Dementia: "We want to achieve earlier diagnosis for more people"

As we get older, we tend to become more forgetful, sometimes strange or even confused and overwhelmed by everyday life. But is it always just the age? With an increasing lifespan, the possibility to suffer from a cognitive disease at one point is also increasing. The majority of cognitive diseases is never diagnosed.

Rickard Forsman talked about this problem and presented a solution at the MEDICA CONNECTED HEALTHCARE FORUM at MEDICA 2021. In this interview with MEDICA-tradefair.com, he explains problems in dementia diagnosis and how the digital assessment tool from Geras Solutions can help here.

Mr. Forsman, what is the difficulty when it comes to current dementia diagnosis?

Rickard Forsman: It is a very complicated disease area – not being one, but several different diseases. The knowledge about these and how they differ from each other is quite low in general healthcare, as is the awareness. A simple lab test is not enough as there are a set of different criteria that are also overlapping between the different diseases. The final diagnosis can be made by examining patients' brains after their death.

These diseases are also often confused with natural aging to some extent. We all have declining cognitive abilities with age, but these diseases are neurodegenerative, meaning they break down the brain. This has also caused somewhat of a stigma, because we do not want to be perceived as getting old. This makes people not reach out for help in time. On the other hand, if they reach out too early, they might not reach enough of the criteria to receive an appropriate assessment. Simply because they are perceived as ‘just getting old’.

Healthcare is in many situations not able to capture these early cases because the tools and standards used are very basic and do not measure progression. They measure cognitive capability once, and that can differ a lot between different people. Globally, an estimated 75% of people affected by cognitive diseases never get diagnosed at all as a result.

How does the test method from your company help?

Forsman: We want to achieve earlier diagnosis for more people. First of all, our method helps with the access issue. We can provide an early screening procedure that can be performed from home, with full discretion. You do not need to visit a hospital or your primary care provider but can obtain a first cognitive assessment and get guidance from a specialist through any smart device.

We are also cooperating with several hospitals and primary care sites in Sweden to build a consensus about what parts of diagnosis that can constitute a new general standard. We also considered the Swedish national guidelines from March 2021 for what should be part of a comprehensive and well-performed diagnostic procedure. Not all of the aspects can be digitalized, of course, but a lot of them can. This way, we provide a higher quality decision support, because we build a standard that covers all aspects that should be covered. We also help clinicians to interpret these data by having them in a digital format. This saves a lot of time in the assessment which translates into higher capacity and better economics.

How are the tests performed?

Forsman: People can do the initial tests in our app for free. This gives an indication if there is a reason to do a more comprehensive cognitive assessment. For the patients where we find early indication of cognitive impairment, we also perform a full anamnesis, in which we also screen for symptoms that looks like a coming cognitive disorder but may have other causes. That can be burnout syndrome, depression, alcoholism, or ADHD, among others.

We also have another validated framework for relatives to assess the symptoms they perceive from a patient. This way, we combine an objective measurement with the impressions of the relatives. Our specialist clinicians then review the data and recommend what to do next. About half of the patients receive a reassuring assessment that there is nothing wrong. About 30% show signs of other causes that are not primarily pointing to a neurodegenerative disease. And to about 20%, we recommend further diagnostic procedure with blood tests or CT scan, among others.

When you look back to MEDICA 2021, how do you evaluate your participation?

Forsman: It was fantastic to be out there again, to meet people and to see so many new solutions. There are so many things that show how healthcare will improve even further in future. For us, it was important and valuable to get international contacts. We are only active in Sweden at the moment, but we are of course looking at international expansion and want to provide our solution to other larger markets soon. One of the major values of participation was that we have established several new contacts which we are currently in dialogue with.