The Two-Minute Test That Will Enhance Early Alzheimer's Diagnosis

With more people living longer, the prevalence of progressive, degenerative diseases like Alzheimer’s and dementia is on the rise in the US and around the world.

In 2023, an estimated 6.7 million Americans aged 65 or older were living with the disease - as many as one in nine older people. By 2050, that number is set to rise further, to 12.7 million, according to Alzheimer’s Association (US).

“Nearly all of us will know someone, or be caring for someone, with dementia,” says Dr George Stothart, a cognitive neuroscientist based at the University of Bath (UK). “For individuals, their family and friends, the impact of the disease is enormous,” he adds.

Despite recent medical advances - including findings released earlier this year into a drug shown to slow cognitive decline – there is still no known cure. Against this backdrop, Stothart is trialling a revolutionary new approach to enable earlier diagnosis.

“One of the key challenges with Alzheimer’s and dementia is that the disease is diagnosed far too late – typically up to 20 years after it has first begun, and often only once symptoms have really set in,” he explained.

Current diagnostic assessment typically relies on rudimentary pen and paper tests, which are prone to errors as they can be impacted by an individual’s language ability and education, as well as by how they are feeling on the day of the test.

Stothart wants to change this. Over the past decade, he has been developing a different approach using a completely passive dementia diagnostic test, known as ‘Fastball-EEG’. It relies on electroencephalogram (EEG) which records brain activity, including visual memory.

Flick through the image gallery on your phone, or fast forward through a previously watched movie, and notice how briefly presented images trigger memories with little or no effort on your part. That’s the mechanism the Fastball technology is testing.

Unlike current methods, with Fastball patients do not need to be aware of what’s happening, nor respond. Instead, they are shown a series of images on a screen, whilst they wear an EEG cap which captures brain wave responses. The test takes just two minutes to complete.

Dr George Stothart, cognitive neuroscientist at the University of Bath, testing an earlier protoype of Fastball-EEG. Credit: University of Bath.

Dr Stothart analyses data from Fastball-EEG to assess predictors for Alzheimer's and dementia from patient's brain waves. Credit: University of Bath.

Stothart’s work, published in the journal BRAIN in 2021, demonstrated that the technique was highly effective at picking up subtle changes which occur when a person remembers an image. It’s these small changes which so interest Stothart.

“The changes in brain waves which we observe using Fastball-EEG are so small, that at the time they might not have an impact on a person’s abilities, yet we also know they are the pre-cursors to developing the disease,” he says.

By improving early diagnosis, Stothart sees a clear opportunity to help people get treatment and support, and to plan for their future. His vision is that Fastball could one day test for dementia in middle-age in the same way that blood pressure is currently checked.

“For decades we have had tools in research that have been able to probe how the brain is working, but we have never made the leap to a viable clinical tool for the objective assessment of cognition. We hope that Fastball may be that leap,” he says.

Crucially, the technology is also completely portable, meaning that diagnoses in the future could be carried out anywhere, including in a patient’s home. It’s also low-cost compared to other forms of brain function assessment such as MRI, which can help overcome current barriers to access says Stothart.

In July 2023, the team behind Fastball announced significant new funding (£1.5 million) from the UK’s National Institute for Health & Care Research to scale-up their ambitions. This will see them take Fastball into a dementia clinic to further test and refine the technology.

Co-lead, Dr Liz Coulthard, Associate Professor in Dementia Neurology at the University of Bristol and North Bristol NHS Trust, runs weekly dementia clinics helping patients in Bristol. She thinks Fastball could transform their journeys.

“As we adopt new treatments into clinical practice, we will need to scale-up our ability to diagnose people at an early stage of Alzheimer’s and avoid language barriers. Fastball offers an opportunity to improve that equitably,” she says.

The pair have also partnered with Cumulus Neuroscience Ltd to develop the technology into a product that could be rolled-out across the National Health Service in the UK, and beyond to healthcare systems around the world.

They will use Cumulus’ existing dry electrode 16-lead EEG headset which is already UKCA marked and has FDA 510-K clearance in the US. For patients, the use of the Cumulus Fastball-EEG cap will also improve their ease and comfort.

“As a passive test, Fastball EEG has the potential to democratize how Alzheimer’s is diagnosed, ensuring all patients have an opportunity for earlier intervention and treatment,” explains Brian Murphy, PhD, Founder and Chief Scientific Officer at Cumulus.

The test requires patients to look at a series of flashing images for two minutes, whilst the Fastball technology scans their brain. Credit: Cumulus Neuroscience Ltd.

Dr George Stothart believes Fastball could enable dementia diagnoses to take place at a far earlier age - enabling patients to plan better for their futures. Credit: University of Bath.

Stothart thinks all this will resonate with patients. A recent survey from Alzheimer’s Research UK found that nearly three-quarters of us would want to know if we were likely to develop the disease at some point in the future.

“The earlier people know they are at risk of developing Alzheimer’s, the sooner they can make simple lifestyle changes, such as exercising more and cutting back on alcohol, that we already know can slow the progress of the disease,” he says.

This is also where Stothart thinks his work alongside recent drug developments will complement each other. “The more we know about the disease earlier in its progression, the more likely these drugs are to be effective,” he says.

In time, he thinks Fastball may even be able to play a role in detecting what effects drugs are having on the brain’s function and whether or not cognitive decline is slowing.

“Receiving an Alzheimer’s or dementia diagnosis today seems like a life sentence, but the rapid advances of drug technology and the insights we are gleaning into how the disease progresses and what lifestyle changes we could make to slow it, both mean there is hope.

“This work has the potential for global impact and our real hope is that by improving early diagnosis through Fastball, in time it will help to lift the burden of dementia on all our lives,” he adds.

Learn more about the project ‘Diagnosing Dementia Using Fastball Neurocognitive Assessment’.

This content was paid for and created by the University of Bath. The editorial staff of The Chronicle had no role in its preparation. Find out more about paid content.