We recently sat down (virtually) with Dr. Leah Rubin from Johns Hopkins School of Medicine to discuss her work with BrainBaseline and BRACE (BrainBaseline Assessment of Cognition & Everyday Functioning) as well as her poster presentation at the AIDS 2020 Virtual Conference. Dr. Rubin is an Associate Professor of Neurology, Psychiatry, and Epidemiology and is focused on researching at-risk individuals’ cognitive and mental health. She uses big data sets to find patterns and predictors for that population, and then drills down to identify the mechanisms behind cognitive or mental decline. With a focus on people with HIV (PWH), Dr. Rubin’s work has been a part of the National Institute of Health’s Women’s Interagency HIV Study (WIHS) and Multicenter AIDS Cohort Study (MACS).

Dr. Rubin first found BrainBaseline through our work with Dr. Howard Fox at University of Nebraska Medical Center’s Department of Neurological Sciences on the HAND in Hand Studies. The HAND (or HIV-Associated Neurocognitive Disorder) in Hand Studies use a custom BrainBaseline iPhone app to test the cognitive function of people with HIV at home.

Adapting BrainBaseline for in-clinic administration

Most HIV clinic visits focus on antiretroviral medication adherence, leaving patients’ cognitive and mental health forgotten. Traditionally, cognitive testing also requires a great deal of training on the part of a test administrator; even those well-trained may differ and deliver data inconsistencies. Because BrainBaseline’s cognitive tests are self-administered, they remove the burden of training a test administrator AND deliver more consistent data.

“Being able to hand an iPad over and have [patients] do it, it basically [takes] away all of the burden.”

In collaboration with Dr. Rubin, BrainBaseline adapted the HAND in Hand at home iPhone app to BRACE, an in-clinic iPad app for Dr. Rubin to deploy at the John G. Bartlett HIV Practice of Johns Hopkins Hospital in Baltimore, Maryland. From January to December 2019, data was collected from over 400 individuals, who typically completed the cognitive battery in 10-12 minutes.

“We needed some sort of electronic method that can be implemented within these busy clinics. When patients are waiting, you have 10 minutes. We can incorporate this into the busy routine of clinic care.”

Study goals

The primary goal for this study was to assess as many people as possible to understand the cognitive burden of people with HIV, and then link that cognitive data to patient medical records. Additionally, there was a desire to study the stability of cognitive function in people with HIV, because it seems to fluctuate. Because most cognitive testing is typically done at infrequent intervals, it does not allow for clear visualization of fluctuation; however, BrainBaseline’s application allows for quick, low-cost, and more frequent testing.

Dr. Rubin intended BrainBaseline’s initial BRACE protocol as a short screening tool that can flag individuals’ area of cognitive impairment. After patients are flagged, more in-depth testing can be done.

“BRACE is a nice screener for minor forms of cognitive impairment which are hard to pick up on.”

In the meantime, BrainBaseline is partnering with Dr. Rubin to create a full cognitive testing battery.

Next steps

Dr. Rubin envisions the BRACE data set growing into the thousands. If BrainBaseline’s cognitive assessments were more widely used in HIV clinics, cognitive decline can be better identified and quantified. Then underlying problems can begin to be identified. For instance: Is HIV causing this cognitive decline, or is it the medication? Is it both? Identifying impairment can also allow for more customized treatments.

“For me it’s just about getting BRACE out there. The data will convince people. If the tool is good, the data is good … [BrainBaseline] has developed an exceptional product.”

With BrainBaseline’s mobile apps for both Apple and Android phones, at-home testing can be completed by a larger population, allowing the BRACE data set to continue to grow. BrainBaseline looks forward to partnering to make Dr. Rubin’s vision a reality.

“[This is] the tip of the iceberg. So many amazing things that will spin off of this.”