My big idea: Cambridge Uni spin-out Cognetivity Neurosciences

Hi Dr Sina! What does Cognetivity Neurosciences do?

I co-founded Cognetivity in 2013 as a spin-out of the Cognition and Brain Sciences Unit at the University of Cambridge. Now commercially active across three continents, our flagship product CognICA - is a brain health screening platform that combines AI with the latest neuroscience to accurately detect early-stage cognitive impairment.

In a nutshell, CognICA is an app that tests for dementia and impairment of cognitive function. It runs on an iPad or tablet. It is FDA-registered and CE-marked Class II medical device.

We developed the CognICA test as a rapid visual categorisation task, to be delivered on standard consumer touchscreen devices. It takes advantage of millions of years of human evolution, specifically the human brain’s strong fear or food reaction to animal stimuli. During the test, 100 natural, grayscale images are presented to the test-taker for 100 milliseconds each. 50 of the images contain an animal; the other 50 do not. The images also vary in terms of their complexity and a number of other statistical properties.

The test-taker is asked to respond as quickly and accurately as possible to each image, tapping on the left or right half of the touchscreen to indicate whether or not they see an animal. The accuracy and speed of responses are then assessed using an artificial intelligence (AI) engine, which compares the test-taker’s performance to ICA tests previously taken by healthy and cognitively-impaired individuals.

Being language agnostic, not subject to any educational bias and not able to be learned, it is an ideal tool for population health management, built for rapid and scalable deployment across global healthcare systems.

Our mission is to establish a new global standard in brain health, bringing about improved health outcomes for millions of people across the globe and saving a growing portion of the trillions of dollars expected to be incurred in the coming years in associated patient care and treatment costs.

What's your biggest strength?

As a company, our biggest strength is in our technology’s potential to revolutionise the diagnosis and treatment of brain health. Much in the same way the ubiquitous blood pressure monitor has become a cornerstone of cardiovascular care, the CognICA delivers a quick and simple gateway to accurately understanding the state of a patient’s brain health.

Being language-independent and free from cultural and educational biases, it can provide objective assessment across diverse populations.

What can be understood, can be treated and this makes this journey an incredibly exciting one to undertake.

What made you think there was money in this?

Brain health represents the biggest healthcare challenge of the 21^st century. Nearly 1 billion people worldwide suffer from a mental disorder: dementia, depression, schizophrenia, post-traumatic stress disorder and other neurological and mental health problems which will cost the world economy US$6 trillion in ill health and reduced productivity by 2030.The primary issue lies in detecting such conditions early enough for effective treatment to take place, as the cognitive assessment tools currently available are based on decades-old science and lack the precision and sensitivity required to be effective in clinical settings. Thus, the market has an enormous and unmet need for an effective, low-cost and scalable solution for detecting cognitive impairment at scale.

The global market for cognitive assessment is projected to grow from US$3 billion in 2020 to US$11 billion by 2025 (CAGR 30%).

How did you research the niche?

My grandmother suffered with dementia and the more I learned about the disease the more I became aware of the size of the problem with dementia detection. Half of people with dementia in the UK and US – the most advanced healthcare systems in the world – never even get a diagnosis. Shockingly, they die without ever being officially diagnosed. And many of those people who do receive a diagnosis receive it so late that their lives are already severely impacted and their options for treatment are limited.

Where is the business today?

The company has early-mover advantage in a rapidly-growing market with high barriers to entry; its technology is fully validated from a scientific and regulatory standpoint and its IP is globally protected. The company is poised to enter a high-growth phase.

CognICA’s is already deployed in multiple countries within numerous primary and secondary healthcare settings.

In future, we will also be targeting: Telehealth providers – providing a value-added service beyond the core platform, EHR providers – providing a value-added service beyond the core EHR application, Insurtech – delivering CognICA as part of regular health check-ups, corporate wellbeing – delivering the CognICA as part of regular health check-ups, and biopharma companies – enhancing drug development clinical trials (recruitment tool, outcome measure) and drug rollout (patient subtyping, beyond-the-pill adjunct)

What is the secret to making the business work?

It is true that, in recent years, we have all become more aware of the importance of looking after our brains. However, the global healthcare system remains desperately under-equipped when it comes to tackling the brain health challenge.

To give an example of our potential, we can see a parallel in how the refinement and widespread introduction of blood pressure monitors revolutionized the management of cardiovascular disease. From heart attacks and heart failure to strokes, peripheral arterial disease and aneurysms, regular blood pressure testing has led to vastly improved outcomes across a wide range of conditions and afflictions. Blood pressure monitors are known to have such a positive impact on the management of cardiovascular disease that they can be found not just in every clinician’s office but in many homes.

Yet, while the world stands on the edge of a brain health crisis, there is no tool that functions as the equivalent of a blood pressure monitor for brain disease, picking up the earliest signs of malfunction and directing hundreds of millions of people towards medical treatment at a stage when intervention is still at its most effective.

The fundamental problem is that existing cognitive assessment tools suffer from a plethora of limitations. Based on decades-old science, they employ crude testing methods that lack precision and sensitivity to early-stage impairment. They are biased in relation to test-takers’ educational and cultural backgrounds, as well as whether they have taken the same test before, meaning that such tools lack objectivity and are unsuitable for long-term monitoring. They also suffer from numerous practical burdens: they are time-consuming, require expert administration, must be used in translated form in different countries and cannot be delivered remotely.

The result is a lack of engagement and early intervention in brain health, leading to worse health outcomes for billions of people. This is where CognICA comes into its own.

How do you market the company?

We are interested in three key markets: clinical cognitive assessment, population health management and integrated partnerships.

Within the target markets listed above, we target high-ranking executives and influencing members of the care teams. Initial campaigns involve direct outreach from the commercial team to Chief Medical Officers; COOs; CEOs; EVPs/VPs of Primary Care, Family Medicine, Clinical Operations and Nursing Operations; and Clinical Directors across the board. This allows us to demonstrate the effectiveness of the CognICA in clinical environments (health economic evidence) and allows data to be collected to support the company’s reimbursement strategy for CognICA.

More broadly, Cognetivity engages, via multiple channels, with physicians, neurologists and therapists operating within the systems where CognICA has been shown to have the most significant impact. Our aim is to educate and inform and create bottom-up demand.

What funding do you have? Is it enough?

To date we have raised US$10 million in financing and received a US$2 million UK Government grant. The company is listed on the Canadian Stock Exchange (CSE) under the ticker symbol CSE: CGN.

Tell us about the business model

We are currently commercially active across three continents, having secured commercial agreements in the US, the UAE and the UK. Large-scale deployment in new territories can be achieved very quickly because CognICA is cloud-based and delivered on standard consumer hardware. The company’s target sales territories for CognICA over the next three years are as follows. In year one, continued expansion in US, UAE and UK. Year 2, we'll expand to Saudi Arabia and Germany. Then in year 3 to Canada, Australia and France.

The most popular pricing model is a volume-based approach whereby pricing is done on a decreasing per-test basis. Other models include a license-based model (price per number of licenses or users, with unlimited testing), an enterprise model (open number of users, pricing calculated based on forecasted number of tests per year) and a per-patient model (usually for a specialized center with a specific number of patients under its care).

Our growth strategy is built on a cutting-edge product pipeline, structured around the clinical-grade ICA as the powerful core of a wide range of technological solutions.

What were you doing before?

My background is in scientific academia. During my doctoral studies, I served as a technology consultant and teaching assistant. After completing my PhD at Cambridge University’s Institute for Manufacturing in 2011, I served as a researcher and application specialist. In this capacity, I worked with the R&D departments of some of Europe’s largest companies, across a wide range of sectors, concentrating primarily on healthcare.

What is the future vision?

Our ultimate aim is for CognICA to become a commonplace method of cognitive health screening, ubiquitous in every doctor’s surgery and healthcare setting. Our technology is already CE marked and having recently received FDA approval, our ambition is for the test to become a cornerstone of the mental health treatment pathway – much in the same way that the blood pressure monitor has become the same for cardiovascular care.

As things stand, we are very well positioned to expand on our early market successes with a technology platform that offers huge advantages over currently-available methods for measuring cognitive function, in an area of massive unmet need in healthcare globally. We also have a number of near-term value-adding milestones that will help to accelerate growth and are excited by the opportunities in front of use to change the worsening status quo of global brain health detection and treatment.