A dementia diagnosis usually starts with a family member noticing that something isn’t quite right: a partner becoming forgetful, a normally placid parent losing their temper more often. From there, there are doctor’s appointments—memory and behavior tests that haven’t changed in years, brain scans if the money is there, or one of the battery of new blood tests looking for the biomarkers of brain damage. And then: nothing.
Neurodegenerative diseases like dementia and Alzheimer’s are more feared than cancer and heart disease combined, according to a 2016 survey, and one of the most frightening things about them is how little we still know. There are no cures, and few effective treatments.
So you might question the benefits of a 5-minute test that can assess your risk of getting dementia before you show any symptoms. The Integrated Cognitive Assessment (ICA) test, developed by the British startup Cognetivity Neurosciences, has been granted Food and Drug Administration clearance to be marketed in the United States and is being trialled at several NHS trusts in the UK. But is there any point in taking a test for a disease you can’t do anything about?
The ICA is designed as a “semi-supervised” screening test, says Cognetivity CEO Sina Habibi. It could form part of an annual health check-up for the over-50s, looking for the earliest signs of neurodegenerative disease before they become apparent in behavior. “In the same way you look at blood pressure, you could look at the brain with a cognitive test to see if there’s something malfunctioning,” he says.
An early diagnosis could help people plan ahead and put their affairs in order—but arguably that’s something they should probably be doing anyway. Lifestyle tweaks such as eating less fat, exercising more, or drinking less can also reduce risk, particularly in vascular dementia, which is caused by poor blood supply to the brain and is therefore closely linked to heart health.
The procedure runs on an iPad. A zebra appears onscreen and then disappears, replaced by a railway bridge. There are flashes of beach scenes in black and white, and then a glimpse of an exotic bird, all interspersed with monochrome grids and fuzzy static—a captcha at warp speed. The user’s task is simple: They tap on the right side of the screen whenever they see an animal in one of the pictures, and on the left side when they don’t.
The test, which was spun out of research at the University of Cambridge, is billed as a quick and easy replacement for the pen and paper memory tests often used early in a dementia diagnosis. (In the widely-employed Montreal Cognitive Assessment, for instance, subjects have to name animals from line drawings, read a list of words and repeat them, or copy a drawing of a cube.) The ICA instead uses an AI, trained on patients with early-onset dementia, which combines the subject’s speed and accuracy on the iPad task with information on lifestyle, age, ethnicity, and other factors to calculate a risk score.
Rather than measuring memory or executive function, it aims to assess the raw information processing speed of the visual system, with a test that should work the same regardless of someone’s language skills, cultural background, or education level, according to Habibi. “We’re focussing on the CPU of the brain rather than the hard drive,” he says. It leans on the fact that our visual processing system, when healthy, has apparently evolved to quickly detect animals—hence the zebra—so any slowdown in this process could hint at an underlying problem.
At the end of the test, participants hand the iPad back to their doctor or nurse, who taps in a passcode to gain access to the patient’s risk score from 1 to 100, with anything over 50 indicating an elevated risk of dementia. It’s up to the medical professional how they choose to present that information.
There are concerns that, given the lack of treatment options, widespread use of screening tests may only serve to overwhelm the health system with anxious people who have been told they are at risk of dementia but aren’t yet showing symptoms. “I worry that this will have huge implications for people. There isn’t the infrastructure to fully support families affected by dementia,” says Karen Harrison Dening, head of research and publications at the charity Dementia UK. Already, she says, the NHS often doesn’t have enough money to pay for brain scans for everyone who needs one in the UK. “Where are they going to go for that post-test counseling?” she asks. “We just don’t have the infrastructure—and there is a moral obligation to support them.”
Source: https://www.wired.com/
November 8, 2022
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Categories: Uncategorized
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Tags: Alzheimer's, blood tests, brain disease, brain health test, brain scans, cognitive tests, gene tests, Huntington’s disease, Lifebrain, Norwegian Institute of Public Health, risk, test, University of Oslo
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