BCI-VR — An early detection of Alzheimer’s disease
A few words on Alzheimer’s
Alzheimer’s disease (AD) is a neurodegenerative disease that causes loss of cognitive functions, progressing dementia, social disadaptation and reduction in life expectancy. However, pathophysiological changes led by Alzheimer’s can start years or even decades before the disease is diagnosed.
Usually the condition is found among the elderly, however, rarely, it can be seen in much younger patients. The condition usually develops after 60, and the further down, the more chances are to get AD. Maybe, this is why there is a common idea that everyone will suffer from Alzheimer’s, however, not all people live long enough to get it.
The first signs of the disease are barely noticeable, often, they are mistaken for stress reaction or just ageing. Thus, people can experience difficulties with everyday tasks or learning and remembering new information. At early stages person’s executive functions can be affected, for instance, one can experience problems planning, focusing, and loss of abstract thinking. Early signs of AD may also be called mild cognitive impairment (MCI). At this time apathy may occurs and becomes the most persistent symptom of the disease. Over time one can see loss of long-term memory and impairment of speech and cognitive functions, hence the patient is no longer available to live by themself.
The reason for developing AD is still unclear, and now it is impossible to cure or stop the disease. However, if one could see susceptibility to Alzheimer’s about a decade prior to the first signs of the disease and start to actively develop cognitive and motor functions, they could enjoy longer life while being mentally fit, and alleviate AD manifestation! Hence we face a question: how to have the risk of Alzheimer’s diagnosed prior to falling ill and what to do with it?
Neurophysiological methods
More and more attention is being attracted to neurophysiological methods, as they allow detecting cognitive defects at functional level way before they become noticeable for the patient and people around. Thus, neurophysiological research of the recent years has shown that the changes in brain reaction to auditory signal presented — event related potential, ERP, — allow gauging risk of AD within the next decade with high degree of accuracy.
It is known that hearing impairment can be revealed at early stages and become a signal symptom of dementia. Besides, there is another correlation: the greater hearing impairment is the more effort is spent to understand and remember speech; hence more structural changes leading to AD happen in person’s brain. The oddball paradigm research featuring auditory stimulation, where the respondents are to quickly and accurately distinguish the signals of two different frequencies, has shown that the increase in delay (latency) and decrease in the amplitude of ERP components, such as N100, P200, N200, and P300 (read more about P300 here), that happen after 100, 200, and 300 ms after presenting stimulus, respectively, tell about reducing functions of cortical processing (find out more here and here) a decade before the manifestation of the symptoms. Moreover, the ERP diagnosis has demonstrated 87% sensitivity and 90% specificity, thus it can be considered a rather accurate method.
It is worth noting that such a test can be very simple and take up to a couple of minutes. One only needs to wear an electrode cap and listen to various sounds, while brain signals are recorded. This is much more comfortable, simpler and faster than conducting tomography (PET, MRI) and cognitive tests, besides, it is better as a preventive method.
BCI Rehabilitation
Neurophysiological methods allow not only detecting defects of brain regions functioning, but also help to effectively restore those functions. This is about the now-popular brain-computer interfaces (BCI) that are also known as neural interfaces. This technology is based on detecting specific signal of brain activity and translating it into commands for controlling various devices (read more about EEG and BCI).
BCI has been used as an excellent tool for rehabilitation for people who suffered from disordered motor activity after strokes, paralysis and plegia, head injuries, ADHD, autism, as well as cognitive functions impairment and dementia.
EEG-based BCI has a number of advantages comparing to other rehabilitation methods.
● It is easy (simply put on a cap).
● It is effective.
● It activates neuroplasticity.
However, it also has some restrictions:
● some methods require time to learn to work with them (motor imagery and rhythms);
● training conditions are not close enough to real-life situations (flashing pictures on the screen, leading the boat);
● many systems that are now used in clinics may be uncomfortable for patients (wet cap, a bunch of electrodes, gel in the hair, long setting process).
BCI has also demonstrated its efficiency for Alzheimer’s patients. For example, the review shows the possibilities of using ERP and SMR (sensorimotor rhythm) to improve cognitive functions of attention, spatial reasoning and short-term memory.
VR Rehabilitation
Virtual reality is another promising method of dealing with Alzheimer’s. Major VR advantage is, of course, the freedom to create any environment and control options! For instance, according to this research, at early stages, before Alzheimer’s signal symptoms manifestation, scientists managed to reach high accuracy (100% sensitivity and 98% specificity) in diagnosing the condition while performing tasks in virtual museum. No scary and unpleasant spinal tap (lumbar puncture) or tomography (PET, MRI), just a VR headset.
Using virtual reality allows accurate and early prediction of loss of spatial and episodic memory, executive functions, attention, motor functions and balance, and foreseeing difficulties performing everyday tasks. Moreover, research has shown that VR training with simple game missions in various environments help to dramatically improve all these functions in patients with AD (read more).
Artificial intelligence and Alzheimer’s
Of course, we will not steer clear of such early diagnosis methods as artificial intelligence (AI) and various data modes machine learning. Previously they were used for great many purposes, while algorithms learned all kinds of data and after all, they achieved good results!
In this resent study on 100 patients with cognitive decline was shown that AI is able to recognized 98% cases of disease progress on PET scans 6 years prior to symptoms manifestation.
AI for diagnosing Alzheimer’s through MRI data is being widely studied. Thus, the possibility of diagnosing diseases at early stages with 88% accuracy was shown, while another study demonstrates AI understanding progressing Alzheimer’s in people suffering from MCI with 98.9% accuracy.
Combinations of machine learning and EEG data have also been embraced. Several minutes of I-FAST resting EEG were enough to tell people suffering from Alzheimer’s from patients with MCI with 94–98% accuracy and MCI patients from healthy people with a 98.25% precision.
Cherry on the cake: BCI + VR + AI
And now imagine that we have taken all the best features from BCI, VR and combined them with AI in a single system. Thus we have the earliest possible detection of neurodegenerative changes and can ensure neurorehabilitation in any VR environment! You can recreate real life events (shop, museum, flat…) or make a captivating game or virtually anything else that can help restore cognitive functions.
This research reviewed BCI efficiency while using VR. According to it, this combination boosted engagement to as much as 10%, and it is a significant result, especially considering it was a simple visualization. BCI-VR combination has already been successfully employed for post-stroke patients using SSVEP and motor imagery, as well as for patients with plegia, autism and ADHD, as well as for keeping normal levels of cognitive functions in elderly people. EEG record during VR training can also help to see changes in patient’s cognitive functions and emotional response in real time, while adjusting the training for comfortable and effective use.
Despite the fact that mix of BCI, VR, and AI seems very promising from all points, there are still lack research combining the methods. Recently Impulse Neiry has started developing fast, convenient, and efficient method of diagnosing Alzheimer’s, mild cognitive impairment, dementia and impairment of certain cognitive functions at early stages, as well as training methods for keeping the level of motor functions in AD patients. The company plans to create game content to diagnose, monitor and rehabilitate patients both in medical centers and at home.
Can I Avoid It?
So, you have read up to this part and you still think that you don’t really want to be in treatment at the age of 60–70 or you’d rather keep understanding where you are and who are the people around. Hence, you need to start actively developing your cognitive functions in all the ways possible: reading books, doing crosswords, playing board games, or something more exciting, like cognitive trainings (Neiry, CongFit, etc.). Besides, we should never forget healthy diet and exercising daily.
Stay healthy and mentally fit!
Author: Alexandra Karpman
