REDEFINING DEMENTIA DETECTION

TECHNOLOGY

Redefining dementia detection

In the ongoing battle against dementia, pre-dementia symptoms can now be detected more quickly and cost-efficiently than ever before through the development of AI-led technology. NR Times speaks to Dr Sina Habibi, CEO of Cognetivity, about their groundbreaking work and how the pandemic has helped in the acceptance of remote-use technology

Through the development of pioneering AI-led technology has come the power to reinvent dementia detection. Following years of R&D, successful clinical trials and medical approval, Cognetivity Neurosciences is now being used in both primary and secondary care to find pre-dementia symptoms through a simple test in a quicker time and at a lower cost than ever before. With its non-invasive, low risk tech system able to be used by patients remotely, as well as in a healthcare setting, Cognetivity is also helping to pave the way towards a digital future for healthcare, which has become much more widely accepted during the COVID-19 pandemic. Broadly, its technology works by showing a patient a series of pictures, to which they have to respond as quickly and accurately as possible whether they have seen a prespecified image category. AI algorithms then cluster test performance in terms of accuracy, speed and image properties, giving rapid and highly accurate results. The information can then prove crucial in determining next steps for patients, securing better outcomes, saving significant sums of money in care and examination costs, and offering “queue-busting functionality” in cutting waiting times and removing the need for potentially unnecessary appointments. Cognetivity, founded in 2013, is pioneered by founders Dr Sina Habiba and Dr Seyed-Mahdi Khaligh-Razavi. Combining their expertise and Cambridge PhDs in engineering and cognition and brain sciences respectively, the concept of Cognetivity was born through the discovery of a break-through idea from Dr Khaligh-Razavi’s research. “We started with a solution and then looked for the problem,” says Dr Habiba, CEO of Cognetivity. “In human vision, the eyes work like a camera and the brain makes sense of what happens. But he realised the ability to process visual information drops in time, as you get older it takes longer. They were very interesting observations, so thought let’s put this hypothesis to the test.

UP TO HALF OF DEMENTIAS CAN BE PREVENTED THROUGH LIFESTYLE FACTORS. IT IS VERY EXPENSIVE FOR HEALTHCARE TO DEAL WITH THIS, BUT WE ARE WELL POSITIONED TO PLAY A ROLE IN TACKLING THIS BY DETECTING EARLIER AND ENABLING A HEALTHIER LIFESTYLE.

TECHNOLOGY

“We wrote the code and put it in front of friends aged between 18 and 35, and we saw correlation between age and performance in the test. “We knew there was something in this and we had a very accurate means of assessing cognitive ability. “There is a huge problem with dementia detection. Half of people would not receive a formal diagnosis, so it is a major risk factor. “We went about collecting a lot of clinical data, but it was a bit of a chicken and egg situation - you need data to validate your solution, but without a validated solution you can’t collect data.” From the origins of Cognetivity in 2013, several years of validating the technology through clinical trials followed, with the team’s painstaking efforts leading to medical approval from regulators in 2019. Through the onset of COVID-19, research into the unassisted remote use of the technology by patients was delayed and is still ongoing, but it is very much in use in NHS primary and secondary care settings. In primary care, the setting Cognetivity believes holds most potential, it has been adopted by Sunderland GP Alliance, a federation of 35 practices in the North East of England. It is also being used by North Staffordshire Combined Healthcare NHS Trust, a specialist mental health trust. “Our technology is very much tailored to primary care use, this is where we see it being most effective. It can be five to ten times faster than other technology available, and five to ten times cheaper. It does both of these things while also being more accurate, saving GPs time in the process,” says Dr Habiba. “Historically, MCI patients have been abandoned because right now there is nothing to be done for them. In the absence of any treatment, lifestyle plays an important role and can delay the onset of symptoms, if applied at earlier stages of the disease progression. “Up to half of dementias can be prevented through lifestyle factors. It is very expensive for healthcare to deal with this, but we are well positioned to play a role in tackling this by detecting earlier and enabling a healthier lifestyle. “In secondary care, patients come in with a referral letter and we can use our technology to triage. It is much more accurate than the pen and paper tests. To be fully assessed is a long and expensive process, so we can help determine the ones who need to be seen as a priority, while also providing reassurance to the ‘worried well’ and telling them everything is fine, come back and see us in a year’s time.” And while its ease of use lends itself to remote operation, giving independence to patients while removing the need for them to consult a GP in the first instance, COVID-19 has played a central role in popularising this mindset within healthcare. “We were telling clinicians ‘You don’t have to bring patients in for cognitive tests’ but many weren’t really open to change, it’s human nature not to want to change habits, but it can really help patients and in-person appointments can be a massive drain on resources,” says Dr Habibi. “COVID accelerated that change, everyone was then talking about not bringing people into hospital unless they absolutely had to and it was a matter of life and death, to bring them in for other matters could be very risky. “They tried to do pen and paper tests via the internet but didn’t succeed, they expected elderly patients to have the full-on kit with fast internet, headphones, webcam. This highlighted how important it is that we can do these things very simply, done remotely without any training or supervision, in a simple and user-friendly way. “We see the future of healthcare going this way. There is lots we can do with the technology and resources available to us. Through products such as ours, where tests can be done on a screen, it can save one day of consulting and travelling time.” With its effectiveness in dementia now recognised and the business progressing rapidly in the wider adoption of its technology, Cognetivity is continuing to innovate to apply its creation to more concerns within healthcare. “We are doing a lot of R&D work and are looking to collect data on other neurological disorders, including MS and other conditions, anywhere there is an impairment due to a medical condition,” says Dr Habibi. “We’re taking it to even the pre-clinical stages of disease, looking at how healthy adults can enter the phase of mild cognitive impairment and how we can detect that. “There is great potential there, undoubtedly.”

INSIGHT

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.

The development of the Cognetivity platform, which uses 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 four 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. Such 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.

INSIGHT

“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.

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. SUCH TREATMENTS CURRENT AND FUTURE MAY WORK BEST, AND MAY ONLY WORK, IN THE EARLY STAGES.