Mobile technology drives timely and more efficient dementia diagnosis

Andy Blackwell talks us through the UK government's dementia challenge and how mobile technology, such as diagnostic tests on iPads, is helping patients receive an earlier diagnosis of this neurological disease, which in turn helps keep down increasing healthcare costs.

The use of mobile devices with diagnostic tests is bringing technologies previously only available at cutting-edge research facilities and hospitals directly into the heart of the community.

These technologies are capable of dramatically improving the quality and efficiency of assessments carried out at local GP surgeries. They have the potential to cut waiting lists, reduce patient stress in waiting for a diagnosis, while also saving time and money for the NHS.

One area where the impact of the wider availability of iPad and other tablet technologies are having a transformative effect is in the field of cognitive impairment, especially in diagnosing conditions such as dementia and Alzheimer's disease.

The UK dementia challenge

It is estimated that 800,000 people in the UK have dementia, yet less than half have been diagnosed – a shocking statistic the government has sworn to tackle in the Prime Minister's Dementia Challenge.

The number of people with dementia is expected to double over the next 20 years as the population lives longer. To put this into perspective, the annual cost of caring for people with dementia in the UK is currently £20bn, a cost that threatens to rise rapidly.

At present, diagnosing dementia is most likely during the later stages of the condition when symptoms are simply impossible to ignore. Patients then face a long and difficult process of identifying the specific cause of their problems, which is a necessary step before appropriate treatment can be initiated.

Diagnosing dementia is a two-step process. When a patient is presented to a GP with concerns, the initial procedure will usually include a very basic memory assessment, traditionally using simple verbal question-and-answers. This approach is subjective, time consuming and often problematic for patients that struggle with their hearing, vision or language.

Once a memory problem has been established, a good GP should then check for depression and also consult with family and friends to get a better understanding of the history of their symptoms. They would also order a standard blood test or brain scan, as in rare cases these can show a distinct medical cause for the memory loss, such as vitamin deficiency or an undetected tumour.

For the vast majority of patients, the GP will detect no obvious reason for their impairment and so they will be sent to a specialist memory clinic for more thorough assessment. In parts of the UK, long waiting lists for appointments at these clinics mean that just when you want answers quickly you are faced with further agonising delays.

Statistics show that of the people sent to memory clinics, around half have normal memory loss for their age, show symptoms of depression or suffer from a problem not related to dementia that could be reversed with treatment.

Clearly if the government is to achieve its ambitious targets it is by improving these early assessments that efficiency can be improved.

Transforming dementia diagnosis

With powerful touch screen technology widely available on a variety of tablet devices there are huge opportunities for more efficient diagnosis, especially in detecting cognitive impairment. For example, sophisticated memory assessments, previously only available at specialist centres, can now be offered on an iPad at a community clinic. These computerised assessments can deliver results consistently in a matter of minutes, with practical advantages over the old-style assessments, such as the ability to deliver tests in any number of different languages.

Using this technology, the same patient, accompanied by a qualified healthcare professional, completes a simple and intuitive ten-minute cognitive function test using an iPad. After entering details about age and education, the patient is asked to judge how good they feel their memory is.

A touchscreen based Paired Associated Learning (PAL) test, which has led to 175 publications in peer reviewed scientific and medical journals and used worldwide by top Universities and clinics, performance is analysed and compared with a dataset of results from 5,000 older adults drawn from a range of UK research projects.

The score, which is automatically adjusted to take into account the effects of age, education and gender, allows a very accurate assessment of memory performance in people between the ages of 50 to 90 years. The test is highly sensitive to the early signs of dementia but by and large remains unaffected by the symptoms of depression, providing GPs better information to help make a more accurate judgement on who should then be referred for further investigation.

By safely reducing referral rates, the long waiting lists for specialist memory clinics can be reduced, allowing people to receive a diagnosis earlier and help to cut costs for the NHS.

Walk-in brain tests of the future available today

The potential of this technology is huge. Highly sophisticated cognitive assessments, administered as easily as blood pressure tests, have already started to help patients to receive timely, consistent and standardised diagnosis in parts of the UK. If deployed on a national scale the benefits to both patients and the NHS are enormous.

There are conflicting views over the benefits of a national screening programme for the early detection of dementia or its predecessor, mild cognitive impairment. The public health community is divided between those who believe there is not yet enough evidence to justify screening, and those who believe screening is the most effective way to improve the current situation of mass under-diagnosis of dementia. If screening is desired, computerised technology may help make it logistically and economically possible to roll out on a wider scale.

Further developments on the horizon will make better use of Big Data and the cloud, using hi-tech tools in local GP surgeries to assess and update patient data, feeding into the UK knowledge base of conditions that affect cognitive function. The anonymised data could also be available to larger databases for wider comparison and study.

For the government to achieve its ambitious dementia targets it has to find ways to help diagnose patients more efficiently. It is clear from pilot studies that devolving the most accurate technology to GPs is a highly cost effective way of making this process work.

"Brain health" technology is on the cusp of dramatic growth and UK intellectual property is at the forefront of this revolution. With the results benefitting patients, GPs, the NHS and the UK, iPads could soon be as common as stethoscopes in GP practices.

About the author:

Dr Andrew Blackwell, PhD is the Chief Scientific Officer at Cambridge Cognition.

Following an MA and a PhD in Psychology from the University of St Andrews, Andrew undertook post-doctoral training in cognitive neuropsychology and Psychopharmacology at the University of Cambridge, working closely on CANTAB® with Professors Trevor Robbins and Barbara Sahakian.

Andrew's research has been driven by two main aims. Firstly, to understand the profile and biological substrates of cognitive impairment in a range of neuropsychiatric conditions including Alzheimer's disease, Mild Cognitive Impairment, Parkinson's Disease, Huntingdon's Disease, Stroke, OCD, ADHD, Depression and Schizophrenia. A second aim is to examine the potential of various pharmacological agents to augment cognitive function both in patients and healthy adults.

Andrew has published numerous papers in quality journals, including Science, American journal of Psychiatry and Neuropsychopharmacology.

Since joining the board of Cambridge Cognition in 2007, Andrew has consulted for most of the leading pharmaceutical research organisations and has worked on over 150 clinical trials of investigational drugs targeting disorders of the CNS.

Andrew is also involved in a number of cutting-edge human performance factor research programs, designed to improve cognitive function during high-performance military and civilian operations. At present he is focused upon the development and commercialisation of Cambridge Cognition's pipeline of products for mainstream healthcare. CANTABmobile, the first of these products to market, is an iPad based CE marked Class II medical device designed to enable early detection and diagnosis of dementia and depression in primary care.

Launched in May 2012, CANTABmobile is now in use in over 25 healthcare trusts in the UK NHS. This year, Cambridge Cognition was listed in the Sunday Times Tech Track as one of the UK's fastest growing technology businesses.

Married with a young family, Andrew lives near Cambridge.

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