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The company uses eye tracking to determine if images are being stored in the hippocampus
Dementia, and more specifically Alzheimer's disease, is a big and growing problem; there are an estimated 50 million people around the world living with Alzheimer's right now, and that number is expected to rise more than 130 million by 2050. Yet, as anyone who has had family or loved ones struggle with the disease knows, diagnosis and treatment still have a very long way to go.
Dealing with the disease in her own family is what led Elli Kaplan to found Neurotrack, a company whose mission it is to to better diagnose and treat people who are suffering from dementia. On Monday, the company announced that it raised $21 million in Series C funding.
The round was led by existing investor Khosla Ventures, with new strategic investments from Dai-ichi Life and SOMPO Holdings, and participation from existing investors Sozo Ventures, Rethink Impact, and AME Cloud Partners. This new funding brings the company’s total funding to date to more than $50 million, including over $3.5 million in grants from the National Institutes of Health and a fast-track grant worth up to $3.3 million from the National Institute on Aging.
A better Alzheimer's diagnosis
"I had two grandparents who died from Alzheimer's disease and, even though I came from a family of doctors, where we felt like we ought to be able to get the very best information around a clear diagnosis and then, certainly, a treatment plan, we had a really, really challenging time. That began with my grandfather on my father’s side, who was a physician himself, and then it struck again on my mother’s side of the family a couple of years later and nothing had changed," Kaplan told me in an interview.
Part of the problem that she found was that the diagnosis of Alzheimer's was being done in what are known as "pen and paper" tests, which she describes as "cognitive tests that are very course measurements of someone’s memory and cognition."
"The challenge with having a pen and paper test is that it’s deeply impacted by lots of different things like levels of stress, how much sleep the person got the night before, where the test is being delivered, and we’ve that found tests given on the east coast in the U.S. are different than the tests that are given on the west coast. So, there’s no consistency. On top of that, you can test a certain way one day and then the next day test for it differently. So, it’s no big surprise that it’s hard to get a definitive diagnosis," Kaplan explained.
In attempting to tackle the diagnotic side of the problem, Kaplan met her co-founder, Stuart Zola, who had led the team that mapped the entire human memory system, and as part of that, had discovered that Alzheimer's begins in hippocampus. He had also developed technology to use eye tracking to assess impairments of the very first memory process that’s affected by Alzheimer's disease.
"The science behind our tech is that, as human beings we are all born with this instinctive biological preference or desire to visually seek out novelty in our environment. It’s a biological preference that has helped us survive as a species. So, we actually use that to track what’s called recognition memory, which is the first memory process to be affected by Alzheimer's," said Kaplan.
The way that the Neurotrack diagnosis works is that it uses a simple interface on a phone, laptop or iPad, which will track eye movement and see what images a person is responding to. The test displays pairs of identical images, which a person with a healthy hippocampus will then imprint and store. About midway through the test, it will start displaying one of the images that the person has already seen before along with a new image, tracking where the person is looking and collecting data around what they are about curious, what they find interesting and where they focus their attention.
"If you have properly imprinted those images onto your hippocampus, then you will actually spend the majority of your time looking at the novel image, because you’ve never seen it before, it’s really fascinating to you, you want to understand and imprint it. If you are impaired in any way, then what we find that you will spend an equal time looking at both images, and that’s because the original familiar image wasn’t properly imprinted and stored. That will then give us a baseline indication of where your memory is and we compare to other people in your age range and according to gender and ethnicity and other demographic factors," Kaplan explained.
The person is then asked to come back at regular intervals to track their memory over time.
Treating the disease through lifestyle changes
While diagnosis is difficult, there are also no disease modifying drugs for Alzheimer's, meaning drugs that will either stop the disease in its tracks, or at least significantly slow it down. Neurotrack was founded in 2012, and it was midway through the diagnostic testing that many large pharmaceutical companies began shutting down their programs for the development of drugs for Alzheimer's, simply because they were all failing. That prompted the company to begin to look at alternative approaches to treating the disease, ultimately learning of what is known as the the "finger protocol," which looks at how lifestyle impacts Alzheimer's disease. That can include things like how much exercise a person gets, their diet, whether they have an active social life and how much stress they have in their life.
"What we have learned about Alzheimer's is that’s only in a very, very small percentage of all cases where the disease is driven by a single pathology; in the majority of cases it’s driven by multiple pathologies, many of which are the result of a bad lifestyle behavior. Either you drink a lot, you eat a lot of red meat, you eat a lot of fried food. If we can figure out what those main drivers are for you, as an individual, and tweak them in easy to follow, habit-forming ways, like all the best behavior-change apps out there, then that’s where we can really move the needle in terms of long-term cognition," said Kaplan.
To validate the program, Neurotrack ran a study with 82 individuals who were characterized as having what they call, ‘subjective memory complaint’, which can be a pre-precursor condition to Alzheimer's. The company was able to show that it could "actually improve people’s cognition in a statistically significant way and we could also reduce their depression and anxiety also in both clinically and statistically significant ways," something that can have a significant impact in cost reduction, as a person with Alzheimer's can spend around $42,000 a year in care.
"The high level that we’re trying to solve is the fact that Alzheimer's is on the verge of being a worldwide epidemic. There are very few really accessible, scalable diagnostics and assessment tools that can collect high quality data. We then pair that with the need for some type of program for reducing that risk. We bring it all together in a fully integrated solution to really try to drive impact in this sorely needed area."
An aging worldwide population
Right now, Neurotrack's main customers are all in Japan, and they include two of the company's investors, Japanese insurance companies Dai-ichi Life and SOMPO Holdings.
Dai-ichi Life, which is the second largest life insurance company in Japan, offers something akin to a life insurance policy to its members; they pay premiums over time but if the customer ever get a diagnosis of Alzheimer's disease then they get a payout to help cover their costs; Neurotrack's products are then given to the user as a benefit of the policy. In the case of SOMPO Holdings, they offer their members the full suite of products, meaning both the assessment tools and the memory health program, to help get people engaged both in assessing their, as well as in reducing, their risk.
The reason that Japan has been so interested in Neurotrack's products is that it has the largest aging population in the world, and Alzheimer's disease is now the number one cause of death in the country, Kaplan told me.
"What seems to drive it is really the population demographics and how urgent an issue Alzheimer's has become. You take a place like Japan where you have these really large companies that you don’t typically think of as being particularly innovative or creative, but, given what this market opportunity looks like, they’ve been able to move very fast and capitalize on it in a financially good way for them, but also by bringing something to the market that has enormous value to these new customers of theirs," she said.
The new funding will, in large part, go toward expanding to other international markets that also have large, aging populations. That might include countries like Singapore, South Korea, Italy, the U.K. and parts of South America. For example, China, with its "one child" policy, which was in place until recently, would be a prime market for Neurotrack.
"The issue with Alzheimer's is that, given the type of care that's involved, it really requires a really strong family unit, or social system, to help manage that care. So, when you have a place where there's such low levels of new births and then children to help take care of disease with the disease, and there's the risk of so many people requiring government or private institutional care, that's where it starts to become pretty dire."
The funding will also go toward growing a market presence in the U.S., and working with other non-health insurance companies, as well as with Medicare Advantage plans and other traditional U.S. healthcare providers, while also deepening adoption of Neurotrack in Japan.
Tackling other brain problems
In the short term, Neurotrack's goal is to impact Alzheimer's disease around the world.
"I started this company because of what my family went through and when I talk to people, I don’t think I have ever had a conversation where someone has said to me, ‘I have no idea what you’re talking about, this has never happened to anyone I know.’ It’s just pervasive. We really want to make a massive impact in this area, and we want to do it on a global scale because we can. Because our technology is highly accessible and highly scalable, and we can reach people around the world. We have users in 160 something countries outside of the B2B play, where they have taken our test and they’re started to test their cognition," Kaplan said.
While what that ultimately looks like isn't entirely clear, to start, least least, it will involve "people becoming aware of the fact that they need to be taking care of their brains in the same way that they take care of the rest of their body."
There’s nothing that is more important, in my personal view, than being able to age in a cognitively healthy way and being able to die with the memories that you’ve spent your life creating," she said.
In the long-term, though, Neurotrack wants to go beyond just dementia, and sees other potential applications for its technology that it already beginning to test.
"What we now know is that eye tracking is a massively powerful way of gaining cognitive information on people, and we can adapt our test to understand things across many, many other conditions including autism and ADHD and Parkinson’s and PTSD and traumatic brain injury and concussions. Anything that impacts the brain, we think that there is a potential application for using eye tracking. So, we’re starting to look in some of those other areas in a really small and targeted way, but being very mindful that the data that we’re collecting may have implications for potential good in other spaces."
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Khosla Ventures offers venture assistance, strategic advice and capital to entrepreneurs. The firm helps entrepreneurs extend the potential of their ideas in both traditional venture areas like the Internet, computing, mobile, and silicon technology arenas but also supports breakthrough scientific work in clean technology areas such as bio-refineries for energy and bioplastics, solar, battery and other environmentally friendly technologies. Vinod was formerly a General Partner at Kleiner Perkins and founder of Sun Microsystems. Vinod has been labeled the #1 VC by Forbes and Fortune recently labeled him as one the nation's most influential ethanol advocates, noting "there are venture capitalists, and there's Vinod Khosla." Vinod Khosla founded the firm in 2004.
Joined Vator onElli Kaplan is Co-founder and CEO of Neurotrack, a digital therapeutics company dedicated to empowering people to prevent memory loss. Previously Elli held positions in both the public and private sectors, and has an M.B.A. from Harvard.