27 Apr 2013

Why diagnosing dementia could become that little bit easier

Diagnosing dementia is notoriously difficult – sometimes taking months, even years – and involves numerous visits to doctors, hospitals, blood tests, scans and more often than not, a great deal of frustration and heartbreak.

But now GPs across England are testing a new IPAD computer programme which aims to speed up diagnosis.

The £3.3 million project – 60 per cent funded by the Department of Health – is also being combined with a trial at a new Brain Health Centre in Sussex and another at the Maudsley Hospital in south London, using a new diagnostic programme attached to existing MRI scanners so doctors can see what type of dementia the patient might have.

More than 800,000 people in the UK have dementia and that figure is expected to grow to one million by 2021. There need for better, more accurate and faster diagnosis has never been greater.

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Yet currently, the tools at the finger tips of most family doctors confronted with a patient worrying about their memory has been little more than a pencil and paper. They ask the patient to write down a series of questions such as the exact date or to repeat back a name and precise address. It is an imprecise way of diagnosing the exact problem and can often lead to more patients being sent for further testing (and, of course, worrying) than need to be.

The new IPAD test developed by Cambridge Cognition is a 10 minute test which tests emotional state, memory and ability with day to day tasks. It adjusts for age, education and gender and automatically generates a report which may say the patient needs further investigation or not, that they may have problems with depression but not memory, that they are having trouble with daily tasks and could need immediate social care or home help.


On the other hand, the report could also allow the doctor to reassure the patient and say that there is nothing, at least for the moment, to worry about. Dr Jonathan Inglesfield, of the Cranleigh Medical Practice in Surrey, is one of the GPs testing the new programme. He said he had probably seen 15-20 patients since last September and of those screened, two-thirds were fine.

“That is important,” he said. “We haven’t had the tools to reassure patients before.”

He added that it also meant that he was able to refer the people who most needed further investigation, which could only be good for the limited resources of the NHS.

Although Cantabmobile, as it is called, has been used in research settings for some time, this trial is to investigate whether it can be used in the primary care and community settings. So far the results look interesting.

But there is a second part to this. Another company, Ixico, has developed a computer programme – using algorithm software – that can be attached to an MRI scanner. The trials at the new Brain Health Centre and the Maudsely, due to begin in June, create a clearer and easier to read picture of the brain and what is going on.

Different conditions

Dementia is a variety of conditions. The best known is Alzheimer’s Disease, but there are others including vascular, frontotemporal, or Lewy Bodies. Each one has a different effect on different parts of the brain. Equally importantly, each one can manifest itself in different ways so some patients may become agitated, others could have sleep problems, or they could become sad and demoralised.

And they may also need to be dealt with in different ways. While there is no cure for dementia, there are some drugs that may slow down the progression of the disease. It may also be the case that the patient will need more hospital care or they may be able to remain in their own homes.

Dr Denis Chann, who is a consultant neurologist and is leading the Brain Health Centre trials, said the current situation meant it was taking too long to diagnose patients. Indeed, it takes an average 18 months and he said that this was unacceptable for patients and families.

“The sooner we can diagnose, the sooner we can start therapies,” he said.

Should this trial be successful, the hope is that the programme will be attached to mobile MRI scanners which are used in the community. The aim would be that once the patient has done the IPAD test, had a blood test to ensure it is not a B12 or thyroid problem, they can then be sent quickly to wherever the scanner is currently parked. And the aim would be to have a proper diagnosis within three months.

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