Accelerating Dementia Pathway Technologies (ADePT)

• Research type

  Research Study

• Full title

  Real-world evidence study of primary care referrals to NHS memory clinics and the clinical and economic case for the adoption of the Integrated Cognitive Assessment to improve the dementia diagnosis pathway

• IRAS ID

  277157

• Contact name

  Sina Habibi

• Contact email

  sina@cognetivity.com

• Sponsor organisation

  Cognetivity Ltd

• ISRCTN Number

  ISRCTN16596456

• Duration of Study in the UK

  0 years, 8 months, 1 days

• Research summary

  Summary of Research
  Early identification and diagnosis of Dementia is essential for improved health outcomes and service provision. Primary care is invariably the main point of identification. \nAt present, GPs clinical judgement is the key driver for instigating full evaluations at memory clinics for conditions such as dementia. Clinical practice is known to be inefficient and variable across GP clinics. Existing cognitive tests used in primary care are crude or time-consuming, and tend to only detect cognitive impairment when the disease has progressed significantly. The more detailed tests used in memory clinics or neuropsychological assessments are expensive and often intrusive for the patient and are therefore not suitable for use as a screening tool. \n \nThe Integrated Cognitive Assessment (ICA) is a quick and easy to use test of cognitive performance, using an iPad. Users are shown a series of images in quick succession and for each they are asked to respond ‘yes’ or ‘no’ to whether they contained an image of an animal or not. The accuracy and speed of responses are then assessed using Artificial Intelligence that compares ICA tests previously taken by healthy and cognitively impaired individuals. This enables the ICA to provide an objective indication of cognitive performance and the likelihood of impairment. The ICA is registered with UK regulators as a medical device. \n\nIn this study, patients who have been referred to NHS memory clinics will be asked to take the ICA, as well as all of the other standard assessments taken as part of their appointment. The ICA result will not inform the diagnosis of the patient or any other aspect of their care. Once the diagnosis of the patient is known, the ICA result will then be compared against the GP referral and the final diagnosis to determine whether the ICA predicted correctly. From this it will be determined whether the use of the ICA could have prevented the referral of patients who were found to be healthy. \n\nThe aim of this study is therefore to build clinical and economic evidence to support the use of the ICA as an inexpensive dementia screening tool in the NHS. The study aims to demonstrate whether the use of ICA can improve the dementia care pathway by streamlining the diagnosis of dementia and improving the efficiency of GP referrals and therefore minimising the need for repeated, costly and time-consuming assessments.\n

  Summary of Results
  At present, GPs clinical judgement is the key driver for instigating full evaluations at memory clinics for conditions such as dementia. Existing tests used by GPs are crude or time-consuming, and tend to only detect cognitive impairment when the disease has progressed significantly.
  The Integrated Cognitive Assessment CognICA™ is a quick and easy to use test of cognitive performance, using an iPad. Users are shown a series of images in quick succession and for each they are asked to respond ‘yes’ or ‘no’ to whether they contained an image of an animal or not. The accuracy and speed of responses are then assessed using Artificial Intelligence that compares CognICA tests previously taken by healthy and cognitively impaired individuals. This study is being funded by Innovate UK, the United Kingdom's innovation agency. It is a non-departmental public body operating at arm's length from the Government as part of the United Kingdom Research and Innovation organisation.
  The patients who participated were referred to a memory clinic within the NHS. They were 55-90 years old and did not already have a diagnosis of dementia.
  In this study, patients who have been referred to NHS memory clinics will be asked to take CognICA, as well as all of the other standard assessments taken as part of their appointment. The CognICA result did not inform the diagnosis of the patient or any other aspect of their care. Once the diagnosis of the patient was known, the CognICA result was compared against the GP referral and the final diagnosis to determine whether CognICA predicted correctly the patient’s status. From this it was determined whether the use of CognICA could have prevented the referral of patients who were found to be healthy. Reducing the number of false referrals is a benefit to the welfare of the patient, for the reduction of waiting times and also savings costs for the NHS.
  The aim of this study was to build practical and economic evidence to support the use of the CognICA as an inexpensive dementia screening tool in the NHS. We demonstrated that, if adopted by the NHS, CognICA could reduce unnecessary referrals from GPs to memory services by 72%. Paired with reduced delivery time compared to current practices, CognICA has proven to be an effective tool to assess cognitive impairment.

• REC name

  North of Scotland Research Ethics Committee 1

• REC reference

  20/NS/0029

• Date of REC Opinion

  14 Feb 2020

• REC opinion

  Favourable Opinion