Akili, Pfizer, and the Rise of Videogame Brain Therapies
The idea that playing video games can affect your brain has been around for a while. Now a startup and a big drug company are setting up a clinical trial to answer a specific question—namely, whether a video game can predict which players are at risk for developing Alzheimer’s disease.
Akili Interactive Labs, based in Boston and San Francisco, is working with pharmaceutical giant Pfizer to plan out a new study involving about 100 elderly people. The patients will be healthy, but half of them will have amyloid in their brains, as seen in imaging scans—meaning they are at high risk for Alzheimer’s—and half will not. The trial will follow their progress in playing Akili’s tablet-based video game at home over the course of a month.
By analyzing the patients’ game performance, the companies will figure out whether Akili’s technology can differentiate between the two groups—and thus be used as a “biomarker” to detect early signs of Alzheimer’s.
A positive result would be significant in a field where early detection is a big problem. So far, it sounds like Pfizer is primarily interested in Akili’s game as a monitoring tool for selecting and assessing clinical-trial patients.
To Akili’s knowledge, this is the first clinical trial of a video game run by a major drug company. But the notion of using games to assess and improve mental health has been brewing for years in scientific and business circles, and the field is beginning to mature. For its part, Akili is also running a number of other clinical trials around the country (more on that below).
“In the past year, pharma has started to get more interested in digital health as it relates to patient engagement and disease management and reporting,” says Eddie Martucci, a senior associate at Boston-based PureTech Ventures, who leads Akili’s research and development.
Indeed, the Akili-Pfizer collaboration is an example of mobile apps and devices “entering into the medical mainstream,” says PureTech partner Eric Elenko, Akili’s chief business officer. “What we believe will drive acceptance by medical leaders will be data.”
Akili got started in early 2011, based on research by Adam Gazzaley’s group at the University of California, San Francisco. Gazzaley, an Akili co-founder, works on the science of neuroplasticity and enhancing cognitive abilities through training. PureTech Ventures incubated the startup with the idea of developing a videogame platform that could detect brain disorders like ADHD and Alzheimer’s, as well as improve cognitive function. The five-person company has raised a total of $7 million in venture capital, grants, and industry collaborations with Pfizer and Shire.
Lest you scoff at the big picture, there is recent science to back up Akili’s approach. In September 2013, Gazzaley’s team published a paper in Nature concluding that videogame training can improve “cognitive control”—multitasking, attention, and memory function—in older adults. People showed better brain performance and neural activity after four weeks of training on a 3D driving-and-multitasking video game (played for one hour, three days a week), and the effects lasted for six months without further practice.
That level of scientific support is lacking in most commercial apps and games out there that claim to improve brain function. (Indeed, other studies suggest that playing certain violent games increases aggression and reduces self-control in kids, even as it may improve spatial navigation, reasoning, and memory skills.) But companies like Lumos Labs (Lumosity), Dakim, Posit Science, and newer startups like LinkedWellness have made progress and are trying to cash in on the digital set’s desire to get smarter, be more productive, and stave off cognitive decline.
One thing that sets Akili apart: it’s planning to sell its product as an FDA-approved medical device as well as a monitoring tool for pharma companies. Of course, it will take a lot of convincing before doctors are willing to prescribe a video game to patients. But setting the bar high means that if Akili is able to get to market, it could have a lot more credibility than its consumer-focused peers.
“They’re trying to build something with a much higher pedigree,” says Ben Sawyer, the co-founder of Games for Health Project, a network of developers and researchers that supports the use of video games in healthcare.
Another differentiator is the detailed design of Akili’s game (see screenshots). The platform, called Project Evo, was developed with all the intricacies of today’s tablets and smartphones in mind. You navigate your character through a complex 3D world, steering with your tablet and earning rewards, and simultaneously deal with other tasks, such as tapping on objects that pop up, but only if they are a particular color, say.
“We set out to make something accessible to a really wide range of people who might play a game, which is unusual,” says Matt Omernick, Akili’s executive creative director, who is based in the Bay Area.
For example, the game world features bright colors, cutting-edge graphics, and modern dance-beat music, but the main character is fairly neutral-looking, and there’s an older doctor character who serves as the player’s mentor. (Some of his equipment looks like it’s from the 1960s.)
Omernick previously worked at LucasArts and Electronic Arts—he led art direction for the Star Wars game franchise and Medal of Honor—and he has been with Akili since 2011, after doing consulting for Gazzaley’s lab. He has found a surprising amount of overlap between neuroscience and gaming, from trying to understand how the brain works—its reward pathways, what triggers addiction, and so forth—to the trial-and-error process of designing both games and cognitive experiments.
One challenge you’ll hear from game developers is that a “clinical” game will be less fun to play. Omernick is well aware of that notion. “I thought we’d have to give up part of the fun in exchange for the science. Not only was that not true, but we turned it around,” he says. He can’t reveal the specifics, but a key moment in the game was driven by scientific constraints, he says, and ended up being one of the best parts.
In fact, Omernick says, “I would tell game companies to hire a neuroscientist.”
That’s all well and good. But Akili will need to show that its technology works as a diagnostic tool and has clinical benefits—and then it has to make money. The company’s market strategy is broad, in that its game platform targets the brain’s “executive function,” Martucci says, rather than specific diseases.
“The clinical path is always a bit daunting,” he admits. “But what we have going for us, what gives us a nice edge, is multiple patient populations and multiple uses.”
In addition to the Pfizer study on elderly people, which should get underway later this year, Akili is running trials with Duke University in children with ADHD; kids with autism spectrum disorders; college students in Vermont with autism, ADHD, and other cognitive deficits; and two studies in people with depression.
By the end of 2014, the company says, more than 400 people will have participated in clinical trials of its game platform. In several studies, the startup is already testing for therapeutic results of the game—whether (and how) it leads to any sustained cognitive benefits—as well as its diagnostic capabilities.
Akili has a “big data” strategy here, too. By collecting game-play data at 30 frames per second of every run by every subject, the company hopes to improve the efficacy of its software and eventually make it adaptive in real-time for each player. And it will analyze behavioral differences between patient populations (and across studies) to sharpen its search for “cognitive signatures” of specific diseases and potential therapeutic benefits, Martucci says.
Of course, making sense of all that data from such a complex game environment, and doing it objectively, will be a major challenge. But if the number-crunching goes according to plan, Akili hopes to ride the wave of digital health into doctors’ offices and patients’ living rooms.
Meanwhile, the healthcare and gaming industries will be watching closely. Games for Health’s Sawyer, for one, thinks Akili is on to something and is the furthest along of its peers.
“You’re starting to see this area of neuro-therapeutics delivered as games, moving beyond the ‘brain training,’” Sawyer says. “It’s really nice to see some of the startups in the space seem to bring a larger sense of maturity, goals, scale, and polish in terms of the whole apparatus.”
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