The RCPsych Article of the Month for June is ‘The usability and reliability of a smartphone application for monitoring future dementia risk in ageing UK adults‘ written by authors Graham Reid, Philip Vassilev et al and published in the British Journal of Psychiatry.

Dementia remains the number one modern day public health challenge and it is becoming clear that therapies targeting neurodegeneration pathology once people already have significant symptoms is unlikely to allow us to address it comprehensively. Digital technologies may offer a solution by allowing identification of and intervention in personal risk factors for dementia in later life. In our recent paper in the BJPsych we demonstrate the high usability and reliability of an app designed to address this challenge.  

What Inspired This Work?

Adding years to life… The average person’s lifespan has increased significantly, but this gain has come at a cost: more diagnoses of age-related conditions such as Alzheimer’s dementia, a neurodegenerative disease affecting memory and autonomy. There is no cure for dementia and people often do not feel comfortable talking about cognitive dysfunction because they think there is nothing they can do.

A window of opportunity… Very recently, some new drug therapies have become available, but these are costly, not appropriate for everyone, have only modest positive impact and carry risks of side effects. What people can do is focus on awareness of their risks for dementia and what they can do to address them. It is estimated that 40% of dementia cases are caused by 12 modifiable lifestyle factors. This means that if we are able to tackle at scale these risk factors in aging adults we can decrease the number of people developing dementia in the coming decades. Also, we now have the technologies to detect the pathophysiology of dementia up to 20 years before memory and autonomy are affected. Much can thus be achieved by identifying modifiable risk factors and directing individuals at high risk to personalised risk reduction programmes.

Adding life to years… Assessing an individual’s dementia risk is a relatively novel approach in healthcare and, if done through in-person assessments, can be impractical to roll out at scale. Digital solutions offer a promising alternative, capable of providing accessible, affordable, accurate and scalable assessments. The Five Lives app leverages this opportunity by providing individuals with a personalised dementia risk assessment with a 10-year horizon, highlighting the factors driving this risk and allowing the articulating of a plan to curb them. By using such innovative tools, we aspire not only to extend the years of life but also add life to those years, ensuring better quality through early detection and intervention.

The Study and Its Findings

The study involved 756 cognitively healthy adults aged 50-79, who completed three assessments over three months using the Five Lives app. The assessments included five gamified tests of cognitive function and a questionnaire establishing demographic, medical history, and lifestyle factors relevant to dementia. The findings were promising:

• Usability: Participants rated the app as “easy to use,” “quick to complete,” and “enjoyable.”
• Reliability: The cognitive tests showed normal or near-to-normal distributions and good test-retest reliabilities.
• Impact of Demographics on Digitally Assessed Cognition: Age significantly impacted cognitive test performance, while gender and education influenced verbal ability tests.
• Impact of Modifiable Dementia Risk Factors and Cognition: No correlation was found between cognitive scores and modifiable dementia risk scores, highlighting the complex interplay of factors influencing cognitive ability in healthy older adults.

Future Research Directions

The current study is the first step in our research plan to develop a comprehensive digital platform to allow ageing adults to stay in control of their future dementia risk. Future studies should focus on:

• Longitudinal Tracking: We plan to conduct longer studies with more frequent assessments to better understand the long-term relationship between lifestyle factors and cognitive decline.
• Diverse Populations: Including more diverse participants in future studies will ensure the app’s applicability across different demographic and cognitive ability groups.
• Integration with Treatments: We aim to explore how digital risk assessments can be incorporated into treatment pathways, particularly with emerging novel disease modification therapies.

Interesting Anecdotes

Participants enjoyed the gamified cognitive aspects of the assessments, finding them both challenging and engaging. However, they suggested improvements in the app’s instructions which were leveraged to improve iterations of the app, highlighting the importance and the quick adaptability of user-friendly design in digital health tools.

The Lasting Impact

The Five Lives app represents an important advancement in dementia risk assessment. By enabling remote, scalable, and reliable monitoring of cognitive health, it holds the potential for personalised dementia prevention. Feedback from participants has shown an empowerment for people to take control of their brain health. The app not only facilitates early detection and intervention but also democratizes access to cognitive health monitoring, making it accessible to a broader population.

This paper describes important research conducted by Graham Reid and his colleagues that has immediate practical relevance. Lifestyle and cognitive assessments serve to inform the diagnosis and management of future risk of dementia but access to such tests is limited and they are often time consuming and costly. Therefore, this study examines the utility of assessing these factors digitally rather than via traditional in-person means. The Five Lives risk assessment is in the form of a smartphone app that uses catchily titled cognitive tests such as Snap, Swift and Breeze along with ratings of relevant lifestyle, and health risk factors to determine an overall risk score. The research shows that the app is quick, easy, and reliable, and that many find it enjoyable to use. The fact that such important testing can be completed on a smartphone makes it far more accessible and immediately immensely beneficial to researchers and clinicians. Hence why this transformative research is the article of the month and a must read.

Professor Gin Malhi
Editor-in-Chief, the British Journal of Psychiatry