Earlier diagnosis of dementia in patients

Dementia is a term used to describe a group of symptoms linked to a variety of diseases. It includes impairments in memory, language, problem solving and other thinking abilities. It impacts everyday life of its patients and carers. Around 1 in 11 people over the age of 65 have dementia in the UK. It is one of the biggest health challenges to the population. As people live longer, the prevalence of dementia increases. It is estimated that around 1 million people will be living with dementia in the UK by 2030.

People with late stage dementia cannot support themselves without help from others. The cost of dementia is vast, not only to the person with the condition, but also to those who care for and support them.

There is currently no cure for dementia. However, there are medicines and other treatments to help manage the symptoms. These treatments are limited. They are often only prescribed when the individual is presenting severe symptoms.

To improve treatment and quality of life outcomes for people with dementia, it is necessary to start treatment at an earlier stage. The Prodromal stage is identified as a stage where treatments are likely to be effective. At this stage, individuals have mild cognitive impairments such as memory loss, difficulty concentrating and mood changes. This stage is where most patients are discharged from dementia services for not meeting the threshold to begin treatment.

This results in increased stress for individuals and their loved ones. It also increases the possibility of irreversible memory problems.

To address this need, Dr Daniel Blackburn, honorary Consultant Neurologist and Senior Lecturer and Professor Heidi Christensen, Professor in Spoken Language Technology both at the University of Sheffield, have developed a digital tool to diagnose people at an earlier stage. The system is CognoSpeak (https://www.cognospeak.com/). It uses speech technology and machine learning to identify distinct patterns of speech. Cognospeak distinguishes people with mild cognitive impairment and Alzheimer’s disease from healthy volunteers and people with functional cognitive disorder. 

Cognospeak was developed in collaboration with NIHR Devices for Dignity MedTech Co-operative. A Somali community group in Sheffield called Israac provided public and patient perspectives. They supported the CognoSpeak team with relationship building with other ethnic minority groups such as the South Asian community, to ensure that CognoSpeak can be applicable to a diverse population such as those for whom English isn't their first language.

The aim of CognoSpeak is to diagnose dementia at an early stage. It measures the respondents’ language and interaction. When accessing the system, via a web browser, a virtual agent asks the user several questions. The user responds and interacts with the virtual agent in a similar way as if they were speaking to a human doctor. The responses are recorded, the speech is analysed for patterns, and the doctor receives a report. If the speech patterns are consistent with those seen in people with cognitive impairment, the individual is referred for more testing.

Dr Blackburn said “The key benefit of CognoSpeak is that people with cognitive impairment who are seeking help can be assessed remotely in their own home. This speeds up the initial part of their diagnostic assessment. It will improve access for people to NHS services because this does not need clinician time. It also does not need a patient to travel for their CognoSpeak assessment.”

The NIHR Dementia TRC has supported CognoSpeak to have greater reach across the UK 

Dr Blackburn praises the NIHR Dementia TRC for connecting him with other TRC members who conduct dementia research in the UK. The TRC helped to improve the visibility and accessibility of CognoSpeak and enabled a shared learning approach. A broader geographical spread of the use of this technology is another benefit. The TRC also made it possible to expand the research to include many more patients across the UK. 

“The Dementia TRC allowed me to meet with other active members in a similar field, so I could learn from them on how to develop and advance CognoSpeak. It helped to make it available to a wider community of researchers and patients” - Dr Blackburn

Sheffield Biomedical Research Centre (a member of the NIHR Dementia TRC) leads the development, set-up and ongoing management of CognoSpeak. Dr Blackburn explained how the NIHR Dementia TRC provided him with access to other sites, including other NIHR BRCs. This access enabled research at various locations including Oxford, Newcastle, Bristol, Manchester, Hull and Bradford. It also provided CognoSpeak with greater research reach and geography. This would not have been possible without the support of the NIHR Dementia TRC.

This also led to an increase in the number of people recruited in studies for CognoSpeak and the accuracy of CognoSpeak improved as a result. There is now evidence that CognoSpeak can distinguish between mild cognitive impairment or Alzheimer’s disease from functional cognitive disorder and healthy volunteers. 

“The Dementia TRC links key opinion leaders in UK dementia research which has helped to enhance the visibility of CognoSpeak. It has enabled me to further develop this technology to improve the lives of people with dementia.”  Dr Blackburn

Next steps and further research plans

So far around 400 people have been recruited in the development of CognoSpeak. There is a need to recruit more people with mild cognitive impairment into the research. Dr Blackburn aims to use social media to achieve this goal. Plans are underway to expand recruitment in primary care settings and other populations. Healthy volunteers can sign up to CognoSpeak on the website (https://www.cognospeak.com/).

A future goal is to research ways to adapt CognoSpeak for other conditions such as Parkinson’s Disease and Motor Neurone Disease.

Our ready-formed Dementia TRC provides streamlined access to networks of internationally recognised investigators in the UK's leading centres of excellence.

To join the network and collaborate with us, please get in touch.