Developing low-cost cognitive tools for dementia assessment in low-to-middle income countries (LMICs)
Lead Research Organisation:
CARDIFF UNIVERSITY
Department Name: Sch of Psychology
Abstract
In 2013, there were 44.4 million people with dementia worldwide. By 2030, this number will likely increase to 75.6 million, and by 2050 to 135.5 million. A new case of dementia is diagnosed somewhere in the world every 4 seconds. Not surprisingly, the costs of this public health challenge are substantial (US$604 billion in 2010, 1% of total global GDP).
Notably, 58% of individuals experiencing dementia are thought to live in low-to-middle-income countries (LMICs), underlining the high impact of dementia in those regions, where - relative to high income countries (HICs) - understanding of dementia is low, health and social care less well developed, and social exclusion high. By 2050, it is estimated that 71% of individuals with dementia worldwide will be living in LMICs; the social and financial burden of dementia, therefore, is increasingly being felt in countries with limited health infrastructure and support for affected individuals. Compounding this problem, less than 10% of individuals in LMICs receive a dementia diagnosis, or tailored medical guidance to help them and their families understand how the particular form of dementia they are experiencing may impact on their daily living. These issues additionally limit involvement of LMICs in global clinical trials where new drug therapies may be subsidized, and supportive care provided.
Rapid action is needed if these problems are to be addressed. In particular, there is an urgent need for effective, low-cost cognitive assessment approaches which can aid diagnosis and be used in geographically- and culturally-diverse areas of the world. When complemented by provision of information about different forms of dementia, this can help families and healthcare professionals implement appropriate and tailored care for patients, and identify individuals who can be included in global clinical trials. To address this problem, the Foundation Award focuses on the development of new digital cognitive testing platforms, able to be provided in LMICs via tablets and smartphones. We will work with collaborators from other HIC and LMICs across the globe also interested in advancing cognitive assessment in LMICs, ensuring a bidirectional partnership with the needs of LMICs foremost. The development and pilot work to be undertaken as part of this project will underpin further grant applications focused on development of a common cognitive assessment platform able to be applied to enhance assessment and interventional approaches focused on reducing the significant worldwide burden of dementia.
Notably, 58% of individuals experiencing dementia are thought to live in low-to-middle-income countries (LMICs), underlining the high impact of dementia in those regions, where - relative to high income countries (HICs) - understanding of dementia is low, health and social care less well developed, and social exclusion high. By 2050, it is estimated that 71% of individuals with dementia worldwide will be living in LMICs; the social and financial burden of dementia, therefore, is increasingly being felt in countries with limited health infrastructure and support for affected individuals. Compounding this problem, less than 10% of individuals in LMICs receive a dementia diagnosis, or tailored medical guidance to help them and their families understand how the particular form of dementia they are experiencing may impact on their daily living. These issues additionally limit involvement of LMICs in global clinical trials where new drug therapies may be subsidized, and supportive care provided.
Rapid action is needed if these problems are to be addressed. In particular, there is an urgent need for effective, low-cost cognitive assessment approaches which can aid diagnosis and be used in geographically- and culturally-diverse areas of the world. When complemented by provision of information about different forms of dementia, this can help families and healthcare professionals implement appropriate and tailored care for patients, and identify individuals who can be included in global clinical trials. To address this problem, the Foundation Award focuses on the development of new digital cognitive testing platforms, able to be provided in LMICs via tablets and smartphones. We will work with collaborators from other HIC and LMICs across the globe also interested in advancing cognitive assessment in LMICs, ensuring a bidirectional partnership with the needs of LMICs foremost. The development and pilot work to be undertaken as part of this project will underpin further grant applications focused on development of a common cognitive assessment platform able to be applied to enhance assessment and interventional approaches focused on reducing the significant worldwide burden of dementia.
Technical Summary
Cost of, and restricted access to, brain scanning (e.g., magnetic resonance imaging [MRI]; positron emission tomography [PET]) limits use of imaging for dementia diagnosis in LMICs; rapid advances in mobile digital technology, alongside new knowledge about the earliest cognitive changes in dementias, could provide a solution to this problem, enabling much-needed, easily accessible, well-validated and low cost cognitive assessments for dementia.
The proposed Foundation Award will catalyse a programme of work focused on development and validation of cheap, offline web and tablet cognitive assessment for dementia at Cardiff University, delivered by working in partnership with researchers from Ireland and the US (including the Institutional leads for the Global Brain Health Institute, GBHI), Cuba and China.
Two major outcomes will be delivered:
(1) development and piloting of novel tablet-based cognitive assessments aimed to support provision of more individualised, and accurate, dementia assessment in LMICs, thereby allowing patients to benefit from enhanced health guidance and appropriate support infrastructure; and
(2) a new research network, encompassing experts from both LMIC and high-income countries (HICs), focused on the generation of novel cognitive assessment tools for dementia as an alternative to more expensive, and often unavailable, technologies, and enhancing acess to these across the globe informed by the needs of patients and clinicians in LMICs.
The proposed Foundation Award will catalyse a programme of work focused on development and validation of cheap, offline web and tablet cognitive assessment for dementia at Cardiff University, delivered by working in partnership with researchers from Ireland and the US (including the Institutional leads for the Global Brain Health Institute, GBHI), Cuba and China.
Two major outcomes will be delivered:
(1) development and piloting of novel tablet-based cognitive assessments aimed to support provision of more individualised, and accurate, dementia assessment in LMICs, thereby allowing patients to benefit from enhanced health guidance and appropriate support infrastructure; and
(2) a new research network, encompassing experts from both LMIC and high-income countries (HICs), focused on the generation of novel cognitive assessment tools for dementia as an alternative to more expensive, and often unavailable, technologies, and enhancing acess to these across the globe informed by the needs of patients and clinicians in LMICs.
Planned Impact
Who will benefit from this research?
This project has been designed to have an impact beyond the academic sector, in particular looking to enable a step change in approaches to dementia diagnosis and healthcare education in low-to-middle-income countries (LMICs). The key outcome will be a novel digital cognitive assessment tool able to be applied in both high-income countries (HICs) and LMICs, with the latter designed to provide robust, individualised dementia assessment but also enabling monitoring of cognitive change associated with new drug or public health interventions.
Three major beneficiaries have been identified: (1) Health professionals involved in the early detection of age-related cognitive decline. (2) Providers of cognitive assessment software and pharmaceutical companies interested in novel neuro- and cognitive-therapeutics. (3) Charitable and government organisations involved in dementia health policy.
How will they benefit from this research?
These groups will benefit from new knowledge that informs our understanding of the very earliest cognitive changes linked to different forms of dementia and the integration of approaches to online / tablet-based cognitive assessment from leading international groups. The Foundation Award will facilitate optimisation of (a) cognitive paradigms for enhanced dementia assessment, (b) new algorithms and analysis tools enabling provision of individualised patient-centred information about dementia conditions and (c) integration of different approaches to cognitive assessment across groups, with the aim of identifying the best approach to enhance dementia assessment and differentiation in LMICs. With further funding, we would wish to trial these new approaches in other LMICs, with the aim of developing a common cross-cultural platform for use in dementia assessment and clinical trials.
What will be done to ensure that they benefit from this research?
To ensure the broadest dissemination of our findings, we will participate in relevant dementia meetings and workshops across the globe, working with leading individuals in the health, charitable, software and pharmaceutical sectors. Our involvement in major global research networks are particularly valuable in this context, providing unique opportunities for bidirectional engagement with other UK, European, US and LMIC researchers, as well as leaders in the pharmaceutical industry and software developers. For example, Graham is on the Steering Group for the Dementias Platform UK, Miller and Robertson are the co-Directors of the Global Brain Health Institute, Bobes is Protocol Professor for the Joint China-Cuba laboratory for frontier research in translational neurotechnology (at the University of Electronic Science and Technology of China), Miller is Co-Director for the Consortium for Frontotemporal Dementia.
This project has been designed to have an impact beyond the academic sector, in particular looking to enable a step change in approaches to dementia diagnosis and healthcare education in low-to-middle-income countries (LMICs). The key outcome will be a novel digital cognitive assessment tool able to be applied in both high-income countries (HICs) and LMICs, with the latter designed to provide robust, individualised dementia assessment but also enabling monitoring of cognitive change associated with new drug or public health interventions.
Three major beneficiaries have been identified: (1) Health professionals involved in the early detection of age-related cognitive decline. (2) Providers of cognitive assessment software and pharmaceutical companies interested in novel neuro- and cognitive-therapeutics. (3) Charitable and government organisations involved in dementia health policy.
How will they benefit from this research?
These groups will benefit from new knowledge that informs our understanding of the very earliest cognitive changes linked to different forms of dementia and the integration of approaches to online / tablet-based cognitive assessment from leading international groups. The Foundation Award will facilitate optimisation of (a) cognitive paradigms for enhanced dementia assessment, (b) new algorithms and analysis tools enabling provision of individualised patient-centred information about dementia conditions and (c) integration of different approaches to cognitive assessment across groups, with the aim of identifying the best approach to enhance dementia assessment and differentiation in LMICs. With further funding, we would wish to trial these new approaches in other LMICs, with the aim of developing a common cross-cultural platform for use in dementia assessment and clinical trials.
What will be done to ensure that they benefit from this research?
To ensure the broadest dissemination of our findings, we will participate in relevant dementia meetings and workshops across the globe, working with leading individuals in the health, charitable, software and pharmaceutical sectors. Our involvement in major global research networks are particularly valuable in this context, providing unique opportunities for bidirectional engagement with other UK, European, US and LMIC researchers, as well as leaders in the pharmaceutical industry and software developers. For example, Graham is on the Steering Group for the Dementias Platform UK, Miller and Robertson are the co-Directors of the Global Brain Health Institute, Bobes is Protocol Professor for the Joint China-Cuba laboratory for frontier research in translational neurotechnology (at the University of Electronic Science and Technology of China), Miller is Co-Director for the Consortium for Frontotemporal Dementia.
Publications
Chandler HL
(2020)
Polygenic risk for Alzheimer's disease shapes hippocampal scene-selectivity.
in Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology
Hodgetts C
(2020)
The role of the fornix in human navigational learning
in Cortex
Hodgetts C
(2019)
Increased posterior default mode network activity and structural connectivity in young adult APOE-e4 carriers: a multimodal imaging investigation
in Neurobiology of Aging
Postans M
(2020)
Uncovering a Role for the Dorsal Hippocampal Commissure in Recognition Memory.
in Cerebral cortex (New York, N.Y. : 1991)
Description | We developed a novel application to test for the early cognitive changes linked to different forms of dementia. This was developed to respond to ODA needs around the lack of healthcare support for dementia diagnosis in low-to-middle-income countries. Working with colleagues in India, we developed a cross-cultural cognitive battery allowing testing of patients in India and the UK. |
Exploitation Route | The online app is now being used in India and the UK to test for the sensitivity of the tasks to different forms of dementia; we are comparing different assessment approaches in India with the aim of improving the quality and sensitivity of dementia diagnosis in the country. We anticipate using the app in other low-to-middle-income countries, as well as enhancing the quality of cognitive data in different cohorts relevant to understanding dementia internationally. |
Sectors | Healthcare |
Description | The award focused on developing a sensitive cognitive app for dementia diagnosis, which could be used in low-to-middle-income countries to address the considerable challenge of appropriate and timely dementia diagnosis. The work directly addressed sustainable development goals aligned to challenges in healthcare. The app is now being used in India, with discussion underway with other LMICs to collect data and test the sensitivity and value of the app for dementia diagnosis. The project team is gender balanced, and the research has included participants from all genders. Analyses are being undertaken to consider potential gender differences, especially as there are gender differences evident in the prevalence of different forms of dementia. |
First Year Of Impact | 2019 |
Sector | Healthcare |
Description | Cardiff University GCRF Internal Funding Call |
Amount | £25,260 (GBP) |
Organisation | Cardiff University |
Sector | Academic/University |
Country | United Kingdom |
Start | 03/2018 |
End | 11/2018 |
Description | Wellcome Trust Institutional Strategic Support Fund |
Amount | £50,000 (GBP) |
Organisation | Cardiff University |
Sector | Academic/University |
Country | United Kingdom |
Start | 02/2018 |
End | 02/2019 |
Title | MinD |
Description | Digital app for measuring cognitive symptoms in dementia, called MiND |
Type Of Material | Physiological assessment or outcome measure |
Year Produced | 2019 |
Provided To Others? | No |
Impact | The ability to collect cognitive data remotely in cohorts / patients across the world. |
Description | Avon Longitudinal Study of Parents and Children (Bristol University) |
Organisation | University of Bristol |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Bringing new digital technological solutions to cognitive data collection in ALSPAC, enhancing cognitive phenotyping in mums and children. |
Collaborator Contribution | Facilitating data collection and analysis of large-scale cohort data, as well as access to retrospective data in participants able to answer new scientific questions regarding the genesis of cognitive inter-individual differences. |
Impact | Funding for a Wellcome Trust Institutional Strategic Support Fund award to obtain new cognitive data in mums within ALSPAC. |
Start Year | 2017 |
Description | Global Brain Health Institute |
Organisation | Trinity College Dublin |
Country | Ireland |
Sector | Academic/University |
PI Contribution | Two partners are leads of the major Global Brain Health Institute; engage with this via submission of potential applicants for their new dementia fellowship training programme but also via dissemination of new methods to address dementia. Working in partnership with Global Brain Health Institute has also |
Collaborator Contribution | Two partners are leads of the major Global Brain Health Institute; engage with this via submission of potential applicants for their new dementia fellowship training programme but also via dissemination of new methods to address dementia. Working in partnership with Global Brain Health Institute has also enabled new collaborations with low-to-middle income countries, aligned to funding for global challenges work. |
Impact | Joint grant funding - MR/P024696/1 - Developing low-cost cognitive tools for dementia assessment in low-to-middle income countries (LMICs) |
Start Year | 2017 |
Description | Global Brain Health Institute |
Organisation | University of California, San Francisco |
Country | United States |
Sector | Academic/University |
PI Contribution | Two partners are leads of the major Global Brain Health Institute; engage with this via submission of potential applicants for their new dementia fellowship training programme but also via dissemination of new methods to address dementia. Working in partnership with Global Brain Health Institute has also |
Collaborator Contribution | Two partners are leads of the major Global Brain Health Institute; engage with this via submission of potential applicants for their new dementia fellowship training programme but also via dissemination of new methods to address dementia. Working in partnership with Global Brain Health Institute has also enabled new collaborations with low-to-middle income countries, aligned to funding for global challenges work. |
Impact | Joint grant funding - MR/P024696/1 - Developing low-cost cognitive tools for dementia assessment in low-to-middle income countries (LMICs) |
Start Year | 2017 |
Title | Cognitive app |
Description | A new app for the detection of dementia |
Type Of Technology | Webtool/Application |
Year Produced | 2020 |
Impact | The app is currently being used to test for feasibility of identification of dementia in low-to-middle-income countries |
Title | Online cognitive testing battery for different memory networks |
Description | We developed an online cognitive battery for collection of data linked to different brain networks involved in dementia |
Type Of Technology | Webtool/Application |
Year Produced | 2018 |
Impact | The online battery is being used to collect data in key UK population cohorts |
Description | Article for Conversation |
Form Of Engagement Activity | A magazine, newsletter or online publication |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | Article on Alzheimer's disease and early changes to the brain, including coverage of the awarded grant |
Year(s) Of Engagement Activity | 2019 |
URL | https://theconversation.com/alzheimers-carriers-of-risk-gene-show-brain-changes-in-their-20s-heres-w... |
Description | Cardiff Sciscreen - Away From Her |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Public/other audiences |
Results and Impact | Gave a talk / took part in a debate regarding the film Away From Her, related to forms of dementia |
Year(s) Of Engagement Activity | 2016 |
Description | Newspaper article |
Form Of Engagement Activity | A magazine, newsletter or online publication |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Public/other audiences |
Results and Impact | Wrote an article on different forms of dementia for major national Welsh newspaper. |
Year(s) Of Engagement Activity | 2017 |
Description | Pint of Science, Beautiful Mind |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Public/other audiences |
Results and Impact | Took part in presentation and debate around memory and dementia for Pint of Science. Almost 100 members of the general public attended the event, and increased interest in Cardiff University research and participation in research was achieved. |
Year(s) Of Engagement Activity | 2017 |