Dementia: New approaches to early detection – AI and apps in focus
Am I just forgetful? Or are these already signs of dementia? Anyone wondering this should definitely not take an online dementia test, warns Anne Pfitzer-Bilsing, head of the science department at the Alzheimer Research Initiative. There are numerous tests available online that supposedly allow users to identify possible symptoms of dementia within a few minutes.
But these tests are by no means valid, the expert explains. In the worst case, they could either cause false concerns or lull users into a false sense of security. "If you're worried that you might be suffering from dementia, it's important to see a doctor as soon as possible and have it checked out," advises Pfitzer-Bilsing.
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Doctors have a variety of so-called psychometric tests to choose from with which they can diagnose dementia.
"It's up to the treating physician to decide which test is best, or whether to conduct multiple tests," says Pfitzer-Bilsing. One of the most commonly used psychometric tests is the clock test. It's good because it combines various cognitive tasks: drawing a shape (in this case, a circle), writing numbers, and arranging them correctly.
However, the clock test, like many other dementia tests, is already older. In the age of digital clocks, which no longer have a dial or hands, the test could well become useless one day, says the Alzheimer's expert. "We can already observe that some younger people can no longer read the classic analog clock at all."
Another problem with the dementia tests currently in use is that they "were not developed to detect mild cognitive impairment (MCI), but rather dementia," says David Berron, who heads the Clinical Cognitive Neurosciences working group at the German Center for Neurodegenerative Diseases (DZNE). MCI stands for Mild Cognitive Impairment—a stage between normal cognitive decline in old age and dementia.
"It's important to identify MCI early, as people with MCI are at increased risk for dementia," says Berron. "In addition, novel medications will become available that, if treated early, can delay the progression of the disease, at least in the case of underlying Alzheimer's disease."
The neuroscientist alludes, for example, to the drug lecanemab, which was approved by the EU Commission for the treatment of Alzheimer's in April. It is an antibody that – put simply – combats protein deposits in the brain that are harmful to nerve cells.
The drug is intended for patients in the early stages of Alzheimer's disease. To be able to use such treatments, it would be helpful for tests to detect the disease as early as possible. "Currently, less than 10 percent of patients with MCI are diagnosed in medical care," says the expert.
More and more people could develop Alzheimer's disease in the future. There is currently no cure, but the EU Commission has now approved a new drug. The potential of the active ingredient lecanemab—and its limitations—are explored.
The good thing about dementia tests is that “these diagnostic tools are not set in stone,” says Pfitzer-Bilsing, “but new tests are constantly being developed, some of which allow for more specific diagnoses.” For example, tests that can distinguish depression from dementia.
Dementia doesn't always have to be the cause of cognitive deficits. "It could also be the result of another underlying illness, such as a vitamin deficiency, age-related brain pressure, or even depression," says the Alzheimer's expert. This can lead to reversible dementias that are treatable and often even completely curable.
Memory changes are part of the normal aging process. As people get older, it becomes more difficult to remember names, multitask, or retain new information. But that doesn't mean they have dementia. Dementia goes far beyond normal forgetfulness, explains Pfitzer-Bilsing. "You're not dementia just because you forget an appointment, for example. You usually remember it later. It's different for people with dementia: They won't remember that they had an appointment because that connection in the brain, that information, is simply gone." With dementia, other cognitive abilities are also lost over time, such as speech or orientation. Dementia can severely limit everyday life. Anyone who is worried about memory problems themselves or notices them in a family member or friend should consider seeing a doctor. They can refer affected people to a memory clinic or a neurological practice with expertise in dementia.
Berron and his team are currently developing a new approach for early detection, together with the Magdeburg-based start-up "neotiv," which he co-founded. It's a smartphone app. Users must, for example, memorize an image, which is then replaced after a short time with the same or a slightly modified version. The task is then to recognize whether, and if so, what has changed. Or an image of a room furnished with different pieces of furniture appears. It disappears, and the users are asked to identify which piece of furniture was where.
"Our studies have shown that these tests engage brain regions and networks that are affected early on in Alzheimer's disease," says Berron. Patients are expected to complete the tests over several weeks. The reason for this is simple: "Our cognitive performance varies. If I, as a night owl, take the test at 7 a.m. at my GP's without having had a coffee beforehand, the results may be different than if I take it at 3 p.m. at noon." By repeating the tests at different times and in different situations, day-to-day fluctuations become less significant.
The app-based test offers further advantages: It can be conveniently administered at home, in a familiar, quiet environment. The results are sent to the patient's primary care physician without the need for regular visits to the doctor's office. Of course, there are also challenges, says Berron. On the one hand, there may be more distractions at home than in an examination room. On the other hand, in extreme cases, patients could cheat, for example, by having someone else administer the test for them.
"Our app will never replace the entire diagnostic process, but it will support doctors in making the diagnosis," says Berron. He reports months of waiting times at specialist clinics and memory clinics that specialize in the early diagnosis of memory problems. Many patients are referred there who don't actually need counseling.
This is where tools like this app could help. "If we had a tool in primary care that could detect cognitive impairments early and accurately, fewer people would come to memory outpatient clinics and specialized memory clinics," says the DZNE researcher. "This would reduce waiting times, and resources would be better distributed to those who truly need detailed assessment."
The app has already been approved as a medical device, and doctors can prescribe it. However, reimbursement has not yet been regulated. Further studies are needed. This means that, for now, patients have to cover the costs of the app themselves.
Researchers in Hungary are also working on a new tool for early detection: the so-called Speech Gap Test. It is designed to diagnose cognitive deficits based on speech. An artificial intelligence (AI) system trained on the voices of elderly and demented people analyzes speech rate, the number of pauses, any hesitations while speaking, and the duration of these hesitations.
Even a 60-second speech sample is sufficient, the researchers report. They have shown in studies that the test is suitable for use with Hungarian, English, and German. It is not intended to provide a direct diagnosis, but rather as an initial screening tool that family doctors can use to assess which patients require more complex dementia testing.
AI is "definitely a field that shouldn't be neglected" in dementia diagnostics, says Pfitzer-Bilsing. In Rostock, researchers are currently testing an AI designed to detect dementia-typical brain changes on MRI images. AI is "another tool to refine diagnostics," says the Alzheimer's expert. Doctors who confirm diagnoses are still necessary, however. "We shouldn't close ourselves off to AI, but it doesn't replace a visit to a doctor's office."
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