: Savonix Presentation. 2018.

34. Charalambous AP, Pye A, Yeung WK, et al. Tools for app-and web-based self-testing of cognitive impairment: systematic search and evaluation. 

35. Williamson JR, Quatieri TF, Helfer BS, et al. Vocal and facial biomarkers of depression based on motor incoordination and timing. 

Proceedings of the 4th International Workshop on Audio/Visual Emotion Challenge

36. Ali MR, Myers T, Wagner E, et al. Facial expressions can detect Parkinson's disease: preliminary evidence from videos collected online. arXiv. December 9, 2020. Accessed July 14, 2021. 

37. Cummins N, Scherer S, Krajewski J, et al. A review of depression and suicide risk assessment using speech analysis.

38. Dagum P. Digital biomarkers of cognitive function. 

39. Hart J, Kraut MA, Womack KB, et al. Neuroimaging of cognitive dysfunction and depression in aging retired National Football League players: a cross-sectional study. 

40. Liotti M, Mayberg HS. The role of functional neuroimaging in the neuropsychology of depression. 

41. Zetterberg H, Blennow K. Blood biomarkers: democratizing Alzheimer’s diagnostics. 

42. Bull CN, Asfiandy D, Gledson A, et al. Combining data mining and text mining for detection of early stage dementia: the SAMS framework

https://eprints.lancs.ac.uk/id/eprint/79004/1/combining_data_mining.pdf

43. Mengoudi K, Ravi D, Yong KX, et al. Augmenting cognitive assessment with instruction‐less Eye‐tracking tests: a machine learning approach for detecting abnormal oculomotor biomarkers. 

44. Crutcher MD, Calhoun-Haney R, Manzanares CM, et al. Eye tracking during a visual paired comparison task as a predictor of early dementia. 

45. Falck-Ytter T, Carlström C, Johansson M. Eye contact modulates cognitive processing differently in children with autism. 

46. Tao L, Wang Q, Liu D, et al. Eye tracking metrics to screen and assess cognitive impairment in patients with neurological disorders. 

47. Harrison AJ, Gibb BE. Attentional biases in currently depressed children: an eye-tracking study of biases in sustained attention to emotional stimuli. 

48. Sanchez A, Vazquez C, Marker C, et al. Attentional disengagement predicts stress recovery in depression: an eye-tracking study. 

49. Gotlib IH, Joormann J. Cognition and depression: current status and future directions. 

50. Itti L. New eye-tracking techniques may revolutionize mental health screening. 

51. EndeavorRx. 2021. Accessed July 14, 2021. 

52. Kollins SH, DeLoss DJ, Cañadas E, et al. A novel digital intervention for actively reducing severity of paediatric ADHD (STARS-ADHD): a randomised controlled trial. 

The world is facing a cognition crisis. Here’s how to face it with measurement-based cognitive care.

Addressing the Cognition Crisis in Our COVID-19 World

“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

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

Helen Lavretsky, MD, MS

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