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JDC Asks...

Tue 05 May 2020

Caring well for people with dementia and preventing the condition in the first place are among the major challenges of our time. How important will technological innovation be to success?

Professor Arlene Astell is director of the DATE (Dementia, Aging, Technology and Engagement) Lab in Toronto:

Technology is going to transform the way we think about dementia. To date we have been quite slow to take advantage of technologies that already exist. Items such as smart phones and tablets, voice-activated assistants and even gaming systems that use gestures to control them, have all been shown to benefit people living with dementia. These items are available right now but because they are not viewed as medical devices, they are not easy for people to acquire due to cost, need for training and support and internet access. Using these everyday devices could rapidly change our expectations of life with dementia from one of dependency and care to self-management and independence. Building on the everyday devices, we can use the data collected to create a mix of personalised human and technological support. This could include physical assistance from robotic devices or smart home technologies to complement input from family and friends. We can also expect much more use of remote participation in group social and leisure activities, support groups and video-consultations with health professionals. In addition, we can expect greater use of artificial intelligence (AI) to move forward our thinking about dementia. Currently we are using machine learning to examine large sets of data from clinical assessments and brain imaging to improve early detection and better target interventions. In future this will focus more on predictive factors with a view to preventing dementia. This could include potential technology solutions to the cognitive difficulties people face, perhaps through brain-computer interfaces or implantable devices. 

 

Dr Grant Gibson is lecturer in dementia studies at the University of Stirling:

Technology has been identified as a key feature of dementia care, with local authorities making significant investment in technology-enabled care. Innovative technologies such as smart care platforms and social care robotics have been identified as a priority across several national dementia strategies. Yet this hopeful rhetoric, that technology will solve the crisis in dementia care, doesn’t meet the reality of technology-enabled care on the ground. For example, the recent ATTILA trial of technology in dementia care found that despite large investment, assistive technologies neither delay entry into residential care nor provide cost effective care. Such findings suggest that technology innovations are unlikely to provide the magic bullet solution seen in policy rhetoric. Alongside technological innovation, we need to change our thinking about how we deliver technology-enabled care. Research indicates that successful technology use is characterised by people with dementia and their carers “tinkering with” or “bodging” technologies, creatively adapting them according to their individual circumstances. Services need to respond in a similar manner, adapting provision to suit individual needs. However, the research also suggests that both services and the devices they provide will need to change significantly to achieve this. If innovations in technology-enabled dementia care are to be successful, we also need to explore as a priority how technologies - and the services providing them - can be used in more individualised, adaptable and person-centred ways. 

 

Dr Carol Routledge is director of research at Alzheimer’s Research UK:

In 2017, research by the Lancet Commission showed that around a third of dementia cases could be prevented if it were possible to eliminate key lifestyle and health risk factors for the condition. We believe technology has a huge role to play in helping people reduce their risk of dementia and in changing public perceptions. Cardiovascular exercise is a great, accessible and fun route to risk reduction. Now more than ever, with many people at home due to the coronavirus outbreak, it’s important for people to keep active – while maintaining social distancing, of course. Recently Alzheimer’s Research UK teamed up with the sports company, Garmin, to encourage people to stay active, no matter what their age or fitness level. Using a smart watch is a great way to track progress, stay motivated, and encourage anyone to get into good habits to achieve their individual fitness goals - whether to simply stay active or for bigger challenges. We have also launched an initiative to revolutionise the early detection of diseases like Alzheimer’s. The Early Detection of Neuro-degenerative diseases (EDoN) initiative will harness the growing power of digital health technology and big data to revolutionise how we develop early tests for these diseases. Developing technology that can detect digital fingerprints of diseases, using phone apps or wearable technologies like smart watches, would provide a low-cost approach to identifying people before they develop symptoms. Identifying the very earliest changes in these diseases would transform research efforts today, giving us the best chance of stopping these diseases before the symptoms of dementia start to get in the way of life.

 

Ron Coleman is a Dementia Diarist and Amazon Alexa user:

As I write I am sitting in my house like many others in lockdown, having been advised to self-isolate for 12 weeks. I’ve written a diary about it elsewhere in this issue of JDC but, added to dementia, these weeks sometimes look almost impossible to navigate. Without technology my self-isolation would indeed be mission impossible. My artificial intelligence (AI) unit is at the centre of my life from the moment she wakes me up with the music I enjoy to giving me a news update, telling me what meetings I have that day, reminding me to take my meds - oh, and to have a shower. She doesn’t pick the clothes I wear yet, my wife does that, but she does brain training that keeps my mind active, and she allows me to hear music and play the books I am listening to (I can no longer read). If the temperature falls below a set figure she will turn the heating up. I can ask her to order my shopping at the local shop which will deliver it to me on that day. I use technology all day. I use a voice program to write, I can boil the kettle or turn lights on and off by using my voice. I feel in control and secure that, as pressure builds up on services over the coming weeks, I will be doing my bit to remove pressure on services that, without my AI, I would need myself. Could this be a way forward? I will leave that for you to decide - I have already made my decision.

 

Professor Ramin Nilforooshan is consultant psychiatrist at Surrey and Borders Partnership NHS Foundation Trust and affiliated to the UK Dementia Research Institute Care Research and Technology Centre:

Already more than 50 million are living with dementia worldwide with that figure set to more than treble by 2050. Health care systems will struggle to support this number of people if we do not make the most of what new technology has to offer. At our NHS trust, we have been trialling a network of digital devices in combination with artificial intelligence in people’s homes. This has allowed us to remotely monitor the health of people with dementia and provide appropriate support. The technology has alerted us to range of health and wellbeing issues, such as infections and changes in behaviour, enabling early detection and intervention, and allowed us to monitor the effects of new medications. Carers have felt better supported and crucially the wellbeing of people with dementia has improved. The potential of this technology to provide large populations with healthcare tailored to their needs at a cost that could be afforded by health care systems is clearly huge. Artificial intelligence (AI) can help us to better measure brain atrophy in MRI scans and more sophisticated digital memory tests will eventually replace pen and paper ones to help us improve diagnosis. Eventually, technology in the home could help us to identify a person developing dementia before they have developed clinical symptoms. Early diagnosis could then help people plan and prepare for their future and increase their access to new drug trials, often targeted at those with very mild dementia.

 

 

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