Prof Greg Savage combines clinical and research perspectives on cognitive assessment

Just before Easter, Jon and I took a trip out to visit Professor Greg Savage at the ARC Centre of Excellence in Cognition and its Disorders, based at Macquarie University. Greg works as a neuropsychologist in both clinical and research capacities. This is incredibly helpful for Frankl, because he understands the needs of both communities when talking about the future of cognitive assessment.

You can watch a video of our conversation above, but if you only have a couple of minutes to spare, here are a few points Greg made that are well worth a read.

1. There’s an inertia in the industry that’s preventing progress in cognitive assessment.

We need a framework for cognitive assessment that is driven by cognitive science. But the time and expense it takes to create new, more finely tuned tests of cognition is a huge challenge within the current clinical environment. We’re reliant on companies with a legacy of investment in the tests they publish, so the current market is dictated by those forces. It’s like trying to change the direction of a big ship — it’s very difficult!

2. We need more affordable and accessible means of testing people for cognitive disorders.

Frankl’s approach of bringing costs down offers potential to open up access for people who currently experience geographical, cultural and linguistic barriers to cognitive services.

3. App-based tests have huge advantages over paper-based tests.

Most paper and pen tests are limited to an answer that is right or wrong, whereas app-based tests can capture richer sets of data including reaction time and other latency data, responses to a variety of activities and multiple forms of data at once. Apps also take the load off the person administering the test so they can focus on other qualitative aspects of their interaction with the person.

4. Current apps are an improvement but there’s much more that can be done.

Some test publishers have started creating apps for iPads, but they’re often just rebadging the same old tests without taking advantage of the technology’s full capabilities.

5. App-based tests tailored to the first signs of Alzheimer’s disease would be a major step towards earlier, more accurate diagnosis.

General cognitive tests commonly used by GPs are very broad-brush and if someone comes from a high functioning background it’s easy to do well even if there’s a problem. So we need to develop tests that home in on the cognitive signs of Alzheimer’s disease — and that’s where a flexible platform with tailored modules could offer earlier detection and more accurate diagnosis.

6. The way forward is to facilitate the combined use of newer, more flexible tests alongside traditional tests.

If new more flexible targeted tests were interspersed with conventional tests so that clinicians were able to try them in concert with other testing, that would be the best way forward for clinicians.

7. A data sharing framework would mean rapid advances in research and treatment.

At the moment we’re relying on fragmented research. There’s a need for some standard protocols in data collection to facilitate the combining of datasets. Data sharing is happening in dementia research but it’s concentrated around expensive neuroimaging rather than cognitive testing.

8. The power of longitudinal data is enormous.

By building a framework for cognitive assessment with a focus on data sharing, we’d allow clinicians and researchers to look back over data as time goes by. This would allow them to develop an understanding of the changes in cognition of healthy individuals and individuals with a cognitive disorder — information that is currently very difficult to collect.

9. Confidentiality is not a showstopper.

There are logistical barriers in sharing data with sufficient richness that they’re able to be understood by another clinician, or able to be fitted into another dataset. There are also confidentiality issues but these can be addressed with proper ethical consideration — they’re not the big blocker here.

10. It will be vital to incorporate both clinical and research perspectives into Frankl.

The success of Frankl will depend on ongoing participation of both the clinical and research communities.

A new cognitive assessment for people to identify people with signs of Alzheimer’s disease

The Frankl team is currently transforming one of Greg’s cognitive tests into a Frankl test app. If you’d like to see it in action, you can watch the video here.

If you’d like to learn more about Professor Greg Savage and his research, click here.

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