Startups fighting Alzheimer's by @advanceHC

ALZHEIMER’SFrank Boermeester //advance.healthcare

Follow @advanceHC @fboermeester

STARTUPS

FIGHTING

“Alzheimer’s Disease has no survivors”

It destroys brain cells and causes memory changes, erratic behaviors and loss of body functions. It slowly and painfully takes away a person's identity, ability to connect with others, think, eat, talk, walk and find his or her way home.Alzheimer’s Association – alz.org

Alois Alzheimer's patient Auguste Deter in 1902. The first described case of what became known as Alzheimer's disease.

Frank Boermeester @fboermeester

https://en.wikipedia.org/wiki/Auguste_Deter

Unrelenting progression of disease

Pre-dementia Early Moderate Advanced

Pre-diagnosis, mild cognitive impairment (memory & executive

functions)

Increasing cognitive impairment (learning, attention, language)

Independence hindered (motor skills, wandering, neuropsychiatric

symptoms)

Completely dependent

(exhaustion, muscle mass deteriorates),

death

Up to 20 years 2-10 years 1 – 5 years


A global epidemicWorld Alzheimer

Report 2015


“There’s an

app for that.”

Or is that a stupid and disrespectful claim?

...in light of the millions spent on unsuccessful pharmaceutical research

(99.6% of drug trials for Alzheimer’s Disease during the period 2002-2012 have failed) http://www.alzres.com/content/6/4/37


There’s a wave that needs riding, it’s called...

Beyond the pill

“A survey conducted by Accenture found that life-sciences executives continue

to warm up to the idea of using wearables and other intelligent hardware,

saying technology will be the catalyst for the industry's move into outcome-

based sales. ….About 85% of respondents said they believe using intelligent

hardware, sensors and devices will help the industry shift from selling pills to

selling outcomes.”

- http://www.mmm-online.com/dataanalytics/smart-devices-will-improve-pharma-sales-survey/article/439278/

See how we helped UCB move beyond the pill

For pharmaceutical company UCB we helped organise a trans-Atlantic hackathon focused on epilepsy. In a single weekend, a hugely motivated group of developers and designers created more than ten viable prototypes.

Find out more atadvance.healthcareor buzz @advanceHC


PreventionEarly

detection & diagnosis

Treatment Management

Diagnosis is difficult (neuropsychological testing), especially early detection

No pills to solve safety issues & risk of injury due to wandering, outburst, aggression

Huge care burden (most costly disease in Europe & the USA). Not enough care workers, family distress, etc.

No ‘silver bullet’ given devastating impact on the patient: cognitive, emotional, motor, neuropsychiatric, social..

Measurement of disease progression (for clinical trials etc) is difficult

Prevention may involve lifestyle/behaviour change (pending more research)

No pills to fix loss of autonomy, isolation, loneliness...

No pills to fix cognitive decline (memory, executive functions, language)

Heavy medication to manage psychiatric symptoms (depression, delusions, aggression)

Why look beyond the pill?


Imaging & Big DataAnalysis of imaging data, medical records, genomic data for predicting disease progress etc

PreventionEarly detection

& diagnosisTreatment Management

Cognitive AssessmentCognitive and neuropsychological testing for early detection, diagnosis and measurement of disease progression

Training & GamesDelaying the progress of AD through retraining of memory, multitasking skills, verbal skills etc

MonitoringSensor-based monitoring (e.g. activity tracking, fall detection, care prediction tools) and telemedicine

AugmentationCognitive and physical augmentation (e.g. memory support, spatial orientation)

Care Robots/PlatformsHelp improve care delivery and emotional stimulation and reduce the burden of informal caregivers.

ConnectivityConnect patients with care networks and comfort services through easy to use communication platforms.

ERP & MarketplacesSoftware for streamlining operational and administrative care tasks and caregiver marketplaces

Opportunities for digital innovation?













Training & StimulationSerious games and apps for cognitive and physical retraining and stimulation, to delay cognitive decline, counter apathy, etc.

Sensor in a sockPressure sensor in sock to detect when person starts wandering out of bed

http://www.fastcoexist.com/3034118/this-kid-designed-a-wearable-health-device-for-his-grandfather-with-alzheimers

Passive wearable monitoring


Smart SoleGPS-enabled monitoring so that can set a “geo-fence” and create customised alerts

http://www.gpssmartsole.com/gps-smart-sole.php



https://www.indiegogo.com/projects/itraq-the-cellular-tracking-device#/story

iTraqCredit-card sized tag enables geo-tracking through cellular networks



Interactive wearable monitoring

EmbraceletGPS tracking, emergency button, customised alerts & reminders. Strong focus on design and destigmatising.

http://www.embracelet.be/


Toshiba Silmee GPS tracking, emergency button, multiple health tracking sensors (heart rate, activity, ultraviolet light)

http://www.psfk.com/2015/09/toshiba-activity-trackers-for-senior-care-silmee-w20-w21.html



Clevercare3G smartwatch GPS tracking, emergency button, customised alerts & reminders, phone calls, 24/7 emergency response call centre

http://clevercare.co.nz/



Tempo (CarePredict)Tracks and learns daily patterns and detects/predicts possible problems

http://carepredict.com/



LivelySolution combines a watch and in-home sensors. Press the button on the watch to call for help (24/7 call center). Watch also counts steps and can set medication reminders. The activity sensors can be placed around the house (e.g. bathroom door) to monitor daily activities and detect abnormalities.

www.mylively.com


IoT monitoring

Scientific Comment

Monitoring tech works... Consumer electronics devices (relying on GPS, wifi, mobile networks) can detect wandering patterns and alert caregivers.

“Experimental results show that the mobile-health application is able to detect wandering patterns including lapping, pacing and random in real-time.”

http://ieeexplore.ieee.org/xpl/articleDetails.jsp?arnumber=6611105


http://ieeexplore.ieee.org/xpl/articleDetails.jsp?arnumber=6611105

Scientific Comment

Can sensor data + machine learning deliver more proactive care?

The University of California San Francisco Memory and Aging Center has developed what they call a "care ecosystem," which uses the Internet of Things and machine learning, as tools to provide care that is "more continuous and proactive and personalized”. The impact of the model is being tested in a 3 year research project.

http://memory.ucsf.edu/research/supportive-trials/careecosystem

http://www.techinsider.io/the-internet-of-things-can-improve-care-for-people-with-dementia-2015-7


http://memory.ucsf.edu/research/supportive-trials/careecosystem

http://www.techinsider.io/the-internet-of-things-can-improve-care-for-people-with-dementia-2015-7

Scientific Comment

Usability can be a problem:“When being targeted to patients with dementia some usability problems appeared, such as difficulties to read information in a small screen or take a proper photo.” http://www.tandfonline.com/doi/abs/10.3109/09638288.2015.1025992

Participatory design (involving people with dementia in design process) is feasible and beneficial:

“Participants felt strongly that future devices should be disguised and be integrated easily into their daily routines. Suggested areas for functional improvement included two-way communications, flexibility of function as the illness progresses, and something to "guide" them home when out walking or driving. Attention should also be focused on minimizing the size, weight and visibility of devices to reduce stigmatization.”http://www.ncbi.nlm.nih.gov/pubmed/19193255


http://www.tandfonline.com/doi/abs/10.3109/09638288.2015.1025992

http://www.ncbi.nlm.nih.gov/pubmed/19193255

Scientific Comment

There are ethical issues that need to be addressed (balancing patients’ need for safety with need to preserve their autonomy and privacy.)

“No-one should be coerced into using tracking technology and, where possible, people with dementia must be involved in the decision-making and their consent sought.”




Interested in more deep dives?

More info? Buzz @fboermeester//advance.healthcare

Don’t miss the next installment on startups active in the field of ophthalmology






Training & StimulationSerious games and apps for cognitive and physical retraining and stimulation, to delay cognitive decline, counter apathy, etc.








‘Augmentation’

Backup MemorySmartphone app that alerts user when a familiar person is nearby and reminds them about their relationship through photos

http://global.samsungtomorrow.com/samsung-volunteers-in-tunisia-develop-app-for-alzheimers-

patients/


‘Augmentation’

Intelligent GlassesSingapore scientists have developed a tool on Google Glass that recognises people and reminds the user who they are, and reminds the user about medication

http://www.straitstimes.com/singapore/health/smart-glasses-for-seniors-with-dementia


‘Augmentation’

Cloudphone (Ollo Mobile)Tracking & communication wearable, includes a ‘safe path’ feature that automatically monitors regular transit activity – like going to and from shop. You set the route and schedule, CloudPhone lets you know if things go wrong.

https://www.indiegogo.com/projects/cloudphone-3g-revolutionize-how-you-care#/story


Connected Patients

CubigoA single, easy to use platform for accessing a personalised portfolio of services, including commucation tools (e.g. videocalls, messages, neighbourhood forum), comfort services (e.g. home shopping, postal services), and security and care (medical appointments, medication reminders, alarms, integration with sensors).

http://www.cubigo.com/


Connected Patients

Smartstones

Give people with

communication

challenges the ability to

speak using a wearable

sensor that detects touch

and motion gestures and

is connected to a

gesture-to-speech app.

http://www.smartstones.co/


Care communication hubs

CareZapp

A platform that lets families,

caregivers and care organisations

create a private network for

seamless, secure communication.

Can be connected to home

sensors and vitals monitoring

http://www.carezapp.com/


Care communication hubs

CareMerge

A platform for coordinating

care among family,

careproviders, physicians

and community.

http://www.caremerge.com/


Care Marketplaces

CareLinx

CareLinx is an online professional

caregiver marketplace for in-home

care services. CareLinx claims to

save families up to 50% verses

traditional brick and mortar

franchise agencies, while

professional caregivers earn higher

wages.

http://www.carelinx.com/


Speech analysis

IBM research team created an automated verbal test (much shorter/faster than standard paper-based tests). IBM Watson is used to analyse speech pattern (not the content but the tone, pauses, continuity of speech etc). The application classifies with 85% accuracy whether user is disease free, pre-dementia and early-dementia. Other (non-IBM) research on speech analysis is also showing good results.

http://www.techrepublic.com/article/how-ibm-research-wants-to-use-mobile-devices-to-detect-early-stage-dementia/

Cognitive assessment



Eye movement analysis

Neurotrack is a computer-based visual cognitive test (tracks eye movement as a means to measure recognition memory) that appears to be capable of predicting patients’ risk of developing AD before behavioural symptoms appear. The tool is potentially useful in clinical trials with early (pre-symptomatic) stage AD patients and later as a general screening test

https://www.neurotrack.com/



Computer game performance as test

Game developer Akili Interactive Labs and Pfizer are doing research to see if brain-boosting app Neuroracer could detect and track the progression of AD. Neuroracer detects attention impairment, which in turn is linked to early stage AD.

http://www.alzheimers.net/2014-01-13/akili-app-may-detect-alzheimers/



Digital pen as dementia prediction tool

Researchers at MIT analysed data from 2600 ‘clock-drawing’ tests (a traditional screening tool for cognitive impairment) performed using a digital pen (Anoto Live Pen – which measures the ballpoint tip’s position 80 times a second). The digital version of the test was shown to be far more accurate diagnostic tool than the original pen and paper version, probably because it picks up more markers than the finished drawing (e.g. pauses, hesitation).

http://groups.csail.mit.edu/mug/pubs/Souillard2015MLJ.pdf



Scientific Comment

Disrupting clinical-based cognitive assessment

“The revolution in mobile technologies provides unprecedented opportunities to overcome the barriers of time and context that characterize traditional hospital and clinical-based assessments.”

Mobile Technologies in the Early Detection of Cognitive Declinehttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275158/


Scientific Comment

Imagine a future of always-on, continuous & contextual cognitive monitoring

“The future vision is one where classically slow, subjective, and data-poor assessments of cognition are replaced by fast, objective, and data-rich digital assessments that can be unequivocally linked to functional improvement by reference to large datasets. …

In a world where the majority of the population carries a mobile digital device, where our behavioral status, cognitive capacity, and clinical function are ubiquitously and continuously tracked by the digital footprint we leave behind, the prospect for transformative efficiency and accuracy in testing novel therapeutics in neurodegenerative disease may rest in the devices we each carry in our pockets.”

C Leurent and MD Ehlers* Digital technologies for cognitive assessment to

accelerate drug development in Alzheimer's disease. Clinical

Pharmacology & Therapeutics 8 SEP 2015


More info? //advance.healthcare or buzz @advanceHC

At Advance Healthcare we are on a mission to improve the lives of patients through digital innovation, one disease at a time.

Market research & technology

scouting

Ideation workshops & brainstorming

Hackathons & events

Venture building

What else do we do?

Big Data: harnessing medical records

Global CEO Initiative on Alzheimer’s Disease

Optum Labs is a research collaborative, founded by Optum (healthcare analytics

company) and Mayo Clinic in 2013 (later joined by AARP), that brings together

de-identified administrative data of more than 100 million patients and

electronic records of 30 million patients. With more than 100 studies on the go,

they aim to generate new predictive models and comparative-effectiveness

evidence. For example, they are playing a key role in the development of a

global Big Data research initiative to fight Alzheimer’s Disease

http://www.ceoalzheimersinitiative.org/


Imaging data

Using MRI data to predict disease progression

Researchers at MIT are using

machine-learning software to

analyse imaging (MRI), genetic,

demographic and clinical data to

help predict change in brain

anatomy among patients with

Alzheimer’s Disease

http://news.mit.edu/2015/predicting-change-alzheimer%E2%80%99s-brain-1006?


Visual Stimulation

Tovertafel

A game that projects light animations on a large table and that people can interact with through gestures. It stimulates physical activity and social interaction among people with mid- to late-stage dementia.

http://www.activecues.com/


Aromatic Stimulation

Ode

A device that emits strong food fragrances (e.g. orange juice, curry, soup) to provide aromatic cues for mealtimes. To counter appetite loss among people with dementia. The power of smell is that it connects directly to the brain’s limbic system.

http://www.myode.org/


Brain StimulationYbrain

Ybrain has developed a nerve stimulating headband for patients suffering early onset Alzheimer’s and is building an analytics platform for disease diagnosis and personalized treatments. The device may enhance brain activity, improve short-term memory and increase perceptual ability (Ybrain lab results, not clinical trials)

http://ybrain.com/


Rise of the Brain Fitness Industry

But are these useful for people with AD?


Scientific CommentBrain training can be effective for normal older adults (no AD or dementia)

Brain training games have been criticised for making false promises. But a study published in Nature, shows that a game that is tailored to a specific cognitive deficit (in this case multi-tasking) can be effective in enhancing cognitive control among older adults. Hence it’s potential use to detect early AD. http://www.nature.com/news/gaming-improves-multitasking-skills-1.13674

Certain mental exercises can offset some of the expected decline in older adults' thinking skills and show promise for maintaining cognitive abilities needed to do everyday tasks such as shopping, making meals and handling finances, according to a new study. The research…showed that some of the benefits of short-term cognitive training persisted for as long as five years.http://www.nih.gov/news/pr/dec2006/nia-19.htm


What about Brain Training for Alzheimer’s Disease?

Some population studies do show that people who engage in intellectual activities such as reading, board games, crossword puzzles, playing music, social interaction, learning a second language later in life, etc. have reduced risk for developing AD or even seems to delay development of AD.

The concept of ‘cognitive reserve’ is used to explain a degree of resilience that some people have to the clinical manifestations of AD, but not to the disease process itself. People with high cognitive reserve may go undiagnosed until disease pathology is severe, then rapid decline follows.

• Wilson RS et al. Participation in Cognitively Stimulating Activities and Risk of Incident Alzheimer Disease. AMA. 2002;287(6):742-748. doi:10.1001/jama.287.6.742.

• Verghese J et al. Leisure Activities and the Risk of Dementia in the Elderly. The New England Journal of Medicine NEJM, 2003, 348:2508-2516

• Stern, Yaakov (2006) Cognitive Reserve and Alzheimer Disease. Alzheimer Disease & Associated Disorders, vol 20, p 112-117.

• Williams JW et al Preventing Alzheimer's disease and cognitive decline. Evid Rep Technol Assess (Full Rep). 2010 Apr;(193):1-727.

Scientific Comment


http://www.ahrq.gov/research/findings/evidence-based-reports/alzcog-evidence-report.pdf

And yet….they can be useful! A literature review of 15 studies on dementia-

related serious games suggests that:

• (1) physical games (or exergames, i.e., games that promote physical fitness) can positively affect several health areas of the players with mild AD and MCI, such as balance and gait (Padala et al., 2012), and voluntary motor control (Legouverneur et al., 2011);

• (2) cognitive games (i.e., games which target cognitive improvement) can improve a number of cognitive functions, such as attention and memory (Stavros et al., 2010; Weybright et al., 2010; Rosen et al., 2011) and visuo-spatial abilities (Yamaguchi et al., 2011);

• (3) both physical and cognitive games can have a positive impact on social and emotional functions, for instance they can improve the mood and increase positive affect and sociability (Weybright et al., 2010; Boulay et al., 2011; Yamaguchi et al., 2011) and reduce depression (Férnandez-Calvo et al., 2011). Very few studies investigated the effects of the use of games for social/emotional health (which encourage the players to link with their friends and/or improve their social and emotional life) in dementia, but the results are encouraging (Boulay et al., 2011).

Dementia Games: A Literature Review of Dementia-Related Serious Games http://link.springer.com/chapter/10.1007%2F978-3-642-40790-1_2

Scientific Comment


http://journal.frontiersin.org/article/10.3389/fnagi.2014.00054/full#B54











Conclusions of a systematic review and SWOT analysis of use of serious games targeting AD patients, analyses which in turn were discussed and validated in a workshop at the 2013 Clinical Trial of Alzheimer's Disease (CTAD) conference, and endorsed by stakeholders in the field:

“The results revealed that SG may offer very useful tools for professionals involved in the care of patients suffering from ADRD. However, more interdisciplinary work should be done in order to create SG specifically targeting these populations. Furthermore, in order to acquire more academic and professional credibility and acceptance, it will be necessary to invest more in research targeting efficacy and feasibility. Finally, the emerging ethical challenges should be considered a priority.”

Recommendations for the use of Serious Games in people with Alzheimer's Disease, related disorders and frailty. Front. Aging Neurosci., 24 March 2014 http://dx.doi.org/10.3389/fnagi.2014.00054

Scientific Comment


http://dx.doi.org/10.3389/fnagi.2014.00054

Memory PlacesPhD research by Kasper Bormans is exploring the use of virtual ‘memory places’ (guided imagery) to enhance memory for familiar faces, thereby improve quality of life of patients and caregivers

Cognitive Training

https://www.youtube.com/watch?v=BMcduh1HEHA


MindMateTablet App providing games for stimulating cognitive abilities (based on research conducted at Uni of Glasgow), memory support tools (lists, alerts), and advice on physical exercises and nutrition

http://www.mindmate-app.com

Cognitive Training


AlzhupTablet app that integrates cognitive exercises and actual memories. Working with University research team for clinical trials.

http://www.alzhup.com

Cognitive Training


http://www.alzhup.com/

Care through Robots & Avatars

Paro

PARO is an advanced interactive robot developed by AIST. It allows the documented benefits of animal therapy to be administered to patients in environments such as hospitals and extended care facilities where live animals present treatment or logistical difficulties. PARO has five kinds of sensors: tactile, light, audition, temperature, and posture sensors, with which it can perceive people and its environment. It works, but raises ethical concerns.

http://www.parorobots.com/


Scientific Comment

Are we ready for robots that care for us?

“Results so far have been encouraging in the sense that they showed that elderly people concerned by cognitive impairment recognize the potential of Socially Assistive Robots (SAR) for supporting health and social care at home. It is true that the current state of the research on SAR does not allow us to conclude that older adults are ready for robots that care for them, but the idea is no longer unimaginable..”

Pino M et al. “Are we ready for robots that care for us?” Attitudes and opinions of older adults toward socially assistive robots. Front. Aging Neurosci., 23 July 2015 | http://dx.doi.org/10.3389/fnagi.2015.00141


http://www.tinybots.nl/


Tinybots

Small, talking robots that provide cognitive training, medication reminders and ‘companionship’, giving structure to a person’s life



GeriJoy

Companionship when family and human caregivers aren't around. GeriJoy's 24/7 team of remote caregivers use an on-screen avatar to provide conversation, emotional support, and wellness reminders -ensuring seniors never feel alone

https://www.gerijoy.com/


Monitoring+Care Platforms

Giraff Plus

GiraffPlus monitors activities in the home using a network of sensors, both in and around the home as well as on the body.

The sensors can measure e.g. blood pressure or detect e.g. whether somebody falls down. A range of services can be tailored to the individual’s needs.

At the heart of the system is a unique telepresence robot, Giraff, which lends its name to the project. The robot uses a Skype-like interface to allow relatives or caregivers to virtually visit an elderly person at home.

Photo Terese Andersson

http://www.giraffplus.eu/


Monitoring+Care Platforms

MobiservA European, multi-partner research project that created a platform consisting of:• A social companion robot - robot,

containing processing power, data storage capability, various sensors, machine learning/experience gathering/adaptation, a touch screen, speech synthesis, and speech recognition

• Wearable smart clothes - monitoring of vital signs or sleeping patterns, and detection of falls

• Smart home environment - smart sensors, optical recognition units, and home automation elements, to detect among others eating and drinking patterns, activity patterns, and dangerous situations

http://www.mobiserv.info/








How will it all come together?


From multi-functional platforms (monitoring,

memory-supporting, connected care

platforms) ...



...to grid-linked cyborgs?

Image: cover of Neal Asher’s book “The Line of polity”


Thanks!


//advance.healthcare

At Advance Healthcare we are on a mission to improve the lives of patients through digital

innovation, one disease at a time.

More info? //advance.healthcare or buzz @advanceHC

At Advance Healthcare we are on a mission to improve the lives of patients through digital innovation, one disease at a time.

Market research & technology

scouting

Ideation workshops & brainstorming

Hackathons & events

Venture building

How we can help

Startups fighting Alzheimer's by @advanceHC

Health & Medicine

Transcript of Startups fighting Alzheimer's by @advanceHC