Ivory Bets on Screening Brains before they Break
By Arunima Rajan
Ivory Co-founder Issac Mathew John speaks to Arunima Rajan about the three post-COVID tailwinds that convinced him India was ready for cognitive screening, why Shark Tank visibility is a double-edged sword, and what it will take for CANTAB Pathway to avoid becoming yet another beautifully designed pilot.
Ivory, a venture-backed brain health startup, on 17 February 2026 announced a strategic partnership with UK-headquartered neuroscience technology firm Cambridge Cognition to bring its flagship digital cognitive assessment platform, CANTAB Pathway, to Indian hospitals, diagnostic chains and consumer health channels. Cambridge Cognition is listed on the London Stock Exchange’s Alternative Investment Market (AIM: COG). Under the agreement, Ivory will commercialise CANTAB Pathway across India’s healthcare and consumer health segments.
CANTAB Pathway is a clinically validated digital cognitive assessment, designed to enable the early identification of cognitive impairment through a set of structured, standardised tasks. It is used across research and clinical environments globally and is now being expanded for scalable deployment in India. The rollout comes at a moment when cognitive decline, long underdiagnosed in the country, is drawing attention from hospitals, insurers and the pharmaceutical industry. Globally, disease-modifying therapies for Alzheimer’s disease have entered the market, and are expected to be introduced in India in the coming years.
Issac Mathew John, Co-founder, Ivory
Ivory was founded in 2023 by Issac Mathew John and Rahul Krishnan. The company says it has reached over 50,000 users since launch, and works with more than 100 clinician partners. It featured on Shark Tank India in March 2025. John, who leads Ivory, spent 18 years at Discovery APAC, HealthifyMe and PUMA before co-founding the company.
In an interview with Arunima Rajan, conducted shortly after the partnership announcement, John discussed the drivers behind Ivory’s launch, the challenges of deploying a digital cognitive assessment in Indian clinical settings, the company’s position on data privacy and misuse, and what it will take for the CANTAB Pathway rollout to scale.
You are building a brain health company in a country that barely does basic preventive checkups. What made you believe India is ready for something as abstract sounding as “cognitive health,” and what were the moments that nearly broke that conviction?
There were three specific tailwinds in our space. Number one was that post-COVID, preventive health checkups became extremely routine, and this was fuelled by both consumers and institutional customers. Pre-COVID, the average age of an adult coming in for a checkup specifically for a brain related issue, weakening memory or brain fog, was 50 to 55, and post-COVID even adults aged 40 plus have started to come up with such concerns; based on anecdotal evidence from our partners. Secondly, in the last three years, there’s been a real upswing in adoption of mental health services as part of an urban consumer’s health and wellness spends. Lastly, both diagnostics and disease modifying therapies for Alzheimer’s are set to launch globally including India. This was never mainstream because it was taken for granted that there is no point in early detection as anyways there are no cures available. Now, that is changing significantly and it’s a matter of time before such drugs are made available in India.
The combination of these three factors told us that it was a time that people would look for objective scores to what is going on with regard to their brain function and especially on their key skills like attention, memory, and reasoning, just like how they track their sleep scores, for example, and that’s what encouraged us to build in this space.
We don’t think our conviction was ever broken on this front because the data keep showing us that people were glad that this product existed and that was evidenced by the organic growth of consumers opting for this test on our various platforms and the feedback we got from both doctors and consumers alike.
On deployment in clinical settings:
CANTAB Pathway arrives in India with serious scientific pedigree from Cambridge Cognition, but most Indian patients will first meet it as yet another app or tablet in a busy OPD. What have you underestimated about this last mile between gold standard science and a hassled 65-year-old in a government or trust run hospital?
There is an element of ease with which CANTAB Pathway can be administered for an early cognitive screening read both in a clinical setting or if the patient so chooses, in his or her home. This experience for the end user, is a lot more frictionless than let’s say doing a one hour long plus clinical examination going through a battery of tests. In a very well-known hospital in Bombay, for example, clinicians are considering using this test as an early screener before they go for their battery of five different tests. So, by default, CANTAB is meant to ease the workload on both clinicians as well as patients. And hence, that journey, when explained with rationale in an OPD department, does make it easier for both consumers to take and for clinicians to administer. Having said that, do we have more work to do in making the form factor even more friendly for busy clinical settings? 100 per cent yes.
On positioning:
Shark Tank visibility, glossy apps, powerful international partners, all of this can make Ivory look like a classic aspirational wellness brand. How do you draw the hard line between being a consumer “brain fitness” play and being a clinical infrastructure layer that Indian hospitals and geriatricians can actually rely on?
Our real impact comes from being used in a clinical setting and we’re not restricted to geriatricians alone. Today, a growing number of mental health clinicians use us in their practice for a wide variety of use cases. What we do on the consumer communication end of things is solely to a.) make the conversation about brain function assessment more mainstream and b.) build trust with the end consumer. We might come across as an aspirational brand but the real goal is to come across as a brand that’s built on scientific rigour and helps doctors triage and arrive at early detection of cognitive risks.
On who Ivory’s primary customer is:
In India, families often normalise “forgetfulness” in older adults until it becomes a crisis. From your vantage point, who is the real customer for early cognitive screening here, the hospital CEO, the treating clinician, the caregiver daughter sitting in another city, or an anxious 45-year-old with a smartwatch and no time?
The treating clinician is our key customer. If we need to create impact at scale, it can only happen when clinicians are able to use our assessments as a guiding tool to make better decisions. Additionally, when we provide longitudinal data on the impact of interventions made by the doctors, we are able to make a distinction for the doctor on what has worked and what hasn’t.
The 45 year old executive, who is also tracking all metrics also needs assurance on how his productivity is shaping up and this the modern urban consumer who wants to keep all health metrics on his fingertips. For him or her, we become a tracking tool that he or she will pay attention to once in 6 to 12 months. However, this segment is a niche urban affluent consumer.
On the risks of failing to scale:
Digital health in India is littered with pilots that never scaled beyond a few enthusiastic clinicians. When you look at this partnership with Cambridge Cognition, what are the uncomfortable questions you are asking yourselves about pricing, workflows and incentives so that CANTAB Pathway does not become yet another beautifully designed pilot?
We do think deeply about pricing and the tradeoff involved between getting to scale and the business being sustainable. Similarly, what clinical workflow would make sense for a standalone clinic might not work for a diagnostic chain and what might work for a diagnostic chain might not work for a hospital inpatient department (IPD) patient. These need to be thought through very deeply before committing to carving the product deployment for different settings.
On data privacy and misuse:
Every cognitive score you generate creates a new kind of power, over a person’s employability, insurability, even their right to drive or live alone. How are you building guardrails so that hospitals, insurers and employers do not weaponise these insights against the very people you say you want to help?
We are very upfront about the fact that our scores cannot be used for any kind of hierarchical ranking in any setting. Outside of clinics, in fact, whenever we’ve worked in let’s say, a corporate setting, we’ve only provided aggregate scores and not individual user scores to anyone else in the company. We are compliant with the Health Insurance Portability and Accountability Act (HIPAA) and ISO 27001, and we ensure the highest standards of privacy. We’ve in fact often refused business when we’ve gotten the sense that our assessment could be used to rank people.
On hospital adoption:
For hospital chains like Narayana or Hiranandani, there is always tension between doing the “right” thing clinically and doing what the P and L demands this quarter. If you were in their boardrooms today, what trade-offs around time, staff and money would you ask them to make to take brain health seriously, and what would you tell them to stop doing?
The unfortunate thing about brain health assessments in India is that people take it only after something has seriously gone awry. We’re here to change that. A simple but appropriate step for hospitals to implement would be to include cognitive screenings in their packages for those above 45 plus. 90 per cent of cognitive impairments in most places around the world go undiagnosed. This simple step would ensure that we’d catch the ones at risk ahead of time so that the relevant interventions can be made by relevant clinicians.
New-age hospitals get it a lot more easily. However, prevention is not an easy sell to hospitals and we understand that in this journey, we might not always be able to get every hospital on-boarded and we’re fine with that distinction. What’s important is that the ones who do focus on prevention become sticky consumers because they see the benefit that the assessment data brings to the table in clinical settings.
On the 2030 outlook:
If this bet on early cognitive screening works, it will quietly redraw care pathways for millions of Indians over the next decade. What would success look like in 2030 in very concrete terms, the numbers, the stories and the things that no longer shock us, and what keeps you awake at night when you imagine the ways this could go wrong?
One of the measures of success is how many healthcare providers and doctors keep coming back to us to use these assessments. Secondly, can we be plugged into every urban healthcare provider’s suite of checkups. For us, by 2030, if we can be included in every preventive health checkup that gets booked, it would be a great endorsement of our work.
What keeps us awake at night are two things. First, a poor end-user experience that erodes trust in our capability. That is where our product gets stress tested, and for us to be able to deliver an efficient experience is a key moment of truth for our business.
At a macro level, the concept of cognitive testing is an established practice in several other countries, but as it stands, this is new in India. While we are convinced that we are at the right place at the right time, traditionally India has always taken time to adopt new concepts, especially in health. On that, one of our challenges will be to keep Ivory adequately capitalised with enough room to keep innovating on the fronts of research and science.
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