My 85-year-old mother has dementia, a memory loss disease that affects about 60 million people in the U.S. And so I can relate to the challenges of fighting the disease that John DenBoer has dedicated his life to fighting. He has started a company called Smart Brain Aging that has created brain-training exercises that he hopes can hold off the onset of dementia, which has seven different stages.
DenBoer’s own grandmother suffered from dementia when he was going to medical school, and it became his obsession to treat it. He became a clinical neuropsychologist and researcher in hopes of treating dementia. And his research shows that cognitive and functional impairment in early stage dementia can be slowed by the right kind of cognitive exercise. His company has created a cognitive training program, an iOS app called Brain U Online, that prevents memory loss and mitigates functional decline.
The company said it can delay early stage dementia by as much as 2.5 years, while reducing cognitive impact by up to 45 percent. Brain U Online is available through an online subscription for people 50 and older, and Smart Brain Aging is working with national hospital chains including Dignity Health and Innovative Care Partners in hopes of getting the game in front of a million patients in a very short period of time.
In a TEDx Talk last year, DenBoer said, “That to me is the worst thing about this disease. It kills us before we die.” The disease, where the brain shrinks faster than it normally does, can develop in your brain six to eight years before you show any symptoms, DenBoer said. The treatment is to give our brains something new and novel, which releases a chemical (glutamate) in your brain and prevents your brain from engaging in that accelerated shrinkage.
“This is a simple lifestyle change that you can make,” he said.
Everybody knows someone who has had dementia or Alzheimer’s disease, DenBoer said, because they have become so pervasive as our bodies outlive our brains. He describes it as a “pandemic level disease worldwide.” DenBoer is the subject of an upcoming Netflix documentary, This is Dementia, and a book as well. DenBoer presented about this topic last week at the Alchemist Demo Day at SRI International in Menlo Park, California. And I interviewed him on the phone.
The market for products and services for seniors is expected to surge past $436.6 billion this year, with as more than 75 million baby boomers continue to age and live longer. It is estimated 28 million Boomers will develop Alzheimer’s by 2050, of which dementia is a symptom. The need for services to help manage and mitigate symptoms will be crucial, and drive continued growth.
Here’s an edited transcript of our interview. This story, by the way, is one in a series of stories in which I’ll talk about my elderly mother, and technology that might help her.
VentureBeat: My 85-year-old mother has dementia, and so I am interested in what your company is doing.
John Denboer: Oh my. I’m sorry to hear that. We strongly feel it is important work we are doing. I’m sorry to hear that.
VentureBeat: Thank you. I wondered how you got the idea of doing some kind of puzzle- or game-like training for people.
DenBoer: I started this because of my grandmother. My grandmother raised me for a good period of my life, and she was extremely important to me. She developed dementia in her late eighties. We lost her as the person she was before she physically died. It’s one of the most horrible experiences that someone can go through, losing their personhood.
I was at Harvard University at the time, and it galvanized me to change my career path a bit and take on my mission to help develop anything I can to help prevent or mitigate dementia as a disease. That was in 2004, 2005. It’s take off since then. But that was the foundational personal experience that led me to try to do everything I can to help get in the way of dementia.
VentureBeat: When you start figuring out this particular path, that dementia in some way could be prevented or held off or treated?
DenBoer: We were researching this at Harvard Medical School and Boston University School of Medicine between 2004 and 2007. At that time we were involved in a randomized clinical trial looking at the effects of cognitive intervention, essentially brain activity, on mitigating and helping to prevent or delay the onset of dementia. There were some good results that came out of that trial, and I decided to switch my career — at that point I was an intern — and became a resident down in Arizona at a place called Barrow Neurological Institute.
I continued to pursue it from there. I worked with Medicare for a couple of years to make the research we were working on publicly available, and then convinced them, over the course of about three years, to change their regulations regarding reimbursement for this. Once they did, we essentially had a bit of a small business model, a research lab that eventually became a business.
VentureBeat: Can you describe where you’re at now?
DenBoer: Right now we’ve been working on — we’re a Delaware C corp. We’ve been incorporated about three years now. We’ve been developing two product lines. One is an online platform where we offer dementia-related brain activity, essentially brain games, but really more like digital therapy. It’s called Brain U Online. We have about 10,000 users, but we’re developing an initiative to scale to 250,000 users in the next month. We also have a Medicare-reimbursable clinic-based product that we work with in assisted living and independent living arrangements.
As a company, we’re serving about 5,000 individuals, or about 15,000 if you count the online platform. We’re doing $3-4 million in revenue this year as a startup. We’re affiliated with Alchemist Accelerator, and we’re looking to raise a Series A round. We’re pitching a demo day on Thursday.
VentureBeat: I know Lumosity was fined by the FDA for their advertising around brain health games. How do you distinguish from something like that? What have you found that really gets results as far as brain activities?
DenBoer: Let me answer the second question first. What works is doing new and novel exercise, doing things people have never done before. What doesn’t work is doing repetitive games or teaching people to the test. One thing Lumosity was criticized for, besides their advertising, was that they were teaching people to a test, to the exams they were giving. People were improving their test scores, but they weren’t discernably improving, because they were being taught how to do the tests they were given.
One thing we do that’s different is we offer new and novel exercises, things people have never seen before. That helps release a chemical in the brain called glutamate, and it helps prevent the brain from shrinking at an overall progressive rate, like in advanced cortical atrophy. Advanced cortical atrophy is a hallmark of all forms of dementia. In that way, we mitigate or help prevent Alzheimer’s disease and other forms of dementia.
Lumosity, just to address the first part of the question, did something really good for our field. They opened up a large amount of people to brain games, to the use of brain games as a potential digital therapy. The only problem is that they did so without any research backing, and in a disingenuous way. They were correctly and accurately criticized and sued by the FDA in 2013 for false advertising in this particular area.
We have the research backing. We’re a research lab that became a company, rather than the other way around, a company that tries to do research. We pride ourselves on our research backing. The research engagements we have include Harvard, UCLA, and some local engagements here in Phoenix. We do things differently because we have research-based exercises, but we also do things differently because we introduce new and novel learnings to individuals.
VentureBeat: What are some of the results you’ve seen so far?
DenBoer: We can mitigate the disease, lessen the extent of it, by 40 to 50 percent. We can reduce the onset of disease, push out the onset of disease by 2.25 years. If somebody has dementia up through about stage two, we’re able to reduce the intensity by 40 to 50 percent. If somebody is aging, we’re able to push out the disease by as much as 2.25 years.
VentureBeat: How much activity do the subjects have to do every day or every week?
DenBoer: They about one to two hours of activity per week. On our online platform, it syncs their calendar and schedules it for them, so they do one to two hours of training per week. They can do it in different spurts, like 15- to 30-minute increments. But they do about one to two hours per week altogether.
VentureBeat: Is the idea essentially that if you’re using your mind, it’s not going to decay over time?
DenBoer: Yes, absolutely, but you have to use it in the right way. One of the major things Lumosity did wrong is they perpetuated this myth that just using your mind is enough. Using your mind is good, but it’s really not that much better than not using it, if you’re just doing the same things all the time.
An example would be, my grandmother got through stage three dementia. She would do the New York Times crossword puzzle up through stage two or stage three, even though she didn’t know the names of her family members. People can do things and do them well, things they know how to do, up through stage two or stage three dementia. This is a very common phenomenon, and it’s very misleading to both doctors and people interested in caregiving.
We introduce new and novel things, things people have never seen or done before. In doing so, that’s helpful and assistive in releasing this chemical, glutamate, which helps engage in this cascade of neurochemical reactions that helps prevent the brain from atrophying.
VentureBeat: What are some of the games like, if you were trying to describe this to someone who isn’t familiar?
DenBoer: We think of what we do as a digital therapy. It’s more like a drug that people are prescribed. On the surface it’s a brain game, but in Phoenix we have physicians in health care organizations prescribing this as a therapy for people in their fifties, sixties, and even their early seventies, people who want to prevent the onset of disease. We think of ourselves more as a prescriptive digital therapy than a brain game per se. We don’t lump ourselves into the brain game market.
VentureBeat: What are the different stages of dementia like? I think you said that this can primarily apply in the first couple of stages?
DenBoer: The stages of dementia are stages one through seven. Stage seven is absolutely the worst. Stage one is just experiencing some very minor problems that can be almost imperceptible. We work through stage three. We give someone an accurate assessment of where they’re at as far as stage, and we give them customized brain exercises they can do up through about stage two or three that would be helpful to prevent their dementia from getting worse.
These are called the Alzheimer’s criteria. Those stages can be found very easily on websites like the Alzheimer’s Association. It’s a very common structure that people use.
VentureBeat: At some point, though, is there some line where you find that even this can’t help people?
DenBoer: Past stage three, nothing can really assist people. It’s more of a comfort care situation. At that point nothing can be significantly helpful, unfortunately.
VentureBeat: How do you get it started, and how do you charge for it?
DenBoer: Right now we have two ways of charging for it. We have a subscription model, where people can log on to our website, BrainUOnline.com, and we have fee-for-service, subscription type of thing where people pay $19.99 a month if they pay for a year up front, or $29.99 per month if they’re paying month-to-month. We do offer a free 14-day trial for people that are interested in trying out a limited version of the program.
We also are developing the first ever Medicare reimbursable form of online exercise. We’re working with Medicare to make sure it can be Medicare reimbursable as well. That’s an initiative we’re undertaking. We’re working with a couple of hospitals here in Phoenix to expand the program to more than 250,000 individuals.
VentureBeat: How much material do you have for people to go through? Could it last for years? How do you generate that?
DenBoer: We have material for years. We generate it out of a pool of exercises we developed at Harvard. That pool has become somewhat limited at this point, so we’ve been developing more new and novel exercises. We have about three and a half years of exercises at this point to keep people in exercises as we’re doing them.
We also have a social platform where people can interact in classes. The whole format is called Brain U Online, as I say. People can interact in classrooms where they’re grouped together via a personality algorithm. They answer some personality questions and they’re grouped together with like-minded individuals that share similar interests and have a similar cognitive profile. They do they exercises online, but they can’t progress to the next unit of exercises without their whole class getting through it. There’s a social component, a social incentive for them to complete their exercises as well.
VentureBeat: How many people are working for you now? Can you tell me more about the money you’re raising?
DenBoer: We have 45 people that work for us at this point. Sal Kohgadai is our chief technological officer. He’s up in the bay today, and I’ll be there tomorrow. We’re raising our first Series A, an $8 million round. We have, right now, about $6 million committed of that round. We’re looking for some additional partners, syndicate investors, to come in and round out the last $2 million. We’ve been fortunate, and we’re excited to try to close that last $2 million, close the round by the end of the month.
Our big initiative is to scale our product from 10,000 users up to 250,000 in a month. That’s our big plan. The company is currently valued at $18 million as far as pre-money valuation. It’d be great to see people attending the demo day to see all the great companies Alchemist has to offer.
VentureBeat: As far as the help you have right now to get to that larger scale, do you have any partnerships working on that?
DenBoer: We have substantive partnerships. One is with Dignity Health. Another is with Honor Health. Honor Health is here locally in Phoenix. Then we have a couple of other major partnerships that we’re developing with Banner Health and some other folks.
We’re also engaging in partnerships with accountable care organizations. Accountable care organizations are responsible for fiscal management of larger hospital chains. Our product is something that saves companies money significantly, and we’re looking forward to having not only improved clinical efficacy for patients, but also fiscal assistance to these ACOs that are looking to save money by providing excellent health care and innovative services to their patients.
This whole market of digital therapy is a new and emerging one. There was an excellent article in the New York Times a few months ago about it. We’re differentiating ourselves from brain games like Lumosity. It underscores the fact that applications and digital mechanisms can be used on a prescriptive basis in medicine. We’re excited to be considered in the class of digital therapy, not just in the old class of brain games.
VentureBeat: I’m starting to see insurance companies take the lead on a variety of these fronts, doing more of these kinds of preventive tasks.
DenBoer: Right. They’re starting to pay for this stuff, because they see the value in it, in many forms. With diabetes care, chronic care management, and so on, so many people are using apps and other forms of digital health care. Prescribing and paying for these things is a new evolution that’s happening. It’s an interesting area of health care that’s innovative and dynamic, and in the end very useful to patients.