The normalization of cognitive tests implemented into annual wellness visits can help dispel the fear of Alzheimer’s testing.

Dispelling the Fear of Alzheimer’s Testing: Standardizing Cognitive Testing

The normalization of cognitive tests implemented into annual wellness visits can help dispel the fear of Alzheimer’s testing.

According to the Alzheimer’s Society, more than half (56%) of people are putting off seeking a dementia diagnosis for up to a year or more, and 62% think that a diagnosis of Alzheimer’s disease or other forms of dementia may mean that “life is over.” According to the Alzheimer’s Association, only half of seniors are being assessed for thinking and memory issues and far fewer are being assessed repeatedly.

Routine cognitive testing is paramount to early Alzheimer’s detection, but many doctors aren’t testing for cognitive disease early. With new drugs and therapies emerging on the market, early diagnosis of cognitive disease is critical. The earlier the diagnosis, the earlier the potential for treatment. Typically, an earlier diagnosis provides a higher likelihood of treatment success. Below, we will discuss:

  • The fear of Alzheimer’s testing.
  • The standardization of cognitive testing.
  • Dispelling the black-box fear of Alzheimer’s testing.

The Fear of Alzheimer’s Testing: Early Diagnoses 

Much of the fear of Alzheimer’s testing stems from deeply entrenched beliefs society has developed surrounding Alzheimer’s disease and dementia. Many individuals worry that being diagnosed with Alzheimer’s will mean a lower quality of life. They may also fear the impact a diagnosis might have on relationships with friends and family, or they may dread the financial impact associated with treatment and monitoring. As a result, individuals tend to avoid seeking medical attention when memory and thinking issues arise, thus delaying their potential diagnosis and ability to intervene.

Early detection of neurocognitive diseases, such as Alzheimer’s, is highly beneficial. When individuals wait to get tested and miss the opportunity for early detection, they deny themselves the benefits of early diagnoses, such as:

  • The ability and time to make plans for the future.
  • More time to assess and implement potential treatments in the early stages of Alzheimer’s.
  • The opportunity to implement lifestyle changes, such as increasing physical activity, controlling blood pressure, eating a healthier diet, and increasing social and mental activity.
  • The chance to participate in clinical trials.

The Standardization of Cognitive Testing

While yearly cognitive assessments for seniors are a required aspect of the Medicare Annual Wellness Visit, in a survey, only one in three seniors reported that they were aware of this requirement. Implementing cognitive testing into annual wellness exams is as simple as allotting 10-15 minutes for a pencil and paper legacy assessment or digitized assessment. 

Examples of cognitive assessments that can be implemented into annual wellness visits include:

  • The Mini-Mental State Exam (MMSE): The MMSE is a five- to 10-minute assessment scored on a 30-point scale. Patients are instructed to state the current date, count backward, and identify everyday objects.
  • The Montreal Cognitive Assessment (MoCA): The MoCA, similar to the MMSE, is a 10- to 15-minute assessment scored on a 30-point scale. Aspects of the MMSE are incorporated in addition to a Clock Drawing Test (CDT) and a two-part Trail Making Test.
  • The Mini-Cog: The Mini-Cog takes only three minutes to complete and consists of three steps: 1) the patient is asked to remember three words, 2) the patient completes the CDT, and 3) the patient must then recall and state the three words provided before the CDT.

While such tests cannot determine specific causes or types of cognitive impairment, they can be used as screening tools to determine if elements of cognitive impairment are present to then decide if further testing is needed. These tests may also take a lot of time because of analog measurements, office waiting times, and the need for a real-time analysis.

Dispelling the Black-Box Fear of Alzheimer’s Testing

Much of the black-box fear of Alzheimer’s testing relates to the fear of unknowns. While current cognitive tests, such as those listed above, can help individuals understand the state of their brain, they may leave patients with more questions than answers.

Cognitive assessment technology that provides more specific, comprehensive, and personalized data could help dispel the fears of not understanding one’s brain and/or diagnosis. Deeper, more granular data on cognitive function across many neurocognitive domains can provide the insight and understanding that patients need to feel confident about the state of their brains and their treatment paths.

Providing Comprehensive, Personalized Cognitive Measurements

With over two decades of research, Altoida is developing a digital platform to provide a more robust and comprehensive method to measuring and assessing brain health. The platform utilizes a unique battery of augmented reality and motor activities designed to be completed in 10 minutes from any smartphone or tablet. 

The game-like activities will provide robust measurements of brain function across 11 unique neurocognitive domains using integrated smart device sensors. The result is data from more than 780 unique digital biomarkers that allow for comprehensive testing and meaningful data tracking on a highly personalized level. Our platform can be used as a cross-sectional measurement of neurocognitive function or as a means of monitoring neurocognitive function over time.

To learn more about how Altoida is working to dispel the fear of Alzheimer’s testing through an innovative digital platform, contact us today.

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The relationship between artificial intelligence and brain health in the future may provide predictive diagnostic support for cognitive diseases.

Exploring The Relationship Between Artificial Intelligence and Brain Health

The relationship between artificial intelligence and brain health in the future may provide predictive diagnostic support for cognitive diseases.

Artificial intelligence (AI) is the science and engineering of creating intelligent machines. Weak Artificial Intelligence, or Narrow Artificial Intelligence, refers to a machine trained to perform specific tasks and drives much of the artificial intelligence we see today. Strong Artificial Intelligence and Artificial Super Intelligence go beyond Weak Artificial Intelligence to match or surpass the equivalent of human intelligence, respectively.

AI has the potential to change healthcare as we know it, and there are a few medical specialties where it is already making an impact. For example, deep-learning-based algorithms have been developed that aim to diagnose tuberculosis after receiving training using thousands of chest images, and deep-learning neural networks have been used to identify skin cancer after being fed images of malignant and benign melanomas.

The artificial intelligence of today can help as an additional screening tool for physicians, while the artificial intelligence of tomorrow may enable precise diagnostics through training on and analysis of large data sets. With that, let’s explore the relationship between artificial intelligence and brain health as well as how AI is used to assess cognitive function.

The Relationship Between Artificial Intelligence and Brain Health

Healthcare, as it relates to assessing brain health and diagnosing cognitive diseases, is well-positioned to be transformed by artificial intelligence. The potential capacity regarding the relationship between artificial intelligence and brain health is immense. 

Below, we discuss a few applications of AI and how it’s used to understand brain health and function.

Brain-Computer Interfaces

Brain-computer interfaces (BCIs) acquire and analyze brain signals and activity, then extract data features from those signals. This information is translated into commands which are relayed to output devices to carry out specific actions. Various techniques are used to measure brain activity for use with BCIs. Often, BCIs will utilize electrical signals which are measured through electrodes placed on the surface of the cortex or noninvasively on the scalp. 

BCIs may have the ability to potentially replace, restore, or enhance functions in individuals with neuromuscular disorders, such as cerebral palsy, spinal cord injuries, and amyotrophic lateral sclerosis. BCI producer Neuralink is in the process of designing the first neural implant known as The Link that will let you control a computer or mobile device anywhere you go. This implant uses micron-scale threads that are inserted into the parts of the brain that control movement. Each of these threads contains electrodes, and the threads connect the electrodes to the implant.

Artificial Intelligence and Mental Health

Artificial intelligence shows great promise in the field of mental healthcare. It is being researched as a means to predict, classify, or subgroup mental health illnesses through the training of machine learning algorithms on sets of electronic health records, brain imaging data, digital monitoring systems, and mood rating scales. Artificial intelligence-powered chatbots are being developed to interact with patients based on cognitive behavioral therapy principles. This tool may be used as an adjunct tool to traditional counseling or even stand-alone.

Artificial Intelligence and Cognitive Brain Health

Artificial intelligence is likely to radically change the way brain health is assessed and in the future how cognitive disease is diagnosed. Because artificial intelligence can enable us to obtain insights from massive amounts of patient data, the possibilities for its application in cognitive disease diagnosis are enormous. 

One application of artificial intelligence to assess brain health is utilizing machine learning techniques to diagnose neurological diseases, such as Alzheimer’s, Parkinson’s, mild traumatic brain injury, multiple sclerosis, and stroke. Several paths can be taken to leverage artificial intelligence as a diagnostic tool, including:

  1. Feeding large amounts of neuroimaging data to artificial intelligence algorithms, including scans of healthy brains and those impacted by specific cognitive diseases, such as Alzheimer’s or other forms of dementia, to train the algorithm to detect patterns indicative of the particular disease. 
  2. Feeding large data sets from digital brain tests from healthy individuals and those impacted by specific cognitive diseases to artificial intelligence algorithms to determine patterns associated with a particular disease.

While the first method can certainly aid in diagnosing cognitive disease, it requires expensive and time-consuming brain scans that can be challenging to implement on a large scale. The second method offers a highly scalable, inexpensive, and non-invasive method for assessing cognitive function. However, traditional pencil and paper cognitive tests, as well as digitized versions of these simple test activities, cannot provide the high quality and high quantity of data required to provide scalable predictive diagnostic support. Additionally, they do not have the infrastructure for longitudinal data analysis. In other words, such tests lack the data granularity and specificity required for meaningful monitoring and prediction. 

The Future of Cognitive Testing and Diagnostics

The relationship between artificial intelligence and brain health has great potential but requires high-quantity and high-quality data to make a meaningful impact. If high-quality brain health data can be collected on a large scale over time, this can lead to the training of artificial intelligence on bigger data sets, allowing for patterns to be recognized across the data and enabling brain health interventions, therapies, or drugs to be utilized much earlier in the clinical pathway via early diagnosis. 

Digital assessments of brain health based on analyzing a wider range of cognitive functions, such as digital biomarker-based tests, may provide the quality of comprehensive brain health data to enable predictive diagnostics in the future. 

Altoida is developing a digital platform that will measure and analyze a wide range of digital biomarkers associated with cognitive impairment. Users will complete a 10-minute series of hyper-realistic augmented reality activities on their smart device. With innovative artificial intelligence and data from nearly 800 unique digital biomarkers, we will provide comprehensive measurements of brain health across 11 unique neurocognitive domains and pioneer predictive diagnosis of Alzheimer's disease and other neurocognitive disorders.

To learn more about how Altoida is exploring the relationship between artificial intelligence and brain health, contact us today.

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Research shows that incorporating elements of a healthy lifestyle, such as regular exercise, may address the question of how to prevent Alzheimer’s disease naturally.

How to Prevent Alzheimer’s Disease Naturally

Research shows that incorporating elements of a healthy lifestyle, such as regular exercise, may address the question of how to prevent Alzheimer’s disease naturally.

While there are currently no proven Alzheimer’s prevention strategies, there is strong evidence that suggests several aspects of leading a healthy lifestyle may play a role in reducing the risk of developing Alzheimer’s disease and other forms of dementia. While a large focus of the Alzheimer’s community is currently around new drugs and therapies, such as ADUHELM™ (Aducanumab), for slowing the onset and reducing the severity of symptoms, there is a significant focus on methods for prevention.

Many locations, such as small villages in Europe as well as Okinawa, Japan, emphasize community engagement, high mental and social stimulation, and healthy diets. Such communities have staggeringly low rates of Alzheimer’s disease and dementia, supporting the idea that cognitive impairment may be prevented through living an engaging and healthy lifestyle.

Below, we will detail a few researched methods that may aid in reducing the likelihood of developing Alzheimer’s disease and other forms of dementia.

How to Prevent Alzheimer’s Disease Naturally: Lifestyle Changes

Research studies are working to show how to prevent Alzheimer’s disease naturally. Some methods of focus include:

  • Control of cardiovascular risk factors
  • Physical activity and diet
  • Mental and social engagement
  • Adequate sleep

Let’s delve further into each of these methods and how they work to prevent Alzheimer’s disease.

Control of Cardiovascular Risk Factors

Brain health depends heavily on heart and blood vessel health. A healthy heart ensures that a sufficient amount of blood is pumped to the brain, and healthy blood vessels allow oxygen-rich blood to reach the brain. High blood pressure, high cholesterol, and diabetes are conditions known to increase the risk of cardiovascular disease. To prevent cardiovascular risk, and thus reduce the likelihood of developing Alzheimer’s, individuals are advised to:

  • Increase physical activity
  • Eat healthily
  • Quit smoking and avoid secondhand smoke
  • Manage stress
  • Control cholesterol and blood pressure

Physical Activity and Diet

Tying closely into controlling cardiovascular risk factors, regular physical activity can also lower the risk of Alzheimer’s disease and other forms of dementia. Physical activities increase blood and oxygen flow to the brain and appear to be a strong factor in the prevention of cognitive impairment. While it is unknown what specific types, duration, and frequency of physical activity are most effective for reducing the risk of Alzheimer’s, researchers believe that the connection between heart health and brain health is strong.

Similarly, it is believed that adhering to a heart-healthy diet can contribute to the prevention effort. Such diets involve limiting sugar and saturated fat intake and increasing fruit, vegetable, and whole-grain intake. Studies suggest that diets such as Dietary Approaches to Stop Hypertension and the Mediterranean diet may decrease Alzheimer’s risk.

Researchers are also investigating the connection between the brain and the digestive system. Studies are being conducted to investigate how biochemical processes of food intake and digestion link to changes in the brain. The gut microbiome, or community of bacteria, viruses, and other microbes, may have an impact on the development of Alzheimer’s disease. Chronic diseases, disruptions in the immune system, and inflammation have been linked to changes in the gut microbiome.

Mental and Social Engagement

Several studies suggest that maintaining social and mental activity throughout life may support brain health and decrease the risk of Alzheimer’s. There are theories that social and cognitive stimulation can help build “cognitive reserve,” where cognitive reserve refers to the brain’s ability to efficiently use networks of neuron-to-neuron connections. This enables individuals to effectively execute cognitive tasks, even as the brain changes over time. However, more research is needed to better understand biological processes which connect such engagement and stimulation to Alzheimer’s risk.

Adequate Sleep

Studies have shown that getting adequate sleep each night can help to prevent Alzheimer’s disease naturally.

Beta-amyloid plaques are one of the neuropathological hallmarks of Alzheimer’s disease. Small studies on sleep deprivation and Alzheimer’s have shown that losing just one night of sleep can increase beta-amyloid protein in the brain, suggesting that sleep deprivation may increase the risk of beta-amyloid build-up. Another study showed that individuals in their 50s and 60s who slept six hours or less per night were more likely to develop dementia later in life, adding to the idea that inadequate sleep duration may increase the risk for developing cognitive impairment.

The incredible amount of research being conducted around how to prevent Alzheimer’s disease naturally—and the emergence of better methods to assess and monitor brain health—provide a positive outlook on the way the disease is perceived. In the future, the hope is that Alzheimer’s disease and other forms of dementia are found to be preventable and treatable diseases. 

A New, Engaging Way to Assess Brain Health and Prevent Alzheimer’s Disease

Understanding how to prevent Alzheimer’s disease naturally requires a scalable, simple method to assess and monitor brain health. Altoida is developing a digital platform that will allow individuals to test their brain function regularly through a set of gamified augmented reality activities. Our platform is indicated as an adjunctive tool to aid in the evaluation of perceptual and memory function and will utilize digital biomarkers to provide robust measurements of the brain over 11 unique neurocognitive domains.

To learn more about how Altoida is working to develop a digital platform to assess brain health that can help understand how to prevent Alzheimer’s disease naturally, contact us today.

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One way to test your brain is through a traditional pencil/paper method, such as MoCA or Mini-Cog, which both use the Clock Drawing Test to assess executive functioning and visuospatial abilities.

The Three Best Ways to Test Your Brain

One way to test your brain is through a traditional pencil/paper method, such as MoCA or Mini-Cog, which both use the Clock Drawing Test to assess executive functioning and visuospatial abilities.
Whether an individual is 35 years old or 65 years old, it is important to understand brain health and cognitive function. Cognitive testing can help assess processes in the brain, such as:

  • Memory
  • Orientation
  • Attention
  • Visuospatial abilities
  • Language
  • Judgment
  • Ability to learn new things

Regular assessments of brain health can provide early indications of cognitive impairment, resulting in the ability for early intervention, whether that be through lifestyle changes or utilization of new therapies and drugs, such as ADUHELM™ (aducanumab) for Alzheimer’s disease and dementia. Similar to other diseases, like cancer, cognitive diseases may be more easily treated in their early stages.

With so many testing methods available, it can be difficult to understand where to start, what the tests can tell you, and which methods are best. Below, we have categorized the top three ways to test your brain with a brief description of each type of test.

Traditional Paper and Pencil Legacy Tests

Pencil and paper legacy tests are typically performed by a doctor, clinician, or other health professional. Such tests are not able to show the specific cause or type of impairment and are most useful as screening tools to help providers better understand a patient’s cognitive abilities to determine if further testing is needed.

Three of the most common validated tests include:

  • The Mini-Mental State Exam (MMSE)
  • The Montreal Cognitive Assessment (MoCA)
  • The Mini-Cog

MMSE and MoCA

The MMSE and MoCA are cognitive screening assessments used to evaluate an individual’s cognitive abilities and are often utilized to track the progression of cognitive diseases, such as Alzheimer’s. Both tests are scored on a 30-point scale.

According to the Alzheimer’s Association, score ranges on such tests can indicate the following:

  • Mild dementia: score of 20-24
  • Severe dementia: score of 13-20

On average, individuals with Alzheimer’s disease show a decline in their score by a multiple of two to four points annually. However, with more early testing and new therapies emerging on the market, the hope is to slow or even stop the progression of cognitive impairment.

The MMSE takes roughly five to 10 minutes to administer and asks the patient to state the current date, count backward, and identify everyday objects. The MoCA takes 10 to 15 minutes to administer and includes the same aspects of the MMSE with the addition of the following two tasks:

  1. The Clock Drawing Test (CDT): The patient is tasked with drawing a clock, placing the numbers in their proper locations, then “setting” the clock to a specific time.
  2. The Trail Making Test: In this two-part test, the patient must first connect 25 numbered circles, starting with one and ending at 25, as quickly as possible while maintaining accuracy. In the next part of the test, the patient must connect 25 numbered and lettered circles, alternating between numbers and letters. In other words, the path is to be traced following the pattern “1-A-2-B-3-C-4-D” and so on.

It’s important to note that while the administration of the MMSE and MoCA tests may be brief, the clinical waiting time, as well as the analysis and results reporting time, can make the entire process inefficient.

Mini-Cog

Another way to test your brain is the Mini-Cog assessment, which takes roughly three minutes to complete. This test consists of three steps:

  1. The patient is asked to remember three words.
  2. The patient completes the CDT.
  3. The patient must then recall and state the three words from before the CDT.

The patient receives up to three points for word recall and up to two points on the CDT, with a maximum score of five points. A score of three, four, or five indicates a lower likelihood of dementia but does not rule out cognitive impairment. Similar to MMSE and MoCA, the Mini-Cog is not a diagnostic test but is most effective as a tool for screening cognitive abilities. It should also be noted that this test is slightly influenced by language and education level.

Digital Legacy Tests

To simplify the process of taking a traditional pencil and paper legacy test, there are several computerized versions of the above tests available. These tests use the same underlying science and methodology to assess cognitive abilities and can be performed at home or in a clinical setting. Results from digital tests can be sent to the patient’s healthcare provider to determine the proper course of action.

Digital ways to test your brain include:

  • Automated Neuropsychological Assessment Metrics
  • BrainCheck
  • Savonix
  • Cogstate
  • CantabMobile

While digital tests offer a more convenient way to test your brain, many of these assessments lack ecological validity—they aren’t representative of how the brain functions in the real world. Traditional testing methods also only examine a few aspects of the brain that may be impacted when a patient is experiencing a decline in cognitive function. This is especially challenging for individuals who may be testing in the early stages, when symptoms, such as memory loss, may not yet be present.

A New Way to Test Your Brain: Digital Biomarker-Based Tests

To address the limitations of traditional testing methods, Altoida has dedicated nearly 20 years of research to finding a more comprehensive approach to testing brain health, while still maintaining the benefits of digital testing.

Altoida is developing a digital platform to measure and analyze cognitive and functional biomarkers associated with neurocognitive impairment. Users will complete a series of hyper-realistic augmented reality activities designed to be completed in 10 minutes on their smart device in any environment. With data gathered from advanced sensors, our algorithms analyze more than 780 unique digital biomarkers to measure and monitor neurocognitive function.

To learn more about how Altoida is working to use digital biomarkers as a way to test your brain, contact us today.

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Can you test yourself for dementia? With the emergence of digital tests and cognitive impairment therapies, many patients are seeking to test their brain health.

Patients Ask: Can You Test Yourself for Dementia?

Can you test yourself for dementia? With the emergence of digital tests and cognitive impairment therapies, many patients are seeking to test their brain health.

As promising therapies and drugs for cognitive diseases, such as the recently approved drug ADUHELM™ (Aducanumab), begin to enter the market, there is more incentive than ever for individuals to test their brain health. When cognitive impairment is detected and diagnosed early, it allows patients to receive the maximum benefit from available therapies and treatments and implement lifestyle changes, such as controlling blood pressure, exercising more frequently, and adding more mental and social activities. 

With interest growing for in-home digital cognitive function tests, more people are asking the question: “Can you test yourself for dementia?” While there is currently no single online test that can diagnose dementia, we’re at a unique period in global brain health, and now is the time to discuss the importance of early testing, the next steps towards better brain health, and the future of digital testing.

Can You Test Yourself for Dementia?

The short answer is no, you can’t diagnose dementia yourself through a single online or digital test. Typically, the path to a diagnosis begins with noticing symptoms of cognitive impairment, whether discovered by a family member or in an annual wellness visit with a caregiver. From there, several tests must be performed to definitively diagnose dementia. Digital cognitive assessments may be used to further understand cognitive function before ruling out other conditions which may present similarly, such as a brain bleed or brain tumor. At this point, a biomarker test, such as an amyloid PET scan or cerebrospinal fluid analysis, may be performed to allow clinicians to provide a diagnosis. However, these tests have limitations that should be considered such as the inability to provide a very early diagnosis. 

The Importance of Early Testing

Like many other illnesses and diseases, the earlier dementia is caught, the earlier it can be addressed. Take cancer for example: if cancer is detected in its early stages, more treatment options are available and the likelihood of treatment success is typically higher. Many individuals are regularly screened for breast cancer and colorectal cancer because early detection means the cancer is more treatable. If we’ve adopted this standard for cancer detection, why is it that cognitive abilities are not tested until symptom onset?

As significant advancements in therapeutic measures are being made for cognitive diseases like Alzheimer’s disease and dementia, the outlook for patients with cognitive impairment is quite positive, especially for individuals who receive an early diagnosis.

Patient Sensitivity to Dementia

Many people who are beginning to have memory issues experience a sense of panic regarding the future state of their brain health and the impact on their lifestyles and loved ones. Concerns about the reality of a diagnosis as well as a lack of available testing tools that are both highly accurate and non-invasive stop many people from getting tested. Because of the challenges in scaling outdated and inefficient tools like the MMSE paper and pencil tests and the lack of robust tools available to the general public, people often end up reliant on dementia tests, which do not provide accurate enough data to understand their brain health and are not sensitive enough to nuanced changes in brain health over time to track their progression.

The Limitations of Current At-Home Dementia Tests

Digital cognitive testing methods offer the ability to assess brain health in a manner that is:

  • Non-invasive
  • Inexpensive
  • Widely accessible
  • Scalable 

However, while digital tests offer substantial benefits over traditional biomarker tests, many of these tests have major shortcomings. When individuals seek online or at-home dementia tests, the results might not be providing the information needed to make an informed decision on taking the next steps with their doctor. 

One of the major flaws with digital dementia tests is that they look only at performance in a small number of cognitive domains. In other words, they only assess a few aspects of the brain that are potentially affected by cognitive impairment. For example, if a digital test focuses on testing an individual’s memory, they may score well on the test and still have preclinical Alzheimer’s disease, but have not yet developed symptoms like memory loss. Digital tests offer convenience when testing your brain health, but many of these assessments also lack ecological validity and aren’t representative of how the brain functions in reality.

Advancements in Digital At-Home Testing

While most current digital tests for dementia fall short in addressing a larger set of neurocognitive domains as well as in assessing these domains using data from ecologically valid tests, there are new digital platforms that hope to change this. Altoida has dedicated two decades to research and is working to change the way we assess brain health by creating a platform that provides a more comprehensive analysis of the brain. 

Altoida is developing a digital platform that will measure and analyze a wide range of both cognitive and digital biomarkers associated with cognitive impairment. Users will complete a series of hyper-realistic augmented reality activities designed to be completed in 10 minutes on their smart device. With innovative artificial intelligence and data from over 780 unique digital biomarkers, we will provide comprehensive measurements of neurocognitive function across 11 unique domains. This platform will combine two subsets of digital biomarkers:

  • Cognitive biomarkers that provide measurable indicators on how individuals think
  • Functional biomarkers that provide measurable indicators on how individuals move and function

The goal of this platform in the future is to provide early testing in a digital environment while aiming to achieve a higher level of diagnostic accuracy than traditional biomarkers.

To learn more about how Altoida is working to change how you can test yourself for dementia, contact us today.

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Neuropsychological tests, such as the Trail Making Test, are used in traditional brain health assessment tests to help measure cognitive function.

What Brain Health Assessment Test Is Best for Your Research Study or Clinical Trial?

Neuropsychological tests, such as the Trail Making Test, are used in traditional brain health assessment tests to help measure cognitive function.

When searching for the optimal brain health assessment test to be used in a clinical trial or research study, it is important to weigh the options. With new and promising therapies and drugs beginning to emerge for cognitive diseases, such as ADUHELM™ (aducanumab) for Alzheimer’s disease, there is a significant amount of research and testing to come

Traditional validated tests include the mini-mental state exam (MMSE), Montreal Cognitive Assessment (MoCA), and Mini-Cog. Beyond traditional pencil and paper tests, many providers and researchers are also utilizing digitized cognitive function tests. Such assessments are operatively similar to MMSE, MoCA, and Mini-Cog but provide the convenience of digital testing methods, results, and data.

While conventional brain health assessment tests can offer insight into the progression of symptoms associated with cognitive decline, it is difficult to employ such tools to provide continuous monitoring on a scalable level.

Traditional Validated Brain Health Assessment Tests

MMSE, MoCA, and Mini-Cog are three of the most common routine tests that are used to assess cognitive function and the progression of cognitive impairment. Such methods are not intended to be differential diagnostic tools for determining the type of cognitive condition a patient may have. Instead, traditional testing methods aim to look at a patient’s cognitive function as a whole to provide direction for diagnosis and track changes in function over time. To properly identify cognitive disease, an additional test, such as an amyloid PET scan or MRI, can be used to diagnose a patient with higher accuracy.

Below we examine some of the most commonly used brain health assessment tests and how they’re used to measure cognitive function and decline in patients. 

MMSE and MoCA

MMSE and MoCA are routine cognitive screening tests rated on a 30-point scale and are widely used as tools for the initial cognitive impairment screening. The MMSE, created in 1975, examines orientation, attention, and calculation as well as language and visuospatial abilities and takes between five to 10 minutes to administer. 

The MoCA, created in 1996, utilizes similar aspects of the MMSE while adding further detail to the test, such as the Clock Drawing Test (CDT) and the Trail Making Test (TMT). With the CDT, the patient is asked to draw a clock and place the numbers as accurately as possible within the clock, while the TMT is a two-part test in which the patient must maintain accuracy while connecting a series of 25 dots as quickly as possible. The MoCA takes between 10 to 15 minutes to administer.

Note: The MMSE is not sensitive to mild cognitive impairment (MCI), whereas the MoCA has a higher sensitivity to MCI.

Mini-Cog

The Mini-Cog, created in 2000, is a three-minute screening tool used to detect cognitive impairment quickly during routine visits or hospitalizations. The Mini-Cog consists of two testing aspects—a three-item recall test to assess memory and a CDT similar to that of the MoCA. The CDT aims to assess cognitive domains including cognitive function, memory, visual-motor skills, language comprehension, and executive function.

Note: The Mini-Cog is slightly influenced by language and education level. This should be taken into account in clinical trials and studies.

Digitized Cognitive Testing 

While functionally similar to conventional assessments, many digitized cognitive tests are being used for healthcare providers and caregivers to analyze cognitive function. Digitized tests, such as BrainCheck and Savonix, use methods similar to MMSE, MoCA, and Mini-Cog through an integrated, digital approach. 

BrainCheck utilizes five standard assessments on a digital platform to provide healthcare providers a clinical report, including an overall score and individual scores from each cognitive domain. This digitized test can be used in a clinic or remotely. Savonix assesses cognitive function via a mobile platform that analyzes multiple cognitive domains, including focus, impulse, verbal memory, and attention.

Traditional pen and paper and digitized brain health assessment tests may be beneficial for clinical trials or studies that aim to assess how lifestyle changes, such as increased sleep, can improve cognitive function. However, for studies that aim to assess the efficacy of a drug or therapy, traditional tests do not have the specificity or sensitivity of data to be the best choice.

The Future of Brain Health Assessment Tests for Clinical Trials

While traditional brain health assessment tests are good indicators of overall cognitive function, there are significant downsides pertaining to their ability to assist in clinical research. Such assessments rely on specific, symptom-oriented testing, which may not provide granular or specific enough data to provide a complete, unbiased story in a trial or study.

Altoida is developing a digital platform that assesses brain function using hyper-realistic augmented reality activities, which are representative of complex tasks of everyday living. These activities can be completed in only 10 minutes on a smart device, and they will collect and analyze a wide selection of cognitive and functional biomarkers to provide predictive aspects in regards to diagnosing cognitive disease and improving brain health as a whole.

The platform’s ability to enable continuous, remote monitoring of brain function through comprehensive, discrete metrics of brain function will provide clinical trials with high data availability and the capacity to scale clinical trials to include a larger set of patients.

To learn more about how Altoida is working to provide better brain health assessment tests for your clinical trials, contact us today.

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A patient is prepped for an MRI early-onset Alzheimer’s test by a medical technician

Early-Onset Alzheimer’s Tests: A Guide to Available Testing Methods

A patient is prepped for an MRI early-onset Alzheimer’s test by a medical technician

Alzheimer’s disease, the most common form of dementia, is a progressive condition that affects memory, thinking, and behavior. More than 50 million people worldwide are living with Alzheimer’s or other forms of dementia.

Alzheimer’s is clinically characterized by a gradual decline in cognitive function and neuropathological hallmarks, including the presence of neuropil threads, neurofibrillary tangles, amyloid plaques, abnormal tau accumulations, amyloid angiopathy, and neuronal and synaptic loss. While Alzheimer’s most commonly affects older adults, it can also impact individuals under the age of 65—this is known as early-onset, or younger-onset, Alzheimer’s disease. While there is currently no cure, there are several promising Alzheimer’s drugs being tested today, such as ADUHELM™, which is produced and distributed by Biogen Inc. and Eisai Co., Ltd. The present focus is on catching the disease early and slowing or impeding the onset of the symptoms.

It is important to test early for Alzheimer’s due to the degenerative nature of the disease. When caught early enough, ideally before the onset of any symptoms, there is a better chance that it can be delayed. There are many diagnostic tools available to test for Alzheimer’s, though many of these tests fail to provide very early detection. The challenge facing the Alzheimer’s community is finding an early-onset Alzheimer’s test that is:

  • Able to provide earlier detection at a high accuracy
  • Non-invasive
  • Easily accessible
  • Inexpensive

Traditional Alzheimer’s and Early-Onset Alzheimer’s Tests

Most examinations of patients who are experiencing symptoms of early-onset Alzheimer’s disease begin with a medical exam and medical history overview, followed by a neurological exam in an office setting. This includes tests that address the patient’s reflexes, speech, coordination, eye movement, and sensations. From here, several tests can be performed to better indicate whether or not the patient will develop Alzheimer’s disease.

In this article, we’ll take a look at the testing methods used to diagnose early-onset Alzheimer’s disease and the pros and cons of each. The most widely used tests to diagnose early-onset Alzheimer’s disease are detailed below.

Amyloid PET Scan

An amyloid positron emission tomography (PET) scan can be used to detect signs of Alzheimer’s disease by utilizing radioactive tracers that highlight amyloid protein plaques within the brain. Extracellular plaque deposits of beta-amyloid peptides are a distinct pathology of Alzheimer’s. Beta-amyloid proteins originate from a larger protein found in the fatty membrane surrounding nerve cells and stick or clump together, eventually building up into a plaque.

Groups of smaller pieces of beta-amyloid may be more damaging than the plaques themselves, as they may block cell-to-cell signaling at synapses, activating immune system cells which devour disabled cells and cause inflammation. Amyloid PET scans have shown to have the ability to diagnose Alzheimer’s disease with 75% accuracy. In some cases, this method can detect Alzheimer’s disease before any symptoms are present, allowing the possibility of delaying the onset.

MRI

Magnetic resonance imaging (MRI) can be used to reveal the anatomical structure of the brain and rule out tumors, hemorrhages, hydrocephalus, and stroke, as these often present in a manner similar to Alzheimer’s. The primary role of an MRI is to assess volume loss in characteristic parts of the brain. More specifically, medial temporal lobe atrophy and parietal atrophy can be evaluated and used as a tool for diagnosis and progression monitoring. However, these volume losses cannot be seen in the early stages of this disease—in other words, an MRI may appear normal if performed in the early stages of Alzheimer's.

Medial temporal lobe atrophy can be assessed as a score that has shown to be predictive of progression from mild cognitive impairment (MCI) to dementia. Atrophy can be assessed directly by calculating parahippocampal volume loss or assessed indirectly by looking at the enlargement of parahippocampal fissures.

On the other hand, parietal atrophy can be scored and assessed to diagnose early-onset Alzheimer’s. This is done by examining the parieto-occipital sulcus and the posterior cingulate sulcus size, as well as the degree of atrophy of the precuneus and cortical surface of the parietal lobe. While MRI can diagnose Alzheimer’s disease with an accuracy of 69%, it does not provide early detection and requires continuous monitoring to assess changes.

Cerebrospinal Fluid

A sample of cerebrospinal fluid (CSF) can be collected from the subarachnoid space in the spine via a lumbar puncture (an invasive outpatient procedure) and analyzed for biomarkers associated with Alzheimer’s. Biomarkers refer to something that can be measured to reliably and accurately indicate the presence of a disease. Biochemical changes in the brain are reflected in CSF, as it is in direct contact with the extracellular space of the brain.

By measuring levels of beta-amyloid, total tau, and phospho-tau, Alzheimer’s disease can be diagnosed with an accuracy of 72%. Low levels of beta-amyloid 1-42, coupled with high levels of total tau and elevated levels of phospho-tau 181, are indicative of the presence of Alzheimer’s.

Current Early-Onset Alzheimer’s Tests

While these early-onset Alzheimer’s tests have relatively high diagnostic accuracy, there are significant downsides. Amyloid PET scans, MRIs, and CSF tests are costly, are not continuous by nature, meaning they can't be used continuously outside the clinic, and fail to provide very early detection. These tests require significant time and resources and cannot be scaled to account for the current trajectory of the number of individuals affected by Alzheimer’s. However, there have been significant and immensely promising advancements in diagnostic tools for Alzheimer’s.

Altoida is developing a platform and device to measure and analyze digital biomarkers associated with cognitive impairment. It is indicated as an adjunctive tool to aid in evaluating perceptual and memory function. In just 10 minutes, users complete a set of immersive augmented reality activities, representative of daily tasks, and receive personalized brain function measurements across 11 unique domains.

This iOS- and Android-based augmented reality (AR) technology utilizes a machine-learning algorithm and uses data from 784 unique biomarkers to predict function in three major cognitive areas:

  • Spatial and memory
  • Prospective memory
  • Executive functions

Altoida’s platform will use accelerometers, gyroscopes, and touch screen sensors in smart devices to detect micro-errors as both a prognostic and diagnostic digital biomarker. The vision for this assessment is for it to outperform gold standards for diagnosis. It will be cost-effective, scalable, and non-invasive.

To learn more about how Altoida is working to provide early-onset Alzheimer’s testing to keep you knowledgeable on the status of your brain, contact us today.

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