Trial could cut agonising wait for dementia diagnosis
Government-backed assessment service trial will see Cambridge Cognition’s state-of-the-art diagnostic technologies placed in the community
The traditional path to diagnosing dementia is long and slow, often taking 18 months of agonised waiting.
Now this could be set to change with a government-backed trial of a dementia assessment service that aims to cut this to just three months.
It is being called a “paradigm shift” as it depends on placing state-of-the-art diagnostic technologies in the community where people can access them quickly and easily.
According to senior lecturer and honorary consultant neurologist Dr Dennis Chan, this trial – dubbed the Brain Health Centre initiative – will accelerate access to the kind of evaluation currently available in only regional centres of excellence in hospital clinics.
He says: “One of the great strengths of the project is the provision of state-of-the-art diagnostic tools to patients based in the community, thus getting rid of regional inequalities.”
This is vital because an early diagnosis makes it possible for people to access the care they need and start to plan for the future. Fewer than half of the estimated 800,000 people with dementia have a firm diagnosis. The government wants to see this rise to 80%.
The service to be trialled by 200 patients in south London and Sussex starts with a visit to the GP from someone worried about their memory. Instead of the usual paper-and-pen based test, they will be handed an iPad and asked to carry out Cambridge Cognition’s CANTABmobile test.
“It takes 10 minutes and indicates accurately whether a person needs a more thorough investigation for dementia,” explains Dr Andrew Blackwell, chief scientific officer at Cambridge Cognition.
Those who do need further investigation will be referred to a Brain Health Centre – one based in a hospital memory clinic at the Maudsley hospital in south London and the other a mobile community based service in Sussex.
Here, they will complete a more detailed CANTABmobile test, again on an iPad, and undergo an MRI scan to look at changes in their brain.
But rather than just being assessed by eye, the MRI result will also be assessed by computer algorithms developed by medical imaging company IXICO. These assess how much key regions of the brain are shrinking, taking into account age, gender and other factors that can influence changes in the brain.
“By making precise measurements on the images collected from an ordinary MRI scanner, we can assess the patient’s brain shrinkage and blood vessel damage compared to normal people their age. Combining these measurements with the memory and other tests helps determine if the patient has dementia and if so, what type.” explains Derek Hill, chief executive of IXICO.
The tests can give three outcomes: the patient gets a green light to say there is no dementia; an amber indicating they should be monitored to see how their memory changes over time; or a red light – high confidence that they have memory problems due to dementia.
With this diagnosis, patients and their GPs can start to plan for the future and access services, information and benefits, potentially adding months or years of independent living.
The £3.3m trial has received £2.1m of government funding from the Biomedical Catalyst fund with the rest coming from Cambridge Cognition and IXICO. Project partners at King’s College London, Universities of Brighton and Sussex and Imperial College London believe it can demonstrate significantly lower NHS and social care costs and increased time efficiency.
Just as important, though, is the involvement of the Alzheimer’s Society, which is supporting the project by ensuring the needs of patients and their carers are fully considered and undertaking an initial impact assessment on the 200 patients assessed in the two trial Brain Health Centres.
Jeremy Hughes, chief executive at the Alzheimer’s Society, says: “There are 800,000 people living with dementia in the UK, but fewer than half of people with the condition have a diagnosis. As numbers double and costs soar, developing new and earlier ways of diagnosing the condition is imperative.
“This technology could potentially reduce the time people need to wait for a diagnosis significantly. After diagnosis, we also need to ensure that people are supported with information and services to enable them to gain the full benefits and support that a diagnosis can give.”
