Study Published in Nature Digital Medicine Shows Potential of Machine Learning and Augmented Reality-based Digital Biomarkers in Alzheimer’s Detection

Building Your Cognitive Reserve: Insights from Our CSO

Over the past decade, an increasing number of studies have reported cases of older individuals with extensive Alzheimer’s disease pathology (e.g., beta-amyloid plaques) during brain autopsy, yet during late life, the cognition of these individuals remained intact. So, why is this?

The answer to this question lies in the concepts of neural reserve and cognitive reserve. Neural refers to new areas in the brain being built and strengthened to withstand disease or age-related damage or injury. Cognitive reserve is the outcome of neural reserve—it represents the brain’s ability to make thicker connections between these brain areas. Together, these concepts explain why some individuals have a greater ability to cope with, or moderate, the clinical consequences of a disease.

We recently sat down with Dr. Ioannis Tarnanas, our Co-Founder and Chief Scientific Officer (CSO) here at Altoida, to learn more about these concepts and discuss methods for building your cognitive reserve.

Building Your Cognitive Reserve: FAQ With Dr. Ioannis Tarnanas

What Are the Primary Factors That Affect Cognitive Reserve?
Education is an absolute necessity when it comes to building your cognitive reserve. Imagine this as a pyramid. Education is the basic level—the foundation of your cognitive reserve. Now, on top of that, you may need to build thicker connections between different brain areas. To achieve this, you must regularly engage in novel activities.

Let’s say you’re a football player. If you learn to play the violin, this would be considered a novel activity that can strengthen your cognitive reserve. The same thing goes for social interactions. If you’re a neuroscientist and you are interacting with astrophysicists, that would be considered a good way to build your cognitive reserve.

The interaction between brain activities and physical activities is what we call ‘exergaming’. This has been proven to be the best way of building your cognitive reserve.
Does Building Your Cognitive Reserve Look Different Depending on the Stage of Your Life?
Yes, it’s very much age-specific and stage-of-your-life-specific. The foundation is education level. The more education you receive, the stronger your cognitive reserve foundation is going to be. Above that, in your work environment, you should try to engage in novel activities with people that are outside of your normal social circle.

Let’s not forget that with everything we do to protect our brains, it needs to be a habit. Taking three violin courses just isn’t going to cut it. It’s not enough to engage in novel tasks on an infrequent basis. Consistency of interacting with novel tasks matters too—and I think that’s the biggest challenge for many of us.
How Do You Think the Concept of Cognitive Reserve Will Play Into Future Alzheimer’s and Dementia Prevention and Treatment Approaches?
The cognitive reserve hypothesis is a very strong theory—and it continues to build evidence as we speak. On the other hand, the notion of making it a habit is the main challenge. However, based on my experience, acknowledging the importance of cognitive reserve in brain health and disease prevention can really help grow awareness which in turn accelerates prevention and treatment approaches.

I would emphasize that the path to a cure should be a combination of technology and biological approaches. If we can leverage technologies like augmented reality (AR) and virtual reality (VR) to create truly engaging exergaming activities, we can help people more easily integrate these novel activities into their lifestyles and make them a habit.
Can You Tell Us a Bit About Your Research Surrounding Cognitive Reserve?
I have a publication that demonstrates a particular exergaming paradigm and how utilizing this paradigm over the course of 10 weeks can help with building your cognitive reserve. We hypothesized that the intrinsic connectivity networks will be affected by the “active” intervention based on both physical and cognitive training compared with the baseline passive protocol followed by a control group. We found that this exergaming paradigm resulted in new connections in the brain, as evident by electroencephalography (EEG).
How Is Cognitive Reserve Measured? Are There Established Models Used To Quantifiably Measure Cognitive Reserve?
Yes, the major way we have today for measuring cognitive reserve is translated as your brain age. This is determined using neuroimaging, cognitive testing, and other techniques. From here, we convert this to peers of your same biological age.

Of course, this theory is not without limitations. Cognitive age is not the same as cognitive reserve. However, we are building new tools that will allow us to get a more precise measurement of cognitive reserve. If you think about it in terms of the neural basis, I think the most direct and precise way to use a molecular signature of brain resilience is by measuring glucose metabolism in specific areas of the brain.

The challenge with cognitive reserve is the ability to predict your health trajectory. It’s not only about assessing your cognitive age. It’s also about predicting your future state of health—and that’s what Altoida is great at.

Spacial Memory
Through our “hide-and-seek” activity, users hide three virtual items in their environments using their smart devices and then relocate the items in a randomized order.
Prospective Memory
In our “fire evacuation drill” activity, users identify virtual tools needed to simulate a fire drill by first learning the tools in a specific order.

Executive Functions
Using our “dual-task condition” activity, users navigate from start to finish using virtual tools in their environment while responding to dynamic sounds on their smart devices when prompted.

Pioneering the World’s First Precision Neurology Platform and Medical Device

At Altoida, we believe that understanding your brain health should be simple and accessible. We are building the world’s-first Precision Neurology platform and app-based medical device—backed by 11 years of clinical validation—to accelerate and improve drug development, neurological disease research, and patient care.

By completing a 10-minute series of augmented reality and motor activities designed to simulate complex Activities of Daily Living on a smartphone or tablet, Altoida’s device extracts and provides robust measurements of neurocognitive function across 13 neurocognitive domains. Our device measures and analyzes nearly 800 multimodal cognitive and functional digital biomarkers. Through the collection of highly granular data from integrated smartphone or tablet sensors, Altoida’s device produces comprehensive neurocognitive domain scores.

This method, along with our innovative artificial intelligence, will pioneer fully digital predictive neurological disease diagnosis. In 2021, our device received the Breakthrough Device designation by the FDA. Altoida's platform has demonstrated the ability to predict conversion from Mild Cognitive Impairment to Alzheimer's disease with a high degree of accuracy.
About Ioannis
Ioannis Tarnanas, Ph.D., is an internationally recognized leader and researcher in degenerative disease of the central nervous system. He is a Senior Atlantic Fellow and Group Leader for Brain Health and Digital Biomarkers at the Global Brain Health Initiative, a joint research center between the UCSF Department of Neurology and the Department of Neuroscience at Trinity College Dublin, Vice Chair with the Hellenic Initiative Against Alzheimer’s and an external collaborator of the Center for Digital Health Interventions (, a joint initiative between the ETH Zurich and Dartmouth College USA.

His awards and distinctions include the EU Archimedes award for Natural User Interfaces for medical devices, the European Open Science Forum (ESOF) award for his symposium on “virtual reality technologies for cognition” and the Novartis AG fellowship on healthy aging. In 2018, he received the prestigious EIT Innovators award for the Alzheimer's Disease Prediction Service (ADPS).
To learn more about building your cognitive reserve, or about using Altoida’s Precision Neurology platform, contact us today.