Digital Therapeutics for Geriatric Psychiatry: From Laboratory to Clinic

Abstract

Despite recent advances in medication treatment for abnormal brain aging such as depression and dementia, it has become increasingly clear that pharmaceutical – based therapeutic strategies have significant limitations in the percentage of patients that benefit, the degree of clinical improvement, the durability of that improvement, the risk of side effects, and cost. Patients who suffer from age-related cognitive deficits have few, if any, efficacious treatment options. Advances in computer science, programming, and portable technology have begun to offer the opportunity for development of digital therapeutics, leveraging novel neuroscience and cognitive science–based approaches, using algorithms as the delivery mechanism to enhance brain function through strengthening cognitive operations and neural network functioning in patients with disorders such as late life depression, cognitive impairment following medical treatment, and dementia. These approaches take advantage of existing neural plasticity, particularly in the frontal lobe, in the aging brain to enhance critical cognitive operations in executive functions which support attention, working memory, and episodic memory performance, but also transfers to clinically meaningful change in symptoms and functioning. Collaborations with game designers, artists, engineers, bioinformaticists, as well as integration of iterative design models and participatory design enhance the likelihood that these cost-effective, and increasingly efficacious platforms can deliver personalized interventions (via telemedicine) directly to patients. Improved access to empirically supported, non-invasive treatments has the potential to revolutionize treatment of geriatric cognitive and mood disorders.This symposium will review the cognitive neuroscience underlying neuroplasticity–based approaches to the treatment of mood and cognitive disorders in geriatric psychiatry and illustrate its potential by examining early therapeutic studies in late life depression (Manning), cognitive impairment following cancer chemotherapy (Vega), and mild cognitive impairment (Conley). Strengths and limitations of this therapeutic approach as well as practical issues such as patient selection, dosing, duration, and implementation will be discussed. The potential for combination approaches with medications that could potentially enhance the plasticity effects of these digital therapeutics will be briefly presented. Discussion will focus on the usability, clinical utility, behavioral adaptations, implementation, limitations and capacity of this technology to deliver a new method of intervention for neurocognitive and affective disorders in the aging brain.The potential for computer-based digital therapeutics has never been brighter in many areas of medicine and geriatric psychiatry is ideally positioned to take advantage of this rapidly emerging technology.