The Medical Futurist

Gradual memory loss, cognitive decline, wandering off to unknown places, being unable to dress in the morning: to live with dementia and Alzheimer’s disease might be a heart-wrenching burden for both patients and their loved ones. As the global population ages, and the number of individuals suffering from these conditions rises, digital technologies must step forward and offer some solutions for early detection and disease management. That’s what we examined in detail here, so let’s see the intersections of digital health and Alzheimer’s disease.

Have you seen Aurora Borealis?

Your mind can play tricks on you even when you’re young, countless silly games leverage on that. However, as the years go by and your body parts start not to obey, these tricks on your mind could take on colossal measures – especially in cases of dreaded diseases of the brain, such as dementia or Alzheimer’s disease. Have you seen Hollywood-movie, Aurora Borealis, where Donald Sutherland plays an old man with dementia insisting he can see the Northern Lights from his window? Or do you remember the hopelessly romantic movie, The Notebook, in which the main character, Allie, lives in a nursing home, where the love of her life tries to recall their memories for her by reading from his notebook?

All these stories take on a daunting overtone as one imagines how the gradual impairment of cognitive functions, such as thinking, remembering, and reasoning, some crucial aspects to the human identity, degrades all other aspects of life as well. Alzheimer’s disease, a progressive brain disorder slowly destroys memory, and, eventually, the ability to carry out the simplest tasks. In mild cases, the patient might only forget what they were told 10 minutes ago, however, in serious instances, the condition can interfere with a person’s daily life and activities. In late-stage Alzheimer’s, patients must completely rely on others to take care of them.

How can families live with the realities of dementia, or one of its most widespread types, Alzheimer’s disease, for years or even decades? Could technology somehow ease the burden on caretakers and family members supporting patients suffering from the condition? Could digital health help in prevention, early diagnostics or better disease management?

Dementia develops in a new patient every 3 seconds

These are absolutely not marginal issues looking at the healthcare burden that Alzheimer’s disease and other types of dementia means. Estimates vary, but experts suggest that more than 5.7 million Americans, most of them aged 65 or older, may have dementia caused by Alzheimer’s. In addition, the condition is currently ranked as the sixth leading cause of death in the United States. The future doesn’t look rosier either. According to a study from the Centers of Disease Control and Prevention (CDC), the U.S. burden of Alzheimer’s disease and related dementias (ADRD) will double by 2060, meaning approximately 13.9 million people by then.

Global trends underpin the same growth as projected for the United States – and the main reason for the increasing number of people with the disease is mainly the rapidly aging population. The international federation of Alzheimer associations around the world, Alzheimer’s Disease International says that currently, dementia develops in a patient every 3 seconds – and the illness is projected to reach 75 million cases by 2030, while 131.5 million by 2050. Much of the increase will be in developing countries. Already 58 percent of people with dementia live in low and middle-income countries, but by 2050 this will rise to 68 percent. The fastest growth in the elderly population is taking place in China, India, and their south Asian and western Pacific neighbors, thus the main acceleration is expected in those parts of the world.

The aggravating numbers need to be counteracted as soon as possible or else the already overwhelmed healthcare systems will have to deal with millions of new dementia and Alzheimer’s patients in the coming years. So, let’s see whether digital technologies could offer solutions and some hope for halting or at least slowing down the trends.

Is the prevention of Alzheimer’s disease and dementia possible?

Researchers are debating the exact causes of the disease, some say that a genetic mutation might be the cause of the condition in people with early-onset Alzheimer’s. However, when symptoms of the diseases how at a much later age, the reasons probably include a combination of genetic, environmental, and lifestyle factors. That seems just as broad as in the majority of diseases, though, and doesn’t bring any step closer to what an individual could do to prevent progressive brain disorder destroying precious memories.

While there’s no panacea for Alzheimer’s, the Harvard Health Letter suggests an active lifestyle with plenty of daily exercise, a Mediterranian diet (or in our reading at least a healthy one), and getting enough sleep. These all seem trivial, but we don’t mind repeating ourselves when it comes to health. In addition, keeping up cognitive health – perhaps with some digital health technologies -, learning new things, and connecting socially might also add to the factors keeping the disease from developing.

Nevertheless, prevention and early management are usually hindered by the fact that the diagnosis already happens in later stages of the disease – although a growing body of evidence indicates that cognitive, behavioral, sensory, and motor changes may precede its clinical manifestations by several years.

Recently, researchers are experimenting with finding digital biomarkers, which harness advances in consumer-grade mobile and wearable technologies, and in the future, could help in diagnosing the disease even before it would clearly form. Although experiments are in early stages, research at digital health company, Mindstrong, has shown that continuous data from seven days of passive smartphone interactions can predict performance on traditional assessments of memory, language, dexterity, and executive function. Imagine that in the future your doctor might tell you during a visit that your phone use shows very early signs of a degenerative brain disorder and here are the steps you can do to prevent it. Although we are obviously decades away from such an option, we hope we will get closer to it day by day.

Virtual reality and smartphones for early diagnostics

Until researchers figure out what the best digital biomarkers for detecting Alzheimer’s are, even decades before it develops, let’s see existing disruptive technologies for early diagnostics. These also aim to capture early changes in behavior and cognitive skills from speech through walking to heart rate.

A study published in the Proceedings of the National Academy of Sciences found that just a few minutes of playing a video game could help identify the earliest stages of Alzheimer’s in ways existing medical tests can’t. The study used a smartphone app called Sea Hero Quest to monitor how more than 27,000 players between ages 50 and 75 with and without a genetic predisposition to Alzheimer’s navigate the virtual world, using their thumbs to move a little boat through a series of maritime mazes.

Another research involving Newcastle University, UK, revealed that body-worn sensors used at home and in-clinic by people with mild Alzheimer’s to assess walking could offer a cost-effective way to detect early disease and monitor the progression of the illness. Changes in speech patterns could also be indicative of the disease, thus alongside with experts, we expect that digital assistants, chatbots, or devices such as Amazon Alexa might be used in the future for diagnosing various types of dementia. In addition, as unusual cardiac activity is also indicative for Alzheimer’s patients due to nervous system damage, digital devices measuring ECG, such as the latest Apple Watch or AliveCor, could be used in the future to detect the condition.

With smart shoes, music, and Amazon Alexa for lifting self-esteem

However, digital assistants, such as the Alexa, can not only support medical professionals in diagnostics but also aid patients and their family members in disease management. In the UK, Amazon made the My Carer Alexa service available, which allows users with early-stage dementia to set reminders for daily tasks, such as when to prepare meals or take medicines – and thus maintaining their independence and boosting their confidence. Dr. János Kollár, a Hungarian clinical psychologist, music therapist, trainer and assistant professor of Semmelweis University, Institute of Behavioural Sciences told The Medical Futurist that listening to music can also help these elderly people regain their sense of self-worth and spirit: remembering, singing along or just listening to old songs significantly improves cognition for Alzheimer patients – they wander off less frequently, they can maintain their independence better, and their self-esteem rises.

Those are important aspects of the management of Alzheimer’s and dementia. While patients struggle with memory losses, and in more serious cases, tend to forget where their home is or wander off from places, they also want to have a sense of independence. Another company called GTX Corp could also help with that: they developed smart shoes with which patients can find their way home and they can orientate quite easily while walking around the street. With the help of Buddi, a smart wearable, a ‘safe zone’, an area that is trusted enough for an elderly person to travel within comfortably, can be established so that if the person travels outside the zone, caregivers are alerted.

The sense of independence: dementia villages

An improved version of these ‘safe zones’ are the so-called dementia villages. In June 2018, it was widely reported that France started to work on its first “Alzheimer’s village” where inhabitants suffering from the most frequent cause of dementia will be given free rein without medication in a purpose-built medieval-style citadel designed to increase their freedom and reduce anxiety. Residents of the village in Dax, southwestern France, will be able to shop in a small supermarket, go to the hairdressers, local brasserie, library, gym, and even a little farm. The inhabitants are confined to the village for their own safety but are allowed to move around freely inside and are watched over by plain-clothed medical staff.

The idea originates from the Netherlands, where a similar care center operates in the village of Weesp, Netherlands. The Hogeweyk – where weyk or wijk means a group of houses, comparable to a village – is a specially designed small residential area with 23 houses for 152 dementia-suffering seniors. The elderly all need nursing home facilities and live in houses differentiated by lifestyle, such as Goois (upper class), homey, Christian, artisan, Indonesian or cultural. The residents manage their own households together with a permanent team of staff members.

These facilities allow much more freedom to residents than traditional nursing homes, and they could decrease the phenomenon of dementia patients roaming around aimlessly on the streets or losing their way home – but they could still walk and live a much more independent life.

And what could the future bring?

Looking at the above trends, it isn’t difficult to imagine that smart algorithms might be able to catch the earliest signs of dementia and Alzheimer’s disease years in advance. This notion is not even that far as we assume: a couple of days ago, the MIT News Office published that a new model developed at MIT can help predict if patients at risk for Alzheimer’s disease will experience clinically significant cognitive decline due to the disease, by predicting their cognition test scores up to two years in the future. Imagine how different the attitude and management of the condition might be when smart algorithms based on digital biomarkers could extrapolate a potential disease curve to the future – and clinicians could act on that way before it actually happens.

On the other hand, looking at disease management itself, digital sensors embedded into wearables, clothing, shoes, or placed near dementia or Alzheimer’s patients as digital assistants will ensure that individuals suffering from the disease can maintain their independence much better than ever before, perhaps even live without any help in the early stages of the disease. That’s what dementia villages and safe zones could also safeguard, also enabling family members to leave their loved ones in safe and comfortable environments. That’s what we all wish and work for.