dementia
dementia. abstract silhouette of human head with simbol of mental illness

Smartphones could help detect dementia early on by reliably and remotely assessing cognitive function, research suggests.

A mobile app was able to identify early frontotemporal lobar degeneration, a neurodegenerative pathology that involves changes in personality, cognition, movement, speech, and language.

The app identified frontotemporal dementia (FTD) before symptoms appeared in people predisposed to the condition and was more sensitive than standard neuropsychological tests.

FTD is the primary cause of dementia in the under 60s, with 30 percent of cases having a genetic basis.

The findings support the use of digital assessments in clinical trials for neurodegeneration, the researchers maintain in JAMA Network Open.

Lead investigator Adam Staffaroni, PhD, an associate professor at UCSF department of neurology, said the app could eventually be used to monitor the effects of treatment and replace in-patient visits to clinical trial sites.

“A major barrier has been a lack of outcome measures that can be easily collected and are sensitive to treatment effects at early stages of the disease,” he explained. “We hope that smartphone assessments will facilitate new trials of promising therapies.”

Staffaroni and colleagues investigated the reliability and validity of unsupervised remote smartphone tests among 360 individuals taking part in ongoing studies of frontotemporal lobar degeneration, who had an average age of 54 years.

Control individuals and participants with frontotemporal lobar degeneration performed app-based tasks involving executive functioning and associative memory three times over the course of two weeks.

The 360 participants were divided into a discovery cohort of 258 and a validation cohort of 102.

Among 329 participants with data available on disease stage, just under 60 percent were asymptomatic or had preclinical frontotemporal lobar degeneration, and just over 20 percent each had early signs or symptoms.

The smartphone tests had moderate-to-excellent reliability, results showed, with validity supported by their association with disease severity, criterion-standard neuropsychological tests and brain volume assessments.

The smartphone tests accurately identified individuals with dementia from controls, with  an area under the receiver operating characteristic curve (AUC) of 0.93.

Furthermore, the tests were more sensitive to early symptoms than the neuropsychological Montreal Cognitive Assessment, with corresponding AUCs of 0.82 versus 0.68.

Although there are currently no plans to make the app available to the public, it could be helpful with research into early treatments before symptoms emerge.

“Most FTD patients are diagnosed relatively late in the disease, because they are young, and their symptoms are mistaken for psychiatric disorders,” said senior author Adam Boxer, PhD, a UCSF professor in memory and aging.

“We’ve heard from families that they often suspect their loved one has FTD long before a physician agrees that is the diagnosis.”

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