Dr Chris Kalafatis is Chief Medical Officer of Cognetivity – a health care start-up which has developed a user-friendly cognitive function test focusing on image recognition. Here, he explains why early diagnosis is so crucial in terms both of health and cost
Being diagnosed with dementia is something none of us would wish for. In fact, according to research carried out by Saga Healthcare, ‘two thirds of people over 50 in the UK are scared of developing dementia more than they are of developing cancer’. Commonly the news that one is suffering from cognitive impairment under the dementia ‘umbrella’ provokes feelings of shock, disbelief, anger, loss and grief. However, for some individuals and their carers, a diagnosis of dementia can be a positive event, particularly when it provides an explanation for previously unexplained symptoms and behaviours.
Even in the absence of a cure, research shows that an early diagnosis has a myriad of associated benefits, not least of which is the potential to delay the onset of incapacitating symptoms. In addition, with early diagnosis, treatments can be effectively delivered to the right person at the right time to provide maximum positive impact, and – if symptoms are delayed – so is admission to care homes, which has major economic and quality of life benefits.
What’s more, studies show that patients do want to know their risk of developing dementia. An early diagnosis can help people feel in control and empowered to make decisions for their future.
Armed with an early diagnosis, and associated early access to specialist services and treatment, individuals are given the opportunity to make lifestyle changes which have the potential to delay the onset of symptoms associated with dementia by up to five years. This, in turn, has the potential to reduce the prevalence of dementia by 50 per cent in the general population.
Once symptoms do occur, an early diagnosis can lead to individuals living with milder symptoms for longer, spending increased years with a higher quality of life. Furthermore, according to a report published by the Alzheimer’s Society and cited in the British Medical Journal, delaying the onset of the disease could reduce the mortality rate of dementia – especially of those suffering with advanced stage Alzheimer’s Disease – by 30,000 annually.
By the time dementia is evident in a person’s behaviour, irreversible brain damage has already occurred. Not only does late-stage detection make the disease difficult to manage and impossible to cure, it also stunts the ability of medical researchers to develop and effectively test new forms of treatment. Early diagnosis gives medical professionals who are pioneering new and experimental treatments, drugs and therapies, the opportunity to conduct research on patients at very early stages of cognitive impairment and track the effects of new potential treatments more accurately and effectively. Additionally, when a disease-modifying therapeutic is finally developed, it will be of vital importance to start to administer this at the very earliest stages of the disease before significant damage is incurred, making early detection crucial.
In 2014, Alzheimer’s Society published a major study, commissioned by King’s College, London and the London School of Economics, called the Dementia UK Report, which looked at the social and economic impact of dementia in the UK. The study showed that the total cost of dementia in the UK is £26.3 billion. While the NHS picked up £4.3 billion of the costs, social care paid £10.3 billion. Of the £10.3 billion in social care costs, £4.5 billion is attributed to local authority social services for state funded care. The remaining £5.8 billion is what people with dementia and their families are forced to pay annually for help with everyday tasks that are provided by professional care workers. According to the Alzheimer’s Association 2018 report, under the current status quo, the cumulative total cost of medical and long-term care expenditures for all individuals alive in the US in 2018, who will develop Alzheimer’s is projected to be $47.1 trillion. Under an early diagnosis scenario, in which 100 per cent of individuals with Alzheimer’s receive a diagnosis during the Mild Cognitive Impairment (MCI) stage, there would be a total cumulative saving of $7.9 trillion.
If early diagnosis was routinely possible, dementia patients could not only delay symptoms and prolong quality of life, but along with social services, they would benefit from a vast reduction in social care costs. Not only this, but a large number of hospital admissions could be prevented altogether, which would represent further significant savings within both the public and private sector.
At Cognetivity, we have developed the Integrated Cognitive Assessment (ICA) a cognitive testing platform for use in medical and commercial environments. As a company, our goal was to create a simple test that would provide the above benefits to society through accessible early dementia diagnosis.
The ICA is a software-based test, which consists of a five-minute computerised cognitive assessment test based on a rapid visual categorisation task which is designed to give a sensitive, repeatable measure of overall cognitive function. Self-administered via an iPad, it uses proprietary AI which clusters test performance in terms of accuracy, speed and image properties and calculates the user’s risk of having early signs of dementia with a previously unattainable level of accuracy Results are unaffected by subjects’ language, culture and educational level. It also does not suffer from learning effect, allowing for regular, high-resolution monitoring. The ICA is designed to detect impairment earlier than conventional cognitive tests because the criteria used are more sensitive to less severe neurodegeneration.
By providing clinicians with an accurate, early diagnosis of cognitive impairment, patients can receive personalised healthcare advice, allowing them access the most effective treatments and make lifestyle choices to delay the onset of symptoms. The data from the ICA can be used as sample points in dementia research, to better help our understanding of the early stages of the condition. And the fact that the test can be taken remotely means that clinicians can monitor their patients’ cognitive abilities away from a healthcare setting, reducing both care home costs and admissions.
Earlier diagnosis is vital if we are to truly tackle what is a global dementia epidemic. To achieve that will require an increase in awareness, both among the public and health professionals, that dementia starts long before symptoms are evident.
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