In part two of Dr Ivan Koychev's blog series, he considers the opportunities for diagnosis and treatment with the introduction of wearable digital technology.
As a clinician scientist, the initial findings of The Deep and Frequent Phenotyping study (DFP) give me some hope for the value of digital technology as a diagnostic tool. The DFP, a DPUK linked study, is an ambitious project aiming to clarify the importance of various molecules, genes or characteristics for the diagnosis and prediction of pre-clinical dementia. In the pilot study, we tested wearable digital accelerometers in clinic-based and free-living situations and showed that gait has the potential to be a diagnostic tool for cognitive decline (Koychev, Galna et al. 2018, Mc Ardle, Morris et al. 2018).
We found that it is feasible, in mild Alzheimer's disease, to relate gait measures with cerebrospinal fluid measures - Alzheimer's disease biomarkers of amyloid and tau proteins. This opens up the possibility of pragmatic approaches to identifying who needs more invasive forms of testing (Koychev, Galna et al. 2018). We are now ready to recruit to the main DFP study, which will focus on the earliest possible disease stage with results expected within 3 years (details on the study protocol are in press at the BMJ Open website).
Will the data collected through wearable tech transform dementia research?
It can be difficult providing clinical care for people showing the first symptoms of dementia when there are so few treatments to offer. However in 2018 we had the first promising evidence from trials that some treatments are interacting with what we believe is a trigger of the disease – the accumulation of amyloid proteins (AlzForum 2018). However, amyloid clearance therapies have not yet proved effective treatments in patients – potentially because we are only able to test them on people late in the progression of the condition, namely when they start to show clinical symptoms.
We know that dementia can start up to 20 years before symptoms show. If we are to understand the origins of the condition, we need longitudinal data – collected over years – on the brain health of healthy individuals, so that we can track and pinpoint tell-tale signs of increased risk of dementia in later life. With such data we can make real progress by testing the effectiveness of interventions on individuals who don't yet have disease symptoms.
To discover the origins of dementia we need volunteers from health studies who have existing health data to build on. To answer this challenge Dementias Platform UK is running a pilot to recruit such volunteers to the Great Minds register (UK 2019). Great Minds invites health study participants to volunteer for clinical trials optimised for dementia research. Importantly Great Minds is also seeking to use advances in digital technology to enrichen the volunteers' brain health data by asking participants to complete ongoing online and smartphone-based cognitive tests. This rich longitudinal cognitive data will help researchers match well-characterised volunteers with targeted clinical trials to fast track development of new treatments.
In the final blog in the series, we examine how digital technology is already assisting in the care – and importantly self-care – of those with a dementia diagnosis.
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'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.