App-based dementia test is awaiting approval
Integrated Cognitive Assessment test for early onset dementia attempts to filter out biases
A tablet app-based way to gauge a person’s loss of memory and other cognitive abilities is poised to replace standard paper and pen dementia tests, such as the one Donald Trump’s lawyer claimed the American president passed with flying colours in January.
The Integrated Cognitive Assessment (ICA) test is a digital method of detecting signs of early onset dementia. It was developed over a five-year period at the University of Cambridge by a team of biomedical engineering, nano-biotechnology, neuroscience and psychiatry experts headed by Dr. Sina Habibi.
It is expected to be available in about a year, after Cognetivity Neurosciences gets approval from various federal health-care regulatory agencies around the world, such as Health Canada, the FDA in the U.S., and Europe’s EMA.
It comes at a time when dementia is the biggest medical challenge of the century, as the global cost of care is estimated at $665 billion (Canadian) annually.
The number of Canadians with dementia is “rising sharply” according to the Alzheimer Society of Canada. In 2016, an estimated 564,000 people had the condition. About 25,000 new cases are identified each year.
By 2031, the society estimates there will be about 937,000 cases, a 66-percent increase.
Canadian health-care costs associated with dementia in 2016 were estimated at $10.4 billion, a figure expected to increase by 60 per cent to $16.6 billion by 2031. Dementia is a mental state caused by brain cell damage.
Key symptoms include memory loss, difficulty in thinking, problem solving and language issues. It is often confused with Alzheimer’s, which is a brain destroying disease that results in dementia.
At the moment there are three commonly used paper and pen evaluations for the loss of cognitive function.
There is the Montreal Cognitive Assessment (MOCA), which is the one Trump was said to have aced with a perfect score of 30 out of 30, the Mini Mental State Exam (MMSA) and the General Practitioner Assessment of Cognition (GPCog).
“Healthcare systems all over the world are failing to detect dementia early and we think this will be a tool that will help people early through software delivered on a device,” said Dr. Thomas Sawyer, Cognetivity Neurosciences’ chief operating officer and one of Habibi’s research and development team members.
The ICA test has five steps and involves the use of images from nature to assess a person’s short-term memory. It engages a large proportion of the brain with visual interaction, a series of questions to gauge motor skill responses and measure accuracy and speed.
“You can do it in your doctor’s office or at home,” Sawyer said. “The most important thing is to catch it (signs of dementia) early to arrest progression. If a patient shows signs of what we call ‘mild cognitive impairment,’ the very earliest stage of the disease, a doctor can start to do a lot to help the patient, even in the absence of disease modifying drugs, which will come.”
He said early detection and comparative testing over time enables people to manage symptoms better and provides time to plan for the future.
“What we are doing at the moment is completing clinical validation studies, demonstrating to the health regulating authorities that it is a valid clinical tool. This is quite an important stra- tegic point for us because there are a ton of apps out there claiming to do X, Y and Z, so we need to differentiate our test with the proper validation.”
Like a prescription drug, the ICA test is expected to be available through government and private health insurance plans, or for a standard fee.
“As software, it isn’t costly to deliver, cheaper than the labour intensive way that things are done at the moment, and as a technology company we are mindful of making it available to as many users as possible. Currently in the U.S., reimbursement for computerized cognitive assessment stands at about $48 per test, which tells us what the market will support in the U.S.,” Sawyer said.
“The analogy I like to use is that it is like a blood pressure test. A routine BP test is very cheap to administer and very meaningful. If you have high BP, it doesn’t mean you’re going to fall over dead from a heart attack that afternoon. It gets looked at in the context of everything else we know about your health and it should be looked at further.”
He pointed out pen and paper tests are limited by the bias effects of culture and language. The ICA test’s artificial intelligence (AI) component takes into account patient attributes such as age, gender and education level, without a cultural or language bias.
Sawyer adds that in order for the ICA test to be validated as a medical device by various nations and territories, it must adhere to strict health-care security and privacy standards.
“It is very important to ensure people that no one can match test results with your name,” he added.