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

Jeffrey L. Cummings, MD, ScD

Global society is faced with interrelated challenges that are complex, systemic, and dynamic from climate change, population displacement, famine, productivity slowdown, and mis- and dis-information to cyber exploitation, mental health crisis epidemics, aging and dementia, COVID-19-related losses, and fraying trust in social and political institutions.

 of neuroscientists, medical doctors, and economists came together to develop new concepts, ideas, and tools to use brain science to tackle some of society’s most pressing problems. A seminal paper outlining their preliminary thinking on brain capital was published in January 2021.

 The agenda has significantly advanced since through deeper, transdisciplinary research and narratives; broader academic, business, and policy networks; and refined measurement to guide all stakeholders and monitor progress. The 

Each of us possesses a complex system—the brain—which is implicated in the emergence, propagation, aggravation, and potential resolution of these challenges. To address these issues, a neuropolitical approach that considers brain capacity as a crucial asset is needed. The insights can be translated into policy, business practices, and civil society advocacy. In response to the urgent needs, a group of researchers and policymakers developed the concept of brain capital.

Brain capital is based on the position that brains are the world’s most important resource and the means by which all problems will be solved, ameliorated, or worsened. The brain capital framework acknowledges the importance of every brain and the corresponding need for brain diversity to achieve equity in solving global issues. Brain capital is a framework incorporating brain health and brain skills in the knowledge economy. In an era that is dependent on intellectual capacity, our brains are our greatest asset. Brain capital provides an approach to define brain issues, quantify them, and track them. Brain preservation and enhancement is critical to advancing brain capital, which can be driven into local, national, and international policies and investments.

Despite the fundamental importance of brain health and brain skills, these factors are often overlooked in policy-making and are not well-reflected in measures of human capital.

 Brain capital differs from human capital in its recognition of the unique role that brain health and brain skills play in human civilization. Unlike human capital measures, which look at broad educational and health metrics, brain capital encompasses and measures brain health as well as society-  and economy-critical variables such as collective confidence, social trust, and shared values and goals. These key social processes in turn depend on critical aspects of individual human functioning such as perceived control, confidence, ability to work collectively, problem-solving capacity, and values-driven goals. It also differs from human capital in its encompassing and measurement of economy-shaping brain health measures such as addiction, depression, anxiety, brain fog, loneliness, and dementia.

There is a range of notable achievements of brain capital in the past 18 months, including new initiatives, expanded partnerships, and more outreach and influence. These are interlocking and mutually reinforcing.

The Organisation of Economic Collaboration and Development (OECD) established the Neuroscience-inspired Policy Initiative in collaboration with the PRODEO Institute.

 Consultations have been held with the United National Development Programme and the World Health Organization (WHO). The OECD NIPI supported the European Brain Initiative in collaboration with EBRAINS, French EU Presidency, the European Commission, the WHO, scientific societies, patient organizations, and health professionals.

 The Meadows Mental Health Policy Institute appointed a senior fellow for brain capital.

 A new chair of excellence in brain capital will be established as part of the recently funded PEPR ProPsy, a project to develop precision psychiatry in France.

 and the Latin American Brain Health Institute (BrainLat)

 both launched brain capital summer courses, respectively.

Brain capital also received notable mentions in 2 US Congressional presentations in front of the Congressional Neuroscience Caucus

 and the US House Select Committee on Economic Disparity and Fairness in Growth.

 There has been engagement with major think tanks including the Center for European Policy Studies

Two working groups were also established. The 

 aims to formalize the field of brain health diplomacy

 and to develop a brain health diplomat toolkit. Working group members include former US State Department official Virginia Bennett and former US Representative Patrick J. Kennedy (D-RI). The 

 aims to quantify and track brain capital and is constituted by economists, neuroscientists, and physicians. This is seen as a critical project and will subserve future policy innovations.

Additional notable achievements for the brain capital agenda are outlined in the 

 Notable Achievements for the Brain Capital Agenda

Most recently, the Brain Capital Alliance, a public-private-people partnership, was launched via a series of events in Europe.

 The alliance aims to advance approaches to measurement, investment, and policy and will further integrate brain capital into policy agendas including productivity, climate change, political stability, gender equality, and neurotechnology. The alliance will raise awareness among public and private leaders for neuroscience-related issues across the life span, from early childhood development to youth resilience and brain reserve, to reduce the risk of cognitive decline in older adults.

The Brain Capital Dashboard will be refined and leveraged in policy discussions. Specific research labs will be developed to experiment at different scales and will be applied to real world problems such as micro-plastic pollution, the youth mental health crisis, caregiver distress, and disinformation. These platforms will improve the statistical bases and analytical foundation to guide decisions and assess progress. Novel financial instruments will also be explored to unlock additional funding for building brain capital such as bonds, venture capital, and exchange traded funds.

The alliance is seeking interested supporters, collaborators, and partners to accelerate this work.

As we look toward the future, it is imperative that brain capital continues to be developed and integrated into policy, business, and society. To sustainably solve the most pressing global challenges, we must place brain capital at the heart of solutions. We must develop ways to use brain science to overcome the most difficult, seemingly intractable global problems.

is the lead of the Brain Capital Alliance, co-lead of the OECD NIPI and Senior Fellow with the Meadows Mental Health Policy Institute. Eyre maintains advisory or adjunct roles with IMPACT at Deakin University, the Heka Fund, Brain Health Nexus at Cohen Veterans Bioscience, GBHI, Baylor College of Medicine, BrainLat, University of Texas Health Sciences Center at Houston, the Davos Alzheimer’s Collaborative, and the Euro-Mediterranean Economists Association (EMEA).

is an associate fellow at the Johns Hopkins School of Advanced International Studies.

is the director of the IMPACT Institute at Deakin University.

is an Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute, a Thiel Fellow at Stanford University, and a Steering Committee member for the OECD Neuroscience-inspired Policy Initiative. 

is theJoy Chambers-Grundy Professor of Brain Science

director of the Chambers-Grundy Center for Transformative Neuroscience

and co-director of the Pam Quirk Brain Health and Biomarker Laboratory

A brain capital grand strategy: toward economic reimagination

2. Angrist N, Djankov S, Goldberg PK, Patrinos HA. 

Measuring human capital using global learning data

3. Neuroscience-inspired Policy Initiative. Organisation for Economic Co-operation and Development. Accessed August 22, 2022. 

4. Towards a European brain initiative. EBRAINS. Accessed August 22, 2022. 

https://www.ebrains.eu/news/Towards-a-European-Brain-Initiative/

5. Harris Eyre, MBBS, PhD: senior fellow for brain capital. Meadows Mental Health Policy Institute. Accessed August 22, 2022. 

6. Brain Capital Alliance launches to accelerate agenda for change. Newsmatics Inc. News release. July 17, 2022. Accessed August 22, 2022. 

https://www.einnews.com/pr_news/581691203/brain-capital-alliance-launches-to-accelerate-agenda-for-change

7. Brain capital continues to advance. Global Brain Health Institute. September 7, 2022. Accessed September 8, 2022. 

https://www.gbhi.org/news-publications/brain-capital-continues-advance

8. Bär N. Políticas públicas y neurociencia, la deuda con la salud cerebral. 

. September 1, 2022. Accessed September 7, 2022. 

https://www.eldestapeweb.com/sociedad/salud/politicas-publicas-y-neurociencia-la-deuda-con-la-salud-cerebral-2022910526?utm_medium=Social&utm_source=Twitter#Echobox=1662030318

9. Improving brain health and reducing the scale and impact of dementia worldwide. Global Brain Health Institute. Accessed August 22, 2022. 

10. Congressional Neuroscience Caucus Briefing long haul neurological & psychological impacts of COVID19. American Brain Coalition on YouTube. May 18, 2022. Accessed August 22, 2022. 

https://www.youtube.com/watch?v=sdUwKIHccFE

11. Graham C. Addressing America’s crisis of despair and economic recovery: a call for a coordinated effort. Testimony to the House Select Committee on Economic Disparity and Fairness in Growth. September 28, 2021. Accessed August 22, 2022. 

https://www.brookings.edu/wp-content/uploads/2021/10/Carol-Graham-Testimony-Sept-28-2021.pdf

12. Launch event of the Brain Capital Alliance: towards a person-centered approach to brain health. CEPS Think Tank on YouTube. July 4, 2022. Accessed August 22, 2022. 

https://www.youtube.com/watch?v=Mo2dASiMrd4

13. Dawson WD, Graham C, Smith E, et al. Build brains better: a proposal for a White House brain capital council to accelerate post-COVID recovery and resilience. The Brookings Institute. December 22, 2021. Accessed August 22, 2022. 

https://www.brookings.edu/research/build-brains-better-a-proposal-for-a-white-house-brain-capital-council-to-accelerate-post-covid-recovery-and-resilience/

14. Dawson WD, Bobrow K, Ibanez A, et al. 

The necessity of diplomacy in brain health

Articles

A transdisciplinary team summarizes key points and reflections after 18 months of activity.

Advancing Brain Capital: Achievements, Lessons, and Next Steps

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.

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Textbook of Clinical Neurology, Volume 355

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

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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 

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

Jeffrey L. Cummings, MD, ScD

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Advancing Brain Capital: Achievements, Lessons, and Next Steps

Addressing the Cognition Crisis in Our COVID-19 World

Boosting Brain Health After COVID-19: A Convergence Solution

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