Simple test provides early diagnosis for dementia

Mindstreams is a battery of computer tests that are user friendly enough for a 90-year-old who has never used a mouse – and are highly reliable and specific to mild cognitive impairment.Pregnancy is easy to diagnose: She either is or …

Mindstreams is a battery of computer tests that are user friendly enough for a 90-year-old who has never used a mouse – and are highly reliable and specific to mild cognitive impairment.Pregnancy is easy to diagnose: She either is or she isn’t. But doctors and psychologists have not had a reliable tool for clear-cut diagnosis of mild cognitive impairment (MCI) – a precursor of dementias such as Alzheimer’s disease – until now.

We all sometimes forget names or misplace objects, but medical help is needed if mental changes interfere with your ability to enjoy life or function normally.

Now a computerized battery of tests – user friendly enough for a 90-year-old who has never used a mouse – has been developed and validated in studies in Israel and Canada as being highly reliable and specific to MCI. After being downloaded from the company site, it takes only about 30 minutes to complete and compiles an instant report for the diagnostician to study.

Called Mindstreams and developed in the Tel Aviv suburb of Modi’in for the NeuroTrax Corporation (www.neurotrax.com), headquartered in New York, the patented software can make it possible to sift out people who have only benign forgetfulness and find those who have MCI or advanced stages of dementia

There are various types of dementias. Mental decline can be metabolic due to a deficiency of B vitamins; neurological due to unnoticed mini-strokes; or vascular due to clogged blood vessels leading to or in the brain. In addition, poorly controlled diabetes has been found to cause cognitive problems in the elderly. A study at Ohio State University found there’s a difference in cognitive capability between diabetics whose disease is under control and those whose disease isn’t adequately controlled.” Thus if MCI is identified in such diabetics, controlling their blood sugar-insulin balance could prevent them from becoming demented. Symptoms of MCI can also result from mild head injuries, depression, parkinsonism , thyroid problems, substance abuse, HIV infections and many medical conditions.

Alzheimer’s disease (AD), a fatal, incurable brain disease, accounts for about half of all dementias, and its incidence rises significantly as people age. AD occurs in 10% of people over 65, becoming more common in those over 80. Within two decades, it is believed that 130,000 Israelis will suffer from this form of dementia. In the US, the number of AD patients is expected to reach 14 million by 2050. But it is not a natural result of aging; it is an abnormal condition whose still-unknown causes are being intensively investigated around the world.

AD primarily affects cognitive function, and is marked by a gradual worsening of the ability to function at home, on the job and in social situations. Cognitive functions such as memory, comprehension and speech deteriorate; attention tends to stray; simple calculations become impossible; and ordinary daily activities grow increasingly difficult. The person is bewildered and frustrated and often suffers from dramatic mood swings such as outbursts of anger, bouts of fearfulness and periods of deep apathy. AD can run its course from insidious onset to death in just a few years, or it may play out over a period of as long as two decades, but the average duration is about nine years. AD is incurable, but specific medications can slow a patient’s cognitive decline and keep him at home for several more years instead of requiring immediate institutionalization.

Dr. Ted Miller, founder of the Jerusalem Medical Center was so captivated by the potential of Mindstreams that he sold his share in the center and his family physician practice to become regional medical director of NeuroTrax. Miller recently presented the research at meetings of the Israel Neurology Society and the Israel Family Practice Association.

NeuroTrax’s chief executive officer is Dr. Ely Simon, an American-trained neurologist who has been here for five years and works out of company offices in Modi’in. Mindstreams has been tested and validated at Jerusalem’s Shaare Zedek Medical Center and McGill University in Montreal, and is being introduced at two family practice/medical centers in Jerusalem. NeuroTrax has also developed collaborative relationships with Beth Israel-Deaconess Hospital in Boston, the University of New Mexico, State University of New York’s Health Sciences Center, Ichilov Hospital in Tel Aviv and Case Western Reserve University in Ohio, among others. Various Israeli health funds have expressed interest in testing the patent-pending program on patients suspected of having MCI or dementia.

Miller, who immigrated from Canada with his family 30 years ago, explained that he had trouble recognizing MCI in his own father, who subsequently developed and died from Alzheimer’s.
“He had Alzheimer’s for seven years and died at the age of 85. But if you’re close to somebody, and if he has good verbal ability, you tend to ‘forgive’ cognitive losses. Even when he was clearly suffering from dementia, when I started to sing the first bars of the Shabbat song Lecha Dodi, he would chant them all by heart.”

Dr. Tzvi Dwolatzky, an Alzheimer’s disease expert at Shaare Zedek who conducted some of the early clinical trials, notes that there are several conventional means of screening for MCI, but none of them is sensitive enough. A family doctor can conduct a 10-minute paper-and-pen test called a “Mini-Mental,” but this gives only some indication. A neuropsychologist can give the patient problems to solve over two to six hours, but this is very expensive and time consuming, needs a trained professional, and is not easily available.

“Unfortunately, such a test in a memory clinic is not covered by the health funds, as it isn’t in the basket of health services. So the only people who can get it are those who pay for it,” says Dwolatzky. “To get a more accurate assessment, you need other methods. At Shaare Zedek, we used Mindstreams on normal people, those with mild cognitive impairment and even some with Alzheimer’s. It was impressive that they all could cope with the test and use the computer mouse, even though they had had no experience with one before. Results of those with Alzheimer’s were on the lower range of the scale.”

Any physician – and even patient – who has Internet access and a PC can get to NeuroTrax for the exam. The charge per patient will be about NIS 450, but clinics and institutes that lease the program for many patients will have to spend much less, Miller adds.

“Mindstreams provides qualitative and quantitative results. The test is of significant use to the doctor, because he can hear the patient’s complaints about a ‘failing’ memory and arrange for the test, as if he wanted to find out if the patient was suffering from osteoporosis. Then, armed with the results, the doctor can look for the causes and monitor it,” Dwolatzky continues. “Sometimes, anxiety may be causing MCI, and it can be alleviated with medication; social problems might also be responsible. Since you can determine objectively with Mindstreams if a patient is improving or declining, you can see the results of medication or other treatment.”

Since medications such as Exelon and Aricept can be prescribed (and provided by the health fund) only with a definite AD diagnosis; having mild cognitive problems is not enough to get them. However, other medications can be prescribed to relieve aggressive behavior, agitation, depression, insomnia and other symptoms. Clinical trials now being carried out in the US are studying the possibility that certain drugs might slow the progression of dementia even if given to patients with mild cognitive impairment.

Among the parameters tested by Mindstreams are verbal and non-verbal memory; executive cognitive function (abstract reasoning, planning and the capacity to govern self-directed behavior); hand-eye coordination; visual-spatial ability, verbal rhyming, attention, motor skills and information processing speed. Since the computer program can measure how many split seconds it takes you to respond (unlike a paper-and-pencil test, unless the neuropsychologist uses a stopwatch, which is not as accurate), your reaction times are registered.

Miller notes that testing of Mindstreams on hundreds of patients has found that a high educational level and even previous experience with computers are of no significant benefit to people who undergo testing. Since the clinical trials compared Mini-Mental and neuropsychological exams with Mindstreams, the findings made it clear that the NeuroTrax was the most efficient of them all. Dwolatzky says he thinks the computerized battery of tests “has tremendous potential. It has significant clinical value, and is also very helpful in dementia research. You can see if the patient is improving or declining, because it monitors the patient’s response to medical, surgical or rehabilitation therapies.”

Mindstreams is already being marketed in the US and purchased by doctors there who have been waiting for an objective, reliable test for mild cognitive impairment. According to Simon there has been great public interest among consumers, and the company is close to a deal in the U.S. which will make Mindstreams accessible to a widespread network of doctors.