The brave new world of monitoring sleep for stress, and a visual test to spot early-stage Alzheimer’s

We’re learning more about how Alzheimer’s affects the brain — and when — by looking into it, but what if there is a way to more quickly spot early signs of the disease by observing how the brain looks at the world?

The premise of a technology developed by Neurotrack is deceptively simple:  Subjects are given a computer-based test that measures how well they remember images on a screen via an eye-tracking device. An algorithm analysis detects Alzheimer’s in relatively early stages, before behavioral symptoms appear and allowing early intervention. The program was developed by neuroscientists from Emory University and the University of Washington, who brought on an entrepreneur to help them bring their idea to market.

Testing so far bodes very well for its predictive value: Of subjects who scored below 50 percent, all went on to develop full-blown Alzheimer’s within six years. The test has other big advantages: It’s noninvasive, requires no special training to administer and is easy and relatively inexpensive to disseminate.

Neurotrack, one of the companies represented at TEDMED’s 2013 Hive, finished Series A funding with $2 million from Founders Fund and Social+Capital, and has begun the long trek toward FDA approval.

Elli Kaplan, co-founder and CEO, says the road to recognition hasn’t been easy for a start-up that grew from academia and continues to progress independently – versus flying under the wing of a pharmaceutical sponsor – but it also has creative advantages. An idea developed by a smaller group is less likely to get lost in the shuffle of a larger organization, and to be discarded if it doesn’t fit a predestined outcome.

“For us, if it doesn’t work for ‘x’ it might work for ‘y.’ We’re a young company, so we think instead, ‘We put all this work into this, so if something’s not working how can we change our plan to bring things to life?” she says.

Stress, the Ill Felt ‘Round the World

If you’re stressed and you know it, raise your hand.

You probably can read stress signals, especially thanks to attention from health care providers and the media. Your breathing becomes more rapid; your muscles rigid; your skin flushes. And even if you don’t notice, there are great gadgets out there that can clue you in.

shutterstock_65065507But what about the other, less hidden symptoms, like poor sleep and varied speech patterns?

SOMA Analytics, a London-based start-up, has developed a smartphone app that tracks these less-noted symptoms. Named after the Greek work for body, the SOMA app monitors movement patterns at night (yes, you have to sleep with your phone), and voice and typing during the day. It then offers interventions tailored to observed needs. For example, not all sleepers are the same; some do better waking early, some sleeping fewer hours; thanks to genetics. There’s no way to scientifically know which group you’re in, short of spending a weekend at a sleep lab.

Co-founder Johann Huber and two friends came up with the idea after watching a fourth friend slide incrementally into depression.

“We had the feeling there was something going on with him, and in between [times we saw him] he got bags under his eyes and had incredible mood swings. He himself didn’t feel it. Humans don’t notice gradual changes over time,” Huber says.

Why not, then, invent something that does and couple it with something so many of us own and know how to use – the smartphone?  The group worked with a number of hospitals to refine its product, which is already in market and geared towards businesses with a concern for employees’ productivity and well-being.  It stacks up well against metrics gathered in sleep labs.

A native of Germany, Huber said the company moved to London for what he says is a business environment more fertile for start-ups. The world seems ready for SOMA; the company was one of 50 companies selected to join TEDMED’s Hive innovation showcase in 2013 and was one of only 20 Digital Health startups on the continent to be part of the Johnson & Johnson Digital Health Masterclass.

With experience in so many countries and it’s technology, will SOMA’s leadership be able to determine who is less stressed, Americans or Europeans?

Pondering, Huber says, “I studied in the U.S. and I had the impression than Americans were far more laid back than Germans especially,” he says, but allows that intense U.S. work schedules may flip the equation.

“The big question is — who is more productive? If it helps productivity to rest, then I would strongly argue for testing that,” he says.

Catalyst: Stress triggers vs. wellness in the workplace, and spotting constellations in a galaxy of health data

What’s the most stressful part of your work day: Your commute, the big meeting – or lunch?

Neumitra has a bio-sensing watch that will tell you. The wearable sensor gives clinically valid measurements of the psychophysiology of stress, such as increased heart rate or body temperature. The triggers are matched with data from a smart phone app, like calls and calendar items, to discern what is creating stress, and vibrates when stress signals appear. For clinicians, an iPad app records sessions to show which events can trigger stress.

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Neumitra’s “Neuma” biosense watch

Neumitra is also working with Fortune 500’s to quantify how cumulative stress affects operations and health costs across industries. After all, stress shuts down the brain and impacts decision-making, the very thing employers least need from their knowledge workers.

Not surprisingly, results so far show that commuting is one of the most stressful times of the day.

“Companies are paying for lower productivity when they expect people to arrive at 9:01 every morning ready to work. People arrive in fight-or-flight mode and read the newspaper or check email to calm down, and then by 10 a.m. or so, getting down to work. In response, we’re looking into how flex hours would help organizations,” says Rob Goldberg, Neumitra co-founder.

There may be limits to just how long you can happily face co-workers at any one time, too.

“We’re using accelerometers to weight physical stress versus mental stress. It turns out that long meetings equate to intense exercise. So, when you have these two-hour meetings it’s almost like asking people to run ten miles,” he says.

Think lunch is a break? Some unfortunate eaters also have a stress spike during mealtimes for reasons yet unclear, Goldberg says, though it may have to do with internal messaging.

He says corporations are receptive to Neumitra’s feedback, with particular interest from typically hard-driving Asian countries.

“Even in Wall Street, we’re finally hearing that firms are cutting back on the number of hours people work. Their mission is to treat their knowledge workers well. We’re realizing it’s all about the quality of output,” he says.

Tracking Wellness Around the World

It’s not all stress in the office. Companies working with ShapeUp have a link to tech-based social networking and wellness solutions. Employees can log in to the platform to monitor their fitness goals and team up with others; challenging those slackers in accounting to an exercise contest, for example.

ShapeUp reported the following milestones for 2013:

  • Acquiring over one million participants across 128 countries
  • Shipping over 400,000 activity tracking devices to members worldwide
  • Launching ShapeUp Complete, a turnkey wellness platform designed to support small- and medium-sized companies with 100-5,000 employees; and conversely working with multiple companies with more than 100,000 employees
  • Working with Fitlinxx to offer a wireless tracking device for outcomes-based incentives
  • Raising $7.5 million in new investment capital to fund mobile technology and global capabilities along with new engagement tools

The company has also been working toward major product enhancements that will be announced in early 2014, including expanding its native mobile app. In addition to activity tracking capabilities, goal setting, and progress reporting, the ShapeUp mobile app will leverage GPS, accelerometers, co-processors, and companion smart watches — there’s the watch theme again — to provide personalized feedback and broader functionality.

Picturing a Pattern in Big-Data Static

Why do drug researcher and best practice guidelines often cling to only one outcome measure in what may be mountains of data?

As someone with type 1 diabetes, Anna McCollister-Slipp has worked hard to manage her blood sugar levels for 28 years. With an insider’s view into a complex chronic disease, she’s frustrated by what she sees as healthcare’s narrow scope of outcome measures and lack of comparative effectiveness research. The disease is a case study for a general weakness in the system, she says.

“Drug companies are generally looking at one outcome measure, and they’re going to advance the one that’s most likely to approved and reimbursed. There’s a degree of complacency that’s incredibly frustrating as a patient,” she says.

Graphic: Galileo CosmosAt the same time, data mining is a time-consuming and expensive procedure normally left to experts. In response, McCollister-Slipp founded Galileo Analytics and created a real-time visual data mining platform, Galileo Cosmos™, in which users can explore large, complex data sets, finding patterns and investigating outcomes. Cosmos delivers visual results for easily digestible information that’s also appealing for users. The system requires no technical expertise; in fact, one could easily see the platform being used for other sectors such as journalism and manufacturing.

Last spring, Galileo contributed its platform to a bold, far-reaching prototype learning health system called CancerLinQ™ in development by the American Society of Clinical Oncology (CancerLinQ’s advisory committee is chaired by Amy P. Abernethy, TEDMED 2013 speaker). It will use patient data to support oncologists’ clinical decisions. Some day, patients may be able to additionally use it to scope constellations of information from the countless facets of information that comprise their health galaxy.

What will a lateral thinker be when he grows up?

This is a guest post by Sandeep Kishore, a post-doctoral fellow at Harvard Medical School and TEDMED 2012 speaker.

Recently, I’ve been struggling on how to explain to other folks what it is that I do – or what it is that I am attempting to do.

I still don’t really know.

But I have found some clues recently via a Harvard University website called the Catalyst. It effectively catalogues all people at 17 schools and hospitals associated with Harvard University (from those studying anthropology to appendicitis, from molecules to masses), ‘catalyzes’ new connections, and provides pilot grants to help incent people to work on problems together.


What I like most is that the translation agenda via this website. It provides a useful frame for PhD basic scientists to communicate with MD clinicians and with the policy/public health community.

In the university community, and certainly in training, there are rifts between bench scientists and the clinical docs. Now add in the fact that the biological/pathogen model is old news, mental models are shifting and there are new behavioral/social issues that add to the canonical biomedical approaches, and now we have a real and urgent need for translation.

The Catalyst profiles a translation agenda labeled T1 thru T4:

T1: Basic Scientific Discovery to Clinical Insights

T2: Clinical Insights to Implications for Practice

T3: Implications for Practice to Implications for Population Health

T4: Implications for Population Health to Improved Global Health

This provides a useful continuum and includes tools to broker linkages along the way. And the curation of resources begins the moment any staff member joins Harvard University. In a moment, your publications, your topic areas, people who publish/think like you and even people who physically sit next to you are highlighted. The website is designed to foster creativity and collaboration – and is blind to exactly where those insights might come from. Anyone, from student to president, can participate and link-up.

Best of all, the site is public so that anyone else can view, learn and engage. This is the sort of multidisciplinary effort that we will need for complex health challenges –and I’m delighted that it’s housed at a major university with access to ideas, young blood and energy.

I connected with Dr. Lee Nadler and Dr. Elliott Antman, founders and leaders of the platform, to learn more on the origins and functions of the Harvard Catalyst. I was looking for practical outputs of this network. They relayed one challenge where engineers and researchers were searching for practical applications of next-generation imaging techniques; and one in which radiologists were searching for, well, next generation imaging modalities. Both groups were unintentionally boxed in their professional silos. The Harvard Catalyst challenged the community – write in 250 words, one big idea to bridge the gap, identify how a biological/medical problem could be solved by imaging techniques.

They expected maybe 30 submissions across the 12,000 people unified on the platform. They received 500.

Next, they arranged a poster session where 150 people presented their idea over three evenings. New ideas including novel ways to image islet cells of the pancreas emerged. Success: People not aware of each other’s existence came together; new teams were formed and there was even a bit of funding for pilot grants to try out the best, most promising ideas. As Drs. Nadler and Antman say, their vision is not to bring institutions together; it is to bring people together.

Sandeep Kishore at TEDMED 2012

TEDMED and a network I co-founded, the Young Professionals Chronic Disease Network (YP-CDN) provide some examples of the sort of ‘safe spaces’ for incubation, networking, curation and then translation of ideas to action. Particularly for the way we train the next generation of university students. These initiatives are exciting in that they provide a new nidus for meet ups that foster imagination, innovation and inspiration and that move us beyond hardened paradigms. This is critical for this generation, and even more so for the next.

It all reminds me of the quote by the playwright Edith Wharton relayed to me by an old mentor: “There are two ways of spreading light: to be the candle or the mirror that reflects it.”

These incubators serve as mirrors that help focus, amplify and merge our individual lights of inspiration. This is a neglected, but vital function, for translators. Maybe I’ll grow up to be a mirror?