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Digital innovation and Alzheimer's Disease

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Opportunities for digital innovation, startups, technology companies in the fight against Alzheimer's Disease, Dementia and related disorders

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Digital innovation and Alzheimer's Disease

  1. 1. DIGITAL INNOVATION & ALZHEIMER’S DISEASE The Startups, The Science Frank Boermeester // Advance.Healthcare @fboermeester
  2. 2. “Alzheimer’s Disease has no survivors” It destroys brain cells and causes memory changes, erratic behaviors and loss of body functions. It slowly and painfully takes away a person's identity, ability to connect with others, think, eat, talk, walk and find his or her way home. Alzheimer’s Association – alz.org Alois Alzheimer's patient Auguste Deter in 1902. The first described case of what became known as Alzheimer's disease. Frank Boermeester @fboermeester
  3. 3. Unrelenting progression of disease Pre-dementia Early Moderate Advanced Pre-diagnosis, mild cognitive impairment (memory & executive functions) Increasing cognitive impairment (learning, attention, language) Independence hindered (motor skills, wandering, neuropsychiatric symptoms) Completely dependent (exhaustion, muscle mass deteriorates), death Up to 20 years 2-10 years 1 – 5 years Frank Boermeester @fboermeester
  4. 4. World Alzheimer Report 2015 A global epidemic Frank Boermeester @fboermeester
  5. 5. “There’s an app for that.” Or is that a stupid and disrespectful question? ...in light of the millions spent on unsuccessful pharmaceutical research (99.6% of drug trials for Alzheimer’s Disease during the period 2002-2012 have failed) http://www.alzres.com/content/6/4/37 Frank Boermeester @fboermeester
  6. 6. There’s a wave that needs riding, it’s called... Beyond the pill “A survey conducted by Accenture found that life-sciences executives continue to warm up to the idea of using wearables and other intelligent hardware, saying technology will be the catalyst for the industry's move into outcome-based sales. ….About 85% of respondents said they believe using intelligent hardware, sensors and devices will help the industry shift from selling pills to selling outcomes.” - http://www.mmm-online.com/dataanalytics/smart-devices-will-improve-pharma-sales-survey/article/439278/
  7. 7. Prevention Early detection & diagnosis Treatment Management Diagnosis is difficult (extensive neuropsychological testing), especially early detection No pills to solve safety issues & risk of injury due to wandering, outburst, aggression Huge care burden (most costly disease in Europe & the USA). Not enough care workers, family distress, etc. No ‘silver bullet’ given devastating impact on the patient: cognitive, emotional, motor, neuropsychiatric, social.. Measurement of disease progression (for clinical trials etc) is difficult Prevention may involve lifestyle/behaviour change (pending more research) No pills to fix loss of autonomy, isolation, loneliness... No pills to fix cognitive decline (memory, executive functions, language) Heavy medication to manage psychiatric symptoms (depression, delusions, aggression) Why look beyond the pill? Frank Boermeester @fboermeester
  8. 8. Prevention Early detection & diagnosis Treatment Management Cognitive Assessment Cognitive and neuropsychological testing for early detection, diagnosis and measurement of disease progression Training & Games Delaying the progress of AD through retraining of memory, multitasking skills, verbal skills etc Monitoring Sensor-based monitoring (e.g. activity tracking, fall detection, care prediction tools) and telemedicine Augmentation Cognitive and physical augmentation (e.g. memory support, spatial orientation) Imaging Analytics Imaging analytics for early detection, diagnosis and measurement of disease progression Care Robots/Platforms Help improve care delivery and emotional stimulation and reduce the burden of informal caregivers. Connectivity Connect patients with care networks and comfort services through easy to use communication platforms. Omics/Big Data Research Analysis of large data sets of medical records, genome-based research etc ERP/EHR software Software for streamlining operational and administrative care tasks Not addressed in this report Opportunities for digital innovation?
  9. 9. Prevention Early detection & diagnosis Treatment Management Cognitive Assessment Cognitive and neuropsychological testing for early detection, diagnosis and measurement of disease progression Training & Games Delaying the progress of AD through retraining of memory, multitasking skills, verbal skills etc Monitoring Sensor-based monitoring (e.g. activity tracking, fall detection, care prediction tools) and telemedicine Augmentation Cognitive and physical augmentation (e.g. memory support, spatial orientation) Care Robots/Platforms Help improve care delivery and emotional stimulation and reduce the burden of informal caregivers. Connectivity Connect patients with care networks and comfort services through easy to use communication platforms. Part 1: monitoring, augmentation, connectivity Frank Boermeester @fboermeester
  10. 10. Sensor in a sock Pressure sensor in sock to detect when person starts wandering out of bed Smart Sole GPS-enabled monitoring so that can set a “geo-fence” and create customised alerts http://www.fastcoexist.com/3034118/this-kid-designed-a- wearable-health-device-for-his-grandfather-with-alzheimers http://www.gpssmartsole.com/gps-smart-sole.php https://www.indiegogo.com/projects/itraq- the-cellular-tracking-device#/story iTraq Credit-card sized tag enables geo-tracking through cellular networks Passive monitoring Frank Boermeester @fboermeester
  11. 11. Interactive monitoring Embracelet GPS tracking, emergency button, customised alerts & reminders Toshiba Silmee GPS tracking, emergency button, multiple health tracking sensors (heart rate, activity, ultraviolet light) http://www.psfk.com/2015/09/toshiba -activity-trackers-for-senior-care- silmee-w20-w21.html http://www.embracelet.be/ Clevercare GPS tracking, emergency button, customised alerts & reminders, phone calls, 24/7 emergency response call centre http://clevercare.co.nz/ Tempo (CarePredict) Tracks and learns daily patterns and detects/predicts possible problems http://carepredict.com/
  12. 12. ‘Augmentation’ Backup Memory Smartphone app that alerts user when a familiar person is nearby and reminds them about their relationship through photos http://global.samsungtomorrow.com/samsung- volunteers-in-tunisia-develop-app-for-alzheimers- patients/ Intelligent Glasses Singapore scientists have developed a tool on Google Glass that recognises people and reminds the user who they are, and reminds the user about medication http://www.straitstimes.com/singapor e/health/smart-glasses-for-seniors- with-dementia Cloudphone (Ollo Mobile) Tracking & communication wearable, includes a ‘safe path’ feature that automatically monitors regular transit activity – like going to and from shop. You set the route and schedule, CloudPhone lets you know if things go wrong. https://www.indiegogo.com/projects/cloudphone-3g- revolutionize-how-you-care#/story
  13. 13. Connected Patients Cubigo A single, easy to use platform for accessing a personalised portfolio of services, including commucation tools (e.g. videocalls, messages, neighbourhood forum), comfort services (e.g. home shopping, postal services), and security and care (medical appointments, medication reminders, alarms, integration with sensors). http://www.cubigo.com/ Frank Boermeester @fboermeester
  14. 14. Scientific Comment Monitoring tech works... Consumer electronics devices (relying on GPS, wifi, mobile networks) can detect wandering patterns and alert caregivers. “Experimental results show that the mobile-health application is able to detect wandering patterns including lapping, pacing and random in real-time.” http://ieeexplore.ieee.org/xpl/articleDetails.jsp?arnumber=6611105 Frank Boermeester @fboermeester
  15. 15. Scientific Comment Usability can be a problem: “When being targeted to patients with dementia some usability problems appeared, such as difficulties to read information in a small screen or take a proper photo.” http://www.tandfonline.com/doi/abs/10.3109/09638288.2015.1025992 Participatory design (involving people with dementia in design process) is feasible and beneficial: “Participants felt strongly that future devices should be disguised and be integrated easily into their daily routines. Suggested areas for functional improvement included two-way communications, flexibility of function as the illness progresses, and something to "guide" them home when out walking or driving. Attention should also be focused on minimizing the size, weight and visibility of devices to reduce stigmatization.” http://www.ncbi.nlm.nih.gov/pubmed/19193255
  16. 16. Scientific Comment There are ethical issues that need to be addressed (balancing patients’ need for safety with need to preserve their autonomy and privacy.) “No-one should be coerced into using tracking technology and, where possible, people with dementia must be involved in the decision-making and their consent sought.” http://www.ncbi.nlm.nih.gov/pubmed/22014284
  17. 17. Prevention Early detection & diagnosis Treatment Management Cognitive Assessment Cognitive and neuropsychological testing for early detection, diagnosis and measurement of disease progression Training & Games Delaying the progress of AD through retraining of memory, multitasking skills, verbal skills etc Monitoring Sensor-based monitoring (e.g. activity tracking, fall detection, care prediction tools) and telemedicine Augmentation Cognitive and physical augmentation (e.g. memory support, spatial orientation) Care Robots/Platforms Help improve care delivery and emotional stimulation and reduce the burden of informal caregivers. Connectivity Connect patients with care networks and comfort services through easy to use communication platforms. Part 2: cognitive assessment Frank Boermeester @fboermeester
  18. 18. Speech analysis IBM research team created an automated verbal test (much shorter/faster than standard paper-based tests). IBM Watson is used to analyse speech pattern (not the content but the tone, pauses, continuity of speech etc). The application classifies with 85% accuracy whether user is disease free, pre-dementia and early-dementia. Other (non-IBM) research on speech analysis is also showing good results. http://www.techrepublic.com/article/how-ibm-research-wants-to-use-mobile-devices-to- detect-early-stage-dementia/ Cognitive assessment http://www.ncbi.nlm.nih.gov/pubmed/23698268 Frank Boermeester @fboermeester
  19. 19. Eye movement analysis Neurotrack is a computer-based visual cognitive test (tracks eye movement as a means to measure recognition memory) that appears to be capable of predicting patients’ risk of developing AD before behavioural symptoms appear. The tool is potentially useful in clinical trials with early (pre-symptomatic) stage AD patients and later as a general screening test https://www.neurotrack.com/ Cognitive assessment Frank Boermeester @fboermeester
  20. 20. Computer game performance as test Game developer Akili Interactive Labs and Pfizer are doing research to see if brain- boosting app Neuroracer could detect and track the progression of AD. Neuroracer detects attention impairment, which in turn is linked to early stage AD. http://www.alzheimers.net/2014-01-13/akili-app-may- detect-alzheimers/ Cognitive assessment Frank Boermeester @fboermeester
  21. 21. Scientific Comment Disrupting clinical-based cognitive assessment “The revolution in mobile technologies provides unprecedented opportunities to overcome the barriers of time and context that characterize traditional hospital and clinical- based assessments.” Mobile Technologies in the Early Detection of Cognitive Decline http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275158/ Frank Boermeester @fboermeester
  22. 22. Scientific Comment Imagine a future of always-on, continuous & contextual cognitive monitoring “The future vision is one where classically slow, subjective, and data-poor assessments of cognition are replaced by fast, objective, and data-rich digital assessments that can be unequivocally linked to functional improvement by reference to large datasets. … In a world where the majority of the population carries a mobile digital device, where our behavioral status, cognitive capacity, and clinical function are ubiquitously and continuously tracked by the digital footprint we leave behind, the prospect for transformative efficiency and accuracy in testing novel therapeutics in neurodegenerative disease may rest in the devices we each carry in our pockets.” C Leurent and MD Ehlers* Digital technologies for cognitive assessment to accelerate drug development in Alzheimer's disease. Clinical Pharmacology & Therapeutics 8 SEP 2015
  23. 23. Prevention Early detection & diagnosis Treatment Management Cognitive Assessment Cognitive and neuropsychological testing for early detection, diagnosis and measurement of disease progression Training & Games Delaying the progress of AD through retraining of memory, multitasking skills, verbal skills etc Monitoring Sensor-based monitoring (e.g. activity tracking, fall detection, care prediction tools) and telemedicine Augmentation Cognitive and physical augmentation (e.g. memory support, spatial orientation) Care Robots/Platforms Help improve care delivery and emotional stimulation and reduce the burden of informal caregivers. Connectivity Connect patients with care networks and comfort services through easy to use communication platforms. Part 3: training & games Frank Boermeester @fboermeester
  24. 24. The Rise of the Brain Fitness Industry But are these useful for people with AD?
  25. 25. Scientific Comment: Brain Training Brain training can be effective for normal older adults (no AD or dementia) Brain training games have been criticised for making false promises. But a study published in Nature, shows that a game that is tailored to a specific cognitive deficit (in this case multi-tasking) can be effective in enhancing cognitive control among older adults. Hence it’s potential use to detect early AD. http://www.nature.com/news/gaming-improves-multitasking-skills-1.13674 Certain mental exercises can offset some of the expected decline in older adults' thinking skills and show promise for maintaining cognitive abilities needed to do everyday tasks such as shopping, making meals and handling finances, according to a new study. The research, published in the Dec. 20, 2006, Journal of the American Medical Association, showed that some of the benefits of short-term cognitive training persisted for as long as five years. http://www.nih.gov/news/pr/dec2006/nia-19.htm Frank Boermeester @fboermeester
  26. 26. What about Brain Training for Alzheimer’s Disease? Some population studies do show that people who engage in intellectual activities such as reading, board games, crossword puzzles, playing music, social interaction, learning a second language later in life, etc. have reduced risk for developing AD or even seems to delay development of AD. The concept of ‘cognitive reserve’ is used to explain a degree of resilience that some people have to the clinical manifestations of AD, but not to the disease process itself. People with high cognitive reserve may go undiagnosed until disease pathology is severe, then rapid decline follows. • Wilson RS et al. Participation in Cognitively Stimulating Activities and Risk of Incident Alzheimer Disease. AMA. 2002;287(6):742-748. doi:10.1001/jama.287.6.742. • Verghese J et al. Leisure Activities and the Risk of Dementia in the Elderly. The New England Journal of Medicine NEJM, 2003, 348:2508-2516 • Stern, Yaakov (2006) Cognitive Reserve and Alzheimer Disease. Alzheimer Disease & Associated Disorders, vol 20, p 112-117. • Williams JW et al Preventing Alzheimer's disease and cognitive decline. Evid Rep Technol Assess (Full Rep). 2010 Apr;(193):1-727. Scientific Comment: Brain Training
  27. 27. And yet….they can be useful! A literature review of 15 studies on dementia-related serious games suggests that: • (1) physical games (or exergames, i.e., games that promote physical fitness) can positively affect several health areas of the players with mild AD and MCI, such as balance and gait (Padala et al., 2012), and voluntary motor control (Legouverneur et al., 2011); • (2) cognitive games (i.e., games which target cognitive improvement) can improve a number of cognitive functions, such as attention and memory (Stavros et al., 2010; Weybright et al., 2010; Rosen et al., 2011) and visuo-spatial abilities (Yamaguchi et al., 2011); • (3) both physical and cognitive games can have a positive impact on social and emotional functions, for instance they can improve the mood and increase positive affect and sociability (Weybright et al., 2010; Boulay et al., 2011; Yamaguchi et al., 2011) and reduce depression (Férnandez- Calvo et al., 2011). Very few studies investigated the effects of the use of games for social/emotional health (which encourage the players to link with their friends and/or improve their social and emotional life) in dementia, but the results are encouraging (Boulay et al., 2011). Dementia Games: A Literature Review of Dementia-Related Serious Games http://link.springer.com/chapter/10.1007%2F978-3-642-40790-1_2 Scientific Comment: Brain Training
  28. 28. Conclusions of a systematic review and SWOT analysis of use of serious games targeting AD patients, analyses which in turn were discussed and validated in a workshop at the 2013 Clinical Trial of Alzheimer's Disease (CTAD) conference, and endorsed by stakeholders in the field: “The results revealed that SG may offer very useful tools for professionals involved in the care of patients suffering from ADRD. However, more interdisciplinary work should be done in order to create SG specifically targeting these populations. Furthermore, in order to acquire more academic and professional credibility and acceptance, it will be necessary to invest more in research targeting efficacy and feasibility. Finally, the emerging ethical challenges should be considered a priority.” Recommendations for the use of Serious Games in people with Alzheimer's Disease, related disorders and frailty. Front. Aging Neurosci., 24 March 2014 http://dx.doi.org/10.3389/fnagi.2014.00054 Scientific Comment: Brain Training
  29. 29. Alzup Tablet app that integrates cognitive exercises and actual memories. Working with University research team for clinical trials. http://www.alzhup.com Memory Places PhD research by Kasper Bormans is exploring the use of virtual ‘memory places’ (guided imagery) to enhance memory for familiar faces, thereby improve quality of life of patients and caregivers Cognitive Training https://www.youtube.com/watch?v=BMcduh1HEHA
  30. 30. Ybrain Ybrain has developed a nerve stimulating headband for patients suffering early onset Alzheimer’s and is building an analytics platform for disease diagnosis and personalized treatments. They have FDA approval for clinical trials, and have secured $4.2 million in Series A funding. “Based on the individual’s brain signals, personalized current stimulation is provided to vitalize certain brain regions to keep the brain healthy.” http://ybrain.com/ Brain Stimulation Frank Boermeester @fboermeester
  31. 31. Prevention Early detection & diagnosis Treatment Management Cognitive Assessment Cognitive and neuropsychological testing for early detection, diagnosis and measurement of disease progression Training & Games Delaying the progress of AD through retraining of memory, multitasking skills, verbal skills etc Monitoring Sensor-based monitoring (e.g. activity tracking, fall detection, care prediction tools) and telemedicine Augmentation Cognitive and physical augmentation (e.g. memory support, spatial orientation) Care Robots/Platforms Help improve care delivery and emotional stimulation and reduce the burden of informal caregivers. Connectivity Connect patients with care networks and comfort services through easy to use communication platforms. Part 4: care robots/platforms Frank Boermeester @fboermeester
  32. 32. Care through Robots & Avatars Paro PARO is an advanced interactive robot developed by AIST. It allows the documented benefits of animal therapy to be administered to patients in environments such as hospitals and extended care facilities where live animals present treatment or logistical difficulties. PARO has five kinds of sensors: tactile, light, audition, temperature, and posture sensors, with which it can perceive people and its environment. It works, but raises ethical concerns. http://www.parorobots.com/ Frank Boermeester @fboermeester
  33. 33. Scientific Comment Are we ready for robots that care for us? “Results so far have been encouraging in the sense that they showed that elderly people concerned by cognitive impairment recognize the potential of Socially Assistive Robots (SAR) for supporting health and social care at home. It is true that the current state of the research on SAR does not allow us to conclude that older adults are ready for robots that care for them, but the idea is no longer unimaginable..” Pino M et al. “Are we ready for robots that care for us?” Attitudes and opinions of older adults toward socially assistive robots. Front. Aging Neurosci., 23 July 2015 | http://dx.doi.org/10.3389/fnagi.2015.00141 Frank Boermeester @fboermeester
  34. 34. http://www.tinybots.nl/ Care through Robots & Avatars Tinybots Small, talking robots that provide cognitive training, medication reminders and ‘companionship’, giving structure to a person’s life
  35. 35. Care through Robots & Avatars GeriJoy A team of remote caregivers (based in the Philipines) provide personalised emotional support, cognitive stimulation and reporting through a care avator (animated dog), all on a 24/7 basis. https://www.gerijoy.com/ Frank Boermeester @fboermeester
  36. 36. Monitoring+Care Platforms Giraff Plus GiraffPlus monitors activities in the home using a network of sensors, both in and around the home as well as on the body. The sensors can measure e.g. blood pressure or detect e.g. whether somebody falls down. A range of services can be tailored to the individual’s needs. At the heart of the system is a unique telepresence robot, Giraff, which lends its name to the project. The robot uses a Skype-like interface to allow relatives or caregivers to virtually visit an elderly person at home. Photo Terese Andersson http://www.giraffplus.eu/
  37. 37. Monitoring+Care Platforms Mobiserv A European, multi-partner research project that created a platform consisting of: • A social companion robot - robot, containing processing power, data storage capability, various sensors, machine learning/experience gathering/adaptation, a touch screen, speech synthesis, and speech recognition • Wearable smart clothes - monitoring of vital signs or sleeping patterns, and detection of falls • Smart home environment - smart sensors, optical recognition units, and home automation elements, to detect among others eating and drinking patterns, activity patterns, and dangerous situations http://www.mobiserv.info/ Frank Boermeester @fboermeester
  38. 38. Cognitive Assessment Cognitive and neuropsychological testing for early detection, diagnosis and measurement of disease progression Training & Games Delaying the progress of AD through retraining of memory, multitasking skills, verbal skills etc Monitoring Sensor-based monitoring (e.g. activity tracking, fall detection, care prediction tools) and telemedicine Augmentation Cognitive and physical augmentation (e.g. memory support, spatial orientation) Care Robots/Platforms Help improve care delivery and emotional stimulation and reduce the burden of informal caregivers. Connectivity Connect patients with care networks and comfort services through easy to use communication platforms. How will it all come together? Frank Boermeester @fboermeester
  39. 39. Cognitive Assessment Cognitive and neuropsychological testing for early detection, diagnosis and measurement of disease progression Training & Games Delaying the progress of AD through retraining of memory, multitasking skills, verbal skills etc Monitoring Sensor-based monitoring (e.g. activity tracking, fall detection, care prediction tools) and telemedicine Augmentation Cognitive and physical augmentation (e.g. memory support, spatial orientation) Care Robots/Platforms Help improve care delivery and emotional stimulation and reduce the burden of informal caregivers. Connectivity Connect patients with care networks and comfort services through easy to use communication platforms. From multi-functional platforms (monitoring, memory-supporting, connected care platforms) to... Frank Boermeester @fboermeester
  40. 40. Cognitive Assessment Cognitive and neuropsychological testing for early detection, diagnosis and measurement of disease progression Training & Games Delaying the progress of AD through retraining of memory, multitasking skills, verbal skills etc Monitoring Sensor-based monitoring (e.g. activity tracking, fall detection, care prediction tools) and telemedicine Augmentation Cognitive and physical augmentation (e.g. memory support, spatial orientation) Care Robots/Platforms Help improve care delivery and emotional stimulation and reduce the burden of informal caregivers. Connectivity Connect patients with care networks and comfort services through easy to use communication platforms. ...grid-linked cyborgs? Frank Boermeester @fboermeester
  41. 41. Thanks! Frank Boermeester @fboermeester //advance.healthcare At Advance Healthcare we are on a mission to improve the lives of patients through digital innovation, one disease at a time.

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