The Subtle Signs of Cognitive Decline, According to a Screening Test for Alzheimer’s

By | September 11th, 2017

What are the subtle signs of early Alzheimer's?

We’ve all had moments of short-term memory loss or confusion: You find your keys in the fridge, you forget the name of the person you just met or you blank out during a conversation. But when is it a cause for concern? When does short-term memory loss mean something more serious is going on in your brain?

Mylea Charvat, Ph.D., CEO of Savonix, spoke to Being Patient about the beginning signs of cognitive impairment and what her company looks for in their screening test for Alzheimer’s disease. Savonix is a screening tool that aims to replace the time-consuming process of memory tests, which currently require a trained physician using a stop watch as a patient puts pen to paper. The testing is based on scientific literature, though there have been no published one-to-one comparisons of the digital tool vs. traditional testing. The scientific community is more frequently turning to digitized forms of testing for cost and time purposes. As Dr. Chiadikaobe Onyike told us, there aren’t enough specialists to diagnose dementia as the population of aging adults grows. In that sense, this test could be a valuable tool in validating the suspicion of cognitive decline in order to set off a formal evaluation. Still, Onyike warns that “there’s a danger that a person could have test results and overreact,” making it important to emphasize how to interpret the results.

  • Memory is not the first indicator of Alzheimer’s or dementia
  • Trouble with toggling, or switching between tasks easily, is one of the first signs of Alzheimer’s disease
  • Changes in psychomotor abilities, like driving, are also an indicator of decline

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Being Patient: Tell me a little bit about the technology, how it works. I mean, there are a lot of people out there who don’t have Alzheimer’s but they’re concerned about their memory. Is this something that they should consider?

Mylea Charvat: Certainly, memory is one cognitive component that Savonix tests. We test things like verbal memory, immediate and delayed; we test cognitive flexibility, executive function, working memory, attention focus. It’s a broad spectrum of screening that we offer.

Being Patient: The typical process is you go to your doctor, they give you a MoCA (Montreal Congnitive Assessement) test or something like that, and that’s really the first test that you’re given. What’s different about Savonix and what does it offer to people?

Mylea Charvat: Well, it’s digital, so it’s not pen and paper, and I think that’s a big thing. It’s also sensitive and specific. So the MoCA is very specific. It will tell you if you’re really cognitively impaired or not. In neuropsychology, it’s what we would call a blunt instrument, and what we’ve developed with Savonix is much more like a precision scalpel. It’s really sensitive around discrete changes in cognition. And your doctor would order the test, and you could take it on an iPad or smartphone in the clinic, or you could just take it at home, on your own device, in your own time.

Being Patient: So, is the technology aimed toward detecting Alzheimer’s in the end, or is it really for any kind of cognitive tracking and impairment?

Mylea Charvat: It’s really for any kind of cognitive tracking and impairment. Memory is the one that comes up when we think of Alzheimer’s. It’s not necessarily the first thing to show up as an early indicator. We actually see psychomotor changes, especially in dementia, and we also see changes in things like attention and executive function. Thinking, planning, complex reasoning and working memory is a piece of it. I think most people focus on memory because it’s the most disturbing. When it starts to go you really notice it, and it’s very disturbing and creates a lot of distress for the person and for their family.

Being Patient: The alarms don’t go off for people and their loved ones until the memory component, right?

Mylea Charvat: Right.

Being Patient: But, are you saying, maybe through these tests, can it possibly be a diagnostic tool to really detect signs of Alzheimer’s?

Mylea Charvat: So, that’s exactly what we’re going for. It’s very sensitive to discrete changes, so we’re looking at trying to find people when they’re prodromal, right? Pre-clinical. When they’re not yet exhibiting identifiable symptoms from a behavioral standpoint, but you can see, maybe compared to their baseline cognitive measure a year or two years ago, that there’s been a real decline; it’s not normative, age-related changes. And that’s when this kind of early warning bells could go off.

Being Patient: What is the test actually looking for if you haven’t gotten to the memory stage?

Mylea Charvat: The test is looking at cognitive flexibility, which is what most people think of as multitasking, but it’s not really multitasking. It’s the ability to quickly switch attention between two different things and do it so seamlessly that it feels like multitasking, and we call it toggling. Cognitive toggling. So, that’s one domain, and this is actually something that goes pretty early, and starts to fall off when they have Alzheimer’s disease. This is the ability to quickly move back and forth between stimuli in an environment, track them both, understand them both and stay involved in both.

Being Patient: Are there any other signs?

Mylea Charvat: There are certainly psychomotor changes. Think about driving. It’s a really good example of a daily skill that requires good psychomotor. This is about reflex and timing, it’s about tracking different stimuli in the environment and responding with fine motor or gross motor responses.

Being Patient: In your opinion, when should somebody be tested?

Mylea Charvat: I personally believe that cognition is the fifth vital sign. If you really think about things like blood pressure and body temperature, cognition is a much more sensitive and accurate indicator of global health. For instance, 75 percent of cancer patients have cognitive impairment, and 35 percent of those patients’ problems after treatment have stopped, so everybody thinks it was related to the chemotherapy. What you see is that cognition emerges as the top three predictor of treatment outcome in disease, after disease, after disease.

If you can’t pay attention, remember, working memory, and think and plan, you can’t participate in your own treatment. You’re just not capable of it. My idea would be that this is something everybody gets.

Being Patient: Thanks, very much.

Mylea Charvat: Thanks for having me.

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