Information and Communication Technologies applied to Neurodegenerative Diseases

Prof. José L. Ayalajayala@ucm.es

Complutense University of Madrid

Interest from the technological community

● Ambient Assisted Living Programme – ICT for ageing well

– Time-to-market perspective of maximum 2 to 3 years after end of the project;

– Project total budget: 1 – 7 M€;

– Maximum funding from the AAL Joint Programme: 3 M€;

– Significant involvement of industry and other business partners, particularly SMEs are encouraged;

– Realistic trial set-up at the end of the project;

– Proactive end-user involvement throughout the life of the project;

– Defined market segment(s), use cases and target group(s) and address the wishes and needs of these specific group(s).

Interest from the technological community

● Horizon 2020 – Work Program 2014-2015

– 8. Health, demographic change and wellbeing

● PHC 10 – 2014: Development of new diagnostic tools and technologies (in vitro)

● PHC 11 – 2015: Development of new diagnostic tools and technologies (in vivo)

● PHC 12 – 2014/2015: Clinical research for the validation of biomarkers and/or diagnostic medical devices

● PHC 17 – 2014: Comparing effectiveness of existing healthcare interventions in the elderly

● PHC 19 – 2014: Advancing active and healthy ageing with ICT: Service robotics with assisted living environments

Interest from the technological community

● Horizon 2020 – Work Program 2014-2015

– 8. Health, demographic change and wellbeing

● PHC 20 – 2014: Advancing active and healthy ageing with ICT: ICT solutions for independent living with cognitive impairment

● PC21 – 2015: Advancing active and healthy ageing with ICT: Early risk detection and intervention

● PHC 22 – 2015: Promoting mental well being in the ageing population

● Etc

75% of the program is related to ICT!!!

ICT & Neurodegenerative diseases

● Where?

– Alzheimer's

– Parkinson's

– Sclerosis● For?

– Early diagnosis

– Monitoring of symptoms

– Treatment and intervention

– Improve quality of daily life

Low Cost!

Alzheimer's

● More than 20 million people worldwide

● Number is expected to double in next 20 years

● Improving home and community-based coordinated care is critical to mitigating effects and to reducing healthcare costs

● Recognition of technology development: Alzheimer's Association partnered with Intel from 2003 to establish the Everyday Technologies for Alzheimer's Care (ETAC) initiative (it supplies 3-years awards of up to US$200,000)

Alzheimer's

● Diagnosis and monitoring

– Early detection and diagnosis: complex due to heterogeneity of symptoms.

– Two promising approaches presented at the 2013 Technology & Dementia symposium focus on identifying early patterns of biological and behavioral changes

Alzheimer's

– Technology to detect voice responses to auditory pitch perturbations, such as changing the sound of your own voice.

– Typically, perturbing the sound of your voice results in a compensatory pitch change in voice response; however, damage to the white-matter tracts, linking auditory and speech production networks in the brain, alters compensatory responses to feedback perturbations.

– This approach is supported by preliminary work demonstrating that individuals with Alzheimer's have a diminished response amplitude and slower adaptation.

– Technology available in mobile phones a tablets

Alzheimer's

– Another approach is to apply new technologies to standard cognitive testing instruments, such as the Clock Drawing Test (CDT).

– Package using a digitalizing pen and paper system to capture these errors and provide metrics of hand kinematics in producing the drawing.

– Pause times at critical points in the drawing, potentially indicate deficits in movement planning that might help to distinguish between healthy and pathological aging.

– The test can measure executive function by the presence of very tiny “hooklets” that occur when drawers think about making the next stroke before they finish the current one. Their disappearance may indicate declining executive function.

– CDT can pick up preclinical cognitive changes that correlate with atrophy in the parietal lobe

Alzheimer's

● Monitoring everyday behavior to continuously asses functioning, such as functional mobility.

● System that includes not only motion, contact, and medication sensors, as well as load sensors that detect someone lying on a bed, but also monitors social activity. This includes telephone sensors that record the amount of time spent on the phone and whether the call was likely to be personal.

● Motion sensors track time spent out of the house, and voice sensors record time spent talking aloud, which typically reflects face-to-face conversations with other people

● Most of the measures of functional and cognitive status drop off over time in people with mild cognitive impairment (MCI), but not in cognitively healthy elderly. Intriguingly, increased day-to-day variability emerged as one of the earliest signs of decline, perhaps reflecting the fact that people in the early stages of AD tend to have “bad days” and “good days. This system detects change in early MCI with greater sensitivity than current clinical methods at a much lower cost.

Alzheimer's

● Other positioning devices based on BT and GPS

● Fall-detection system based on building vibration patterns associated with fall events

● Localization devices based on radio-frequency emitting modules attached to the walls

Alzheimer's

● Treatment and intervention

● Art-based therapies (valuable outlet for expression for people with varying stages of dementia, offering a creative activity that fosters engagement)

● The device lets art therapists create customized painting and drawing screens to accommodate specific client needs, selecting different tools, colors, sounds, and animation. An artificial intelligence program runs behind the client interface and employs audible and visual prompts to reengage a client that becomes disengaged.

Alzheimer's

– Other works on integrating cognitive exercise, physical exercise, sleep management , and socialization, with each module incorporating both assessment (home monitoring and self-reporting) and coaching

● Providing assistance for activities of daily living

– Intelligent technologies can help people with dementia complete activities of daily living (independent hand-washing, making a cup of coffee...) → cognitive orthosis

– Although the most require help with dressing, no assistive technology for that

– Context-aware computing with motivational counseling to provide dressing assistance

Parkinson's

● Diagnosis and evaluation of gravity

● Gait analysis (wireless and ambulatory)

Parkinson's

● Diagnosis and evaluation of gravity

● Tremor analysis by accelerometers on upper and lower extremities, and mouth

Parkinson's

● Diagnosis and evaluation of gravity

● Analysis from speech (iPhone applications, 99% accuracy with a 20s phone call)– Parkinsonian dysarthria: phonatory impairment

(hoarseness, hypophony, or tremulousness; incomplete closure of vocal folds causing turbulent air flow) and articulatory impairment (speech rate accelerates initially, then slows with disease progression)

– Patients tend to speak in a soft, breathy monotone – Reduction of fundamental frequency variability leads to

‘‘monopitch’’ intonation – Feedback mechanism is interrupted and patients feel they

are speaking normal volume – Speech declines earlier than gait

Parkinson's

Parkinson's

● Diagnosis and evaluation of gravity

● Analysis from speech: speech disorder treated by iParkinson (it changes how your hear your voice in earphones, in three ways)

– Multitalker babble noise treats hypophonia or low vocal volume. It sounds likes a party with people talking around you. This induces the Lombard effect and increases vocal volume 5-10 dB.

– Delayed auditory feedback (DAF) treats festinating speech or "run together" words. The user hears his or her voice delayed a fraction of a second. This helps pace the user’s speech.

– Pitch-shifting frequency-altered auditory feedback (FAF) changes the pitch of the user’s voice in his or her earphones. This increases speech motor activity and articulation clarity in some persons with Parkinson’s.

Parkinson's

● Diagnosis and evaluation of gravity

● Automatic EMG morphology

Parkinson's

● Treatment and live aids

● Tremor compensation by Electrical Functional Stimulation

https://www.youtube.com/watch?v=jX-sIoNCXYw

Sclerosis

● Treatment

– Multiple Sclerosis rehabilitation with KINECT

Where are we heading to?

● Ambulatory non-intrusive monitoring devices

● Wireless technologies

● Earlier, pre-symptomatic, diagnosis techniques

● GRAPHENE!!!

– Neuromonitoring: electrochemical sensors, electrical field stimulator to increase cerebral blood flow

– Molecular diagnosis: detection of DNA strands and dopamine, it is able to strongly quench fluorescent molecules (graphene biosensors based on fluorescence resonance energy – FRET)

– Neuroregeneration: Because of the unique electroconductive properties of graphene → design of electroactive scaffolds that may be able to transmit externally applied electrical stimuli and, therefore, to enhance neuroregeneration.