Duke researcher discusses how a new approach could be key to effective treatments
Murali Doraiswamy, MBBS, the director of Duke’s Neurocognitive Disorders Program, is a globally recognized expert on Alzheimer Disease (AD) and other cognitive disorders. He also directs a clinical trials unit at Duke that is focused on developing novel diagnostics, mobile health tools, and therapeutics to enhance brain health. Here, he discusses the potential role of technology, including “brain games,” in diagnosing and treating AD.
What are the challenges in developing treatments for AD?
The biggest challenge is that we don’t fully understand the causes. Right now, most clinical trials have targeted just 2 pathologies in the brain, and most of those trials have failed. So we need to diversify; we need new targets. And for that, we need more basic research and more trials targeting those newer proteins. Of course, to do more trials, you need to mobilize more patients, and you need more efficient trial platforms, which is the second challenge—as much as 30% of the cost and time of an AD trial goes to identifying and screening patients. So if we could somehow reduce that, we could do more trials.
How can technology be used to address these challenges?
We need to find a new approach to conducting clinical trials and accelerating enrollment. With the increasing number of people, particularly older adults, who have access to smartphones and the internet—in the United States and Europe, 70% of older people use the internet, and as many as 40% own a smart phone or tablet—technology is not only convenient, it also offers the chance to collect data points that traditional clinical trials can’t. For example, it may be inconvenient for a patient to come into the clinic on a specific day to undergo evaluation, but a phone or wearable sensor can collect continuous real-time data. Through digital testing, we can collect an enormous number of data points, which allows us to assess cognitive function on a finer level. It also offers the opportunity to individualize tests so that everyone who takes the test is challenged to the same extent.
How did you get interested in using technology in this context and what are some of your ongoing projects?
About 10 years ago, I found that a lot of my patients were playing “brain games” with the hope of improving their cognitive function. I was less interested in the games as a potential therapeutic tool at the time, but I started seeing how patients’ scores changed as their disease progressed. Their performance in these games tracked very well with the standardized test they were taking in clinic, which suggested to me that these games may have enormous diagnostic value, whether they’re therapeutic or not.
Right now, we’re working with Columbia University on a 2-sided trial that will have one-half of participants playing brain games that are digitally tailored to improve specific domains, such as memory and executive functioning, and the other half will be doing computerized crossword puzzles. Essentially, we want to know whether a digital intervention like these brain games is more effective at improving memory and cognitive functioning than what older people are doing anyway. We will also examine brain structure in these 2 groups. Overall, from a clinical trial design perspective, it will be beneficial to see how comfortable people are with using this technology.