App that detects mental decline may be lifesaver amid the Asia dementia tsunami doctors are forecasting
As Asia braces for a rise in dementia cases, a start-up’s app, now available in Chinese, may prove a good option for families to monitor the health of ageing loved ones from afar. It detects the early onset of mental health problems
Dr Mylea Charvat, a Stanford University-trained neuropsychologist, regularly checks on her mother’s cognitive health through a mobile app.
The San Francisco-based entrepreneur is behind Savonix, a start-up that digitised various neurocognitive tests so screenings can be done easily, frequently, and inexpensively, using a smartphone.
Her mother lives in a rural farming community in the American state of Kansas and has taken the app’s Trail Making Test, which assesses factors such as attention and mental flexibility. “I have her do it every six months as she’s 80 and she’s caring for her elder sister who is dying, so that’s a lot of stress,” Charvat says.
At a conference in the United States in 2016, a Mexican-Japanese insurance executive based in Singapore approached the entrepreneur, having clearly studied Charvat through media reports. He asked: “Are you worried about your mother?”
“All the time,” she replied.
“There’s this woman in Shanghai [in a similar situation] as your mother. Do you believe the life of her mother in rural China is worth less than the life of your mother?” he asked.
The question floored Charvat, who replied: “Do you think I’m a horrible human being?”
Speaking in Hong Kong, Charvat becomes emotional as she recalls the encounter, which would change her life’s direction.
Her questioner pressed Charvat to go to Asia where her expertise was desperately needed, and particularly China. That prompted a trip to a Shanghai hospital, where she saw the dire situation. “For most doctors there … I was the first neuropsychologist they had ever talked to,” she recalls.
At a community centre, young professionals in Shanghai shared the struggles they had caring for their parents in rural communities. They couldn’t move back to help because of their city-based jobs. Charvat observed elderly people from rural communities arriving at hospitals who struggled to get care.
The experience shook her, and all the more so as she came to realise a dementia crisis is looming in Asia, where health care is often woefully inadequate and populations in countries such as China are ageing rapidly.
Dementia is a general term representing a group of neurodegenerative conditions such as Alzheimer’s disease, Parkinson’s disease, Lewy body dementia and more.
Health experts forecast that by 2050 a third of those aged 80 or over in Hong Kongwill have dementia. China faces a similar problem: it has more than nine million dementia sufferers now, a figure expected to balloon to 23.3 million by 2030 and to cost the country an estimated US$114.2 billion, according to a 2016 World Health Organisation report.
The dementia field facesnumerous diagnostic challenges, including the lack of good assessments available, and the lack of specialists to conduct them. These realities contribute to late diagnoses.
Dr Yolanda Lo, of Ageing & Better Care in Hong Kong, says the waiting time to access a specialist in the public health system in Hong Kong is too long. “If someone has memory complaints and goes through the Hospital Authority, the wait could take two years, so your [condition could have progressed] by the time you see someone,” she says.
Charvat says the US faces similar challenges. “In the US and Canada, there are only 1,061 board-certified neuropsychologists, and we are the only experts in the profession trained and qualified to assess cognition.”
There are multiple assessments widely used in Hong Kong, including the Mini-Mental State Exam (MMSE), aquestionnaire that measures cognitive impairment. A very low score indicates severe cognitive decline.
Current assessments can indicate whether someone has dementia, but fail to detect small cognitive changes over time that could signal the onset of a cognitive problem.
According to Charvat, assessment results are judged against a percentile across a population. The average healthy range for a cognitive domain is between 16 per cent and 84 per cent – and 85 per cent of the population will fall within that range. Current assessments, like the MMSE, reveal if you’re in the 0 to 3 percentile range – known as a severe state of decline – but by that stage there is little anyone can do, she says.
However, this fate can be avoided.
“There’s a saying in medicine that genes are the gun, but it’s the environment that pulls the trigger,” she says. While not all cases of dementia are preventable (such as early onset Alzheimer’s disease, a genetic disease which is rare and represents about five per cent of cases), Charvat insists that many people have an opportunity to reduce their risk through lifestyle changes.
Technology can plug some cognitive assessment gaps, so users can get data to decide if they must recalibrate their lifestyle.
Savonix’s dementia-focused neurocognitive testing app acts like a virtual doctor that conducts assessments and calculates scores. In future, it will add expert feedback and recommendations as it works with neuropsychologists worldwide to consolidate their expertise into the technology with the help of machine algorithms.
Currently, assessments on its platform can be done individually over time or all at once, which takes 20 to 30 minutes and covers 14 cognitive domains. Examples include a digit span test that assesses working memory, in which users are asked to recall numbers previously flashed on the screen.
Research has mapped out the patterns of healthy adults over their lifetime, as well as the patterns that result from everything from mild cognitive impairment to severe Alzheimer’s disease. For healthy individuals, one’s cognition should be relatively stable across the lifespan.
“Your cognition develops, plateaus and then it gently declines as we age,” Charvat says.
Thanks to data on small cognitive changes between the ages 40 to 70 and above – all normalised by age – the app can be used to track movements in your scores over various cognitive domains. “If I have historical data on you and your score has moved significantly, then I’m going to be worried, even if it’s in the average range, because you are declining and it’s subtle,” she says.
Such data empowers individuals to take action to reduce their dementia risk. Interventions can include getting better sleep, abiding by a healthy diet, exercising regularly, and having more face-to-face social engagement. Another is to stop smoking, a major risk factor for Alzheimer’s disease, Charvat says.
Importantly, keep moving – 150 minutes a week is optimal – as exercise oxygenates muscles and the brain, and keeps your cardiovascular system healthy.
Charvat cites the landmark Framingham Heart Study that began in 1948 and still ongoing. Over the years, the study expanded its scope of chronic illnesses to include dementia, and showed what is bad for your heart is bad for your brain, she says.
Savonix has developed a simplified Chinese version of its app, so users in China can monitor their cognitive health or do so for their relatives cared for at a distance.
It’s how Charvat keeps tabs on her mother in Kansas, who remains “sharp as a tack”, she says, as noted from the elder Charvat’s Trail Making Test score in the 96th percentile.
The Mexican-Japanese insurance executive who initiated the conversation that changed Charvat’s life is now an adviser to Savonix.
“We work on multiple projects in Asia together,” Charvat says, adding: “I’m really glad that he asked [that question].”