1. Implementing technology for clinical assessment: opportunities and challenges
Gemma Stringer
Manchester Dementia Clinical Research Group
Division of Neuroscience and Experimental Psychology

2. Manchester Dementia Clinical Research Group Clinical Research Portfolio
Finding the problems….
And treating them…
SENSE-Cog Trial
INVEST
GREAT
ATTILA
iCST
Dementia Matters Toolkit (NOWGEN)
Memory drop in events (NIHR)
Disease modification in prodromal Alzheimer
Mild-moderate AD (MADE)
Behaviour (SYMBADD)
Deep & Frequent Phenotyping
CYGNUS
SENSE-Cog
MODEM
SAMS
Detection and monitoring
Phase llb/III medication trials
Psychosocial interventions
Public engagement
Interventions

3. Manchester Dementia Clinical Research Group Clinical Research Portfolio
Finding the problems….
And treating them…
SENSE-Cog Trial
INVEST
GREAT
ATTILA
iCST
Dementia Matters Toolkit (NOWGEN)
Memory drop in events (NIHR)
Disease modification in prodromal Alzheimer
Mild-moderate AD (MADE)
Behaviour (SYMBADD)
Deep & Frequent Phenotyping
CYGNUS
SENSE-Cog
MODEM
SAMS
Detection and monitoring
Phase llb/III medication trials
Psychosocial interventions
Public engagement
Interventions

4. Deep and Frequent Phenotyping Study
Collaborators – UoM, Cambridge, Oxford, Edinburgh, Newcastle, KCL
Funding: NIHR and MRC
Dementias Platform UK
250 participants (some at risk of developing AD) over 12 months
The tests will involve:
Movement and walking (gait) assessments using wearable devices
Ophthalmological assessments
Magnetic Resonance Imaging (MRI)
Magnetoencephalography (MEG) and electroencephalogram (EEG)
Positron emission tomography (PET)
Thinking and memory (cognitive) assessments
Clinical assessments including blood and urine samples and cerebrospinal fluid.
Development of a multi-modal marker set for measurement of change and its prevention or modification in AD.

5. Multidisciplinary collaborative project
Funding: EPSRC
Objective: To investigate the potential of measuring computer use as a marker of change in cognitive and functional ability

6. Methodology Study 1 Study 2 Study 3
Expert Reference Group Which computer-use behaviours are indicative of cognitive decline?
Which cognitive domains are implicated?
Study 2
Cross –sectional How do computer use behaviours relate to cognitive and functional ability?
Sample: MCI/mild AD (n=19) and healthy controls (n=24)
Study 3
Longitudinal Can the SAMS software detect subtle changes in computer-use behaviours over time?
Does this relate to a change in cognitive functioning over time? Sample: 33 (SCI and MCI)

7. Results
A number of computer use behaviours (keystrokes, mouse clicks, pixel count etc) were shown to be different between MCI/mild AD and HCs
Computer use behaviours were related to scores on cognitive tests and measures of functional capacity
NB. Hierarchical regression models showed that participants age and number of years of computer use could not account for these effects.

8. Results
Combined computer-use behaviours (pauses, keystrokes, mouse clicks) predict functional abilities
High sensitivity and specificity for cognitive impairment
e.g. ‘Text’ keystrokes per min 91% correct classification of cognitive impairment (90% sensitivity and 78% specificity)
ROC analysis for pauses (per min), ‘Text’ keystrokes (per min) and total mouse clicks.

9. Next steps for SAMS Complete the longitudinal data analysis
Apply for further funding to develop the software and validate in a large sample
Opportunities:
Implement SAMS in other clinical trials
Henry Brodaty - Centre for Healthy Brain Aging, Sydney
Deep and Frequent Phenotyping

10. Challenges (Valley of Death)
Ensuring that the academic aspirations of all collaborative teams are translated into the research objectives
Clinical motivation = positive outcomes for patients
How to develop a proof of concept software for routine clinical practice/the home
Finding funding for implementation
Bridging the gap between proof of concept and implementation with patient group
Finding an industry partner to develop a proof of concept

11. Possible solutions
Create solutions to problems that are patient-led rather than tech-led
Think about the next steps (next grant) at the earliest stage
Consider the academic priorities of all collaborators and integrate this into the objectives
Design software that can be developed after proof of concept
Involve industrial partners who want an active role in proof of concept studies
Maintain communication between collaborators to keep momentum after the end of the project
Utilise the CeHRes Roadmap (or new NeuroD roadmap) when designing the study

12. CeHRes Roadmap
Contextual Inquiry: understanding prospective users and their context, analyze strong and weak points of current provision of care.
Value Specification: determine which values the different stakeholders deem important and translate into user requirements.
Design: develop prototype technology based on requirements, cooperative design with prospective users and stakeholders.
Operationalization: launch technology, marketing plans, organizational working procedures.
Summative Evaluation: evaluation: how is it being used? what is its effect on patients and healthcare?