How new technologies are transforming care for dementia patients

A conversation with Dr. Arlene Astell: using tech to improve the quality of life for aging population

How new technologies are transforming care for dementia patients

Dementia is taking a serious toll on Canada’s aging population: roughly 76,000 people are diagnosed with the condition every year. It is estimated that the number of Canadians living with dementia may even double over the next 20 years due to our growing senior demographic. 

Diagnosing, treating, and managing dementia brings many challenges for both those affected by it and their caregivers. Fortunately, the rapid growth of technology in recent years has sparked innovation which help tackle these issues. But lacklustre awareness and slow implementation of these technologies have limited their outreach.

Time is of the essence in dementia research. The surge in innovation, coupled with our aging population, means that we need to quickly change the way we treat dementia. 

What is dementia? 

Dementia is a medical term that covers a variety of syndromes affecting the brain. It can be caused by conditions such as Alzheimer’s, Parkinson’s, and head trauma. Patients affected by dementia experience memory loss, difficulties with problem solving and, in some cases, severe changes in mood.

Treating dementia can come with many challenges. However, technology can play a huge role in mitigating some of these obstacles.

Dr. Arlene Astell, an Ontario Shores Research Chair in Community Management of Dementia at U of T’s Medical Sciences Department, recently co-authored a paper summarizing developments on the diagnosis, treatment, and management of dementia.

The paper highlighted the multifaceted uses of technology in treating a syndrome like dementia.  

“Direct healthcare has very little to offer people once they have been diagnosed,” wrote Astell to The Varsity. While a range of medical interventions and services to support lifestyle management can be offered to patients with conditions such as diabetes and cancer, such is not the case with dementia.

“There are no disease-modifying therapies available,” continued Astell. Patients may only receive some medication for symptom management, which is not available for all types of dementia.

Most treatment plans for dementia largely rely on sending the patients “home to live as well as they can with support from family or friends.”

Improve treatment plans for dementia

Limitations of the current approach for treating dementia, according to Astell, lie in the way we treat the syndromes. Dementia has vast implications on a patient’s everyday life, which cannot be easily treated through traditional health care approaches. 

“Individuals with dementia need practical interventions and supports to compensate for their cognitive challenges,” she wrote. “By leveraging their retained abilities and enabling them to maintain independence for as long as possible.” 

Improving the ways in which we treat dementia can induce widespread benefits throughout the health care sector. Current methods for treating dementia are putting unnecessary strain on our hospital systems.

“We are seeing, for example, growing numbers of people with dementia filling acute hospital beds, which is leading to cancellation of planned surgeries due to [a] lack of recovery beds,” Astell noted.

Changing dementia treatment methods could also better ensure that patients with different conditions than dementia get the help they need more quickly. 

The role of technology in dementia treatment

Fortunately, many novel innovations for treating dementia are becoming more accessible with the rising use of smart home devices and wearable technology.

Prototypes, such as the Gloucester Smart House, have been developed to help dementia patients in their everyday lives. It comes programmed with bathing and cooking monitors, an automatic night light, and prompts that remind users when to take their medication. 

Since its introduction, smart home technology has grown rapidly. Newer systems use artificial intelligence, machine learning, and sensor technology to reduce reliance on caregiving and help patients with tasks such as dressing and cooking.

Researchers are hoping to use the easily-installed technology to run wide-scale clinical trials to understand its potential benefits on those with dementia. 

Developments in Global Positioning System (GPS) applications on smartphones and motion-enabled gaming can also be used to help maintain patients’ social and active lifestyles. Many GPS applications on smartphones can now detect whether the user is lost.

Such a feature is especially useful for dementia patients, who may rely heavily on the app to navigate. Helping users walk safely makes it easier for them to maintain an active lifestyle.

Many motion-based games have also been tested to improve cognitive and physical stimulation in those with dementia. These games, which can be used on tablets and consoles like the Kinect or Nintendo Wii, also enable patients to spend their leisure time with others without having to leave their homes.

The upshot is that technology can help dementia patients manage their symptoms daily. According to Astell, accessible technology has the potential to play a huge role in this stage.

“Providing technology to assist individuals to monitor how they are doing would empower them to self-manage their condition,” she wrote. “This could be in the form of an app or device that they interact with throughout the day as their companion for living with dementia.”

“We need to develop new kinds of services to provide this support, with digitally-enabled staff.” 

Moving forward 

Improving accessibility to these technologies remains a major challenge. “We currently do not have one place that people can access to find out what is available and what other people are using,” wrote Astell.

To address this issue, her research team has launched their AcTo Dementia website, which provides dementia-friendly gaming apps that have been reviewed for their suitability for patients affected by the syndrome. 

Astell is currently working on a new online resource to guide users on how to use smart home and motion-based technology to manage dementia. 

Yet another issue in the implementation of these technologies lies in research. Unlike traditional big pharma research, most dementia studies do not involve dementia patients. 

“It has focused either on families of people with dementia (as proxies) or care providers to address their needs in relation to dementia,” wrote Astell. Putting more focus on understanding dementia patients directly could broaden the care that is available for them. 

Technology-based dementia treatments are rapidly evolving. But its limited accessibility and slow implementation are preventing them from reaching patients who need it. Our traditional approach to treating dementia must keep up with the pace of innovation.

Unfortunately, dementia patients do not have the luxury of time. “We have accessible, affordable technologies at our fingertips that can revolutionise how we approach dementia,” wrote Astell.

“[We can] improve the lives of people who receive a diagnosis… and provide something useful and beneficial in the face of no effective medical treatments [for dementia patients].”

New surgical technique allows doctors to add more organs to the donor pool

Two types of light-based therapies can sterilize donor organs prior to transplantation

New surgical technique allows doctors to add more organs to the donor pool

A new technique co-developed by U of T researchers uses light-based therapy to kill viruses in organs meant for transplantation. The method lets physicians treat human donor lungs infected with Hepatitis C, preventing viral transmission to the organ recipient.

The co-authors of the procedure, published in Nature, are hopeful that it could vastly increase the number of organs eligible for transplantation in North America.

The new surgical technique is based on existing methods

This technique uses an existing procedure known as ex-vivo lung perfusion. Here, after retrieval by practitioners, the lungs are placed in a chamber with a circuit and specific liquids flow through the organs’ vasculature.

During this circuit the solution passes through the lungs, washing out a lot of viruses. The newly developed technique uses a machine with two light-based therapies — namely, ultraviolet C irradiation and photodynamic therapy — to eventually sterilize the organs before the transplantation.

The research team developed a customized illumination device which is attached to the machine where perfused liquid passes through, irradiating the virus and therefore inactivating it with light.

The researchers aim to further develop the technique by treating the lungs themselves with light, not just the liquid that passes through them. To achieve this, more research is needed on the optical properties of the lungs to engineer new technology to illuminate them.

Adding organs to the donor pool

Co-author Dr. Marcos Galasso, a U of T thoracic surgeon and ex-vivo lung perfusion specialist, stressed the importance of this new technique in an interview with The Varsity.

“There is a great need for donor organs,” he said, “[which has led] to some people dying on the waiting list for transplantation.”

Galasso added that treating Hepatitis C-infected donor lungs alone could make a huge impact on the donor pool due to the opioid crisis gripping North America. He noted that most patients who die from drug overdoses test positive for the virus.

According to Galasso, if health care practitioners could add volunteers infected with Hepatitis C to the donor pool, there could between 1000 to 2000 new lung donors eligible per year in North America.

“We could actually have a massive impact in the organ donation environment in North America [with this surgical technique].”

Where computers and clinics intersect

Raw Talk Podcast hosts expert panel discussions about AI’s role in healthcare

Where computers and clinics intersect

Experts in medicine, academia, and industry explored the promises and perils of the applications of artificial intelligence (AI) in health care during panel discussions with the Raw Talk Podcast on May 7. The event was organized by graduate students of U of T’s Institute of Medical Science.

The two panels, collectively named “Medicine Meets Machine: The Emerging Role of AI in Healthcare,” aimed to demystify sensationalism and clarify misconceptions about the growing field of study.

“On one hand, it seems like everyone has heard about [AI],” said Co-executive Producer Grace Jacobs. “But on the other hand, it seems like there’s a lot of misunderstanding and misconceptions that are quite common.”

How AI is used in health care

While discussing the reality of AI, several panelists emphasized that it should be viewed and treated as a tool. “It is statistics where you don’t have to predefine your model exactly,” said Dr. Jason Lerch of the University of Oxford.

Other speakers agreed that AI is an expansion of — or a replacement for — traditional statistics, image processing, and risk scores, as it can provide doctors with more robust and accurate information. However, final health care recommendations and decisions remain in the hands of doctors and patients.

“You always need a pilot,” said Dr. Marzyeh Ghassemi, a U of T assistant professor of computer science and medicine.

But what advantages can this tool provide? Ghassemi thinks it can assimilate clues from a wider range of patients’ conditions to predict treatment outcomes, replacing the experience-based intuition that doctors currently rely on.

Speaking on her time in the Intensive Care Unit as an MIT PhD student, Ghassemi said, “A patient would come in, and I swear they would look to me exactly the same as prior patients, and the… senior doctors would call it. They would say, ‘oh, this one’s not going to make it. They’re going to die.’ And I would say, ‘Okay… why?’ And they said, ‘I’m not sure. I have a sense.’”

“They used different words — gestalt, sense — but they all essentially said the same thing. ‘I just — I have a sense.'”

Doctors develop this sense by seeing many cases during their training, but they can intuit only the cases that they had personally experienced; AI algorithms can potentially understand many more cases using a wider dataset.

Accessing those cases requires access to patient data, and access to data requires conversations about consent and privacy. Ghassemi and Dr. Sunit Das, a neurosurgeon at St. Michael’s Hospital and Scientist at the Keenan Research Centre for Biomedical Science, said that “de-identification” — the removal of information that can be traced back to individual identities — protects privacy.

Large de-identified datasets from the United States and the United Kingdom are available for AI research, but generally, Canada lags behind these countries in making health data available for this purpose.

Dr. Alison Paprica, Vice-President of Health Strategy and Partnerships at the Vector Institute, agreed that data should be used for research, but argued that de-identification alone does not eliminate risk.

“You’re not just giving a dataset to anybody,” she said. “You’re giving a dataset to people who are extremely skilled at finding relationships and patterns and maybe piecing together information in ways that most people couldn’t. So I think there’s going to be heightened sensitivity around re-identification risk.”

Society must manage this risk and balance it against the benefits. “How do we balance that?” Paprica asked. She suggested that consulting all involved stakeholders could help strike that equilibrium.

Advice for scientists aiming to use AI in their research

So what advice did the panelists have for scientists hoping to harness the power of AI in their own research?

Ghassemi stressed the importance of knowing what you’re doing: researchers have created many tools that make AI research easy to implement, but conscientious scientists need to know the statistical and training principles behind the methods.

“If you’re not aware of how these things are trained,” she said, “it’s really easy to misuse them. Like, shockingly easy to misuse them.”

Other panelists advised users to take care when choosing data to train the algorithms. “A learning algorithm can’t overcome bad data that goes in, or can’t completely overcome it,” said Lerch.

Moderator Dr. Shreejoy Tripathy summed up a key takeaway on applying AI to health care: “Understand your data… And understand your algorithms.”

In conversation with Professor Cynthia Goh

Chemistry professor bridges passions for research and entrepreneurship

In conversation with Professor Cynthia Goh

Professor Cynthia Goh balances many responsibilities. She is a professor in the Department of Chemistry, the Department of Materials Science and Engineering, the Institute of Medical Science, and the Munk School of Global Affairs.

She is the director and founder of the Impact Centre, which strives to bring “science to society” through entrepreneurship, and also the academic director of University of Toronto Entrepreneurship.

Goh describes herself as “a STEM student through and through.” Explaining her interest in STEM, she says, “I think if you know the rules that govern the world you can make a better world.”

Goh’s research interests lie in nanoscience — specifically, the properties, structures, conformations, and interactions of molecules such as polymers and biomolecules, and how these molecules can be used to improve areas such as health care and disease treatment.

After receiving tenure, she shifted her focus to entrepreneurship. “I was making impact in my discipline, I would write a paper and people would quote it and write papers about it. But, I really wanted to see how to make a difference in people’s lives and I learned, basically, that’s about bringing this nice research result to creating a product that somebody can use.” This is how the Impact Centre was created.

The Impact Centre was recognized by the university in 2013, but it has been in operation for years prior to that. Goh describes the centre’s mission as striving to connect the research being done in institutions to a service or a product to create positive impact.

In its beginning stages, Goh had designed an extracurricular entrepreneurial skills training program for students who believed that the skills would be of value to them.

But according to Goh, there was a disconnect between research and application. The change in direction was a challenge. However, Goh views challenges as opportunities to overcome obstacles and forge paths to new areas.

In fact, when Goh began working at U of T, she was the only woman in the Department of Chemistry, and this continued for eight years.

“When I had my kid, nobody knew what the maternity leave rules were because nobody has asked for maternity leave before me,” says Goh. She recounts that she would carry her child at work and would, at times, receive strange looks.

But instead of “carrying a chip on [her] shoulder,” she explains, “I’ve always had the attitude that if people maybe may sound like they’re not on your side, it’s probably because they just don’t have the experience.”

From the small sample of children Goh has worked with, she says that despite the generalization that boys seem to have more outward confidence than girls, “confidence comes from having done your homework.”

The nature of STEM subjects, she says, allows for checking if an answer is correct. “In math, you can tell what the correct answer is, so I can build a lot of confidence knowing I’m right.”