In this serialised blog, Dr Ivan Koychev and Heather Holve explore how clinicians are testing digital technology in the diagnosis, treatment and care of people with cognitive decline and dementia.
A quick web search on 'the value of wearable technology' provides impressive results on the growth in its uptake of 22% per annum and an expected market value of $34 billion by 2020 (Lamkin , Muller, Winter et al. 2013). With sports and health related wearables now firmly embedded in mainstream culture, life-loggers are already analysing every aspect of their lives (wearabletechnologylife.com). In dementia research too, clinicians are trialling technology aimed at monitoring changes in cognition and behaviour. Could data captured by wearables be the vanguard of early diagnosis, intervention and treatment in dementia? What value does big data really bring to people's lives and health?
Dementia is a complex condition with a variety of causes. We now know that even within each diagnosis there is still huge variability in terms of how quickly people progress and the underlying disease process. This has moved research efforts towards defining individual trajectories to establish whether a medical intervention has been effective for an individual. Creating such individual trajectories requires large data sets collected over long periods of time, and wearable and connected technologies offer an unprecedented opportunity for unobtrusively collecting the amounts of data required.
Wearable tech and managing brain health
As a scientist clinician with DPUK and working with patients showing the first signs of cognitive decline, I'm interested in the efficacy of digital tech in the diagnosis and care of cognitive decline and dementia. During consultations, clinicians rely on self-reported changes in brain health and behaviours, however in this inherently unnatural setting patients often struggle to recall information in detail, or are biased towards giving favourable or unfavourable examples. In addition, there is an obvious limitation in asking patients attending memory clinics to recall their memory difficulties.
Through trialling wearable tech – smartphones, smartwatches and smart homes – we can track more as patients go about their day-to-day life, away from the pressures of the consultation and the so-called 'white coat syndrome'. The resulting detailed data can detect subtle changes in cognition, informing diagnosis and treatments, and helping individuals navigate behaviours that put them at risk.
Digital diagnosis, treatment and care
With the prevalence of dementia set to triple by 2050, we need to address the three fundamental issues of the dementia epidemic: how does dementia start in healthy brains; how can we manage preventable risk factors; and how can we target interventions at those most at risk of developing dementia. In a 2018 review of the impact of body worn and digital sensors within a clinical setting, we found that most devices are in the early stages of development, and there is limited data on whether patients accept the use of such devices. (Chinner, Blane et al. 2018). If we are to realise the promise of accelerated early diagnosis and treatment of dementia, we need to rapidly increase the number of studies testing the value of digital tech to both patient and clinician.
In next week's blog we consider the opportunities for diagnosis with the introduction of wearable digital technology.
What to read next
Ivan Koychev, Great Minds lead and Clinical Scientist at Dementias Platform UK (DPUK), describes an exciting new chapter in dementia research which, with the support of generous new members of Great Minds, promises to accelerate the development of innovative new treatments.
'I’d thought it was all doom and gloom for dementia research’ Marianne said. ‘But I’d not understood that sometimes this is because testing on volunteers only takes place too late'. DPUK brought Marianne Talbot – a cohort participant, and Ivan – an old-age psychiatrist, together to discuss the bright prospects cohorts offer dementia research.