This week, we welcome Elli Kaplan, co-founder of Neurotrack, onto the show. Her company is dedicated to the detection and management of cognitive health. Elli and I chat all about the difference between cognition and IQ exams, highlighting the importance of tests like hers in identifying temporary or long-term cognitive changes ranging from overmedication to age-related mental decline. Bonus: we kick the episode off with AGEIST’s infamous Tinder origin story.
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“This is not an IQ test; this is a cognitive function test, and everybody should want to understand how their brain is functioning and if there are issues that you could then fix. As you point out, it may be that someone is on too many medications that are conflicting with each other. It may also be that they are eating fried food seven days a week, are not sleeping, and never exercise.”
“You know, historically, we haven’t had good drugs for, or even good supplements, from a treatment perspective, for cognitive issues. I think that is also starting to change, at least on the lifestyle side. We know that there’s a tremendous number of things that you can do to help your brain function.”
Hey Elli, how are you doing today?
I’m good. Thanks, David. Thanks for having me.
It’s great to have you on. Today. We’re going to talk about a test you created, which is I call it a cognition test. But what would you call it?
That’s what we call it too. We call it a cognition test.
A cognition test Awesome. Tell us a little bit about your background and how you came to develop this test.
Well, it depends on how far you want to go back. I will say it’s important to go back a bit because I was raised by probably you’d call them a couple of hippies now. My dad was a pediatrician who worked in the Indian Health Service and he went into the Indian Health Service during the Vietnam War. I spent my early childhood, up until actually around seventh grade, living on and around Native American Indian reservations and really getting a sense of how healthcare operated from a child’s perspective but nonetheless, and the need for access. I think that really deeply influenced my thinking and went into how we think about cognitive testing and cognitive health. Fast forward to post-college. I was working in government. I worked in the Clinton administration, at the White House, state and treasury departments, again with a lens of public policy. I went into finance and then worked at the UN for a bit before going to business school. When I was in business school, leading up to business school, my grandfather, who was also a doctor, started to show signs of Alzheimer’s disease. Here we were the family of healthcare providers. We went to try to get them diagnosed and it was next to impossible to really understand what was going on with his cognitive health. Fast forward. A few years later, my grandmother on the other side of my family started to show signs. I remember talking to my dad about it and we were like, well, this has got to be a little bit easier now. We’ll just go get her tested and we’ll get a diagnosis and there must be some form of treatment. Literally nothing had changed. It struck me, thinking about it, with these various previous hats on of public policy, access to healthcare, aging, population, economic impact and finance, that there was both a massive need to people who may be in the same boat as us, as well as a huge opportunity. It was then that I started looking around for better tools, met my co-founders, who were neuroscientists at Emory University at the time, who had developed a technology that we use as part of later stage testing, but tools that could better identify people who are at risk for cognitive decline and Alzheimer’s disease. We started the company, we raised some capital and fast forward to where we are today.
I had the opportunity to take the test. I observed the test, so I didn’t actually take the test. As it is now, it’s on an iPad device. My understanding is the way the initial utilization of the test, as seen now, is to be used. I think at 65 and over, you have to. Your doctor has to ask you are you cogent and have some evaluation, but this evaluation can cut into the amount of time that the doctor has been allocated to spend with you. This is something that can be like a pre-screen before you meet the doctor, and so you get time with the doctor. Did I get that right?
Yeah, that’s right. Fortunately it’s a bit more rigorous now than just the doctor asking you are you cogent? Cms, which is the government agency that governs Medicare, has put in place new regulations that says that doctors must actually give a cognitive test To your point exactly. The issue is that the historical test, which are these very antiquated pen and paper tests which have all kinds of problems around bias and accuracy and other things, are also quite long. When you are a primary care doctor and all you have is 20 minutes with each patient, to then have to contemplate conducting a 15 to 20 minute test, that’s just one small piece of the work that just doesn’t work. So we developed specifically for primary care this shorter tool that fits very neatly within clinical workflows. Just as you said, you can either take it ahead of the visit or you can take it after you’ve had your other vitals collected things like weight, high blood pressure, that sort of thing. Then you take our test.
Yeah, and I just want to say the test involves numbers and symbols and matching in a certain amount of time and that this is something that, should you score low, you have a cognitive issue which may or may not be dementia-related, Alzheimer’s related, but could also be indicative of overmedication or something else. Is that right?
Yeah, I mean the test is specific to brain function, so we’re measuring things like attention, brain processing speed, executive function, memory, and sometimes those things can be impacted by overmedication, and we know that so often at all different ages. But particularly when you get older, there’s a tendency to just start prescribing lots of different things and not coordinating how those medications are interacting, and so that can have an impact on score and cognitive ability.
One of the things I thought was interesting about this was that it’s a cognition test. This is not a test for Alzheimer’s or dementia, so that this could be used too much information here. But I have a microvascular issue with one of my toes and it has to do with I have capillary spasming which causes something called pernio. So I spoke to my docs last week and I now have a way to cause this to happen without it’s generally called a cause of it. But I found another way so I can control it and cause it to happen if I choose. And I said this is great, we can run an experiment as to what we can do. And they’re like okay, well, we’re just going to give you the full stack of everything that can possibly stop this. And I said well, like what’s going to happen to me if you give me all this at once? And he’s like you know, you might get a headache, a little dizzy. Well, I would have failed your cognition test Because my blood pressure was like a way down and I couldn’t think properly. But so I can see that this would be really useful in there. You know, I think one of the things about and I want to talk a little bit about greater use of these cognition tests, because I think people are very scared about and you know, sort of rightfully so if they, if you have Alzheimer’s, this is a very scary thing. Your life is going to be very different, and so there’s a tendency to not want to know. But that’s just one thing that can interfere with cognition. There’s a lot of things out there, right? My thinking on this got after I took the test. It became a little more broad, and I thought, well, why is it that the DMV wants to check my eyes but they don’t want to check my cognitive ability, which you would think would be tough of mind, right you? would think this test that I saw is a three-minute test. It takes about as long as a vision test. What is your thought on this? Can we get this into the? You should be able to think yeah. You can try to drive.
No, trust me, you are preaching to the choir in that we know that as people’s cognitive health declines, they become a risk for all kinds of issues. It’s not. It goes well beyond. Dmv is central, and you hear these horror stories of seniors mistaking the gas for the break and the break for the gas and plowing into crowds of people and you know they’re absolutely. It should sit in the DMV. It should also sit with your financial advisor. It should also sit with, you know, a whole host of others. We we also just given the space that we work in. You know hear stories of people who are declining cognitively and transfer their entire life savings to some small nonprofit that you know is working on an issue that their kids didn’t know anything about, and now they’re wiped out financially. So you know, cognitive health is, is core, it’s fundamental to absolutely everything, and you know I would say that this is where the cynical side of of healthcare and just our society in general kind of clicks in a bit. The problem is that because we haven’t had drugs for, broadly speaking, that are considered disease modifying, for cognitive decline, for Alzheimer’s disease, there has been a lack of focus across all of these different industries and verticals, and I think that is now starting to shift. It would be wonderful if, at age 65, you could show up the DMV and after you take your eye test, you take a cognitive test and it spits out you know the person sitting behind the desk who may not be equipped to have those conversations. They don’t have to have that conversation, right? It just says sorry, charlie, you’re not eligible.
I don’t think it should be age-based. I think that you should just take this test. If you want to drive a car, Tell me about. Is there utility for a test like this in sports? Post-traumatic brain injury yeah, so can this be used diagnostically that way?
Yes, it can. So, backing up a little bit, you know, as you mentioned, the way that our tests have been designed, developed and clinically and scientifically validated is to test cognitive domains. So all the things that we just talked about attention, executive function, brain processing speed. So, because we’re not a test for Alzheimer’s or a test for ADHD, because we test all brain function, we can use these tests or repurpose them for other kinds of issues. And so, certainly, concussions and traumatic brain injury that could come from sports or could come from jumping out of an airplane because you’re in the military and you know. So lots of applications, applications in the education space. I think it’s very early days. I mean, we’ve been around for quite some time now working hard on these issues. It’s early days for really pushing cognitive tests across all of these different areas. And you know, I think it is this next decade is going to be the decade of the brain and I think it’s just going to be unbelievably exciting to think about how we can equip people, regardless of age, regardless of income level, regardless of anything else, to have a much better understanding of their brain health, their cognitive function and then things that they can do about them. Right.
Yeah, as we’re talking, I’m thinking one of the primary applications of this would be in the US Senate, and I wonder how many of them would pass this. This is not a political broadcast, but you know, clearly there’s some people there that have maybe should not be doing what they’re doing.
Yeah, you know. I mean Diane Feinstein passed away. She was obviously declining cognitively. We know that Mitch McConnell he’s had probably some TIA strokes when he froze up and could no longer speak, you know. So those are the people that create policy and create laws. Let’s also think about people who are performing surgery. You know, I met with the Dean of Johns Hopkins Medical School many years ago and he said you know, honestly, I want this for my doctors. I want to know that if you hit a certain age, that you become aware that you’re going to get a cognitive test and if you don’t pass it, you can’t show up in the operating room anymore. So there are lots of different industries where this is critical and I think we’re at the beginning of starting to see some changes there.
You know I have a company called Agist, so we’re kind of sensitive about this stuff. But I’m sorry, any any right, okay, so you could be. Here’s another example.
Here’s another example. We know that alcohol abuse or drug abuse is a creates all kinds of cognitive issues. So, regardless of age, people should be getting tested Truck drivers, you know anyone who is performing any kind of work or personal things where this could become an issue.
I think that’s right and I, for some reason, this cognitive testing. It’s interesting to me how it’s sort of shunted off into this other like I don’t want to know sort of area, whereas things like dentistry, right, like we go to the dentist every year. I go to the dentist twice a year. I get my teeth cleaned, that’s just, you know.
Okay great Something we do you know, actually it’s, it’s important for your brain health. There’s a connection between oral health and brain health.
And so I use a water pick every night. Happy gums, happy brain. Hearing testing sort of falls into this camp that a lot of people just don’t want to know, and and of course hearing loss is directly correlated with brain health. But a lot of people won’t do it for one reason or another, and you know I don’t have any sympathy for that. You just do it, sorry, just do this. And I think that you know cognitive testing it’s, and I’m sort of wondering why this is that, why, like I would have loved to have had speed of processing tests given to me at like 20, 30, 40, 50, 60, and you know, because these things exist and for me to be able to just see like, oh okay, I feel my brain works differently now than it did then and allegedly it works better in certain ways. I’m better at recognition, but I’m probably a little slower at other things. But I would love to see, like that graph, decade by decade, but there’s no, like that doesn’t happen. The way my LDL is tracked. Like I’ve got a very comprehensive graph of my LDL but I have no record of my cognitive stuff. Why do we put that in a different category?
It’s a great question. I mean, you know, when I started this company and met with some very future focused venture capitalists and Peter Thiel, love and Rohatim from Founders Fund led our seed round, along with Social Capital Chamath Palihapagia, both very visionary when it comes to the future and they saw it and they understood, you know the value of getting cognitive testing, not just for understanding your progression from a function perspective, but also for things like drug development, and so you know, I think it’s critical. The problem has been that it’s really difficult outside of a direct-to-consumer or a concierge medicine like you know business model, it’s hard to get systems to pay for it and what you want is population level activity right. So I think you know, if you are seeing, if you’re able to afford to see a concierge medicine starting in your 20s, you probably will get cognitive testing. But for the rest of the group you don’t, and I think that’s a disservice.
That’s very interesting to me. Maybe where this comes from is this idea of I’m not politically correct, so I’m going to say dumb people, you know, this is not about that. This is not an intelligence test, this is a cognitive test and it’s a very different thing. So you can potentially be very smart, very high IQ, but you’ve been poorly prescribed something and your cognitive ability goes down, which right, it’s a different thing, yeah.
Yeah, yeah, no, that’s exactly right. This is not an IQ test, this is a cognitive function test and everybody should want to understand what their how their brain is functioning and if there are issues that you could then fix, and that may be. As you point out, you know that you’re on too many medications that are conflicting with each other. It may also be that you are eating fried food seven days a week and you’re not sleeping and you never exercise. So you know there’s an aspect of preventative medicine. You know, historically we haven’t had good drugs for, or even good supplements or whatever you know, from a treatment perspective for cognitive issues. I think that is also starting to change, at least on the lifestyle side. We know that there’s a tremendous number of amount of things that you can do to help your brain function. And you know I, because I have a history, a family history, of Alzheimer’s, and obviously because I spend all day, a night, working on this, I’m very focused on it and sometimes I slip up. You know, last night I had a bowl of ice cream and I woke up this morning and I felt slower. You know, the sugar in the ice cream makes a difference and if I, similarly I don’t. You know, I no longer drink a lot for the same reason. If I have a glass of wine the next day, you know my body doesn’t feel great, but my brain is what is most impacted. And so as we start to think about, you know, we’ve forever we’ve had this mantra of what’s good for your heart. You know, because of cardiovascular, all the money that has gone into cardiovascular health and the campaigns and the advocacy group what’s good for your heart is good for the rest of your body. It’s also true, and I would say, maybe more important that what’s. I mean, they’re both pretty important, but what’s good for your brain is good for the rest of your body. And if you really start to look at things through the lens of taking care of your brain health, everything else sorts out. And we know that. I took your quiz before, you know you know what are you?
well, I know what you are you’re an owl.
I could have told you earlier.
Anybody who’s studying brain science here now?
Okay, dig into what that means, but I do do a lot of those things around. What I was going to say is metformin, which is a diabetes drug, is also seen as a drug that’s very good for longevity for women, hormone replacement therapy, very good for for a clinical client. So I think you know, as we get more aware, as broadly you know as a society, about how all these things can impact your brain but also your other. You know other aspects of your health. We’ll start to see more acceptance around the need for cognitive testing in lots of different places.
You don’t have to answer this question. I was just curious. Have you tested for the APOE4, belial I?
have tested and I don’t have the gene, which is sort of remarkable because I have a lot of Alzheimer’s in my family. What’s pretty exciting, though, is there there have been some new studies just in the last couple of years that are one of many that show that, even if you do have the gene, that lifestyle plays a role 100% yeah. Yep. So having the gene is scary, sure, but there’s so much you can do about it and maybe that motivates you a bit more.
That’s where I was going to go with this that just because you have the gene, even if you have two copies of the gene, if you do things, you get your blood sugar under control stop the alcohol, increase your exercise you can delay or prevent the onset of the disease. That’s right, as I understand. So the cognitive test means that I will just say, worst case, my wife would say she’s like well, what’s wrong with your brain? You forgot your keys. She’s lovely. So is this specific test? If what we’re testing for here is cognitive issues and we think that these cognitive issues are related to brain disease of some kind, if we test indicating disease, this is an advanced form of the disease. There’s something wrong happening here.
Yeah, you know, what’s considered in this space as advanced is mild cognitive impairment, moving to moderate cognitive impairment and then to Alzheimer’s disease. There are obviously there are stages before that subjective memory complaint with worry, where you are forgetting your car keys a lot, and so much so that you notice it’s a big issue, which is not to say that that’s what you have. Obviously I’m not quite sure. Whatever we all probably do at certain times in our life, but it’s not a test where, if you are 35 and you have a crystal ball and the crystal ball says at age 85 or 75, you’ll enter into one of those stages that we could detect it. We hope for that and I think, longer term, as the systems come into play for testing earlier at scale and when I say systems, that often means like health insurance or providers, doctors, who build it into their workflows you can get somebody to start either preventing through lifestyle or if there are more drugs that would make sense, then absolutely. But today the focus really is on finding people who are later stage but still early enough to be able to do something.
I’m not a doctor, I’m not a scientist. I’m going to throw out some words that I have heard. So they’re PET scans. I believe there are blood-based markers that can test, I think for it. You can show some indications of early Alzheimer’s and such, where people can take action. I’m guessing, with your test, if I was a physician and somebody scored low cognitively, I would probably say oh well, let’s see what’s going on here.
Leading down to some other tests.
Two of the biggest hallmarks for Alzheimer’s disease pathological hallmarks can be don’t necessarily have to be, but can be what they call plaques and tangles. The plaques are amyloid protein that builds up in the brain and the tangled are tau tangles. These tests that you mentioned PET scans, also a spinal tap lumbar puncture can identify amyloid and or tau in the brain. There are some blood tests that are coming onto the market. I just heard it’s still early days for a lot of those blood tests but yes, if somebody gets flagged by our test before actually we would get to that stage, the doctor would actually do more comprehensive cognitive testing. So we have other products besides that. Or, in addition to the three-minute screening test, we have our screening test and then we have a more comprehensive set of tests that a doctor can use to say okay, you got flagged by the screener test. Here in our office we want to do a little more testing and try to better understand is this something that would need a neurologist to take a look at or is this something that is maybe not as much of an issue? So they would do that more comprehensive testing. We also have a program that takes all that great stuff and lifestyle and it’s actually a clinically validated program that we’ve put through longitudinal studies that the NIH funded to show that gives everybody the information and the tools in order to take a proactive approach for the brain health. So if they don’t go on a neuro then they’ll get enrolled into that program and be given everything that they need to try to prevent.
We had somebody who’s now one of my friends, dr Rudy Tanzi, who is head of neurology who’s a mass general? At the young age of 22,. He discovered the early Alzheimer’s gene and I asked him this question. I said so why is it that there seems to be this sort of selective memory fail at about age 60 with name recall? Like what’s up with that, rudy? He says, well, I have the same problem. And I said, what do you do about it? He’s like, well, I don’t know. I don’t know, it’s just sort of a thing that happens. Do you have any thoughts on this?
I’ve always been really bad with names. I’m a very visual person. So if I saw you walking in a mall in the middle of like Columbus, ohio, I would remember you, but I would be like, oh, I know that guy and I’ve met with him, but what’s his name? And then it would come to me eventually Word recall and in fact there are a lot of cognitive tests around word recall. They call them the wordless memory test, but that is something that does happen kind of often in midlife. I try really hard when I meet somebody new, because I’m visual, to focus on their face and to repeat the name a few times, and that tends to be helpful. I think that there’s something about mindfulness and presence that goes with cognitive function, and so if you can really for me anyway, focus on being present where you are and taking note of who you’re with and the name. That tends to help me a little bit. But I don’t know, it’s a tough one and if Rudy Tansy can’t answer that, certainly I’m not gonna do a better job.
Yeah, it’s interesting what you said, like this is the decade of the brain and as I think about this, we had Dr Richard Davidson see, I recall that name his Healthy Minds program, which I think is brilliant and he comes out of neurology. This idea of presence, meditation, is becoming much more to the forefront and psychedelics are being talked about today in a way like even a year ago was rather I was in the sauna last night we have a very social sauna where I live at the gym. And it’s yeah, so the conversation was like started at breath work and then people are like talking about their ayahuasca experiments and low dosing psilocybin and this is just like sort of normal. These are not like out there people how common this sort of discussion is and this is really part and parcel to your field, what you’re talking about, the brain stuff. I have some strong feelings about the two field that I won’t share. I think he’s right about this.
I agree, and I think what’s interesting is we’re starting to see more money, both public and private, blowing into research and into companies that are trying to develop things in a similar way. I think there’s a lot of work to be done, and rigorous work that needs to be done, because the last thing you want is someone going on a bad trip and never returning and not having the right guides or recommendations. But it’s fascinating and it just speaks to the beauty and the wonder of the brain and I think it’s pretty exciting. I know people who this is different, but who have serious depression and then went on a protocol of ketamine and it was life changing. So I just think there’s so much about the brain that we don’t know that we’re learning every day and, no pun intended, we have to keep an open mind to it because it could be life changing for lots of people.
I’m still puzzling about the societal resistance to cognitive testing, but I’ve worked with a lot of young people and their openness about things like therapy or gender, all these things. For us we’re just like total third rail, do not go there. And they’re just like bantering about it. An open conversation, and I think that that’s. I can see them having zero resistance to oh, you wanna be like a cognitive test? Oh, interesting yeah it’s funny.
Yeah, it’s funny. At our company, obviously, we do a lot of product testing. We do a lot of user testing on people who are older, given that that’s the majority of our population who take the test to make sure that it works for them. But we also end up testing our kids and trying things out and there’s just an, as you say, like an openness to all of these things that never exist before. It’s really, I mean, I think it’s very exciting.
I just wanna touch on Japan. Japan is my favorite country in the whole world. I think it’s an amazing, amazing place. They’re just like more evolved than we are. They’re higher on Maslow’s pyramid, so. But what you notice immediately, like when you land there, is the age range of people who work in sort of like what would you call it? Like going through, like passport control, and that, yeah, like the age range low end, maybe 20, high end, I don’t know mid 90s. So, as we get into this, we’re preventing a lot of diseases, we’re. You know, people are living longer, japan probably being the forefront of this. Is there any interest in Japan with a test like this?
Yes, and we have. We’ve actually worked virtually in Japan for a while now. That was because they were so much more advanced when it came to understanding the need for cognitive testing and the role of prevention and the role of research, and so we actually launched in Japan before we launched in the US, from a B2B perspective, and I think there is just a different understanding of age and aging there than exists today or that exists in the US, rather, and so working in Japan was, I mean, it’s an incredible country. I had the privilege of being able to go there quite a lot pre-COVID to work with our customers there, and I think you know, to a certain degree it’s cultural, but to another degree it was about their economy and because so many you know it’s a country that is has the largest aging population in the world. People live much longer there, they and they’re not growing from a population perspective as rapidly as some other companies. It was a real need to ensure that people, as they get older, can continue to work, so that they can have people who stamp passports, and you know people are needed to work.
I just want to wrap up here and let people know I’m so bad at promotion. The name of your company is Neurotrack and I never mentioned it, so went to Merritt for the podcast host.
We can do it at the beginning and the end.
If somebody wants to get in touch with you, who wants to tell their doc like, hey, why don’t you have this thing? What do they do?
Well, I always keep up my email because I love to hear from people. So they can email me at leleli, at Neurotrackcom, or they can go to our website and their forms that you can fill out to get in touch. But we love to hear from people who are concerned about their health. They’re not concerned, they dislike what we’re doing or they want their doctor to start using it. Please get in touch.
That’d be great. It’s a great product and I really appreciate the science behind it. And what I really like about your product is of use. Like it’s that’s right. Right, it’s three minutes on a pad. Like it’s not that hard.
Well, david, thank you so much for saying that, because our product team is spectacular and are designed. I think that’s building the product, but also designing the product and then, obviously, the clinical team to validate it. But you wouldn’t believe the amount of work and energy and passion that has gone into that making it easy. We want this to be a stress-free experience for people, so they come back and they test again and we start to get that longitudinal data that you talked about.
That’s right. Great job, product dev team Awesome Thank you. Ellie, it has been wonderful having you on the show today. Thank you, David. We’re going to put all your contact information and a link to your website in the show notes. I think that this is the decade of the brain and I’m really looking forward to going into the DMV and them saying okay, you can see, but can you think take this three-minute test? I would love that, yeah.
Yeah, me too, and I just want to say thank you so much for having me, thank you for this podcast. It’s wonderful that you’re out there doing this and excited to continue to listen Very well.
Thanks for joining us today.
All right, take care.
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