Five minute dementia screening iPad app debuts

An iPad app developed in the United States could help doctors screen for a wide range of neurological diseases, such as Parkinson’s and dementia, in five minutes or less.

Developed at Northwestern Medicine in Chicago, the NIH (National Institutes of Health) Toolbox V3 iPad app allows time-strapped clinicians to quickly but thoroughly assess patients, from young children who need screening ahead of school to older people who may be concerned about dementia.

The developers claim that tests that would once have taken two or three hours to complete can now be reliably done in under 30 minutes.

Project leader Richard Gershon, vice chair for research in the department of medical social sciences at Northwestern University’s Feinberg School of Medicine, said: “The problem in clinical care today is nobody has time for long tests for everything; we need very brief tests.”

While some clinical screening tools require expensive custom hardware, this app = which can be downloaded from the Apple App Store – allows anyone with an iPad to access the full assessment suite of more than 50 tests spanning four areas – cognition, motor, sensation (hearing, smell, pain, vision and taste) and emotion.

COVID-19 patients complaining of “brain fog,” for instance, can now take several brief tests to determine what areas could be the target for cognitive rehabilitation.

Or someone who has recently lost their sense of smell can take the Toolbox’s olfactory test – and any others as need via the – to better understand if it could be an early sign of Parkinson’s disease.

Parts of the Toolbox are already being used at Northwestern to help detect dementia. And researchers are working on developing a self-administered version of the tests that could be taken in the waiting room before a patient’s visit with the results being sent straight into their electronic health record.

One example of a test to measure episodic memory is a series of pictures displayed on the screen describing a trip to the park. After they’ve been scrambled, the patient has to put the pictures back in order.

The NIH Toolbox has been in development for more than a decade. It was first launched in 2012 with a more portable iPad app unveiled three years later.

This newest version was originally intended solely for researchers. But it was decided to release it for clinical use following appeals from physician-scientists and psychologists looking for a way to improve patient care by allowing access to a wide variety of easily administered tests.

As an example, the researchers say it could be used for an older adult presenting to their neurologist with complaints of cognitive decline.

The examiner could assess the patient’s cognitive abilities as well as emotional functioning, such as depression and anxiety, which can also contribute to those complaints.

The NIH Toolbox has been developed by more than 250 scientists and sponsored by 15 institutes of the Maryland-based National Institutes for Health, that make up the NIH Neuroscience Blueprint, a collaborative framework supporting research on the nervous system.

Because the app is being distributed through the Apple App store, Richard Gershon and his colleagues don’t always know everyone who is using the Toolbox, but by tracking analytics detailing how often and where it’s purchased, they know it is currently in 21 countries.

The earlier V2 version of the app has been used by 3,000 researchers from 1,200 institutions globally and has been authenticated in 300 separate validation studies.

Dr Igor Koralnik, chief of neuro-infectious disease and global neurology at Feinberg, said: “The NIH Toolbox cognitive tests are extremely useful for testing the cognitive function of our neuro covid-19 clinic patients complaining of ‘brain fog,’ The results are adjusted according to age, education and other demographics, allowing us to tell our patients immediately of their performance, and if they may benefit from cognitive rehabilitation.”

Additionally, a Northwestern-led National Institute on Aging cohort study examining midlife determinants of later-life cognitive decline and dementia, is using the Toolbox to capture a range of conscious mental abilities.

Michael Wolf, associate vice chair for research in the department of medicine at Feinberg, commented: “Patients find the tests easy to use and are more engaged than with other standard measures we have deployed previously. Overall, this is an incredibly important research assessment tool that will help our work be more translatable to other studies.”

The app has been made available in both English and Spanish. Hebrew and Arabic versions are set to be released in late 2023. Additionally, numerous studies in Africa are using the Toolbox and have incorporated a translation app to communicate in Swahili, Dholuo and Twi.

Many of the streamlined tests are accomplished through computer adaptive testing. This means the app is constantly adjusting the questions to meet the level of the person being tested, eliminating irrelevant questions.

Richard Gershon said: “We zero in on that person’s individual level of functioning and don’t waste their time asking questions far above or below their ability.”