Refined Digital Tools Have Revolutionized the Return on Cognitive Screening: Investigator Rodney Swenson, PhD, Explains

"If we're going to get a handle on dementia, we have to start picking it up long before it is a problem. Instead of managing dementia, we want to be detecting the earliest beginnings of mild cognitive impairment, even subtle cognitive impairment."

The quote above, from Rodney Swenson, PhD, is the rallying cry across the scientific and medical communities that research, diagnose, and manage cognitive decline and frank dementia in the aging population in the US and globally.

Swenson is clinical professor of psychiatry and behavioral science at the University of North Dakota School of Medicine and Health Sciences, in Grand Forks, ND, and has spent decades studying the neurologic and behavioral changes that herald an individual's waning ability to understand and effectively interact with the world around them.

In a recent interview with Patient Care,© Swenson and his long-time colleague David Libon, PhD, talked about the remarkable level of data on cognitive performance that is available to clinicians and researchers with no more elaborate equipment than an iPad. Behaviors or qualities of behavior exhibited during office-based cognitive assessment that were previously invisible or unmeasurable are now captured digitally and analyzed with technology rooted in artificial intelligence and machine learning.

In the video segment above, Swenson highlights how the shift from paper-and-pencil to the iPad and AI has radically improved the potential to "detect the earliest beginnings of mild cognitive impairment, even subtle cognitive impairment."

The following transcript has been lightly edited for style and flow.

Patient Care: Dr Swenson, how widespread is use of digital technology currently for assessment of dementia, including in primary care.

Rodney Swenson, PhD: The digital space is quite active in developing ways to evaluate cognition, though these methods can be highly variable. Some digital applications are simply reproductions of traditional paper-and-pencil tests, just on an iPad. However, we're finding that digital technology, while another tool in our toolbox, is turning out to be very powerful when leveraged to evaluate human behavior. We're starting to realize that we can assess many behaviors very accurately and quickly in ways that were previously unattainable.

For example, when you're talking about latencies or acoustic parameters in speech, you can't capture that with a stopwatch. David and I were trained to do much of that type of assessment, even with traditional evaluations. We would sit by the patient and try to flowchart what they were doing so we could look at the process of how they arrived at their solutions. We've tried to take that process-based approach to neuropsychological assessment and build it into the digital platform, utilizing AI and machine learning to understand what the patient is truly doing and what really predicts whether they have a problem.

So, we've tried to use the paradigm we've employed throughout our careers in evaluating behavior, but now we have this very powerful tool that provides access to more behavioral data. The more behavior we can access, the more we're finding that we can detect certain cognitive biomarkers that indicate emergent, early cognitive decline. We're trying to shift the paradigm, if you will, to say that if we're going to get a handle on dementia, we have to start picking it up long before it becomes a significant problem. Instead of managing dementia, we want to detect the earliest beginnings of mild cognitive impairment, even subtle cognitive impairment. This allows primary care to focus on addressing known contributing factors, such as managing cardiovascular health. We believe that identifying these issues earlier so we can address them sooner will reduce the amount of dementia that ultimately occurs.