Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)
Please could you give a brief introduction to dementia?
Dementia is a huge public health problem, affecting about 800,000 people in the UK and 36 million people around the world. Caring for people with dementia costs the UK twenty billion pounds a year and, unlike other big killers such as cancer and heart disease, dementia is increasing. Because people are living longer, the number of people living with dementia is predicted to double over the next twenty years.
Dementia can be caused by different diseases, of which the most common is Alzheimer’s disease. As we get older, many people find they have occasional lapses of memory, such as forgetting where they put the car keys, or someone’s name. Dementia is different from this normal ageing process – in dementia, memory and thinking is so severely impaired that the person can no longer function independently. Treatments are available which help reduce the symptoms of Alzheimer’s disease, but sadly, there is not yet a cure for Alzheimer’s or other dementia-causing diseases.
How is dementia normally diagnosed?
First, a doctor needs to rule out other possible causes of the problem, so they will take some blood to check for vitamin and other deficiencies, and also do a brain scan to exclude the possibility of a tumour or stroke. A good doctor will also want to talk to the patient and someone who knows them well, to understand the history of the symptoms and make sure they aren’t being caused by something like depression, which in some people can look like the early stages of a dementia.
Once these alternatives are ruled out, a specialist doctor will do a simple question and answer assessment to check how well the person is able to do things like remember lists, follow instructions, and copy drawings. This allows a doctor to decide if someone has dementia, and then to understand which disease is causing it, the doctor may order additional tests including additional brain scans or psychological testing.
What are the main problems with current methods and tools used to detect early signs of dementia?
In the UK, the problem is largely that the system is set up to only act once dementia is at a relatively late stage. If you’re worried about your memory and go see your GP, the options that are available to your GP are limited. They can tell you not to worry and send you home. They can check for reversible causes of memory problems, such as vitamin deficiency or depression. Or they can decide to refer you the local memory service, which in some parts of the UK can have a waiting list of many months.
Before doing that, most GPs would want to be sure you do have a significant problem, so they’d probably do a quick assessment of your memory, sometimes using a validated but lengthy measure, sometimes just by asking you a few questions. These tests are relatively insensitive – they will pick up if you have already have fully-fledged dementia, but they won’t pick up the early signs.
Please could you describe Cambridge Cognition’s new product CANTABmobile? How does this test help to detect the signs of early dementia?
CANTABmobile is a computer-based memory test that is very sensitive to the earliest signs of Alzheimer’s and other dementias. It runs on an iPad and from the patient’s point of view, it’s like doing a simple puzzle. You watch a series of patterns appear, remember where they were, and then touch on the iPad screen where you saw the pattern. That sounds simple but in fact the test has been developed through 25 years of scientific research led by the University of Cambridge.
What’s new this year is that in CANTABmobile we’ve adapted the test to make it most useful, and useable, for mainstream healthcare settings such as GP surgeries. For example, the iPad version can provide the test instructions in multiple languages, and it outputs a simple report that tells the doctor whether the person’s performance is as expected for someone like them, or whether they are at high risk for dementia and should be assessed further.
Most people experience a gradual decline over a period of several years prior to developing a full dementia. It’s in this period that CANTABmobile can detect that there is probably a problem developing, and that gives people more time to make plans and set themselves up so that they can stay well and independent for as long as possible.
What other benefits are there of CANTABmobile?
As well as being more sensitive than the best tools that doctors previously had access to, CANTABmobile is also much easier to use. That is important in a busy GP surgery, where short appointments mean that doctors don’t always have enough time to make a really thorough assessment.
CANTABmobile also includes a tool for detecting depression and another to assess how well someone is functioning in their everyday tasks. These are important pieces of information that helps a doctor understand whether referring a patient to memory services is the best thing for them. All this information can be gathered in about ten minutes and it can be overseen by a nurse or healthcare assistant, if the doctor is busy.
How was CANTABmobile developed?
CANTABmobile is the result of a 25-year programme of research originally started by Professors Trevor Robbins and Barbara Sahakian at the University of Cambridge. They developed the original memory test back in the 1980s, and they and other groups around the world have been using it ever since in research in Alzheimer’s and other diseases.
The test has always been based on a touchscreen computer, so that the patient doesn’t have to worry about using a keyboard or mouse. But it’s only in the last couple of years that cheap, reliable touchscreen computers have appeared everywhere, in smartphones and tablet computers. It’s the universal availability of touchscreen devices like the iPad that has allowed us to take this well-validated scientific tool and make it available for the first time to mainstream healthcare.
Who is CANTABmobile aimed at?
Because it provides information about a person’s risk for dementia, CANTABmobile is used under the supervision of a healthcare professional – usually a GP. Is it designed to help older adults who are worried about their memory and who would like to understand whether their memory is normal for someone of their age.
Where is CANTABmobile currently available?
As a Cambridge-based company, we have chosen to roll out CANTABmobile first in the UK, in GP clinics and some other private and NHS settings. It is currently being used in 25 primary care trusts around the country.
What are Cambridge Cognition’s plans for the future?
Our immediate plans are to roll out the CANTAB mobile device in Europe and elsewhere around the world. In the future we will release a range a digital ‘brain health’ products - watch this space!
Where can readers find more information?
They can find more information on CANTABmobile here: http://www.cantabmobile.com/
For further information on Cambridge Cognition they can visit: http://www.cambridgecognition.co.uk/
About Dr Andrew Blackwell
Andrew Blackwell, PhD
Chief Scientific Officer, Cambridge Cognition
Following a MA and a PhD in psychology from the University of St Andrews, Andrew undertook post-doctoral training in cognitive neuropsychology and psychopharmacology at the University of Cambridge, working closely on CANTAB® with Professors Trevor Robbins and Barbara Sahakian.
Andrew’s research has been driven by two main aims. Firstly, to understand the profile and biological substrates of cognitive impairment in a range of neuropsychiatric conditions including Alzheimer’s disease, Mild Cognitive Impairment, Parkinson’s Disease, Huntington’s Disease, Stroke, OCD, ADHD, Depression and Schizophrenia. A second aim is to examine the potential of various pharmacological agents to augment cognitive function both in patients and in healthy adults.
Andrew has published numerous papers in quality journals, including Science, American Journal of Psychiatry and Neuropsychopharmacology.
Since joining the board of Cambridge Cognition in 2007, Andrew has consulted for most of the leading pharmaceutical research organizations and has worked on over 150 clinical trials of investigational drugs targeting disorders of the CNS.
Andrew is also involved in a number of cutting-edge human performance factor research programs, designed to improve cognitive function during high-performance military and civilian operations. At present, he is focused upon the development and commercialization of Cambridge Cognition’s pipeline of products for mainstream healthcare. CANTABmobile, the first of these products to market, is an iPad based CE marked Class II medical device designed to enable early detection and diagnosis of dementia and depression in primary care.
Launched in May 2012, CANTABmobile is now in use in over 25 healthcare trusts in the UK NHS. This year, Cambridge Cognition was listed in the Sunday Times Tech Track as one of the UK’s fastest growing technology businesses.
Married and with a young family, Andrew lives near Cambridge.