Forward Thinking Revolutionizing Neurodegenerative Care: Dr. Robert Bilder Discusses AI Solutions for Aging, Brain Disorders, and Cogensus
Social connectedness (SC) is an important social determinant of health (SDoH) associated with decreased mortality, improved mental health, and increased self-efficacy in adults and adolescents.
Interest in the potential relevance to health of social connectedness or lack thereof (e.g., isolation and loneliness) has been growing globally (2, 30, 41, 57, 69), amid a backdrop of long-standing public health research suggesting that anywhere from 40% to more than 80% of health and wellness can be directly or indirectly attributed to social factors (44). https://doi.org/10.1146/annurev-publhealth-052020-110732
Studies have shown that there is an association between loneliness, social isolation, and reduced cognitive function, in older adults, across multiple cognitive domains, as well as a heightened risk of dementia. J Alzheimers Dis Rep. 2023 Jun 29;7(1):699–714. doi: 10.3233/ADR-230011
Cogensus is aimed to alleviate loneliness in the elderly and help physicians provide better care to aging patients facing cognitive decline and mental health challenges. The platform extracts insights from A.I. powered daily conversations and uses them to preserve patients’ memories.
Cases of cognitive decline among the elderly are expected to jump in the next 30 years.
The American population aged 65 and older is projected to grow nearly 30% to 82 million by 2050, and U.S. cases of Alzheimer’s and dementia are expected to double to 13 million by that same year. These trends highlight a growing need for doctors who can treat brain degeneration.
Joining us on this journey is Dr. Robert Bilder, a Los Angeles-based clinical neuropsychologist who's spent the last 40 years studying brain-behavior relations specifically around Alzheimer’s and other cognitive disorders linked to aging. He’s the Michael E. Tennenbaum Family Distinguished Professor of Psychiatry and Biobehavioral Sciences at UCLA and the Principal Investigator of the National Neuropsychology Network.
As a Clinical Advisor to Cogensus, Dr. Bilder provides consultation and advice on the assessment of cognitive and mood functions using psychological measurement tools.
Dr. Bilder sat down with Cogensus for a Q&A to discuss the current state of U.S. healthcare and how innovative technologies like A.I. could address neurodegenerative diseases. The interview has been edited for length and clarity.
What drew you to joining Cogensus?
Cogensus aims to provide a critically needed service.
In the United States, it's particularly problematic we don't have enough care for our older adults. We have more people living to older ages, meaning more people are living to experience cognitive disorders. As more people experience cognition disorders, the number of aging patients could far outstrip the supply of healthcare providers needed to give adequate care. While ideally we would have enough humans to provide all of these services, I think it's now possible using some of the advanced technologies like artificial intelligence to provide some support that is really valuable for people.
What is the main challenge doctors in the U.S. face today when providing care?
The biggest pressure faced by physicians today is they don't have enough time to interact with their patients. A doctor during a typical visit may spend 10 minutes with you, eight of which they're spending looking at their computer screen entering data they need to record for charting. And then the poor physicians actually have to spend hours every night adding other documentation and addressing what's in their inbox.
These tasks really take time away from clinicians. It's not like it was in the 1950s and 1960s when physicians spent a lot of talking and getting to know a patient. We're losing some of these uniquely human aspects of medical care.
How do you think Cogensus could address this issue?
One is by increasing the efficiency of which the physician can gather information. When patients are willing and able to complete self-report rating scales, or their family members are able to provide information, that provides a huge amount of information to the clinicians that can help them to understand exactly where patients are at. Rather than have to ask yes-or-no questions that are critical for the medical record, physicians can go on to ask open ended questions that actually help them engage with the patient more directly. It frees up the physician's time to be able to spend more time actually interacting with the patient.
There’s also the provision of a recording territory where patients can begin to store their memories. There's a lot of literature that's come out about how if you can log information in the form of narratives or video clips that this can actually serve as a great reminder for people who are experiencing memory disorders. That way, they can then begin to get prompts that will trigger their memories. While the evidence is still emerging, Cogensus’ legacy preservation feature is a potentially powerful tool to increase the memory functioning of older adults and record narratives and images both from the patients and their family members.
How could Cogensus improve the care provided to patients with neurodegenerative diseases?
One of the advantages is through enhanced diagnostics. When physicians have more clear diagnostic information like patient reported symptoms and are able to track those over time, they can use that enhanced diagnostic precision to select certain treatments for patients accordingly. In addition, most clinicians don't have access to continuous measures of patient behavior, which makes monitoring those treatments really difficult. Cogensus would be one of the first times we’d have a platform that enables clear, longitudinal tracking of patient symptoms over time in a way that's systematic and evidence based.
Can you provide a concrete example of how doctors could use Cogensus to enhance patient outcomes?
Let's imagine we have an older adult experiencing cognitive decline and mild depression. A doctor may want to prescribe something that could enhance cognition and an antidepressant. But older adults are explicitly sensitive to different kinds of medications and they tend to be on multiple medications which makes the potential for drug interactions high.
Physicians do their best to avoid any problems, but there's nothing to substitute for being able to track how somebody's doing. If you see somebody's actually becoming more lethargic after they get an antidepressant drug, then you may say, ‘Well, maybe they're getting too much of the medication. Maybe they need a different medication.’
Cogensus’s ability to really continuously track symptoms and to be in touch in ways that would not be possible, I believe, is the future of healthcare.
