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What are most promising lifestyle and tech options to harness lifelong
neuroplasticity, and what are key roadblocks ahead?...
Towards a Brain Health Index:
Perturbation-based Biomarkers
Alvaro Pascual-Leone, M.D., Ph.D.
Berenson-Allen Center for No...
Disclosures
• Scientific Advisory Board Member for Neosync,
Starlab, Neuroelectrics, Magstim, Axilum Robotics,
Constant Th...
www.brainfitclub.org
The Brain Fit Club
at BIDMC
1. Measure
2. Personalize Prescription
3. Supervise Interventions
4. Asse...
Brain Health Index
Monitor Progress
Adjust the Plan
Personalized Plan
https://club.bbhi.cat
Barcelona Brain Health Index
Transcranial Magnetic Stimulation
Controlled
Perturbation
Measure Evoked
Responses
1. (Noninvasive) Brain Stimulation offers valuable
translatable perturbation biomarkers to bridge the
model systems to hum...
Regional cortical hyperexcitability in
epilepsy
Shafi et al
Ann Neurol 2015
Mo Shafi
TMS: Paired-Pulse
Kobayashi et al Lancet Neurol 03
SICI
GABA-A
ICF
NMDA
Defective ICI
in Pain
Lefaucher et al Neurology 2007
GABA-A
GABA-B
Identifying inhibitory deficits in disease
Farzan 2010 Brain; Frantseva 2014 Cerebral Cortex
Faranak
Farzan
TMS-EEG measures correlate with cognition
Rogasch 2015 Cortex
Repetitive TMS:
Theta Burst Stimulation
Frontiers Synaptic Plasticity 2011; Brain Topography 2011; Eur J
Neurosci 2012
8 s...
TBS
Frontiers Synaptic Plasticity 2011Brain Topography 2011; Eur J Neurosci 2012
Measuring Plasticity in Humans
Lindsay Ob...
The efficacy of the mechanisms of
plasticity decreases over the lifespan
Frontiers in Aging Neuroscience 2011; Brain Topog...
r = -0.54
p = 0.001
12
10
6
4
0
ADAS-CogScore
2
8
-100 -50 0 50 100 150
T10 MEP Amplitude (% ∆ from baseline)
200
ADAS-Cog...
Age
Brain
Plasticity
CognitiveCapacity
Genetic Factors
Environmental Factors Individual Differences
Alteration of Mechanisms of Plasticity as
measured by TBS
LTD-like
Plasticity
LTP-like
Plasticity
Oberman et al
Eur J Neur...
CorticalReactivityandE/IBalance
CorticalPlasticity
TMS in Animal Models
NMDA-
dependent
LTD-like
effect
Mechanisms of cort...
Brain Health Index
Monitor Progress
Adjust the Plan
Personalized Plan
Barcelona Brain Health Initiative
David Bartrés-Faz
Faculty of Medicine and Health Sciences
University of Barcelona
Alvaro...
To better understand lifestyle determinants and their mechanisms leading to optimal
brain function in advanced age.
Prospe...
Disease DisabilitySymptoms
Diagnoses
Treatment
Health
Brain resilience
Preserved function
Resilience promotionPrevention
B...
Relevance of modifiable lifestyles to maintain brain health at old age
35% of cases with dementia are atributed to a
combi...
Erickson et al. PNAS 2011
Lifestyles and Brain Health: Lifespan & individualized perspective
Previous, reported
Current, i...
Cognitive activity Physical activity Nutrition Socialization
Sleep Vital plan General health
Lifestyle pillars in BBHI
30
BBHI apprach: combining observational and interventional studies
Longitudinal
prospective
cohort
+ 5,000 participants ...
31
Phase I: Healthy Habits Monitor
https://club.bbhi.cat
Peers
comparison
• ICT-based intervention
• 500 participants
• Personalized
• Individualized coaching support
• Motivation, adherence
• Sma...
In summary…..
• The BBHI combines a follow-up study cohort and a multimodal intervention to
investigate the impact of posi...
Simone Schürle, PhD
Responsive Biomedical System Lab
ETH Zurich
Department of Health Science and Technology
Institute for ...
36
06.10.201
7
37
06.10.201
7
38
06.10.201
7
Nanotechnology for Neurotechnology
39
06.10.201
7
Nanostructures: a platform for brain repair and augmentation
Image source: Vidu et al. Front Syst Neurosci....
40
06.10.201
7
Human Enhancement
https://toplink.weforum.org/knowledge/insight/a1Gb0000001k1imEAA/explore/summary
Global F...
41
06.10.201
7
Human Enhancement
Body Brain
Human enhancement aims to improve the
quality of life over its course, at any ...
42
Human Enhancement
4 main pathways
1) Manipulation and extension of our body and brains
2) Modifications of our genes, o...
43
Call for Code of Ethics
Key Issues
1) Equity and Social Justice
2) Maintaining Humanness and Autonomy
3) Transparency a...
44
Concluding Notes
▪ Responsible research and tech development
▪ Engagement of the public in this conversation
Need for e...
Lunch break
Please be back at 12.30pm US Pacific Time/
3.30pm Eastern Time for a fascinating afternoon!
Thank you, Speakers & Participants!
Thank you, Summit Sponsors!
Thank you, Summit Partners!
To learn more, visit sharpbrains.com
What are most promising lifestyle and tech options to harness lifelong neuroplasticity, and what are key roadblocks ahead?
What are most promising lifestyle and tech options to harness lifelong neuroplasticity, and what are key roadblocks ahead?
What are most promising lifestyle and tech options to harness lifelong neuroplasticity, and what are key roadblocks ahead?
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What are most promising lifestyle and tech options to harness lifelong neuroplasticity, and what are key roadblocks ahead?

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*Dr. Álvaro Pascual-Leone, Director of the Berenson-Allen Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center
*Dr. David Bartrés-Faz, Principal Investigator of the Barcelona Brain Health Initiative (BBHI)
*Dr. Simone Schurle, Assistant Professor for Responsive Biomedical Systems at the Swiss Federal Institute of Technology
*Chaired by: Dr. David Bach, Founder and President of the Platypus Institute

*Álvaro Fernández, CEO and Editor-in-Chief of SharpBrains
*Sarah Lenz Lock, Senior Vice President for Policy at AARP and Executive Director of the Global Council on Brain Health (GCBH)
*Dr. April Benasich, Director of the Baby Lab at the Rutgers Center for Molecular and Behavioral Neuroscience
*Chaired by: Dr. Cori Lathan, Co-Chair of the World Economic Forum’s Council on the Future of Human Enhancement

Slidedeck supporting session held during the 2017 SharpBrains Virtual Summit: Brain Health & Enhancement in the Digital Age (December 5-7th). Learn more at: https://sharpbrains.com/summit-2017/

Published in: Health & Medicine
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What are most promising lifestyle and tech options to harness lifelong neuroplasticity, and what are key roadblocks ahead?

  1. 1. What are most promising lifestyle and tech options to harness lifelong neuroplasticity, and what are key roadblocks ahead? Chaired by: Dr. David Bach, Founder and President of the Platypus Institute Dr. Álvaro Pascual- Leone, Director of the Berenson-Allen Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center Dr. David Bartrés-Faz, Principal Investigator of the Barcelona Brain Health Initiative (BBHI) Dr. Simone Schurle, Assistant Professor for Responsive Biomedical Systems at the Swiss Federal Institute of Technology
  2. 2. Towards a Brain Health Index: Perturbation-based Biomarkers Alvaro Pascual-Leone, M.D., Ph.D. Berenson-Allen Center for Noninvasive Brain Stimulation Division of Cognitive Neurology • Brain Fit Club Beth Israel Deaconess Medical Center & Harvard Medical School
  3. 3. Disclosures • Scientific Advisory Board Member for Neosync, Starlab, Neuroelectrics, Magstim, Axilum Robotics, Constant Therapy • I will talk about off-label applications of noninvasive brain stimulation • Listed inventor on various patents on combination of noninvasive brain stimulation with EEG and fMRI Alvaro Pascual-Leone, MD, PhD
  4. 4. www.brainfitclub.org The Brain Fit Club at BIDMC 1. Measure 2. Personalize Prescription 3. Supervise Interventions 4. Assess Benefit
  5. 5. Brain Health Index Monitor Progress Adjust the Plan Personalized Plan
  6. 6. https://club.bbhi.cat Barcelona Brain Health Index
  7. 7. Transcranial Magnetic Stimulation Controlled Perturbation Measure Evoked Responses
  8. 8. 1. (Noninvasive) Brain Stimulation offers valuable translatable perturbation biomarkers to bridge the model systems to humans 2. Characterization of the dynamics of such circuits can provide novel insights into the neurobiology of neuropsychiatric diseases and offer new individualized therapeutic opportunities Non-invasive Brain Stimulation Perturbation Biomarkers
  9. 9. Regional cortical hyperexcitability in epilepsy Shafi et al Ann Neurol 2015 Mo Shafi
  10. 10. TMS: Paired-Pulse Kobayashi et al Lancet Neurol 03 SICI GABA-A ICF NMDA
  11. 11. Defective ICI in Pain Lefaucher et al Neurology 2007 GABA-A GABA-B
  12. 12. Identifying inhibitory deficits in disease Farzan 2010 Brain; Frantseva 2014 Cerebral Cortex Faranak Farzan
  13. 13. TMS-EEG measures correlate with cognition Rogasch 2015 Cortex
  14. 14. Repetitive TMS: Theta Burst Stimulation Frontiers Synaptic Plasticity 2011; Brain Topography 2011; Eur J Neurosci 2012 8 s 2 s 200 ms Bursts of 3 pulses at 50 Hz 600 pulses over 192 s Following iTBSBaseline LTD-like Plasticity LTP-like Plasticity Following cTBS
  15. 15. TBS Frontiers Synaptic Plasticity 2011Brain Topography 2011; Eur J Neurosci 2012 Measuring Plasticity in Humans Lindsay Obermann Marine Vernet
  16. 16. The efficacy of the mechanisms of plasticity decreases over the lifespan Frontiers in Aging Neuroscience 2011; Brain Topography 2011 Caterina Freitas Age [years]20 80 BrainPlasticityIndex 10 50
  17. 17. r = -0.54 p = 0.001 12 10 6 4 0 ADAS-CogScore 2 8 -100 -50 0 50 100 150 T10 MEP Amplitude (% ∆ from baseline) 200 ADAS-Cog score by T10 Plasticity Peter Fried NIDDK NINDS The Mechanisms of Plasticity Predict Cognitive Function
  18. 18. Age Brain Plasticity CognitiveCapacity Genetic Factors Environmental Factors Individual Differences
  19. 19. Alteration of Mechanisms of Plasticity as measured by TBS LTD-like Plasticity LTP-like Plasticity Oberman et al Eur J Neurosci 2012 Autism Spectrum Disorder Koch et al J Alz Dis 2012 Brem et al Ann Neurol in press Alzheimer’s Disease Fried et al DM2Translatable Phenotype
  20. 20. CorticalReactivityandE/IBalance CorticalPlasticity TMS in Animal Models NMDA- dependent LTD-like effect Mechanisms of cortical reactivity and plasticity
  21. 21. Brain Health Index Monitor Progress Adjust the Plan Personalized Plan
  22. 22. Barcelona Brain Health Initiative David Bartrés-Faz Faculty of Medicine and Health Sciences University of Barcelona Alvaro Pascual-Leone Berenson-Allen Center for Nonivasive Brain Stimulation BIDMC Harvard Medical School
  23. 23. To better understand lifestyle determinants and their mechanisms leading to optimal brain function in advanced age. Prospective on the Catalonia (Barcelona) population 2014 Josefson et al. JAGS 2012•Population is ageing •Ageing is an important risk factor for major brain diseases •Brain diseases are #1 leading cause of disability Maintenance of optimal cognitive performance occurs in around 20% of elders.
  24. 24. Disease DisabilitySymptoms Diagnoses Treatment Health Brain resilience Preserved function Resilience promotionPrevention Brain health maintenance is best adressed from current brain health Altered function
  25. 25. Relevance of modifiable lifestyles to maintain brain health at old age 35% of cases with dementia are atributed to a combination of these 9 risk factors Removal of APOE effects only reduces risk -7%
  26. 26. Erickson et al. PNAS 2011 Lifestyles and Brain Health: Lifespan & individualized perspective Previous, reported Current, intervention Modulation by genetic background Wirth et al. J Neurosci 2014
  27. 27. Cognitive activity Physical activity Nutrition Socialization Sleep Vital plan General health Lifestyle pillars in BBHI
  28. 28. 30 BBHI apprach: combining observational and interventional studies Longitudinal prospective cohort + 5,000 participants  Phase I : lifestyle questionnaires / scales 1,000 participants  Phase II: in person assessment 250 control, health education 500 participants  Phase III: Intervention 40-65 years old, no neuropsychiatric diagnosis PRE-POST: MRI, EEG, TMS, Neuropsychological assessment, gait analysis, voice recording, blood samples… ICT-based, mobile Apps, personalized... 250 personalized coaching
  29. 29. 31 Phase I: Healthy Habits Monitor https://club.bbhi.cat Peers comparison
  30. 30. • ICT-based intervention • 500 participants • Personalized • Individualized coaching support • Motivation, adherence • Smartphones, wearables and Apps • Tracking and monitoring • Managing and communication • Automatic alert systems Phase III: mHealth for monitoring and adherence 32
  31. 31. In summary….. • The BBHI combines a follow-up study cohort and a multimodal intervention to investigate the impact of positive lifestyles on brain health. • The study is focused on middle-aged healthy individuals and incorporates biological-based measures for the investigation of the mechanisms through with such lifestyles exert its effects. • It provides individual web-based/APP feedback to participants and uses mobile Health technologies and a personalized coach approaches, aiming to increase engagement and adherence.
  32. 32. Simone Schürle, PhD Responsive Biomedical System Lab ETH Zurich Department of Health Science and Technology Institute for Translational Medicine
  33. 33. 36 06.10.201 7
  34. 34. 37 06.10.201 7
  35. 35. 38 06.10.201 7 Nanotechnology for Neurotechnology
  36. 36. 39 06.10.201 7 Nanostructures: a platform for brain repair and augmentation Image source: Vidu et al. Front Syst Neurosci. 2014; 8: 91.
  37. 37. 40 06.10.201 7 Human Enhancement https://toplink.weforum.org/knowledge/insight/a1Gb0000001k1imEAA/explore/summary Global Future Council on the Future of Human Enhancement
  38. 38. 41 06.10.201 7 Human Enhancement Body Brain Human enhancement aims to improve the quality of life over its course, at any age and stage, by enhancing our functional capabilities.Performance Age
  39. 39. 42 Human Enhancement 4 main pathways 1) Manipulation and extension of our body and brains 2) Modifications of our genes, our own biological mass 3) Alterations on a molecular and pharmacological level 4) Changes of our environment
  40. 40. 43 Call for Code of Ethics Key Issues 1) Equity and Social Justice 2) Maintaining Humanness and Autonomy 3) Transparency and Access to Information
  41. 41. 44 Concluding Notes ▪ Responsible research and tech development ▪ Engagement of the public in this conversation Need for ethical guidelines and frameworks that ▪ help innovation to foster ▪ benefit individuals and society ▪ and prevent catastrophe
  42. 42. Lunch break Please be back at 12.30pm US Pacific Time/ 3.30pm Eastern Time for a fascinating afternoon!
  43. 43. Thank you, Speakers & Participants!
  44. 44. Thank you, Summit Sponsors!
  45. 45. Thank you, Summit Partners!
  46. 46. To learn more, visit sharpbrains.com

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