A simple hearing test delivered on a smartphone or tablet could help memory clinic doctors diagnose Alzheimer’s disease more accurately and earlier. Dementia pathologies target the parts of the brain that process sound, causing subtle changes in how people pick out a voice in a noisy room or locate where a sound comes from. These changes often occur years before memory problems become obvious. Current NHS memory clinic diagnosis is slow, uneven across the country, and relies on expensive or invasive tests. This project will develop a digital battery of auditory tests and test it on patients attending real-world memory clinics that serve a diverse inner-city population. If the tests prove accurate and cost-effective, they could become a routine triage tool in the NHS—quick, cheap, and fair across different languages and educational backgrounds. The same platform could also be used to stratify patients in clinical trials for new Alzheimer’s drugs, and eventually to screen healthy people for dementia risk. The researchers will also combine the hearing tests with blood-based biomarkers to see if the two together give a more complete picture than either alone.
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Research question How useful are digital auditory biomarkers to support the diagnosis of Alzheimer s disease and stratification of patients with mild cognitive disorder in NHS memory clinics? Background There are substantial problems with dementia diagnosis in the NHS. Cost effective tools that can support more timely and accurate diagnosis and remove geographic variations are urgently required. Dementia pathologies target the auditory brain and cause early changes in auditory scene analysis, spatial hearing and degraded speech perception. Our proof-of-concept work has shown that these tests can differentiate Alzheimer s patients from controls with very high accuracy (AUC 0.91), measure disease severity, monitor response to treatment, and even stratify risk of incident dementia over a 10 year follow-up in healthy adults. Hearing markers have substantial advantages of epidemiological and clinical relevance, culture-fairness, flexible digitisation and potential for scalable web translation. Aims and Objectives Develop and refine a battery of digital biomarkers of auditory perceptual function in a research cohort Establish the value of auditory biomarkers to support diagnosis at initial assessment in a real-world memory clinic setting serving a diverse population Assess the utility of auditory biomarkers for stratification and prognosis in mild cognitive disorder and Alzheimer s disease with longitudinal follow up online at 1 year and in-person at 2 years Establish the predictive and diagnostic value of combining auditory biomarkers with blood-based biomarkers for Alzheimer s disease Examine the culture-fairness of auditory biomarkers and estimate their ability to improve diagnostic equity Evaluate the cost-effectiveness of the technology for use in the NHS Define neuroanatomical associations of hearing markers to demonstrate specificity for underlying patterns of neurodegeneration Understand the acceptability and value of the technology for patients through public involvement Develop a web-based platform for future evaluation of the technology as a research tool to predict risk of dementia in healthy populations Methods and timeline In year 1, we will pilot and refine a digital auditory battery in a research cohort. In year 2 we will recruit 500 patients presenting to memory clinics serving a diverse inner city population and 100 healthy controls, administering digital auditory tests and collecting clinical and demographic information together with plasma samples for measurement of emerging blood-based biomarkers of Alzheimer s disease. Participants will be followed up online in year 3 and then in-person in year 4 with longitudinal auditory testing and ascertainment of progression to dementia (in mild cognitive disorder) and longitudinal change (in Alzheimer s disease). We will model the performance and cost effectiveness of digital auditory biomarkers both in isolation and in combination with blood biomarkers for: initial memory clinic diagnosis; predicting dementia in mild cognitive disorder; and measuring disease severity and progression. Anticipated Impact and Dissemination We will develop plans to commercialise the software as a diagnostic tool to support more timely and equitable dementia diagnosis in NHS memory clinics, and as a tool for improved patient selection and stratification in clinical trials. We will work with public, clinical, academic and corporate stakeholders to disseminate the results and secure support for further development and entry to market.
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