A three-minute test could play a role in diagnosing people at risk of developing dementia, spotting signs of cognitive decline years before other approaches, say researchers from the UK.
The Fastball test asks people to remember a stream of images viewed on a screen whilst wearing an electroencephalogram (EEG) headset, and analyses the brain’s ability to differentiate between images based on previous exposure.
The team from the Universities of Bath and Bristol – led by Bath cognitive neuroscientist Dr George Stothart – have carried out a small clinical study of Fastball that suggests it can reliably identify memory problems in people with mild cognitive impairment (MCI) that precedes Alzheimer’s.
The scientists have previously shown that it can spot memory problems in people with established dementia, but now – for the first time – have demonstrated that it can be administered in people’s homes, outside of a clinical environment.
Their study – published in the journal Brain Communications and funded by BRACE Dementia Research – enrolled 33 people with memory deficits, 20 people with deficits in other cognitive domains, and 54 people without cognitive deficits.
They found that subjects with amnestic MCI, which largely affects a person’s memory for objects, exhibited markedly reduced responses to the test compared with healthy adults and those with non-amnestic MCI.
As people with amnestic MCI are much more likely to go on to develop Alzheimer’s, the hope is that it could allow earlier intervention with an emerging generation of potentially disease-modifying drugs, such as Eisai/Biogen’s Leqembi (lecanemab) and Eli Lilly’s Kisunla (donanemab) – both targeting the amyloid plaques that characterise the disease.
“We’re missing the first 10 to 20 years of Alzheimer’s with current diagnostic tools,” said Stothart. “Fastball offers a way to change that – detecting memory decline far earlier and more objectively, using a quick and passive test.”
While acknowledging that much more testing will be needed before it can be used routinely in health settings, the authors of the paper said it has the potential to deliver wider screening and monitoring and could be scaled for use in GP surgeries, memory clinics, or at home.
Commenting on the results, Prof Vladimir Litvak of UCL Queen Square Institute of Neurology – who was not involved in the study – said that it represents an early step towards developing a clinically useful test, but it does not yet demonstrate such a tool.
“The study found a clear difference in EEG responses between patients with and without amnesia. However, the ability to classify individual patients using this effect, including estimates of error rates, was not assessed,” said Litvak.
“Furthermore, all patients tested were already symptomatic,” he added. ” A crucial next step would be a prospective study to determine whether this effect can predict an individual’s clinical trajectory and support patient stratification for treatment. This is yet to be done.”
Earlier this year, the FDA approved the first blood test to aid in diagnosing Alzheimer’s, with reports suggesting this has already led to an uptick in usage of anti-amyloid therapies.
Other experimental approaches to detecting individuals who may go on to develop this form of dementia include AI-powered eye examinations, virtual reality navigation assessments, tests based on smell, typing, handwriting, and driving patterns, and applying AI to the standard cognitive assessments carried out by doctors.
