**5. Neurotechnology for global mental health**

Mental healthcare in developing nations has long been overlooked by organizations concerned with global health needs. A number of reasons can be cited for this, but one significant factor is the difficulty of accurately diagnosing and classifying mental disorders and the relatively intensive need for human expertise to administer assessments and care. Precision healthcare is a term coined by Clayton Christensen to describe objective medical diagnosis and prescription that is enabled by new technologies. Innovative neurotechnologies that enable basic mental diagnosis to be administered in a cost effective manner in clinics that may be staffed by technicians is urgently needed in developing nations. Even if the diagnostic precision is not as high as might be possible in big city hospital in the developed world, low-cost basic care would serve to alleviate a great deal of personal suffering as well as the economic burden imposed.

The need for neurotechnology to enable precision mental healthcare has never been greater. The developed world is spending greater and greater amounts of money on healthcare and costs threaten their economic vitality. Developing nations will benefit tremendously from even basic neurological and mental healthcare.

While considerable resources have been devoted to finding cures for infectious diseases such as HIV and malaria, relatively little attention has been given to the neurological and cognitive effects of these infections on young patients that recover from the acute infection. A majority of HIV infected patients manifest HIV-associated neurocognitive disorders despite receiving highly active antiretroviral therapy (Van Rie et al., 2009). The developing brains of children who have acquired HIV through vertical infection are particularly vulnerable to central nervous system insults either directly, through secondary infections or from side effects of antiretroviral therapies (LLorente et al., 2009). For example, school age children with perinatally acquired HIV infections receiving antiretroviral therapy displayed lower cognitive function than either HIV affected or HIV unaffected children. Although the antiretroviral therapy reduced HIV symptoms, the cognitive deficits were not improved (Puthanakit et al., 2010).

These clinical observations inform the need to obtain a better understanding of how and when HIV affects cognitive function and to develop novel therapeutic drug candidates to prevent or interfere with progression of HIV associated neurocognitive impairment (Robertson et al., 2010). Some treatments for the primary or secondary infections, may be more harmful to vulnerable brain tissue in children that have been compromised by HIV infection than in adults (LLorente et al., 2009). Research on the effects of HIV infection on the developing brain is a topic of increasing importance as new antiretroviral treatments become more widely available causing many more HIV-1 infections to be treated as a chronic condition to be managed rather than as a fatal disease (Abubakar et al., 2008). Few longitudinal studies have been done of HIV infected children in developing regions who have been receiving antiretroviral therapy. The methods for measuring and analyzing brain electrical activity developed here may help to fill the need for objective, cross-cultural measures of cognitive function to estimate the effects of HIV on brain development in children.

It is hoped that neuroengineers will adopt methods outlined in this chapter to discover biomarkers for monitoring the progression of cognitive development and demonstration their utility in the context of HIV associated neurocognitive disability (HAND). Protocols are needed for early assessment and diagnosis of mental and cognitive impairment due to HIV infection, secondary infections and drug therapy. These may also be used as a clinical tool for widespread screening of HIV infected or exposed infants that may enable developmental cognitive impairments to be diagnosed before other HIV symptoms are apparent. Such tools would represent a major step forward in the effort to understand the long-term impact of chronic HIV infection and other infections on cognitive development in children and to provide a new approach for monitoring the cognitive effects of long term management of HIV as a chronic condition in developing regions of the world.

## **6. Conclusion**

526 Biomedical Science, Engineering and Technology

thickness from infancy to early teen years were highly correlated with above or below average intelligence (Shaw et al., 2006), suggesting that growth curves of brain function may contain more information than any combination of measurements at one specific age. This would require routine brain measurements become part of the medical record and algorithms that recognize abnormal trends would need to be used to interpret data after

Mental healthcare in developing nations has long been overlooked by organizations concerned with global health needs. A number of reasons can be cited for this, but one significant factor is the difficulty of accurately diagnosing and classifying mental disorders and the relatively intensive need for human expertise to administer assessments and care. Precision healthcare is a term coined by Clayton Christensen to describe objective medical diagnosis and prescription that is enabled by new technologies. Innovative neurotechnologies that enable basic mental diagnosis to be administered in a cost effective manner in clinics that may be staffed by technicians is urgently needed in developing nations. Even if the diagnostic precision is not as high as might be possible in big city hospital in the developed world, low-cost basic care would serve to alleviate a great deal of

The need for neurotechnology to enable precision mental healthcare has never been greater. The developed world is spending greater and greater amounts of money on healthcare and costs threaten their economic vitality. Developing nations will benefit tremendously from

While considerable resources have been devoted to finding cures for infectious diseases such as HIV and malaria, relatively little attention has been given to the neurological and cognitive effects of these infections on young patients that recover from the acute infection. A majority of HIV infected patients manifest HIV-associated neurocognitive disorders despite receiving highly active antiretroviral therapy (Van Rie et al., 2009). The developing brains of children who have acquired HIV through vertical infection are particularly vulnerable to central nervous system insults either directly, through secondary infections or from side effects of antiretroviral therapies (LLorente et al., 2009). For example, school age children with perinatally acquired HIV infections receiving antiretroviral therapy displayed lower cognitive function than either HIV affected or HIV unaffected children. Although the antiretroviral therapy reduced HIV symptoms, the cognitive deficits were not improved

These clinical observations inform the need to obtain a better understanding of how and when HIV affects cognitive function and to develop novel therapeutic drug candidates to prevent or interfere with progression of HIV associated neurocognitive impairment (Robertson et al., 2010). Some treatments for the primary or secondary infections, may be more harmful to vulnerable brain tissue in children that have been compromised by HIV infection than in adults (LLorente et al., 2009). Research on the effects of HIV infection on the developing brain is a topic of increasing importance as new antiretroviral treatments become more widely available causing many more HIV-1 infections to be treated as a chronic condition to be managed rather than as a fatal disease (Abubakar et al., 2008). Few longitudinal studies have been done of HIV infected children in developing regions who have been receiving antiretroviral therapy. The methods for measuring and analyzing brain

regular checkups.

**5. Neurotechnology for global mental health** 

personal suffering as well as the economic burden imposed.

even basic neurological and mental healthcare.

(Puthanakit et al., 2010).

Neuroscience has been called the next frontier science after the breakthroughs achieved by physics in the mid-twentieth century and genetics and biophysics at the end of the 20th century and early 21st century. The brain is of great scientific interest because of the emergent phenomenon of thought that arises from the vast complexity of this organ. While the question of how the brain thinks is likely to remain a challenging scientific and philosophical topic for a long time, the need for practical innovations to meet the healthcare needs of the world is more urgent. Two issues drive this need at the present time. First, of course, is the tremendous amount of suffering that is the result of brain injury and mental disease. Mental disorders in particular are a difficult challenge for medicine because in most cases there is not a single cause that can easily be diagnosed and "cured". Rather, the perspective throughout this chapter has been that mental disorders are complex emergent phenomena and must therefore be analyzed as such.

This is an exciting and promising time for clinical neuroscience research due to the convergent development of several technologies at this time in history. Although EEG equipment has been around since the 1920s, the creation of inexpensive, wireless, high quality EEG headsets by innovative companies such as Emotiv Systems and Neurosky opens up research possibilities with EEG equipment for many more neuroscientists. As the cost comes down and quality goes up, these tools become practical for routine clinical use. The rapid development of the physics of complex networks and systems, as well as mathematical methods for analyzing complex (chaotic) time series that are produced by complex networks enables new information from the signals measured with inexpensive EEG devices to be extracted and studied as markers for neural correlates of behavior. Finally, the continuing advance of pattern recognition algorithms from the artificial intelligence community enables more subtle pattern-markers to be discovered in complex EEG signal features.

The high cost of healthcare threatens the economies of developed nations and prevents many people in developing regions from obtaining the psychiatric care that they need. On both of these fronts, innovative neurotechnologies for early detection and monitoring of mental disorders are urgently needed. The ready availability of mobile communication devices introduces a platform for making information technology based mental healthcare available to many people that have no access at this time. Integration of EEG devices and complex systems methods with clinical decision support tools and mobile device-based health records promises both greatly improved neuropsychiatric healthcare and lower costs. It is hoped that the methods introduced in this chapter will inspire a new generation of bioengineers concerned with mental health to create new tools for clinical neuroscience while closing the gap between neurology and psychiatry.

### **7. Acknowledgements**

This research was supported by grants from the National Institute of Mental Health and the Simons Foundation.

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