A student-led team of researchers at Washington University School of Medicine (WUSM) in St. Louis, Missouri, has developed an online app designed to streamline the process of Alzheimer’s disease diagnosis. It provides physicians with more information about patients before they are evaluated in person, enabling physicians to assess and assist patients more quickly.
Less time spent on information gathering to determine a patient’s condition frees up more time for doctors to explain the life-changing implications of an Alzheimer’s diagnosis to patients and their families, and to discuss treatment options.
“This app is not meant to replace the visit with the physician,” WUSM MD/PhD student Robert Chen explained in a press release. “It is meant to help physicians have more information about the patient before they are evaluated in person. With additional reliable and clinically relevant information in the hands of physicians beforehand, the hope is that physicians can make a diagnosis more quickly and confidently, and spend the extra time building a treatment plan and answering questions from patients and caregivers in the face of a devastating diagnosis,” he said.
Chen is co-leader of Memento, the student group that designed the app. Memento was established by Sling Health (formerly IDEA Labs), a student-run biotechnology incubator founded in 2013 at WUSM.
The WUSM Memento team’s Alzheimer’s diagnostic app represents a collaboration between students at the Schools of Medicine, Arts & Sciences, and Engineering & Applied Science. The app presents 60 to 100 questions to be answered on an iPad by a patient’s caregiver before the patient’s initial interview with a dementia specialist.
The app generates a report based on the completed questionnaire, organizing it into categories consistent with the WUSM-developed Clinical Dementia Rating Scale (CDR) — the most commonly used dementia diagnosis tool. The CDR categorizes the patient’s symptoms under six domains: Memory, orientation, judgment and problem-solving, community affairs, home and hobbies, and personal care, providing a score for each.
“Having all the intake information from the patient and family summarized in alignment with the CDR could be really helpful,” said WUSM assistant professor of neurology, psychiatry and faculty mentor on the project, Nupur Ghoshal, MD, PhD. “It wouldn’t make the diagnosis for us, but it could feed into the thought processes that we go through as we evaluate each patient.”
Noting that developing the app required understanding of how Alzheimer’s disease is diagnosed and treated, in addition to software programming and design, Ghoshal said one of the Memento team students, Jenny Liu, who earned a bachelors degree in biology in 2016, particularly helped in making the app’s user interface appealing and intuitive, observing: “It doesn’t look like your standard questionnaire. We hope that a warmer design will help caregivers feel more comfortable answering these questions,” she said.
A six-month trial of the app is underway at the WUSM’s Memory Diagnostic Center. After the caregiver of a new patient arriving for a dementia evaluation completes the app’s questionnaire a doctor will examine the patient in person and make a diagnosis as usual. Meanwhile, without seeing the patient, another of the clinic’s doctors will review the app’s report and make a diagnosis as well. Using feedback provided by the physicians, the student developers will apply machine-learning techniques to identify which questions provided helpful information that contributed to the app providing an accurate diagnosis. The doctors also will provide data on how long it takes them to read and digest the report so the students can estimate how much time the app saves.
“We will determine which questions were most indicative, which were the least indicative and, at any given point, what’s the next best question to ask,” said Allen Osgood, the co-leader the WUSM Memento team. “Having the ability to go in and work with professionals to learn HIPAA compliance and systems security and all the different things we need to implement this on the user and technical side has been instrumental to the success of the project.
If the trial proves successful, the development team plans to work with the Alzheimer’s Association in launching the app at other St. Louis-area neurology clinics.