Introduction
Dementia is a complex and debilitating group of neurological conditions that affects millions of individuals worldwide, leading to memory loss, a decline in cognitive abilities, and a loss of independence. As the global population ages, the increasing prevalence of dementia is creating an urgent need for innovative and effective treatment approaches. In recent years, artificial intelligence (AI) has emerged as a promising tool in the battle against dementia. From early detection and diagnosis to personalized treatment plans and ongoing monitoring, AI is transforming the landscape of dementia care. In this article, we will discuss the use of ethical AI in dementia treatment, considering theoretical uses alongside the currently available treatment.
Understanding dementia
Dementia is a term used to describe a group of cognitive disorders that affect a person's ability to think, remember, reason, and perform everyday activities. It is a progressive condition that primarily impacts the ageing population, although it can also occur in younger individuals. Dementia is not a specific disease itself but rather a collection of symptoms caused by various underlying conditions1.
Common symptoms of dementia
- Memory loss: People with dementia often have difficulty remembering recent events, conversations, or simple tasks.
- Impaired communication: They may struggle to find the right words, follow conversations, or express themselves clearly.
- Difficulty with reasoning and problem-solving: Complex tasks, decision-making, and logical thinking become challenging.
- Impaired judgement: Individuals with dementia might exhibit poor judgement and decision-making skills.
- Changes in behaviour and personality: Personality traits can shift, leading to increased irritability, anxiety, depression, or even aggression.
- Disorientation: Dementia can cause confusion about time, place, and even personal identity.
- Decreased ability to perform daily activities: Activities of daily living, such as dressing, grooming, and eating, can become increasingly difficult.
- Loss of motor skills: As the condition progresses, motor skills and coordination can deteriorate further.
Though an individual may not experience all of these symptoms, they are often present in conjunction with each other and rarely experienced as isolated incidences.
Standard treatment of dementia
The treatment of dementia varies depending on the underlying cause of the condition and the specific symptoms that an individual is experiencing. While there is no cure for most types of dementia, there are various approaches and interventions that can help manage symptoms, improve quality of life, and provide support for both individuals with dementia and their caregivers. Here are some common treatment strategies:
- Cholinesterase inhibitors: These drugs, such as donepezil, rivastigmine, and galantamine, are often used to treat Alzheimer's disease.
- Memantine: Another medication used for Alzheimer's disease, memantine, works by regulating glutamate, a neurotransmitter involved in memory and learning.
- Antipsychotic and mood-stabilising medications: These may be prescribed to manage behavioural and psychological symptoms, such as aggression, agitation, and hallucinations. However, their use is carefully monitored due to potential side effects.
- Cognitive Stimulation and Rehabilitation: Cognitive therapy, memory training, and other cognitive stimulation programs can help individuals maintain and improve cognitive function to some extent.
- Occupational and Physical Therapy: These therapies focus on maintaining independence and improving motor skills, mobility, and daily living activities.
- Behavioural Interventions: Techniques such as behaviour modification, structured routines, and environmental modifications can help manage behavioural and psychological symptoms.
- Supportive Care: Providing a supportive and structured environment is crucial. This may involve assistance with daily activities, ensuring safety, and offering emotional support.
- Social Engagement: Encouraging social interactions, participating in activities, and engaging in hobbies can help maintain cognitive function and emotional well-being.
- Nutrition and Exercise: A balanced diet and regular physical activity can contribute to overall health and well-being. Some evidence suggests that certain diets, such as the Mediterranean diet, may be beneficial for brain health.
- Caregiver Support: Caregivers play a critical role in managing dementia. Support groups, counselling, and respite care can help caregivers cope with the challenges and stress of caregiving.
Even though there are many options for the management of dementia symptoms, none actually cure dementia. All available options are either to slow down or stop the progression of dementia.
Problems with traditional dementia treatment
- Late Diagnosis: Dementia is often diagnosed in later stages when symptoms are more pronounced, leading to missed opportunities for effective intervention. Traditional diagnosis relies heavily on observable symptoms and cognitive tests, which may not detect early-stage changes.
- One-Size-Fits-All Approach: Traditional treatments often use a standardised approach that may not address individual patients' unique needs and variations in disease progression. This can result in sub-optimal outcomes and reduced quality of life. For example, it is typical for individuals with a Down syndrome diagnosis to encounter diverse types of dementia in their later years; despite no existing medications showing effectiveness in those with Down Syndrome,2 they are still utilised in standardised care.
- Limited Drug Efficacy: Pharmaceutical treatments for dementia have shown limited success, with no cure currently available. Traditional drug discovery methods are time-consuming and often fail to target the complex mechanisms of dementia.3
- Lack of Continuous Monitoring: Traditional treatments lack continuous monitoring capabilities, making it challenging to detect subtle changes or trends in patients' health conditions. This can lead to delayed interventions and adjustments to treatment plans.
- Caregiver Burnout: Caring for individuals with dementia can be physically and emotionally demanding for caregivers. The lack of technological support and resources in traditional treatments can contribute to caregiver burnout and stress.
- Inadequate Personalization: Traditional treatments often do not consider the individual variations in genetics, lifestyle, and cognitive abilities of dementia patients. This can result in less effective interventions and suboptimal outcomes.
How does AI address these problems?
Early detection and diagnosis
One of the critical challenges in treating dementia is early detection and accurate diagnosis. Identifying the condition in its early stages allows for timely intervention, significantly slowing down the progression of symptoms. AI technologies, such as machine learning algorithms, have demonstrated remarkable accuracy in analysing vast amounts of data, including medical records, brain imaging scans, and genetic information, to predict the likelihood of developing dementia.
Example:
A team led by Professor Zoe Kourtzi at the University of Cambridge has developed a machine-learning algorithm that can detect early signs of dementia. By analysing brain scans and memory tests, the algorithm predicts the likelihood of individuals developing Alzheimer's disease. It is over 80% accurate in identifying those with mild cognitive impairment likely to develop Alzheimer's. The goal is to diagnose patients 5-10 years before symptoms appear, aiding in new treatment development. The algorithm is also being trained to recognize different types of dementia.4
Personalized treatment plans
Every individual's journey with dementia is unique, necessitating personalised treatment plans that cater to their specific needs and challenges. AI plays a pivotal role in tailoring interventions to individual patients by analysing data from multiple sources, such as medical histories, genetic profiles, and real-time monitoring devices. Machine learning algorithms can process this information to identify patterns, predict disease progression, and recommend personalised treatment strategies.
Example:
Liu et al.,20225 used AI to predict post-drug cognitive scores based on patient data. The selected drug causing the least cognitive decline was recommended. The result suggests that those following AI-prescribed drugs had smaller cognitive score reductions after 2 years compared to others. It is concluded that personalised AI prescriptions showed improved cognitive performance after 2 years, making it a promising approach for dementia treatment.
Drug discovery and development
The search for effective pharmacological treatments for dementia has always been challenging, with numerous clinical trials yielding disappointing results. AI is now being employed to assist the drug discovery process by analysing vast datasets of biological and chemical information. Machine learning algorithms can identify potential drug candidates, predict their efficacy, and simulate their interactions within the human body.
Through AI-driven simulations, researchers can gain insights into the complex molecular mechanisms underlying dementia and test the effects of various compounds virtually. This approach accelerates the identification of potential drug targets and increases the efficiency of the drug development pipeline. While the journey from lab to market remains long and complex, AI offers renewed hope for discovering breakthrough treatments that could alter the course of dementia.6
Continuous monitoring and management
AI's role in dementia care doesn't end with diagnosis and treatment initiation; it extends to ongoing monitoring and disease management. Wearable devices and sensor technologies equipped with AI algorithms can track patients' physical and cognitive activities in real-time. These devices can detect changes in sleep patterns, gait, speech, and other indicators, alerting caregivers and healthcare professionals to potential issues.
Example:
Nakaoku et al.,2021 investigated whether unobtrusive home power monitoring systems could help predict cognitive decline in older adults. They observed 94 adults aged 65 or older. By analysing how these individuals used household appliances, they found that certain power monitoring patterns were linked to cognitive impairment with up to 82% correct prediction7.
In simpler terms, this study found that monitoring how older adults use household appliances can help detect cognitive decline, suggesting that home power monitoring systems could be a useful tool in identifying cognitive issues.
Other notable AI products for dementia
- Robotic Pets - PARO is one of the most well-known robotic pets for dementia care. Paro is an advanced interactive robot by AIST that offers animal therapy benefits in hospitals and care facilities where live animals are impractical. Key advantages include stress reduction for patients and caregivers, improved interaction, psychological well-being, and enhanced social connections.8
The study examines the effectiveness of the PARO robotic pet, an FDA-approved biofeedback device, as a treatment for dementia-related symptoms. Results show that the treatment group which interacted with PARO experienced decreased stress and anxiety, leading to reductions in the use of psychoactive and pain medications. The study suggests that the PARO robotic pet could offer a promising alternative therapy for managing dementia-related symptoms and improving the well-being of elderly patients.9
Summary
In conclusion, the integration of artificial intelligence into dementia treatment marks a significant leap forward in addressing the complex challenges posed by this debilitating condition. By overcoming the limitations of traditional approaches, AI offers hope in the realms of early diagnosis, personalised therapeutic interventions, efficient drug discovery, and continuous patient monitoring. As showcased by innovations like PARO, AI's potential extends beyond conventional methods, introducing novel avenues to improve the quality of life for individuals with dementia. With AI-driven advancements, the path towards more effective, tailored, and compassionate dementia care becomes clearer, inspiring optimism for a future where technology plays a pivotal role in enhancing the well-being of those affected by this condition.
FAQ
Are there ethical concerns surrounding AI in dementia care?
Yes, ethical considerations include maintaining patient autonomy, ensuring informed consent and transparency, and addressing biases in AI algorithms.
Can AI replace human caregivers in dementia care?
No, AI is a tool to support caregivers, not replace them. The human touch, empathy, and emotional connection remain essential.
How can caregivers ensure responsible AI use in dementia care?
Caregivers should undergo training to understand AI tools and their limitations and ensure they make informed decisions alongside AI recommendations.
What benefits does AI bring to dementia care?
AI offers accurate diagnosis, personalised care plans, improved patient monitoring, reduced caregiver stress, and potential advancements in dementia research.
Reference
- What is dementia? symptoms, types, and diagnosis [Internet]. U.S. Department of Health and Human Services; [cited 2023 Aug 17]. Available from: https://www.nia.nih.gov/health/what-is-dementia#:~:text=Dementia%20is%20the%20loss%20of,and%20their%20personalities%20may%20change.
- Mohan M, Carpenter PK, Bennett C. Donepezil for dementia in people with down syndrome. Cochrane Database of Systematic Reviews. 2009;2021(5). doi:10.1002/14651858.cd007178.pub2
- Gauthier S, Albert M, Fox N, Goedert M, Kivipelto M, Mestre‐Ferrandiz J, et al. Why has therapy development for dementia failed in the last two decades? Alzheimer’s & Dementia. 2015;12(1):60–4. doi:10.1016/j.jalz.2015.12.003
- Ai could detect dementia after Single Brain Scan [Internet]. [cited 2023 Aug 17]. Available from: https://www.turing.ac.uk/news/ai-could-detect-dementia-after-single-brain-scan
- Liu Q, Vaci N, Koychev I, Kormilitzin A, Li Z, Cipriani A, et al. Personalised treatment for cognitive impairment in dementia: Development and validation of an artificial intelligence model. BMC Medicine. 2022;20(1). doi:10.1186/s12916-022-02250-2
- Bucholc M, James C, Al Khleifat A, Badhwar A, Clarke N, Dehsarvi A, Madan CR, Marzi SJ, Shand C, Schilder BM, Tamburin S, Tantiangco HM, Lourida I, Llewellyn DJ, Ranson JM. Artificial Intelligence for Dementia Research Methods Optimization.: Alzheimers Dement.
- Nakaoku Y, Ogata S, Murata S, Nishimori M, Ihara M, Iihara K, et al. Ai-assisted in-house power monitoring for the detection of cognitive impairment in older adults. Sensors. 2021;21(18):6249. doi:10.3390/s21186249
- Paro Therapeutic Robot [Internet]. [cited 2023 Aug 17]. Available from: http://www.parorobots.com/
- Petersen S, Houston S, Qin H, Tague C, Studley J. The utilization of robotic pets in Dementia Care. Journal of Alzheimer’s Disease. 2016;55(2):569–74. doi:10.3233/jad-160703
