Dr Sina Habibi, CEO of Cognetivity, tells Tech For Good about a potentially groundbreaking screening solution and how it could revolutionise detecting the early signs of Alzheimer’s and dementia.
The Alzheimer’s Association believes “the first person to survive Alzheimer’s Disease is out there now”.
The truth of the matter, though, is the medical profession is not much better at detecting the early signs of the condition than way back in November 1906 when Dr Alois Alzheimer reported “a peculiar severe disease process of the cerebral cortex”.
Since then, many forms of testing have been developed which are able to identify what we now know as Alzheimer’s Disease as it progresses to its more advanced stages, but figures estimate only one in four people with the condition receives a proper diagnosis.
According to Dr Sina Habibi, CEO of healthcare company Cognetivity, a huge reason for that is that detection methods are “crude”, comprising fairly standardised memory tests.
But alongside his partner and co-founder Dr Seyed-Mahdi Khaligh-Razavi, a computer scientist who obtained his PhD from the Cognition and Brain Sciences Unit at Cambridge University, they have developed and commercially marketed an AI-based test that is capable of early detection of the disease and is now being rolled out at hospitals in the UK.
“I think one major reason that we have failed, over the past 20 years, to come up with a cure for Alzheimer’s is because of a lack of sensitive tools to pick up the disease at an early stage or to show efficacy of any drugs,” says Habibi. “We use these old and rudimentary cognitive tests. For example, in MoCA [Montreal Cognitive Assessment], you’re asked to tell a rhino from an elephant, or you’re asked ‘who was the president of the United States who got assassinated in the ’60s?’
“So, first of all, by the time you don’t remember those, your condition is probably at an advanced stage. And if you go on a course of treatment in a clinical trial, first time, and you don’t remember these ones and they tell you what they were, then the second time they ask you these, you probably do better, even though the drugs have not had any impact.
“The third time, you probably do better again so the assumption is ‘okay, my drugs are actually working’. But, before you know it, it’s late phase 3 of the drug trial, which is the worst time you want a trial to fail, because you already spent a billion dollars on it and then they realise that it all went wrong because of patients getting better at doing repetitive cognitive tests.
“So we can play an important role in picking early stage signs, where the drugs can be more effective, and also we can show efficacy of drugs in a short period of time.”
The ‘learnability’ of the current testing methods is a factor, as are biases such as language, culture or education which can all affect the outcome. In addition to that, all of these existing tests are focused primarily on a single part of the brain, the hippocampus, so it becomes easier for other areas of the brain to compensate, once again affecting the accuracy of results.
Cognetivity has built a solution, the Integrated Cognitive Assessment (ICA) tool, which is far more sensitive and stimulates multiple areas of the brain simultaneously. The product’s AI then compares an individual’s responses with a previous data spectrum which has been built in from a group of around 400-500 individuals, some of whom were suffering with the disease at varying stages, and some of whom were healthy. It’s this vast range of pre-recorded responses and the ingenuity of the product’s AI – which builds a vector with 100 multi-dimensional data points that can all be measured at every stage of the screening test – that allows the test to be so accurate and so sensitive, particularly in terms of early detection of the disease.
For the individual taking the test, a succession of images is displayed, some more distorted and adapted than others, and the idea is to activate different parts of the brain in a short period of time. The key to a participant’s success is in the speed and timing of their responses; it happens in such a short timeframe that it’s very difficult for the brain to cheat the test in any way. This, combined with the AI, is what allows the test to become more acutely sensitive to minor deteriorations.
So much so, in fact, that even during the co-founders’ time as students at Cambridge University, none of their fellow boffins were able to beat or cheat the test.
“We wrote a very basic code and we gave it to our friends, who were aged between 18 to 35, and we asked them to take the test every other day, each morning, in the same basic conditions,” Habibi says. “None of them could improve their score and we’re talking about the most active and very, very sharp brain performances here, even though they took the test every other day for a course of a month. That’s when we realised this is something seriously important.”
Habibi’s entrepreneurial spark – since 2010 he has been an active member of Cambridge University Entrepreneurs, the most successful entrepreneurial student society in Europe – then kicked into gear. From that point onwards, driven and guided by the fact he suffered his own personal loss to dementia through the passing of his grandmother, he set about rigorously raising the $4 million required in funding to put the test to trial, in order to achieve the relevant medical certification.
The ICA software was approved as a CE-marked medical device, allowing for its deployment across Europe just over a year ago. Now, in the UK, Cognetivity has partnered with North Staffordshire Combined Healthcare NHS Trust – one of only two Centres of Excellence for mental health in the country to use the technology in their memory clinics – as well as Sunderland GP Alliance, a leading federation of 35 primary care practices in the north-east of England. Overall, these partnerships cover almost 750,000 patients, many of whom are 65 or over.
Habibi is clearly excited by the potential of the partnerships in terms of helping the team prove they can help detect the disease at an earlier stage in patients and, from a more holistic perspective, he hopes it can spark a change in the culture of how clinicians think about the testing process.
“This is to triage and prioritise the patients that need to be seen,” he says. “The fact that the process starts with very crude tests is something that we can come in and change, and that’s where we’re going to be used in Staffordshire, sending people through the funnel that need to be seen before others.
“Ideally, we envisage a scenario where, in a few years’ time, we become a screening tool at primary care: as part of an annual checkup, everyone who is above a certain age and has a certain risk profile takes the test. And as soon as we pick up signals that show they might be at risk, they’re sent to secondary care, so we can look at a screening programme where people are discovered at very, very early stages.
“I think we will see, as a result of what has happened, a huge paradigm shift in behaviour of clinicians. We were showing our technology to the physicians: they like it, they say it works well. But you’re dealing with people who are very risk-averse and they don’t want to have any change.
“However, as a result of what happened [through COVID-19] and closure of the clinics and the fact that you don’t want to bring patients to clinics unless you absolutely have to, then the whole appetite to use our technology increased significantly.”
Screening, though, is only one part of the battle against the disease.
The fight against Alzheimer’s received a huge boost when in October 2019, US biotech giant Biogen and Tokyo-based Eisai announced plans to pursue regulatory approval for their drug Aducanumab. In a subset of patients who received a high enough dose of the drug, it has been shown to provide significant benefits, which could be a hugely important step towards the cure for the condition.
The decision by the FDA (United States Food and Drug Administration) on the drug application was expected on March 7 this year, but is now delayed until June 7, but Habibi remains hopeful and knows that Cognetivity is ideally placed for exponential growth should a cure hit the market.
“They have managed, for the first time in the history, to slow and stop the disease and this is going to play a hugely important role, because this drug has been shown that it is effective in helping and stopping patients with mild cognitive impairment [MCI], versus mild and severe AD. So, they will be looking at MCI patients, because that’s where the drug is effective and we are very much capable to detect that stage of the disease, so it’s a perfect alignment.
“Now, we need to build the evidence, both clinical and health economics evidence, for both clinicians and also policymakers – who look at the whole problem, both clinically and economically – and make the case that, if we do this, we will save the patient’s life or improve the patient’s outcome, and also, in the process, save a lot of money for the NHS.”
Cognetivity is also continuously working to ensure that their solution can be applied in as many different contexts as possible, by ensuring it can be integrated directly into existing hospital systems. The company is also trialling smartphone-based remote cognitive assessment and exploring options to make the tech accessible for as many people as possible in these challenging times.
It is also working on utilising the technology to screen for other diseases such as HIV and multiple sclerosis as well as mental health conditions such as depression, all with positive early results.
Habibi is excited about the potential of adapting and scaling the technology to provide a range of solutions which can make a difference in the world.
“We are a small but innovative company,” he says. “We continue innovating in order to get this technology out to as many people as possible, because we believe it’s a game changer and it can play a significant role in mental health. COVID was initially something that shut down everything. But as a result, we ended up building our remote capabilities.
“The fact that our technology is a platform technology, it enables us to build new solutions around the core. This is going to be a sector which is going through a lot of disruption in the next decade, so there’s a lot of change coming and we are ready to adapt and innovate so that we continue scaling up and reaching out to more people.”
