Startups fighting Alzheimer's by @advanceHC

ALZHEIMER’S
Frank Boermeester //advance.healthcare
Follow @advanceHC @fboermeester
STARTUPS
FIGHTING

“Alzheimer’s
Disease has no
survivors”
It destroys brain cells and causes
memory changes, erratic
behaviors and loss of body
functions. It slowly and painfully
takes away a person's identity,
ability to connect with others,
think, eat, talk, walk and find his
or her way home.
Alzheimer’s Association – alz.org
Alois Alzheimer's patient Auguste Deter in 1902. The
first described case of what became known as
Alzheimer's disease.
Frank Boermeester @fboermeester

Unrelenting progression of
disease
Pre-dementia Early Moderate Advanced
Pre-diagnosis, mild cognitive
impairment (memory & executive
functions)
Increasing cognitive
impairment (learning,
attention, language)
Independence
hindered (motor
skills, wandering,
neuropsychiatric
symptoms)
Completely
dependent
(exhaustion, muscle
mass deteriorates),
death
Up to 20 years 2-10 years 1 – 5 years

A global epidemic
World Alzheimer
Report 2015

“There’s an
app for that.”
Or is that a stupid and disrespectful claim?
...in light of the millions spent on unsuccessful
pharmaceutical research
(99.6% of drug trials for Alzheimer’s Disease during the
period 2002-2012 have failed)
http://www.alzres.com/content/6/4/37

There’s a wave that needs riding,
it’s called...
Beyond
the pill
“A survey conducted by Accenture found that life-sciences executives continue
to warm up to the idea of using wearables and other intelligent hardware,
saying technology will be the catalyst for the industry's move into outcome-
based sales. ….About 85% of respondents said they believe using intelligent
hardware, sensors and devices will help the industry shift from selling pills to
selling outcomes.”
- http://www.mmm-online.com/dataanalytics/smart-devices-will-improve-pharma-sales-survey/article/439278/

See how we helped UCB move
beyond the pill
For pharmaceutical
company UCB we helped
organise a trans-Atlantic
hackathon focused on
epilepsy. In a single
weekend, a hugely
motivated group of
developers and
designers created more
than ten viable
prototypes.
Find out more at
advance.healthcare
or buzz @advanceHC

Prevention
Early
detection &
diagnosis
Treatment Management
Diagnosis is difficult
(neuropsychological
testing), especially early
detection
No pills to solve safety
issues & risk of injury due
to wandering, outburst,
aggression
Huge care burden (most
costly disease in Europe &
the USA). Not enough care
workers, family distress,
etc.
No ‘silver bullet’ given
devastating impact on the
patient: cognitive,
emotional, motor,
neuropsychiatric, social..
Measurement of disease
progression (for clinical
trials etc) is difficult
Prevention may involve
lifestyle/behaviour change
(pending more research)
No pills to fix loss of
autonomy, isolation,
loneliness...
No pills to fix cognitive
decline (memory, executive
functions, language)
Heavy medication to
manage psychiatric
symptoms (depression,
delusions, aggression)
Why look beyond the pill?

Imaging & Big Data
Analysis of imaging data,
medical records, genomic data
for predicting disease progress
etc
Prevention
Early detection
& diagnosis
Cognitive Assessment
Cognitive and neuropsychological
testing for early detection,
diagnosis and measurement of
disease progression
Training & Games
Delaying the progress of AD
through retraining of memory,
multitasking skills, verbal skills etc
Monitoring
Sensor-based monitoring (e.g.
activity tracking, fall detection,
care prediction tools) and
telemedicine
Augmentation
Cognitive and physical
augmentation (e.g. memory
support, spatial orientation)
Care Robots/Platforms
Help improve care delivery and
emotional stimulation and reduce
the burden of informal caregivers.
Connectivity
Connect patients with care
networks and comfort services
through easy to use
communication platforms.
ERP & Marketplaces
Software for streamlining
operational and
administrative care tasks and
caregiver marketplaces
Opportunities for digital innovation?

Imaging & Big Data
etc
Prevention
Early detection
& diagnosis
disease progression
Monitoring
telemedicine
Augmentation
Connectivity
through easy to use
ERP & Marketplaces
operational and
Training & Stimulation
Serious games and apps for
cognitive and physical retraining
and stimulation, to delay cognitive
decline, counter apathy, etc.

Sensor in a sock
Pressure sensor in
sock to detect
when person
starts wandering
out of bed
http://www.fastcoexist.com/3034118/this-kid-designed-a-
wearable-health-device-for-his-grandfather-with-alzheimers
Passive wearable monitoring

Smart Sole
GPS-enabled monitoring so that can set a “geo-
fence” and create customised alerts
http://www.gpssmartsole.com/gps-smart-sole.php

https://www.indiegogo.com/projects/itraq-
the-cellular-tracking-device#/story
iTraq
Credit-card sized tag
enables geo-tracking
through cellular
networks

Interactive wearable
monitoring
Embracelet
GPS tracking,
emergency button,
customised alerts &
reminders. Strong
focus on design and
destigmatising.
http://www.embracelet.be/

Toshiba Silmee
GPS tracking,
emergency button,
multiple health
tracking sensors
(heart rate, activity,
ultraviolet light)
http://www.psfk.com/2015/09/toshi
ba-activity-trackers-for-senior-care-
silmee-w20-w21.html
monitoring

Clevercare
3G smartwatch GPS
tracking, emergency
button, customised
alerts & reminders,
phone calls, 24/7
emergency response
call centre
http://clevercare.co.nz/
monitoring

Tempo
(CarePredict)
Tracks and learns
daily patterns and
detects/predicts
possible problems
http://carepredict.com/
monitoring

Lively
Solution combines a watch and
in-home sensors. Press the
button on the watch to call for
help (24/7 call center). Watch
also counts steps and can set
medication reminders. The
activity sensors can be placed
around the house (e.g.
bathroom door) to monitor
daily activities and detect
abnormalities.
www.mylively.com
IoT monitoring

Scientific Comment
Monitoring tech works... Consumer electronics
devices (relying on GPS, wifi, mobile networks) can
detect wandering patterns and alert caregivers.
“Experimental results show that the mobile-
health application is able to detect wandering
patterns including lapping, pacing and random in
real-time.”
http://ieeexplore.ieee.org/xpl/articleDetails.jsp?arnumber=6611105

Scientific Comment
Can sensor data + machine learning deliver more
proactive care?
The University of California San Francisco Memory and
Aging Center has developed what they call a "care
ecosystem," which uses the Internet of Things and machine
learning, as tools to provide care that is "more continuous
and proactive and personalized”. The impact of the model
is being tested in a 3 year research project.
http://memory.ucsf.edu/research/supportive-trials/careecosystem
http://www.techinsider.io/the-internet-of-things-can-improve-care-for-people-with-
dementia-2015-7

Scientific Comment
Usability can be a problem:
“When being targeted to patients with dementia some usability
problems appeared, such as difficulties to read information in a
small screen or take a proper photo.”
http://www.tandfonline.com/doi/abs/10.3109/09638288.2015.1025992
Participatory design (involving people with
dementia in design process) is feasible and
beneficial:
“Participants felt strongly that future devices should be disguised
and be integrated easily into their daily routines. Suggested areas
for functional improvement included two-way communications,
flexibility of function as the illness progresses, and something to
"guide" them home when out walking or driving. Attention should
also be focused on minimizing the size, weight and visibility of
devices to reduce stigmatization.”
http://www.ncbi.nlm.nih.gov/pubmed/19193255

Scientific Comment
There are ethical issues that need to be addressed
(balancing patients’ need for safety with need to
preserve their autonomy and privacy.)
“No-one should be coerced into using tracking
technology and, where possible, people with
dementia must be involved in the decision-
making and their consent sought.”

Interested in more deep dives?
More info?
Buzz @fboermeester
//advance.healthcare
Don’t miss the
next installment
on startups active
in the field of
ophthalmology

Imaging & Big Data
etc
Prevention
Early detection
& diagnosis
disease progression
Training & Stimulation
Serious games and apps for
cognitive and physical retraining
and stimulation, to delay cognitive
decline, counter apathy, etc.
Monitoring
telemedicine
Augmentation
Connectivity
through easy to use
ERP & Marketplaces
operational and

‘Augmentation’
Backup Memory
Smartphone app
that alerts user
when a familiar
person is nearby
and reminds them
about their
relationship through
photos
http://global.samsungtomorrow.com/samsung-
volunteers-in-tunisia-develop-app-for-alzheimers-
patients/

‘Augmentation’
Intelligent Glasses
Singapore scientists have
developed a tool on
Google Glass that
recognises people and
reminds the user who they
are, and reminds the user
about medication
http://www.straitstimes.com/singapor
e/health/smart-glasses-for-seniors-
with-dementia

‘Augmentation’
Cloudphone (Ollo
Mobile)
Tracking &
communication
wearable, includes a
‘safe path’ feature
that automatically
monitors regular
transit activity – like
going to and from
shop. You set the
route and schedule,
CloudPhone lets you
know if things go
wrong.
https://www.indiegogo.com/projects/cloudphone-3g-
revolutionize-how-you-care#/story

Connected Patients
Cubigo
A single, easy to use platform for
accessing a personalised portfolio
of services, including commucation
tools (e.g. videocalls, messages,
neighbourhood forum), comfort
services (e.g. home shopping,
postal services), and security and
care (medical appointments,
medication reminders, alarms,
integration with sensors).
http://www.cubigo.com/

Connected Patients
Smartstones
Give people with
communication
challenges the ability to
speak using a wearable
sensor that detects touch
and motion gestures and
is connected to a
gesture-to-speech app.
http://www.smartstones.co/

Care communication hubs
CareZapp
A platform that lets families,
caregivers and care organisations
create a private network for
seamless, secure communication.
Can be connected to home
sensors and vitals monitoring
http://www.carezapp.com/

Care communication hubs
CareMerge
A platform for coordinating
care among family,
careproviders, physicians
and community.
http://www.caremerge.com/

Care Marketplaces
CareLinx
CareLinx is an online professional
caregiver marketplace for in-home
care services. CareLinx claims to
save families up to 50% verses
traditional brick and mortar
franchise agencies, while
professional caregivers earn higher
wages.
http://www.carelinx.com/

Speech analysis
IBM research team created an
automated verbal test (much
shorter/faster than standard paper-
based tests). IBM Watson is used to
analyse speech pattern (not the
content but the tone, pauses,
continuity of speech etc). The
application classifies with 85%
accuracy whether user is disease free,
pre-dementia and early-dementia.
Other (non-IBM) research on speech
analysis is also showing good results.
http://www.techrepublic.com/article/how-ibm-research-wants-to-
use-mobile-devices-to-detect-early-stage-dementia/
Cognitive assessment

Eye movement analysis
Neurotrack is a computer-based
visual cognitive test (tracks eye
movement as a means to measure
recognition memory) that appears to
be capable of predicting patients’ risk
of developing AD before behavioural
symptoms appear. The tool is
potentially useful in clinical trials with
early (pre-symptomatic) stage AD
patients and later as a general
screening test
https://www.neurotrack.com/

Computer game performance
as test
Game developer Akili Interactive
Labs and Pfizer are doing
research to see if brain-
boosting app Neuroracer could
detect and track the
progression of AD. Neuroracer
detects attention impairment,
which in turn is linked to early
stage AD.
http://www.alzheimers.net/2014-01-13/akili-
app-may-detect-alzheimers/

Digital pen as dementia prediction tool
Researchers at MIT analysed data from 2600
‘clock-drawing’ tests (a traditional screening
tool for cognitive impairment) performed
using a digital pen (Anoto Live Pen – which
measures the ballpoint tip’s position 80 times
a second). The digital version of the test was
shown to be far more accurate diagnostic
tool than the original pen and paper version,
probably because it picks up more markers
than the finished drawing (e.g. pauses,
hesitation).
http://groups.csail.mit.edu/mug/pubs/Souillard2015MLJ.pdf

Scientific Comment
Disrupting clinical-based cognitive assessment
“The revolution in mobile technologies provides
unprecedented opportunities to overcome the
barriers of time and context that characterize
traditional hospital and clinical-based
assessments.”
Mobile Technologies in the Early Detection of Cognitive Decline
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275158/

Scientific Comment
Imagine a future of always-on, continuous &
contextual cognitive monitoring
“The future vision is one where classically slow, subjective, and data-poor
assessments of cognition are replaced by fast, objective, and data-rich digital
assessments that can be unequivocally linked to functional improvement by
reference to large datasets. …
In a world where the majority of the population carries a mobile digital
device, where our behavioral status, cognitive capacity, and clinical function
are ubiquitously and continuously tracked by the digital footprint we leave
behind, the prospect for transformative efficiency and accuracy in testing
novel therapeutics in neurodegenerative disease may rest in the devices we
each carry in our pockets.”
C Leurent and MD Ehlers* Digital technologies for cognitive assessment to
accelerate drug development in Alzheimer's disease. Clinical
Pharmacology & Therapeutics 8 SEP 2015

More info? //advance.healthcare or buzz @advanceHC
At Advance Healthcare we are on a mission to improve the lives of
patients through digital innovation, one disease at a time.
Market research
& technology
scouting
Ideation
workshops &
brainstorming
Hackathons
& events
Venture
building
What else do we do?

Big Data: harnessing medical
records
Global CEO Initiative on Alzheimer’s Disease
Optum Labs is a research collaborative, founded by Optum (healthcare analytics
company) and Mayo Clinic in 2013 (later joined by AARP), that brings together
de-identified administrative data of more than 100 million patients and
electronic records of 30 million patients. With more than 100 studies on the go,
they aim to generate new predictive models and comparative-effectiveness
evidence. For example, they are playing a key role in the development of a
global Big Data research initiative to fight Alzheimer’s Disease
http://www.ceoalzheimersinitiative.org/

Imaging data
Using MRI data to predict
disease progression
Researchers at MIT are using
machine-learning software to
analyse imaging (MRI), genetic,
demographic and clinical data to
help predict change in brain
anatomy among patients with
Alzheimer’s Disease
http://news.mit.edu/2015/predicting-change-alzheimer%E2%80%99s-brain-1006?

Visual Stimulation
Tovertafel
A game that projects light
animations on a large table
and that people can
interact with through
gestures. It stimulates
physical activity and social
interaction among people
with mid- to late-stage
dementia.
http://www.activecues.com/

Aromatic Stimulation
Ode
A device that emits strong
food fragrances (e.g.
orange juice, curry, soup)
to provide aromatic cues
for mealtimes. To counter
appetite loss among
people with dementia. The
power of smell is that it
connects directly to the
brain’s limbic system.
http://www.myode.org/

Brain Stimulation
Ybrain
Ybrain has developed a nerve stimulating headband for patients
suffering early onset Alzheimer’s and is building an analytics platform
for disease diagnosis and personalized treatments. The device may
enhance brain activity, improve short-term memory and increase
perceptual ability (Ybrain lab results, not clinical trials)
http://ybrain.com/

Rise of the Brain Fitness Industry
But are these useful
for people with AD?

Scientific Comment
Brain training can be effective for normal older adults (no AD or dementia)
Brain training games have been criticised for making false promises. But a
study published in Nature, shows that a game that is tailored to a specific
cognitive deficit (in this case multi-tasking) can be effective in enhancing
cognitive control among older adults. Hence it’s potential use to detect early
AD. http://www.nature.com/news/gaming-improves-multitasking-skills-1.13674
Certain mental exercises can offset
some of the expected decline in older
adults' thinking skills and show
promise for maintaining cognitive
abilities needed to do everyday tasks
such as shopping, making meals and
handling finances, according to a new
study. The research…showed that some
of the benefits of short-term cognitive
training persisted for as long as five
years.
http://www.nih.gov/news/pr/dec2006/nia-19.htm

What about Brain Training for Alzheimer’s Disease?
Some population studies do show that people who engage in intellectual
activities such as reading, board games, crossword puzzles, playing music,
social interaction, learning a second language later in life, etc. have
reduced risk for developing AD or even seems to delay development of
AD.
The concept of ‘cognitive reserve’ is used to explain a degree of resilience
that some people have to the clinical manifestations of AD, but not to the
disease process itself. People with high cognitive reserve may go
undiagnosed until disease pathology is severe, then rapid decline follows.
• Wilson RS et al. Participation in Cognitively Stimulating Activities and Risk of Incident Alzheimer Disease.
AMA. 2002;287(6):742-748. doi:10.1001/jama.287.6.742.
• Verghese J et al. Leisure Activities and the Risk of Dementia in the Elderly. The New England Journal of
Medicine NEJM, 2003, 348:2508-2516
• Stern, Yaakov (2006) Cognitive Reserve and Alzheimer Disease. Alzheimer Disease & Associated Disorders,
vol 20, p 112-117.
• Williams JW et al Preventing Alzheimer's disease and cognitive decline. Evid Rep Technol Assess (Full Rep).
2010 Apr;(193):1-727.
Scientific Comment

And yet….they can be useful! A literature review of 15 studies on dementia-
related serious games suggests that:
• (1) physical games (or exergames, i.e., games that promote physical fitness) can positively
affect several health areas of the players with mild AD and MCI, such as balance and gait
(Padala et al., 2012), and voluntary motor control (Legouverneur et al., 2011);
• (2) cognitive games (i.e., games which target cognitive improvement) can improve a
number of cognitive functions, such as attention and memory (Stavros et al.,
2010; Weybright et al., 2010; Rosen et al., 2011) and visuo-spatial abilities (Yamaguchi et
al., 2011);
• (3) both physical and cognitive games can have a positive impact on social and
emotional functions, for instance they can improve the mood and increase positive
affect and sociability (Weybright et al., 2010; Boulay et al., 2011; Yamaguchi et al., 2011)
and reduce depression (Férnandez-Calvo et al., 2011). Very few studies investigated the
effects of the use of games for social/emotional health (which encourage the players to
link with their friends and/or improve their social and emotional life) in dementia, but the
results are encouraging (Boulay et al., 2011).
Dementia Games: A Literature Review of Dementia-Related Serious Games
http://link.springer.com/chapter/10.1007%2F978-3-642-40790-1_2
Scientific Comment

Conclusions of a systematic review and SWOT analysis of use of serious
games targeting AD patients, analyses which in turn were discussed and
validated in a workshop at the 2013 Clinical Trial of Alzheimer's Disease
(CTAD) conference, and endorsed by stakeholders in the field:
“The results revealed that SG may offer very useful tools for
professionals involved in the care of patients suffering from ADRD.
However, more interdisciplinary work should be done in order to
create SG specifically targeting these populations. Furthermore, in
order to acquire more academic and professional credibility and
acceptance, it will be necessary to invest more in research
targeting efficacy and feasibility. Finally, the emerging ethical
challenges should be considered a priority.”
Recommendations for the use of Serious Games in people with Alzheimer's Disease, related disorders and frailty. Front. Aging Neurosci., 24 March
2014 http://dx.doi.org/10.3389/fnagi.2014.00054
Scientific Comment

Memory Places
PhD research by Kasper
Bormans is exploring the
use of virtual ‘memory
places’ (guided imagery) to
enhance memory for
familiar faces, thereby
improve quality of life of
patients and caregivers
Cognitive Training
https://www.youtube.com/watch?v=BMcduh1HEHA

MindMate
Tablet App providing
games for stimulating
cognitive abilities
(based on research
conducted at Uni of
Glasgow), memory
support tools (lists,
alerts), and advice on
physical exercises and
nutrition
http://www.mindmate-app.com
Cognitive Training

Alzhup
Tablet app that
integrates cognitive
exercises and actual
memories. Working
with University
research team for
clinical trials.
http://www.alzhup.com
Cognitive Training
http://www.alzhup.com/

Care through Robots & Avatars
Paro
PARO is an advanced interactive
robot developed by AIST. It allows
the documented benefits of animal
therapy to be administered to
patients in environments such as
hospitals and extended care
facilities where live animals present
treatment or logistical difficulties.
PARO has five kinds of sensors:
tactile, light, audition, temperature,
and posture sensors, with which it
can perceive people and its
environment. It works, but raises
ethical concerns.
http://www.parorobots.com/

Scientific Comment
Are we ready for robots that care for us?
“Results so far have been encouraging in the sense that they
showed that elderly people concerned by cognitive
impairment recognize the potential of Socially Assistive
Robots (SAR) for supporting health and social care at home.
It is true that the current state of the research on SAR does
not allow us to conclude that older adults are ready for
robots that care for them, but the idea is no longer
unimaginable..”
Pino M et al. “Are we ready for robots that care for us?” Attitudes and opinions of older adults toward
socially assistive robots. Front. Aging Neurosci., 23 July 2015 | http://dx.doi.org/10.3389/fnagi.2015.00141

http://www.tinybots.nl/
Tinybots
Small, talking robots that
provide cognitive
training, medication
reminders and
‘companionship’, giving
structure to a person’s life

GeriJoy
Companionship when family and human caregivers aren't around.
GeriJoy's 24/7 team of remote caregivers use an on-screen avatar to
provide conversation, emotional support, and wellness reminders -
ensuring seniors never feel alone
https://www.gerijoy.com/

Monitoring+Care Platforms
Giraff Plus
GiraffPlus monitors activities in the home
using a network of sensors, both in and
around the home as well as on the body.
The sensors can measure e.g. blood pressure
or detect e.g. whether somebody falls down.
A range of services can be tailored to the
individual’s needs.
At the heart of the system is a unique
telepresence robot, Giraff, which lends its
name to the project. The robot uses a Skype-
like interface to allow relatives or caregivers
to virtually visit an elderly person at home.
Photo Terese Andersson
http://www.giraffplus.eu/

Monitoring+Care Platforms
Mobiserv
A European, multi-partner research project
that created a platform consisting of:
• A social companion robot - robot,
containing processing power, data
storage capability, various sensors,
machine learning/experience
gathering/adaptation, a touch screen,
speech synthesis, and speech
recognition
• Wearable smart clothes - monitoring of
vital signs or sleeping patterns, and
detection of falls
• Smart home environment - smart
sensors, optical recognition units, and
home automation elements, to detect
among others eating and drinking
patterns, activity patterns, and
dangerous situations
http://www.mobiserv.info/

testing for early detection, diagnosis
and measurement of disease
progression
Training & Games
Delaying the progress of AD through
retraining of memory, multitasking
skills, verbal skills etc
Monitoring
Sensor-based monitoring (e.g. activity
tracking, fall detection, care prediction
tools) and telemedicine
Augmentation
Cognitive and physical augmentation
(e.g. memory support, spatial
orientation)
emotional stimulation and reduce the
burden of informal caregivers.
Connectivity
Connect patients with care networks
and comfort services through easy to
use communication platforms.
How will it all come together?

From multi-functional
platforms (monitoring,
memory-supporting,
connected care
platforms) ...

Monitoring
Sensor-based monitoring (e.g. activity
tracking, fall detection, care prediction
tools) and telemedicine
...to grid-linked cyborgs?
Image: cover of Neal Asher’s book “The Line of polity”

Thanks!
Frank Boermeester
@fboermeester
//advance.healthcare
At Advance Healthcare we are on a mission to
improve the lives of patients through digital
innovation, one disease at a time.

More info? //advance.healthcare or buzz @advanceHC
At Advance Healthcare we are on a mission to improve the lives of
patients through digital innovation, one disease at a time.
Market research
& technology
scouting
Ideation
workshops &
brainstorming
Hackathons
& events
Venture
building
How we can help

Startups fighting Alzheimer's by @advanceHC

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