Digital innovation and Alzheimer's Disease

DIGITAL INNOVATION &
ALZHEIMER’S DISEASE
The Startups, The Science
Frank Boermeester // Advance.Healthcare
@fboermeester

“Alzheimer’s Disease
has no survivors”
It destroys brain cells and causes
memory changes, erratic behaviors
and loss of body functions. It slowly
and painfully takes away a person's
identity, ability to connect with
others, think, eat, talk, walk and find
his or her way home.
Alzheimer’s Association – alz.org
Alois Alzheimer's patient Auguste Deter in 1902. The first
described case of what became known as Alzheimer's disease.
Frank Boermeester @fboermeester

Unrelenting progression of disease
Pre-dementia Early Moderate Advanced
Pre-diagnosis, mild cognitive
impairment (memory & executive
functions)
Increasing cognitive
impairment (learning,
attention, language)
Independence
hindered (motor skills,
wandering,
neuropsychiatric
symptoms)
Completely dependent
(exhaustion, muscle
mass deteriorates),
death
Up to 20 years 2-10 years 1 – 5 years

World Alzheimer
Report 2015
A global
epidemic

“There’s an
app for that.”
Or is that a stupid and disrespectful question?
...in light of the millions spent on unsuccessful pharmaceutical research
(99.6% of drug trials for Alzheimer’s Disease during the period 2002-2012
have failed)
http://www.alzres.com/content/6/4/37

There’s a wave that needs riding, it’s called...
Beyond the pill
“A survey conducted by Accenture found that life-sciences executives
continue to warm up to the idea of using wearables and other
intelligent hardware, saying technology will be the catalyst for the
industry's move into outcome-based sales. ….About 85% of
respondents said they believe using intelligent hardware, sensors and
devices will help the industry shift from selling pills to selling
outcomes.”
- http://www.mmm-online.com/dataanalytics/smart-devices-will-improve-pharma-sales-survey/article/439278/

Prevention
Early detection &
diagnosis
Treatment Management
Diagnosis is difficult
(extensive
neuropsychological testing),
especially early detection
No pills to solve safety issues
& risk of injury due to
wandering, outburst,
aggression
Huge care burden (most
costly disease in Europe &
the USA). Not enough care
workers, family distress, etc.
No ‘silver bullet’ given
devastating impact on the
patient: cognitive,
emotional, motor,
neuropsychiatric, social..
Measurement of disease
progression (for clinical trials
etc) is difficult
Prevention may involve
lifestyle/behaviour change
(pending more research)
No pills to fix loss of
autonomy, isolation,
loneliness...
No pills to fix cognitive
decline (memory, executive
functions, language)
Heavy medication to
manage psychiatric
symptoms (depression,
delusions, aggression)
Why look beyond the pill?

Prevention
Early detection &
diagnosis
Cognitive Assessment
Cognitive and neuropsychological
testing for early detection, diagnosis
and measurement of disease
progression
Training & Games
Delaying the progress of AD through
retraining of memory, multitasking
skills, verbal skills etc
Monitoring
Sensor-based monitoring (e.g. activity
tracking, fall detection, care prediction
tools) and telemedicine
Augmentation
Cognitive and physical augmentation
(e.g. memory support, spatial
orientation)
Imaging Analytics
Imaging analytics for early detection,
diagnosis and measurement of disease
progression
Care Robots/Platforms
Help improve care delivery and
emotional stimulation and reduce the
burden of informal caregivers.
Connectivity
Connect patients with care networks
and comfort services through easy to
use communication platforms.
Omics/Big Data Research
Analysis of large data sets of medical
records, genome-based research etc
ERP/EHR software
Software for streamlining operational
and administrative care tasks Not addressed
in this report
Opportunities for digital innovation?

Prevention
Early detection &
diagnosis
progression
Training & Games
Monitoring
Augmentation
orientation)
Connectivity
Part 1: monitoring, augmentation, connectivity

Sensor in a sock
Pressure sensor in sock to
detect when person starts
wandering out of bed
Smart Sole
GPS-enabled monitoring so that
can set a “geo-fence” and create
customised alerts
http://www.fastcoexist.com/3034118/this-kid-designed-a-
wearable-health-device-for-his-grandfather-with-alzheimers
http://www.gpssmartsole.com/gps-smart-sole.php
https://www.indiegogo.com/projects/itraq-
the-cellular-tracking-device#/story
iTraq
Credit-card sized tag
enables geo-tracking
through cellular
networks
Passive monitoring

Interactive monitoring
Embracelet
GPS tracking,
emergency button,
customised alerts &
reminders
Toshiba Silmee
GPS tracking,
emergency button,
multiple health
tracking sensors
(heart rate, activity,
ultraviolet light)
http://www.psfk.com/2015/09/toshiba
-activity-trackers-for-senior-care-
silmee-w20-w21.html
http://www.embracelet.be/
Clevercare
GPS tracking,
emergency button,
customised alerts &
reminders, phone
calls, 24/7 emergency
response call centre
http://clevercare.co.nz/
Tempo
(CarePredict)
Tracks and learns
daily patterns and
detects/predicts
possible problems
http://carepredict.com/

‘Augmentation’
Backup Memory
Smartphone app that alerts
user when a familiar person
is nearby and reminds them
about their relationship
through photos
http://global.samsungtomorrow.com/samsung-
volunteers-in-tunisia-develop-app-for-alzheimers-
patients/
Intelligent Glasses
Singapore scientists have
developed a tool on
Google Glass that
recognises people and
reminds the user who they
are, and reminds the user
about medication
http://www.straitstimes.com/singapor
e/health/smart-glasses-for-seniors-
with-dementia
Cloudphone (Ollo Mobile)
Tracking & communication wearable,
includes a ‘safe path’ feature that
automatically monitors regular transit
activity – like going to and from
shop. You set the route and schedule,
CloudPhone lets you know if things
go wrong.
https://www.indiegogo.com/projects/cloudphone-3g-
revolutionize-how-you-care#/story

Connected Patients
Cubigo
A single, easy to use platform for accessing a
personalised portfolio of services, including
commucation tools (e.g. videocalls, messages,
neighbourhood forum), comfort services (e.g.
home shopping, postal services), and security
and care (medical appointments, medication
reminders, alarms, integration with sensors).
http://www.cubigo.com/

Scientific Comment
Monitoring tech works... Consumer electronics devices (relying on
GPS, wifi, mobile networks) can detect wandering patterns and alert
caregivers.
“Experimental results show that the mobile-health application is
able to detect wandering patterns including lapping, pacing and
random in real-time.”
http://ieeexplore.ieee.org/xpl/articleDetails.jsp?arnumber=6611105

Scientific Comment
Usability can be a problem:
“When being targeted to patients with dementia some usability problems
appeared, such as difficulties to read information in a small screen or take a
proper photo.”
http://www.tandfonline.com/doi/abs/10.3109/09638288.2015.1025992
Participatory design (involving people with dementia in design process) is feasible
and beneficial:
“Participants felt strongly that future devices should be disguised and be
integrated easily into their daily routines. Suggested areas for functional
improvement included two-way communications, flexibility of function as the
illness progresses, and something to "guide" them home when out walking or
driving. Attention should also be focused on minimizing the size, weight and
visibility of devices to reduce stigmatization.”
http://www.ncbi.nlm.nih.gov/pubmed/19193255

Scientific Comment
There are ethical issues that need to be addressed (balancing
patients’ need for safety with need to preserve their autonomy and
privacy.)
“No-one should be coerced into using tracking technology and,
where possible, people with dementia must be involved in the
decision-making and their consent sought.”

Prevention
Early detection &
diagnosis
progression
Training & Games
Monitoring
Augmentation
orientation)
Connectivity
Part 2: cognitive assessment

Speech analysis
IBM research team created an automated
verbal test (much shorter/faster than standard
paper-based tests). IBM Watson is used to
analyse speech pattern (not the content but the
tone, pauses, continuity of speech etc). The
application classifies with 85% accuracy
whether user is disease free, pre-dementia and
early-dementia. Other (non-IBM) research on
speech analysis is also showing good results.
http://www.techrepublic.com/article/how-ibm-research-wants-to-use-mobile-devices-to-
detect-early-stage-dementia/
Cognitive assessment

Eye movement analysis
Neurotrack is a computer-based visual cognitive test
(tracks eye movement as a means to measure
recognition memory) that appears to be capable of
predicting patients’ risk of developing AD before
behavioural symptoms appear. The tool is potentially
useful in clinical trials with early (pre-symptomatic)
stage AD patients and later as a general screening
test
https://www.neurotrack.com/

Computer game performance as test
Game developer Akili Interactive Labs and
Pfizer are doing research to see if brain-
boosting app Neuroracer could detect and
track the progression of AD. Neuroracer
detects attention impairment, which in
turn is linked to early stage AD.
http://www.alzheimers.net/2014-01-13/akili-app-may-
detect-alzheimers/

Scientific Comment
Disrupting clinical-based cognitive assessment
“The revolution in mobile technologies provides
unprecedented opportunities to overcome the barriers of time
and context that characterize traditional hospital and clinical-
based assessments.”
Mobile Technologies in the Early Detection of Cognitive Decline
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275158/

Scientific Comment
Imagine a future of always-on, continuous & contextual cognitive
monitoring
“The future vision is one where classically slow, subjective, and data-poor assessments
of cognition are replaced by fast, objective, and data-rich digital assessments that can
be unequivocally linked to functional improvement by reference to large datasets. …
In a world where the majority of the population carries a mobile digital device, where
our behavioral status, cognitive capacity, and clinical function are ubiquitously and
continuously tracked by the digital footprint we leave behind, the prospect for
transformative efficiency and accuracy in testing novel therapeutics in
neurodegenerative disease may rest in the devices we each carry in our pockets.”
C Leurent and MD Ehlers* Digital technologies for cognitive assessment to
accelerate drug development in Alzheimer's disease. Clinical
Pharmacology & Therapeutics 8 SEP 2015

Prevention
Early detection &
diagnosis
progression
Training & Games
Monitoring
Augmentation
orientation)
Connectivity
Part 3: training & games

The Rise of the Brain Fitness Industry
But are these useful for people with AD?

Scientific Comment: Brain Training
Brain training can be effective for normal older adults (no AD or dementia)
Brain training games have been criticised for making false promises. But a study published in
Nature, shows that a game that is tailored to a specific cognitive deficit (in this case multi-tasking)
can be effective in enhancing cognitive control among older adults. Hence it’s potential use to
detect early AD. http://www.nature.com/news/gaming-improves-multitasking-skills-1.13674
Certain mental exercises can offset some of the
expected decline in older adults' thinking skills and
show promise for maintaining cognitive abilities
needed to do everyday tasks such as shopping,
making meals and handling finances, according to a
new study. The research, published in the Dec. 20,
2006, Journal of the American Medical Association,
showed that some of the benefits of short-term
cognitive training persisted for as long as five years.
http://www.nih.gov/news/pr/dec2006/nia-19.htm

What about Brain Training for Alzheimer’s Disease?
Some population studies do show that people who engage in intellectual activities
such as reading, board games, crossword puzzles, playing music, social interaction,
learning a second language later in life, etc. have reduced risk for developing AD or
even seems to delay development of AD.
The concept of ‘cognitive reserve’ is used to explain a degree of resilience that some
people have to the clinical manifestations of AD, but not to the disease process itself.
People with high cognitive reserve may go undiagnosed until disease pathology is
severe, then rapid decline follows.
• Wilson RS et al. Participation in Cognitively Stimulating Activities and Risk of Incident Alzheimer Disease.
AMA. 2002;287(6):742-748. doi:10.1001/jama.287.6.742.
• Verghese J et al. Leisure Activities and the Risk of Dementia in the Elderly. The New England Journal of
Medicine NEJM, 2003, 348:2508-2516
• Stern, Yaakov (2006) Cognitive Reserve and Alzheimer Disease. Alzheimer Disease & Associated Disorders,
vol 20, p 112-117.
• Williams JW et al Preventing Alzheimer's disease and cognitive decline. Evid Rep Technol Assess (Full Rep).
2010 Apr;(193):1-727.

And yet….they can be useful! A literature review of 15 studies on dementia-related serious
games suggests that:
• (1) physical games (or exergames, i.e., games that promote physical fitness) can positively affect
several health areas of the players with mild AD and MCI, such as balance and gait (Padala et al., 2012),
and voluntary motor control (Legouverneur et al., 2011);
• (2) cognitive games (i.e., games which target cognitive improvement) can improve a number of
cognitive functions, such as attention and memory (Stavros et al., 2010; Weybright et al., 2010; Rosen
et al., 2011) and visuo-spatial abilities (Yamaguchi et al., 2011);
• (3) both physical and cognitive games can have a positive impact on social and emotional
functions, for instance they can improve the mood and increase positive affect and sociability
(Weybright et al., 2010; Boulay et al., 2011; Yamaguchi et al., 2011) and reduce depression (Férnandez-
Calvo et al., 2011). Very few studies investigated the effects of the use of games for social/emotional
health (which encourage the players to link with their friends and/or improve their social and emotional
life) in dementia, but the results are encouraging (Boulay et al., 2011).
Dementia Games: A Literature Review of Dementia-Related Serious Games
http://link.springer.com/chapter/10.1007%2F978-3-642-40790-1_2

Conclusions of a systematic review and SWOT analysis of use of serious games
targeting AD patients, analyses which in turn were discussed and validated in a
workshop at the 2013 Clinical Trial of Alzheimer's Disease (CTAD) conference, and
endorsed by stakeholders in the field:
“The results revealed that SG may offer very useful tools for professionals
involved in the care of patients suffering from ADRD. However, more
interdisciplinary work should be done in order to create SG specifically targeting
these populations. Furthermore, in order to acquire more academic and
professional credibility and acceptance, it will be necessary to invest more in
research targeting efficacy and feasibility. Finally, the emerging ethical
challenges should be considered a priority.”
Recommendations for the use of Serious Games in people with Alzheimer's Disease, related disorders
and frailty. Front. Aging Neurosci., 24 March 2014 http://dx.doi.org/10.3389/fnagi.2014.00054

Alzup
Tablet app that integrates cognitive exercises and
actual memories. Working with University
research team for clinical trials.
http://www.alzhup.com
Memory Places
PhD research by Kasper Bormans is
exploring the use of virtual ‘memory
places’ (guided imagery) to enhance
memory for familiar faces, thereby improve
quality of life of patients and caregivers
Cognitive Training
https://www.youtube.com/watch?v=BMcduh1HEHA

Ybrain
Ybrain has developed a nerve stimulating
headband for patients suffering early onset
Alzheimer’s and is building an analytics
platform for disease diagnosis and
personalized treatments.
They have FDA approval for clinical trials, and
have secured $4.2 million in Series A funding.
“Based on the individual’s brain signals,
personalized current stimulation is provided
to vitalize certain brain regions to keep the
brain healthy.”
http://ybrain.com/
Brain Stimulation

Prevention
Early detection &
diagnosis
progression
Training & Games
Monitoring
Augmentation
orientation)
Connectivity
Part 4: care robots/platforms

Care through Robots & Avatars
Paro
PARO is an advanced interactive robot
developed by AIST. It allows the documented
benefits of animal therapy to be administered
to patients in environments such as hospitals
and extended care facilities where live animals
present treatment or logistical difficulties. PARO
has five kinds of sensors: tactile, light, audition,
temperature, and posture sensors, with which it
can perceive people and its environment. It
works, but raises ethical concerns.
http://www.parorobots.com/

Scientific Comment
Are we ready for robots that care for us?
“Results so far have been encouraging in the sense that they
showed that elderly people concerned by cognitive
impairment recognize the potential of Socially Assistive Robots
(SAR) for supporting health and social care at home. It is true
that the current state of the research on SAR does not allow us
to conclude that older adults are ready for robots that care for
them, but the idea is no longer unimaginable..”
Pino M et al. “Are we ready for robots that care for us?” Attitudes and opinions of older adults toward socially
assistive robots. Front. Aging Neurosci., 23 July 2015 | http://dx.doi.org/10.3389/fnagi.2015.00141

http://www.tinybots.nl/
Tinybots
Small, talking robots that
provide cognitive
training, medication
reminders and
‘companionship’, giving
structure to a person’s life

GeriJoy
A team of remote caregivers (based in the
Philipines) provide personalised
emotional support, cognitive stimulation
and reporting through a care avator
(animated dog), all on a 24/7 basis.
https://www.gerijoy.com/

Monitoring+Care Platforms
Giraff Plus
GiraffPlus monitors activities in the home using
a network of sensors, both in and around the
home as well as on the body.
The sensors can measure e.g. blood pressure or
detect e.g. whether somebody falls down. A
range of services can be tailored to the
individual’s needs.
At the heart of the system is a unique
telepresence robot, Giraff, which lends its name
to the project. The robot uses a Skype-like
interface to allow relatives or caregivers to
virtually visit an elderly person at home.
Photo Terese Andersson
http://www.giraffplus.eu/

Monitoring+Care Platforms
Mobiserv
A European, multi-partner research project that
created a platform consisting of:
• A social companion robot - robot, containing
processing power, data storage capability, various
sensors, machine learning/experience
gathering/adaptation, a touch screen, speech
synthesis, and speech recognition
• Wearable smart clothes - monitoring of vital signs
or sleeping patterns, and detection of falls
• Smart home environment - smart sensors, optical
recognition units, and home automation elements,
to detect among others eating and drinking
patterns, activity patterns, and dangerous
situations
http://www.mobiserv.info/

progression
Training & Games
Monitoring
Augmentation
orientation)
Connectivity
How will it all come together?

progression
Training & Games
Monitoring
Augmentation
orientation)
Connectivity
From multi-functional
platforms (monitoring,
memory-supporting,
connected care
platforms) to...

progression
Training & Games
Monitoring
Augmentation
orientation)
Connectivity
...grid-linked
cyborgs?

Thanks!
Frank Boermeester
@fboermeester
//advance.healthcare
At Advance Healthcare we are on a mission to
improve the lives of patients through digital
innovation, one disease at a time.

Digital innovation and Alzheimer's Disease

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