A nautical adventure or an animal safari could test the brain in more ways than one. Using these themes and more, a spate of new games and apps are hoping to identify signs of dementia years or decades before a person might typically receive a diagnosis.
Just this month, one platform won an award for , and was announced in Canada. But do any of them actually work? And if they do, is it worth knowing you have an incurable, terminal disease years before it begins to impact your life?
While cognitive tests that purport to measure your knowledge, memory or “brain age” have been around for a while, the last few years have seen an uptick in tests that specifically look for early signs of dementia, including Alzheimer’s disease.
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, a game that requires players to travel the oceans searching for lost memories, tests a person’s ability to navigate, for example. One of the earliest clear signs of Alzheimer’s disease is disruption to spatial orientation, says of University College London, who collaborated on the game’s design.
The current version of Sea Hero Quest functions only as a game, but Spiers and his colleagues are working on a version that could use a person’s score to tell their doctor whether they might be showing early signs of Alzheimer’s.
Sina Habibi has a similar goal for his own company , a spin-out from Cambridge University. Cognetivity’s five-minute test, which is played on an iPad, involves being shown various scenes in quick succession. Players have to pick out those that contain animals as quickly as they can.
The test doesn’t score memory. “The brain can hide and mask deterioration in memory tests for a long time,” says Habibi. His team chose to focus on visual processing because this is another of the first skills to suffer in the early stages of dementia. The task also recruits various brain regions, says Habibi, including those involved in movement.
takes yet another approach. The Canada-based company behind the test have based their product on existing cognitive tests, which assess a range of cognitive skills by testing a person’s ability to perform calculations, orientate themselves and solve problems. “It’s not just a memory test – it looks at language, memory and visuospatial skills,” says of Ohio State University, who advised on the test’s development.
Which app is best
If you ask any company, they will say their own test is the best, says Carol Routledge, head of research at Alzheimer’s Research UK.
The tests all focus on different aspects of brain function – which can really give us the best indication of dementia? “We don’t know,” says Routledge, “because we don’t diagnose dementia early enough.” As more people use the different apps, a winning strategy may eventually emerge.
However, even if we learn that visual processing, for example, really was the first sign of dementia onset, it would take a lot more work to figure out exactly which form of dementia was likely to strike. “There are up to 80 different diseases that can cause dementia,” says , head of research at Alzheimer’s Society. The various forms can affect different regions of the brain in different ways, and their symptoms can vary, so it is important to be able to tell them apart.
While early versions of the tests are available online as games, these don’t tell people if they are showing signs of dementia. The companies contacted by żěè¶ĚĘÓƵ were all in agreement that any diagnostic test has to be offered under the supervision of a medical professional.
The problem is that this could mean very little change from the current status quo, which leaves many undiagnosed until their brain damage is untreatable. Most people with dementia aren’t diagnosed until their 70s and 80s, when they show noticeable symptoms – but the brain changes underlying the disease are thought to start some two to three decades before then. An alternative would be to incorporate the tests as part of regular health checks in middle age, but it is hard to say whether such an approach would take off.
But a simple test for early dementia is a worthy goal, says Pickett. Of the hundreds of clinical trials of drugs for dementia, all have failed to demonstrate a cure – probably because they have been tested in people whose brain damage is already too far gone to be rescued, he says. If there were a way to identify such people in the first stages of the disease, we’d have a much better chance of treating them – potentially with some of the drugs that have already been written off.
And while there are no treatments that can slow, halt or cure dementia, recent evidence suggests there are things you can do to delay the onset of symptoms – namely by upping your exercise and fruit and veg intake, and cutting out fatty foods. Hobbies and a social life seem to help, too.
“If you have a healthier lifestyle you may be able to slow the onset of symptoms,” says Routledge. “And theoretically if you can slow the disease by 5 to 10 years, those people will die of old age rather than dementia.”
Article amended on 15 June 2018
We clarified that though a few drugs have passed trials and been approved for use in dementia by the US Food and Drug Administration, none are cures
