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Dementia

The huge potential of technology in dementia detection

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With technology playing an increasing role throughout healthcare, leading dementia expert Dr Naji Tabet discusses its growing importance in early-stage dementia detection

 

Through the use of technology, the potential for patients in both primary and secondary care to have dementia detected at an earlier stage than ever before is being realised. 

With the development of the Cognetivity platform, the first entrant to the market in using AI to conduct rapid cognitive analysis and can be completed by patients remotely, is supporting medical professionals by making the process quicker and simpler through the use of digital. 

The platform is currently in trial as part of a clinical study to screen patients for signs of cognitive impairment at Sussex Partnership NHS Foundation Trust, under the guidance of Dr Naji Tabet. 

The study has seen people taking Integrated Cognitive Assessment (ICA) tests both in-person and remotely through using an iPad, and is expected to be concluded within the next three months. 

However, Dr Tabet – an honorary consultant at the Trust and highly-respected figure in dementia studies, who has previously led clinical trials in advancing potential treatments for Alzheimer’s disease – already sees the potential for its use both remotely and in medical settings.  

“Technology can be very important for screening in primary care and simplifies the pathway of referral to secondary care assessment services,” says Dr Tabet, also director at the Centre for Dementia Studies at Brighton & Sussex Medical School. 

“There is more potential for treatment through using such early-stage tests. By being able to diagnose people earlier, it opens the door to hopefully earlier treatment. That treatments current and future may work best, and may only work, in the early stages.”

In a medical environment, the use of digital assessment platforms such as Cognetivity can be particularly effective in relieving pressure on already stretched resources, says Dr Tabet. 

“If you go to a GP surgery and say you’ve got a memory problem, the GP may use some very brief screening tools, and more likely than not the patient will be referred,” he says. 

“A GP needs screening that is easy to do – it is impossible to spend 30-45 minutes doing this with a patient, a GP does not have that time. Their time is valuable and they are under pressure. 

“This platform can be completed  in five minutes while you’re waiting for your appointment, simply a patient can be handed the iPad to complete the assessment, there and then.

“Once referred to secondary care, it can determine which patients are seen first. It’s sometimes good to use simple tests to prioritise investigation. 

“Dementia diagnosis is very labour intensive, there is a need for  a brain scan, blood test, may be ECG, completion of cognitive assessment by a specialist nurse, psychologist, or occupational therapist. This assessment can take several hours, which can often be too much for a patient in one day, so they need another appointment.

“Through the use of this platform and technology, the cognitive testing process is simplified.”  

And in addition to completion of the test in a medical environment, its potential for remote use is equally compelling to medical professionals and patients alike. 

“You don’t need a 45-minute clinic appointment to do a cognitive assessment if a person can complete the test at home. Patients may be monitored remotely and invited back to the clinic if results indicate a deviation from what is expected for that particular patient, ” says Dr Tabet. 

“We’re collecting evidence in the real world, to supplement data collected from earlier clinical trials, and this is very important.

“The study is assessing patient acceptability of the platform and its role as a remote assessment tool. Patients can complete the digital assessment  on their own without the presence of  a professional. If they can access this on an iPad, then this  will impact positively on follow up decisions”. 

Technology can be a valuable asset in the field of dementia, with digital-based cognitive tests helping to advance diagnosis and care. 

“It is a good thing that AI is integrated into the digital platform, it’s very helpful to gather information on a particular individual as an individual and over time, rather than simply comparing them to the norm,” says Dr Tabet. 

“If we are gathering information on a person and they are, for example, scoring 80 per cent and then that suddenly drops to 70 per cent, then that is meaningful.

“A great advantage of digital cognitive assessments such as Cognetivity ICA is that there is no bias in relation to language, culture or education. With some tests, the more educated you are, the better you do. 

“Another advantage is that the cognitive tasks cannot be learnt. Inevitably for patients with mild cognitive impairment or mild dementia, there is a tendency to remember the answer to some of the questions when you take the test repeatedly..”

With the clinical study at the Trust now well underway – “lockdown thwarted some of our activity, but it’s picking up now,” says Dr Tabet – the findings could help pave the way to the more widespread adoption of the digital platform solutions in the NHS. 

“We complete a wide range of research and studies focused on the quality of life of people with dementia, and the use of technology is absolutely important in the future,” he adds.

Dementia

Classical music and Alzheimer’s – could it improve memory?

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Could classical music improve memory in people with Alzheimer’s disease and other cognitive impairment?

A three-year study – The Mozart Effect and Memory in patients with cognitive impairment – will assess that exact topic, with music anecdotally being said to have benefit on those living with such conditions. 

The project, from the Cognitive Neurolab at the Universitat Oberta de Catalunya (UOC), will investigate whether music can be used to facilitate or enhance learning in those with mild cognitive impairment (MCI) or mild Alzheimer’s disease (AD).

It will also look at which aspects of music are key in establishing a cognitive benefit, so which kinds of music – relaxing or vitalising – and what times are most useful; for example, in the phase in which we learn new information or in that in which we retrieve information we have previously learned.

Previous studies have indicated that exposure to music can increase performance in learning and attention-related tasks, but this will look at the most effective kind for memory.

“The majority of these studies were on healthy people and we don’t know if music could be a complementary tool for cognitively stimulating those with memory deficits,” says Dr Marco Calabria, leading the project.

“These neurodegenerative diseases are characterised by difficulties in forming new memories, and music could be one way of helping to consolidate new learning.”

The study will involve patients from both Barcelona’s Hospital de Sant Pau and from SINGULAR Musica & Alzheimer, a centre in Barcelona specialising in the rehabilitation and cognitive stimulation of people with Alzheimer’s through music. 

In the study’s first phase, participants will carry out memory-related tasks with classical music in the background. They will have to memorise unknown faces and remember them afterwards. 

Dr Calabria explains that classical music is being used because “it’s a kind of music that is characterised by being both relaxing and vitalizing, and has proven to be the most effective in giving memory a boost. 

“What’s more, the fact that it has no lyrics means there is less of the interference that verbal information can cause with regard to the content that participants will have to learn in the memory tasks.” 

In phase two, researchers will use music familiar to participants to see whether the fact they like it could deliver emotional, and therefore memory-related, benefits. 

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Brain injury

‘We want to be part of the solution – for Bill and future generations’

Dr Judith Gates speaks to NR Times about this weekend’s football match organised by Head for Change, which will be the first ever to involve no heading of the ball

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The first football match which involves no heading of the ball will help raise awareness and stimulate conversation about the impact of head injury in sport, its organisers have said. 

The 11-a-side match, involving 25 former professional footballers, has been hailed as an experiment as researchers try to discover whether the game can function without heading, in light of ever-growing research which links football to neurodegenerative disease.

It is organised by Head for Change, the organisation helping to drive forward calls for changes to player safety, and will only allow headers in the penalty box for the first half and then restrict all heading during the second half. 

It will be held at Spennymoor Town Football Club, in County Durham, on Sunday at 3pm. 

The event forms part of the “legacy” for former Spennymoor Town and Middlesbrough defender Bill Gates, who has sports-related dementia, and whose wife Dr Judith Gates is co-founder and chair of Head for Change. 

Dr Judith Gates

“When Bill received his diagnosis in 2017, we made two promises to him,” Dr Gates tells NR Times. 

“One was to optimise his life and do all we could to make his life as good as we could as a dad, grandad and great grandad, and the second was for his legacy, to do everything we could to be part of the solution for future generations of footballers and their families not to have to face this.

“The purpose of this match is to raise awareness of the dangers of heading the ball and to provide alternative discussion with purpose. It’s an experiment to see what the game will look like. 

“To be clear, Head for Change is not suggesting heading should be banned, that is a decision for football’s governing authorities, not for us. 

“But we want people to realise the impact. Bill was a Titan to me in his 20s, fit and indestructible, so if this disease can do this to him, it can happen to anyone.”

The match has attracted widespread media attention and comes after an array of stark academic findings, including the research from Professor Willie Stewart that footballers are up to five times more likely to suffer from dementia than the general population. 

“Part of why I co-founded Head for Change was to be part of the solution,” says Dr Gates. 

“We’re extremely aware that there is a lot of bashing going on and everyone is saying it’s someone else’s fault, but lessons must be learnt from the past. 

“For too long we have been assured that our brain was safe in our skull, but we are increasingly understanding how the brain works and how it can be damaged through contact sports. Education will continue to play a very important role in what happens going forward.”

The match itself – which will also be raising money for The Solan Connor Fawcett Cancer Trust – will be held at Spennymoor Town’s stadium, The Brewery Field. 

The town is where Dr Gates grew up and met her husband, and in a quirk of fate, Spennymoor Town’s chief executive Brad Groves used to work for Bill as a warehouseman when Bill owned a chain of sports stores. 

The club, alongside those playing in the match, have been hugely supportive of their ambitions, says Dr Gates. 

“We’ve been amazed at the extent to which they have stepped up, Spennymoor have been phenomenal. Brad has been so kind in offering whatever he can do to help. We are hugely appreciative,” she says. 

“The players taking part are excited to be part of it, they may not be able to use one of their many footballing skills but they can use the rest of them. 

“Spennymoor is a small town with a big heart and we are so pleased to be able to hold this match, and particularly here, at Bill’s first club.”

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Dementia

EEG test could increase early diagnosis of Alzheimer’s

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Fastball EEG data for alzheimers

A simple but revolutionary approach to early Alzheimer’s diagnosis is being pioneered, in a breakthrough that could pave the way for improved outcomes for individuals who develop the disease in the future.

The research uses a new method to passively measure brain activity. It involves participants looking at a series of flashing images on a computer over two minutes, whilst their brain waves are measured using an EEG cap.

New research on this, published today on World Alzheimer’s Day, shows that the technique is highly effective at picking up small, subtle changes in brain waves which occur when a person remembers an image. 

Crucially, the technique is completely passive, meaning the person doing the test doesn’t need to understand the task or respond, and may not even be aware of their memory response.

The team behind the ‘Fastball EEG’ technology – led by psychologists at the University of Bath and funded by the dementia charity BRACE – say the approach is cheap, portable and relies on pre-existing technology already available in hospitals, making it easily scalable. 

They are now beginning to use Fastball EEG in a study of the earliest stages of Alzheimer’s disease in collaboration with the Research Institute for the Care of Older People (RICE) and the Bristol Brain Centre at Southmead Hospital.

Alzheimer’s is the underlying cause of approximately 60 per cent of dementia, with an estimated prevalence rate in Europe and North America of 5 to 7 per cent of the population. Estimates suggest the disease costs the UK economy around £26 billion a year, with costs expected to rise as an ageing population will see numbers increasing.

Alzheimer’s disease is currently diagnosed using a combination of subjective and objective reports of cognitive decline, often involving memory tests administered in a clinic. 

These tests are prone to various biases, including assessment anxiety, but also require verbal and written communication abilities which make them ineffective for certain people.

By knowing more about people’s disease at an earlier stage, drugs can be prescribed earlier when they may be more effective, such as the recently-approved Aducanumab, the first disease modifying treatment for Alzheimer’s disease. 

Lifestyle interventions can also be implemented to help slow disease progression. Current diagnosis for Alzheimer’s typically occurs late in the progression of the disease.

In the near future, the researchers hope that Fastball EEG could help lower the age of diagnosis by up to five years. Longer-term, they say it may offer opportunities to expand this further. They liken their future aspirations for its application to current screening tools used to test for high blood pressure in middle age.

Lead researcher and cognitive neuroscientist Dr George Stothart, of the Department of Psychology at the University of Bath, explains: “Fastball offers a genuinely novel way of measuring how our brain is functioning. 

“The person being assessed doesn’t need to understand the test, or even respond, they simply watch a screen of flashing images and by the way we manipulate the images that appear we can learn an enormous amount about what their brain is, or is not, able to do.

“The tests we currently use to diagnose Alzheimer’s miss the first 20 years of the disease, which means we are missing huge opportunities to help people.

“For decades now we have had tools in scientific research that have been able to probe how the brain is working, but we have never made the leap to a viable clinical tool for the objective assessment of cognition. We hope that Fastball may be that leap.

“We are at a really exciting stage in its development. We are testing the tool in earlier and earlier stages of Alzheimer’s and expanding the type of brain function it can measure, to include language and visual processing. 

“This will help us to not only understand Alzheimer’s but also the many other less common forms of dementia.

“Ultimately the Holy Grail of a tool like this would be a dementia screening tool used in middle age for everyone, regardless of symptoms, in the same way we test for high blood pressure. We are a long way from that, but this is a step towards that goal.”

Mark Poarch, chief executive of BRACE, added: “We were delighted to be able to fund Dr Stothart’s research, which clearly has exciting potential. 

“It could result in an early diagnostic tool with benefit for innumerable people and help turn the tide against dementia. More generally, we have seen in the last year what happens when the world ploughs resources into medical research to find a vaccine for a dangerous virus, and we now need to give dementia researchers the resources they need to achieve comparable breakthroughs.”

Dr Stothart and colleagues will soon start work on a significant £100,000 longitudinal study of early dementia funded by the Academy of Medical Sciences. The study will involve testing patients with Mild Cognitive Impairment using the new Fastball tool.

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