Developing low-cost cognitive tools for dementia assessment in low-to-middle income countries (LMICs)

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.

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.

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.