2023 Shortage: 50.000 psychiatrists, 78.000 mental health counselors, 171.000 psychologists, 500.000 GPs, 50 M caregivers... WHO: "The world needs 6 M nurses by 2020 ... "
General challenges in treatment neurological disease
* Incomplete understanding of the aetiology and progression...lack of data
* Faillure to diagnose at presymptomatic stages
lack of data
* A lack of robust and sensitive biomarkers
lack of data
* A short therapeutic window ...lack of data
Alzheimer's disease is a multifactorial disease likely requiring a combination-like treatment
IMPORTANT PROBLEM FOR iCBT...Dropout 0-75%
Internet-based cognitive behavioral therapy (iCBT), provided with guidance, has been shown to outperform wait-list control conditions and appears to perform on par with face-to-face psychotherapy. However, dropout remains an important problem. Dropout rates for iCBT programs for depression have ranged from 0% to 75%, with a mean of 32%.
- 7,9 Trillion is the potential cost savings for the current US population from early diagnosis of AD
- 1 patient: estimated lifetime cost $341,840
- 18,4 billion hours of care value or 232 billion are provided by family and friends unpaid
- 1 in 3 seniors dies with AD or another dementia
75% dementia not diagnosed or 41 million
25% have a diagnosis of which 20% misdiagnosed
This is only the tip of the iceberg
Grace a social robot for Alzheimer's disease...
Social isolation is the biggest cause of almost all mental diseases...also Alzheimer's disease...
7,9 Trillion is the potential cost savings for the current US population from early diagnosis of AD
Why is Grace the best choice for dementia...prevention, intervention and care ?The LANCET Commission report 2020
Grace can't replace a human but it can be a close relationship 24 h/day
Why a social AI-robot need Human Interface....?
1. Co-presence...this is the effect of sharing the same experience with someone because you share the same place. Because co-presence make us believe that we share or have a simular experience.
2. Physical proximity...this is the study of physical distance and formation.Sitting one meter from someone is very different from sitting five meters away.
3.Behavioral Realism...this is the complete absence or presence of nonverbal behavioral...predictor of perceived social presence...
Computerised cognitive behavioural therapy ( CBT)
The ability to provide CBT to a larger population is not possible using traditional methods. CBT for Alzheimer's and dementia treatment, as a fully automated, advanced algorithm-driven program being used without any support from a human, offers a sollution to the problem of scalability.
CBT is practiculary appropriate for digitisation, given its structured format, emphasis an active participation and self-monitoring and intrasession "homeworks" requirements. Computerised CBT for Alzheimer's disease has been shown to be an effective treatment with effects comparable to those found for face-to-face therapy.
AI chatbot for dementia and Alzheimer's patients
The robots that caregivers want
Un. of California San Diego
Study Alzheimer's and Dementia robots
- pet-like robots
- cleaning robots
- telepresence robots
- smart speakers
1. Robots to be capable of facial recognition
2. Support positive moments shared by caregivers and their loved ones
3. Lessen caregivers emotional stress by taking on difficult tasks...such as answering repeated questions and restricting healthy food
4.Robots should be able to adopt to new situations ( progression of the disease)
5. Robots should be able to learn from end users and customize and personalize
6. Human-l with ike components not look like humans
7. Interact with human via voice activation
^Personality of our robots are based on the OCEAN personality theory
In 2011, a researcher did a postmortem analysis of 426 Japanese-American residents of Hawaii, about half of whom had been diagnosed with some form of dementia, typically Alzheimer’s. According to the autopsies, roughly half of that group had been misdiagnosed as having Alzheimer’s — their brains didn’t show evidence of the brain lesions typical of the disease. At a 2016 conference, Canadian scientists presented preliminary findings, based on more than 1,000 individuals, that patients were correctly diagnosed only 78 percent of the time. In nearly 11 percent of cases, patients thought to have Alzheimer’s actually didn’t, while another 11 percent did have the disease but weren’t diagnosed.
Accurate diagnosis is needed for Dementia Lewy Body
Dementia with Lewy Bodies (DLB) may account for up to 30% of all dementia cases. The symptoms of DBL can be difficult to disentangle from other dementia subtypes. DLB is characterized by a build-up of abnormal proteins (Lewy bodies) in areas that control cognition, movement, allertness and behavior.
Eye tracking ( saccadic eye movement tracking) and EEG are very sensitive digital biomarkers to make an accurate diagnosis.
AD and DLB pathologies often overlap within individuals. An individual is diagnosed with Parkinson disease dementia ( PDD) or DLB depends on the timing of symptoms onset. In dementia with Lewy Bodies, cognitive decline occurs within one year of the onset of movement disorder symptoms.
DLB is sensivity to antipsychotic drugs. We see also REM behavior disorder. Visual hallucinations and fluctuations in cognition, attention and allertness.
Mild Cognitive Impairment or MCI
MCI causes a slight but noticeable and measurable decline in cognitive abilities, including memory and thinking skills. Long-term studies suggest that 15-20 percent of the aged 65 and older may have MCI. There is a difference between normal aging cognitive decline and MCI. With all kind of rating scales it is not possible to see any difference.
Biomarkers for Alzheimer's disease can be really measured to indicate the presence or absense of the disease. For AD there is only one biomarker accepted amyloid beta. Preclinical b. amyloid as biomarker is difficult and very expensive to detect and it is only possible in hospitals. Digital biomarkers can be used outside the hospital POC ( in the waiting room or at home).
Blood glucose levels are a biomarker for diabetes and blood cholesterol for heart disease.
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These are the most commonly misdiagnosed conditions.
It is a degenerative disorder of the central nervous system with symptoms including tremors in hands, arms or legs, stiff muscles, and problems with balance or walking.
However, it is commonly mistaken for Alzheimer’s disease, stroke, stress, a traumatic head injury and essential tremor.
The condition causes an overactive thyroid gland, and is the most common cause of hyperthyroidism.
Symptoms include eyes bulging, anxiety, sweating, rapid pulse, unplanned weight loss or gain, and extreme tiredness.
Without treatment, it can prove life-threatening, however it is often mistaken for depression, ageing and under-exercising.
It is a chronic arthritis-like disorder characterised by widespread pain.
However, symptoms - anxiety, sensitivity to pain and incapacitating fatigue - can be confused with rheumatoid arthritis and chronic fatigue syndrome.
Normal pressure hydrocephalus
It is a build-up of cerebrospinal fluid in the brain that most commonly occurs after a stroke or ahead injury from a fall.
Symptoms of unsteady gait, progressive dementia and urinary problems, can be interpreted as Alzheimer’s disease or Parkinson’s disease.
The progressive autoimmune disease that attacks the central nervous system has symptoms including muscle spasms, lack of coordination, balance problems, blurred vision and cognitive impairment.
However, it is commonly mistaken for a viral infection, lupus, Alzheimer’s disease and bipolar disorder.
It is an autoimmune disorder marked by an inability to digest gluten, a protein in wheat, rye and barley.
Symptoms can include vomiting, abdominal pain and bloating, diarrhoea, weight loss, anaemia and leg cramps.
However it can be mistaken for irritable bowel syndrome, Crohn’s disease and cystic fibrosis
Chronic fatigue syndrome
The complex disorder has no known cause but symptoms include loss of memory or concentration, a sore throat, painful lymph nodes in neck or armpits, unexplained muscle or joint pain and extreme exhaustion.
It is often confused with sinus problems, hepatitis, fibromyalgia, lupus and rheumatoid arthritis.
It is a chronic inflammatory disease, with symptoms including fatigue, kidney, heart and lung damage, rash and joint pain.
However, it can be mistaken for chronic fatigue syndrome, fibromyalgia and rheumatoid arthritis.
This is where a tear develops in the aorta, the largest blood vessel branching from the heart, which causes the inner and middle layers to separate.
Symptoms can include sudden chest or upper back pain, loss of consciousness, shortness of breath, sweating and weak pulse in one arm.
However it can be misdiagnosed as heartburn, heart attack and stroke.