Collaboration with the UCSF Memory and Aging Center in the Development of Computer-based Technology for the Diagnosis of Neurodegenerative Diseases

Parkinson's disease, Alzheimer's disease and Lewy Body Dementia are three of the most common neurodegenerative brain disorders, affecting in excess of 600,000 people in the UK alone. All three disorders share similar symptoms and consequently, can be easily misdiagnosed. For example, diagnosis of idiopathic Parkinson's disease based on clinical features is particularly unsafe with an error in diagnosis of up to 25% having been reported.

Dr Smith has developed a novel non-invasive assessment of Parkinson's Disease which uses a computer-based system to measure patients undertaking simple tasks used in conventional clinical evaluation, such as finger tapping and drawing simple geometric shapes. An initial clinical trial has recently been completed at Leeds General Infirmary which demonstrated that this technology can be used to reliably identify Parkinson's disease patients, despite them receiving medication to compensate for their symptoms. The technology has also recently been patented by IP21 Ltd on behalf of the University of York.

The aim of this work is to develop the technology further to discriminate between Parkinson's disease, Alzheimer's disease and Lewy Body Dementia. The purpose of the proposed visit to the Memory Center at the University of California, San Francisco is to establish a collaboration in which to study these conditions, having well integrated teams of academics and clinical staff using the latest methods of assessment.

Some 700,000 people in the UK alone have dementia with over 180,000 new cases occurring in England and Wales every year [1]. The total cost of patients with late onset dementia in 2005/6 is estimated to be £17.03 billion [2]. It is evident that a reliable early diagnosis of these diseases is important for the patient and for the cost effectiveness of the NHS [3]. As stated in [2] "A lack of diagnosis means a lack of specific treatment and care for dementia. Diagnosis is the gateway for care."

Alzheimer's disease accounts for approximately two thirds of all dementia cases, but shares features with Lewy body dementia and Parkinson's disease with dementia. Parkinson's disease is particularly noteworthy as it is reported that up to 25% of all diagnoses is incorrect [4] having substantial consequences for patients receiving incorrect medication such as debilitating side effects and lack of treatment for their true condition. This is particularly important as potential new therapeutic approaches for Parkinson's disease with dementia become available [5]. The cost implications of misdiagnosis are obviously significant.

A reliable and cost effective test for these diseases will have a considerable impact both patient quality of life and NHS budgets. Currently, diagnosis of these conditions is largely subjective and ultimately unreliable. The test proposed here is objective, safe and easy to use and may be readily integrated into current clinical practice. Once developed, and the technology verified through a small scale investigation, further funding will be sought to develop a product suitable for use in the NHS and other health markets.

If successful, this new device can be used to:
i) Achieve reliable diagnosis of a number of neurodegenerative diseases.
ii) Aid effective administration of medication or therapy.
iii) Establish the effectiveness of new drugs or therapies.

Early diagnosis is important for management of these conditions and consequently, the introduction of this technology will have a major impact on:
i) Immediate patient benefit - appropriate treatment/therapy and improvement in quality of life.
ii) Long term patient benefit - better understanding of prognosis and ability to plan ahead.
iii) Benefit to NHS - ability to plan more accurately the administration and cost of the medication/therapy required.

[1] Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M et al, Global prevalence of dementia: a Delphi consensus study, Lancet, December 17, Vol.366, No.9503, 2112-17, 2005.
[2] Dementia UK, A report into the prevalence and cost of dementia prepared by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and the Institute of Psychiatry at King's College London, for the Alzheimer's Society.
[3] Metzler-Baddeley, C. "A Review of Cognitive Impairments in Dementia with Lewy Bodies Relative to Alzeimer's Disease and Parkinson's Disease with dementia," Cortex, Vol.43, 583-600, 2007.
[4] Levine, C., et al. "Diagnosis and Treatment of Parkinson's Disease: A Systematic Review of the literature", Evidence Report/Technology Assessment, Agency for Healthcare Research and Quality, No. 57, 2003.
[5] Dubois,B. et al. "Diagnostic Procedures for Parkinson's Disease Dementia," Movement Disorders, Vol.22, No.16, 2314-2324, 2007.