Spring 2024 (adapted from Medium’s Future Human Series – 2018)
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Our lives on this planet have improved in many meaningful ways over the last century. On average, we are healthier, more literate, and live longer than ever before. Despite these positive changes, clear signs exist that we are in the midst of an emerging crisis that has not yet been fully recognized, even though it lurks beneath the surface of our casual conversations and swims in the undercurrents of our news feeds. This is not the well- established crisis that we inflicted upon the earth’s climate, but one that is just as threatening to our future. This is a crisis of our minds – a cognition crisis.
A cognition crisis is not defined by a lack of information or skills. We have done a fine job in accumulating those and passing them along across millennia. Rather, this a crisis at the core of what makes us human: The dynamic interplay between our brain and our environment, an ever-present cycle between how we perceive our surroundings, process this information, and act upon it. This ancient perception-action cycle ensured our earliest survival by allowing our primordial ancestors to seek nutrients and avoid toxins. It is from these humble beginnings that the human brain evolved to pursue more diverse resources and elude more inventive threats. It is from here that human cognition emerged – attention, memory, perception, creativity, imagination, reasoning, language, decision making, emotion regulation, empathy, compassion, wisdom – enabling us to thrive in an increasingly complex and competitive environment. And it is here that our crisis exists.
Over a billion people around the world are suffering debilitating impairments in cognition: major depressive disorder, generalized anxiety disorder, autism, post-traumatic stress disorder, dyslexia, obsessive-compulsive disorder, attention deficit hyperactivity disorder (ADHD), addiction, dementia, and many more. There is an immense personal, societal, and economic impact of this dysfunction, with a financial toll of trillions in healthcare costs and lost productivity. Despite substantial investment in basic research and treatments, the prevalence and impact of these conditions are significantly increasing, notably in our youth and seniors. To some degree, these trends reflect the overall growth and aging of the world’s population, as well as growing awareness leading to more frequent diagnoses. However, the magnitude of the escalation suggests a deeper problem.
Critically, the cognition crisis extends beyond what has been referred to as a mental health crisis. Even if one’s cognition and functioning does not meet criteria for a medical diagnosis, challenges to our perception, attention, emotions, memory, decision making, and empathy confer a real-world cost on the quality of our lives. And it’s getting worse, e.g., creative thinking and empathic concern have been declining in children and teens, and the Flynn Effect — a world-wide increase in intelligence over the last century — is showing signs of stagnation and even reversal in some developed countries. You just have to read the news to appreciate the state of the human mind in our world today.
Our brains have simply not kept pace with the rapid transformations to the environment that we introduced, notably the ubiquity of powerful information technology. At our core, we humans are information-seeking creatures, and so a profound shift in the flow of information will inevitably have major effects on our lives. Unfortunately, much of that impact has been negative.
The extreme plunge that we’ve taken into the information age on the heels of the digital revolution has radically changed the environment that we interact with daily. The old environment – the one in which higher-level cognition evolved from the perception-action cycle to support our survival – is gone. The new environment, where multisensory information floods our brain like water blasted from a firehose, challenges us at a fundamental level. This has been shown in the laboratory, where scientists have documented the influence of information overload on attention, perception, memory, decision making, emotional regulation, and in the real world, where technology use has been connected to rising rates of depression, anxiety, suicide, and attention deficits, especially in children. This is not to deny underlying genetic factors, the existence of organic pathology, and multifactorial etiology, but the influence of the information environment on our minds is profound.
While the mechanisms that underlie these relationships are still being studied, rapid reward cycles have been associated with intolerance to delayed gratification and sustained attention; excessive information exposure has been connected to stress, depression, and anxiety; and multitasking has been linked to safety and productivity issues. Moreover, our constant engagement with technology interferes with the pursuit of behaviors that are critical for maintaining a healthy mind, such as nature exposure, physical exercise, interactions in the real world, and restorative sleep. Its negative influence on empathy, compassion, cooperation, and social bonding are just beginning to be understood.
Although there is cause for alarm, it’s not all doom and gloom. The information age has benefited our minds in many ways, notably by offering us an unprecedented opportunity to connect with one another and access to content and skill training that have addressed global inequities. The negative consequences of information technology are also now being recognized, feeding a growing awareness that development needs to be informed by an understanding of how our brain functions, its limitations and its vulnerabilities. And fresh ideas are emerging for how we might modify our behavior to foster healthier use of software and devices, essentially approaching the consumption of information in a comparable manner to the consumption of food.
But next-generation information technology, even when thoughtfully designed and well intentioned, will continue to challenge our cognition. Behavioral change alone is unlikely enough to be enough, especially as we find ourselves immersed in persuasive virtual realities guided by powerful artificial intelligences. Bottom-line, we need better functioning brains to thrive in this new environment.
There are two massive, global institutions that, on the face of it, seem well positioned to tackle the cognition crisis by developing, enhancing, and maintaining higher levels of cognition to meet the challenges of our environment: education and healthcare systems. Developing and enhancing cognition in healthy brains should be a core mission of education, and maintaining and remediating cognition in those suffering deficits should be a foundational objective of healthcare. However, neither incumbent has been effective in this regard; the infrastructure, regulation, funding, and processes are not available, and our cognition practitioners – teachers, therapists, coaches, psychologists, psychiatrists, neurologists – are simply not equipped with the tools or training to address the depth and breadth of the cognition crisis.
There are five aspects of our current education and healthcare approach to cognition that present major hurdles in addressing this crisis: 1) inadequate assessments, 2) poorly-targeted interventions, 3) lack of personalized treatments, 4) siloed practices, and 5) open-loop interventions (defined as an absence of real-time, data-driven adaptivity):
Here is an example of the status quo in the medical domain:
Sarah is a 75-year-old woman who presents to her doctor with concerns about her attention. She feels overly distracted and is alarmed by increasingly frequent “senior moments.” Following an outdated and inadequate paper-and-pencil test that is unaccompanied by functional brain imaging (inadequate assessments), she is placed on a drug used to treat dementia — an acetylcholinesterase inhibitor (poor targeting) — whose starting dose was based on population data from a clinical trial (non-personalized), and prescribed to her in isolation of other approaches, like physical exercise (siloed practices). After several months of subjectively monitoring effects and side effects, she returns to see her doctor for follow-up in a stressful clinic. This leads to an imprecise dosage adjustment, devoid of any data-driven decision- making, which sets off another long round of trial-and-error (open-loop system).
Sarah might have been fortunate enough to visit a top-notch physician who offered her extensive neuropsychological testing, a lower starting dose that is more appropriate for her age, an accompanying walking program, and frequent check-ins to review side effects and make dosage adjustments. But, even this scenario, which is as good as it gets right now, falls tragically short of the level of care that we should be receiving. This is the same disheartening scenario that all patients experience when seeking treatment for diverse neurological and psychiatric conditions: major depression, post-traumatic stress disorder, anxiety disorder, ADHD, autism, dyslexia, traumatic brain injury, multiple sclerosis, stroke, Alzheimer’s disease, Parkinson’s disease — all of them.
Advances in functional brain imaging have offered valuable insights into brain and cognition in the laboratory, but they have not jumped the gap to inform real-world practices (likely due to a lack of focus on individual differences). This reality, coupled with the use of imprecise, inaccessible, and outdated assessments of cognition, dominates today’s medical practices. It means that clinicians simply do not understand the brain and cognition of the people who are seeking their care.
When practitioners do make diagnoses of clinical conditions with impaired cognition, pharmaceuticals are almost always prescribed to treat the symptoms. But these are blunt instruments that broadly influence neurotransmitter systems and do not selectively target underlying brain networks. For some individuals, these medications have been lifesavers, but without specificity to target brain networks or modify underlying pathology, current treatments are highly imprecise and encumbered by side effects. There is nothing conceptually wrong with the idea of using a small molecule to improve cognition, but our medicines have not advanced after decades of effort by a multi-billion-dollar industry. While death and suffering from cancer, heart disease and infectious disease have declined, the reverse trend has occurred for inflictions of the mind: dementia, anxiety, depression, suicide.
The scenario is even more grim for children, because these same limitations exist in our education system:
Peter is an 11-year-old boy whose parents are concerned that he has attention issues. He is doing well in school, maintaining a B average, but is distractible and has trouble sitting still. Although his teachers share these concerns, he has never received a cognition evaluation (inadequate assessments), nor any intervention directed at improving his attention. What is unknown to everyone is that Peter’s sustained attention abilities are significantly below average for his age. A detailed assessment at the time would have made this clear and revealed that he was above average in other cognitive domains, which allowed him to compensate for his poor sustained attention. Ideally, this knowledge would have been obtained by precise, neuroscience-informed assessments at a young age, allowing him to receive a targeted, personalized, closed-loop intervention to enhance his sustained attention – but this is not what happens today.
Children take exams that assess their ability to regurgitate recently consumed information, but their cognition – e.g., abilities to sustain attention, manipulate stored information (working memory), and flexibly switch between task demands – is not evaluated unless clinical-grade learning differences are suspected. And even then, the assessments lack precision. And how about Peter’s capacity for creativity, emotional control, and empathy? Unquantified. While there are certainly exceptional teachers and schools that go the extra mile, they operate within a constrained system that has not prioritized assessment of cognition, and when it is evaluated, there is currently no systematic approach to make this data actionable.
Now, imagine that Peter’s teachers became convinced that his attention challenges are symptomatic of a clinical condition. His transition from the education system to the medical system begins, and it is just as problematic:
When Peter turns twelve, he starts junior high school, a disorienting whirlwind of new experiences and challenges that further stress his sustained attention. His grades now suffer, and his behavior degrades. He spends more time with peers who are similarly challenged and disenchanted, leading to his rejection of offers to help. His teachers are alarmed, and he is sent for an evaluation. This leads to a visit to a clinical psychologist and his first formal assessments, which lack sophisticated tests of cognition (inadequate assessments), but still earn him a diagnosis of ADHD and a daily helping of standard doses of Adderall (non-personalized).
And just like that, Peter went from student to patient. After treatment begins, he is more docile and gets in less trouble in class, but his grades do not improve. Both he and his parents are increasingly troubled that his formally explorative personality seems to be suppressed (poor targeting). The lack of a complementary behavioral intervention limits the development of his ability to master challenging academic demands (siloed practices). And infrequent, uninformed adjustments of drug dosage result in a failure to achieve the solution that Peter desperately needs (open-loop system).
Inadequate assessments, poor targeting, lack of personalization, siloed practices, and open-loop systems are major issues that prevent our education and healthcare systems from delivering interventions that develop, enhance, and maintain cognition. Medical practices have focused on symptom management, while education curricula have been directed at content transfer and skill development, both failing to quantify and directly target underlying cognition.
And what about generally healthy adults? Education has largely been for children and young adults, while healthcare has essentially been sickcare, leaving the wellness movement to bear the weight of enhancing and maintaining cognition throughout the lives of most people. Unfortunately, this field has been marginalized as an alternative and has not received the benefits of mainstream attention, regulation, or funding. We need a new path forward.
In response to a lack of effective solutions, new approaches for cognition enhancement that leverage modern technology are now being advanced. Interestingly, the same technologies that have been a source of the cognition crisis can play an important role in enhancing cognition. Like everything humans have ever created, technology is a two-sided sword. If we can advance beyond our current obsession with technology for entertainment and communication, there is an opportunity to build real-world cognition assessments coupled with targeted, personalized, multimodal, closed-loop interventions.
Mobile technologies are now being developed with a wide range of sophisticated sensors – touch screens, accelerometers, voice / speech interpreters, heart rate / respiration trackers, facial expression detectors, eye motion capturers, and brain activity recorders – coupled to accessible devices that interpret both passively- and actively-acquired data. This technology is perfectly positioned to serve as a basis for the next generation of cognition assessments, allowing us to better understand how our brain functions in the real-world and in real- time. These tools can yield much more nuanced assessments of cognition, distinguishing stable traits from fluid states, offering insights into the currents and tides of our abilities across the lifespan, and tracking its ebbs and flows in response to life’s unpredictable triumphs and traumas.
Using technology in this way must advance responsibly and with care to protect such sensitive data. It is also important to recognize that obtaining this type of information is coupled with a burden to overcome deep biases about cognition. Some people have a concern about monitoring perception, attention, and emotions, which does not apply to testing cholesterol, glucose, and blood pressure. This parallels the stigma of mental health disorders as being reflective of the quality of a person, e.g., referring to someone as being inattentive and having high blood pressure, the former defining them, and the latter being inflicted upon them.
As we obtain a more precise understanding of an individual’s cognition, it is critical that these data are not used to label or pigeonhole, but rather to actionably inform approaches that enhance cognition. Here too, technology can play a critical role. We are now learning how closed-loop systems can be engineered to maximally harness our brain’s plasticity. Closed-loop designs use sensors for real-time data feedback, with the goal of achieving and maintaining a desired state without human intervention. They are currently used in many physical appliances, e.g., home thermostats and clothes dryers constantly sense air temperature and moisture, respectively, and use these data to control how much heat is supplied, thus achieving and maintaining a predetermined room temperature and clothes dryness. While highly effective in inducing change and establishing equilibrium, these design principles have had very limited application in education and medical practices.
Technology-based interventions can now be designed using sophisticated closed-loop systems to generate digitally-delivered experiences that sense an individual’s performance in real-time to deliver cognitive challenges that are maintained right at the sweet spot – not too hard, not too easy. The brain responds to such challenges by modifying its structure, chemistry, and physiology to optimize function, a process known as neuroplasticity. The closed-loop system detects these changes in engagement (like a home thermostat sensing a drop in temperature from an open window) and dynamically adapts the parameters to maintain a constant level of challenge, thus driving continuous optimization of the brain.
Imagine playing a video game where detailed and accurate data about you in the moment (e.g., performance, emotional responses, body movements, and brain activity) are collected via sensors, and this data is used in real- time to adapt the game environment delivered to you (e.g., stimuli, challenges, and rewards). It is the nature of the stimulation and the mechanics of the interactions that activate brain networks selectively, something never accomplished with a molecule alone. And it is the adaptive aspects of the closed-loop experience that applies continuous pressure to modify underlying neural networks, harnessing your brain’s inherent plasticity to optimize function over time. It is like sparring with the ultimate personal cognition trainer.
Now imagine that the game mechanics and content are informed by the extensive scientific literature on the cognitive benefits of real-world experiences, so that aspects of physical exercise, meditation, social interactions, art, music, dance, story, and nature are integrated into these closed-loop experiences to yield personalized cognition enhancement tools. By leveraging affordable, safe, and accessible technologies that exist today (smartphones, tablets, wearable physiological devices, motion capture, and interactive media) we can better understand and improve our minds, unlocking the potential to address the cognition crisis right now.
Take a step into the near future and envision the role that innovations in artificial intelligence and sensory immersion technologies can offer. Imagine yourself deeply engaged in an adaptive multi-sensory virtual environment, where your full-body interactions are guided by an AI that knows you better in the moment than any human being is capable of. Such a closed-loop experience can be designed to optimally enhance your cognition, and by detecting and adapting to shifts in your perception, mood, stress, aggression, attention, and memory, maintain it at a high level throughout your life. I can imagine no better use for AI than to enhance and maintain HI – human intelligence.
By designing, developing, validating, and monitoring new technologies with the goal of not replacing or controlling us, but potentiating our control over our own minds, we can enhance cognition in healthy people, proactively prevent the slippery slide into debilitating clinical conditions, and remediate deficits in those of us who are desperately suffering. If we are rigorous and tenacious, we can achieve what may be technology’s ultimate promise: The delivery of experiences that foster the next phase in the evolution of the human mind. But something major is going to have to change for these advancements to make a difference in the setting of today’s intransigent institutions.
Addressing the cognition crisis should be positioned as a grand challenge, and placed on par with other pressing global priorities, such as eradicating infectious disease, disseminating clean water and stabilizing climate change. Relying on our incumbent education institution, or healthcare system, or consumer technology industry, or wellness movement, to tackle the cognition crisis is an ill-fated proposition. It is not as if we need to dial in the fine details of an otherwise well-oiled machine; there are deeply rooted, fundamental flaws at the core of our global systems of cognition enhancement. This calls for coordinated efforts by major international organizations, like the United Nations, WHO, and power brokers at Davos.
The stakes of not recognizing this crisis and its consequences are immense; not only is the quality of our lives in jeopardy, but success in addressing any of our global challenges depends upon us having the capacity to do so: high-level attention, reasoning, creativity, decision making, empathy, compassion, and wisdom. If we can’t focus our attention in a sustained manner and make wise, creative, and future-oriented decisions that prioritize others over ourselves, we will never effectively deal with complex, time-delayed crises like the one affecting our climate, no matter how much information we acquire.
To have a consequential and enduring impact, a grand challenge directed at enhancing cognition needs to be positioned as a broad pursuit aimed at individuals suffering from deficits in cognition, and for people who are generally healthy. There have been times throughout human history when societies have placed tremendous value on elevating the human mind. Now is just not one of those times, and the price for this neglect is growing.
This proposal of a global effort directed at enhancing human cognition should not seem foreign. We have long been obsessed with self-optimization in the physical domain: augmenting strength, endurance, power, speed, balance, flexibility, and coordination with specialized technologies and programs delivered by trained practitioners to yield benefits for entertainment, athletic, sports, rehabilitation, and fitness goals. But we are tragically lacking when it comes to optimizing cognition to save our lives.
Advances over the last hundred years have improved the overall health of our species. But for us to continue to thrive and flourish in the increasingly complex world we are creating, perhaps even to survive extinction-level crises, we must engage in the practice of turning the lens inward and looking for cracks in the mirror. A crisis is a time of great challenge when critical decisions must be made to avert future disaster. When it comes to the functioning of the human mind, the time has arrived. The status of cognition on a global scale is in crisis, and it is getting worse, especially for our children. Now is the time to take account of what we truly value in being human, embrace it and mend our broken minds.