The world’s population is ageing rapidly, with the projected number of people over the age of 60 expected to more than double from 605 million to 2 billion between 2000 and 2050.
At the same time we are witnessing an unprecedented growth in instances of mental illness, most commonly dementia and depression, affecting older people as the risk of developing these diseases increases significantly with age. In this demographic every additional five years of age sees the percentage of people with dementia nearly double, affecting 5% of those individuals over 65 and 20% of those over 80.
To compound this challenge, one in five elderly people living independently and two in five living in care homes suffer from depression, often as a side effect of other age-related diseases including dementia or their increased social isolation. Research suggests that in the UK over half (51%) of all people over 75 live alone and 5 million elderly people report that TV is their main form of company.
These illnesses not only undermine the independence and confidence of those suffering themselves, they also place a great emotional strain on their family, friends and the communities in which they live.
Age-related mental ill health is a complex and multi-faceted problem with a significant impact on all parts of society, including the economy. The costs associated with dementia are far higher than all other mental health disorders combined, with estimates suggesting that by 2026 dementia will make up 73% of all mental health service costs.
Hopes to find a cure for this global epidemic have overwhelmingly been pinned on the pharmaceutical industry. But so far the sector has been unable to deliver, plagued by unsuccessful trials – the failure of Dimebon infamously cost US pharmaceutical giant Pfizer $750m – and the drying up of research funding. According to NeuroPerspective, the number of drugs for nervous system disorders being developed by pharmaceutical companies has fallen by 50% to 129 in the last 5 years.
In the UK alone, dementia research receives 13 times less funding than cancer, with only 8p spent on researching new treatments for each £10 spent looking after those affected.
Even where drugs have been effective in mental illnesses such as depression, they only work in a proportion of patients and do not alleviate all of the symptoms. Drug treatments for depression have side effects, which often exacerbate the condition, especially in the elderly.
Governments across the globe have recognized the severity of the issue and have taken steps in an attempt to tackle the problem. Only last year, the UK Government pledged £90 million to improve dementia diagnostics and care, and launched a partnership with Health Education England to ensure that 100,000 members of NHS staff are specifically trained in treatment of dementia. This represents investment in costly and time intensive work and unfortunately many of the problems will persist as the implemented initiatives are not getting the desired traction.
The growing severity of these problems has meant that the global community has started turning its attention to technology for its promise to provide new and innovative solutions to what many see as intractable problems.
In the UK, having launched the Innovative Medicines and MedTech review in 2014 with the aim of discovering how NHS patients can be given quicker access to new medicines and technology, the NHS has adopted online health products such as the Big White Wall, a social media platform for those with mental health issues.
Technology is also a very important tool in our arsenal to help meet the demands of an ageing population. Innovations such as Visbuzz, an application that allows the elderly to make and receive video calls easily, can help reduce loneliness amongst retired older adults whilst boosting their self-confidence. A study in Journals of Gerontology found that Internet use among this demographic reduces the probability of depression by 33%.
Furthermore, products such as 3rings, a plug accessory which sends family members notifications to let them know their elderly loved ones are all right, allows those in the early stages of dementia to retain their independence as long as possible.
Two approaches in medtech, cognitive assessments and training, deserve particular attention for their potential to help people with or at risk of developing dementia and depression in old age to diagnose, treat and prevent these conditions.
Cognition is synonymous with the way our mind operates. It is the ability to plan and organize, solve problems, recall events and people, focus attention with speed and accuracy. A healthy, balanced cognition enables people to carry out their daily functions and perform to the best of their abilities.
All humans experience a certain amount of cognitive decline as a normal part of the ageing process. Cognitive deterioration is however, far more pronounced in individuals suffering from dementia.
Dementia patients often experience a sharp decline in a wide range of cognitive functions, most noticeably those in working memory (problem solving) and attention (concentration), to the point where they struggle to live independently.
For those suffering from depression, cognitive symptoms – including lowered psychomotor speed and executive function, which may translate into lethargy and indecisiveness – are prominent and their existence could indicate that a patient is suffering from the disease.
In a study of 267 depressed patients, poor cognitive symptoms were present 94% of the time during major depressive episodes. Improving a patient’s cognition should therefore be a key aim of any treatment process.
So how can cognitive assessments and training help?
Cognitive assessment can provide a detailed picture of the health of an individual’s cognition, and help detect the changes in cognition that may signal the early stages of mental decline. MyCognition’s MyCQ (MyCognition Quotient) is a cognitive assessment tool, which empowers individuals to screen for cognitive health issues in a quick and user-friendly way.
Healthcare professionals are already picking up on the idea that cognitive assessments are an important tool in our arsenal when screening for mental illnesses. Earlier this month in the US the FDA approved Cognivue, a cognitive assessment tool which picks up those early signs of cognitive decline that could indicate dementia. This method of screening frees up valuable GP time as it is self-administered.
Cognitive training is based on the theory of neuroplasticity; the idea that our brain is not a static organ and that we can improve our cognition at any age. Just as we can develop and improve our bodies through physical exercise, we can also develop and improve our mental wellness by exercising our minds.
While research is still trying to keep up with developments in this area, there are a number of scientific studies that demonstrate clear benefits to cognitive training. For example, a recent study in The Lancet, featuring a randomized controlled trial of brain training in a group of 1,260 people at risk of dementia, aged from 60 to 77, suggested that brain training can play a central role in preventing cognitive decline and improving mental faculties.
In elderly patients with depression, cognitive training games have even been shown to relieve depression in cases where antidepressants were ineffective. A 2014 study in Nature Communications introduced brain-training to a group of over 60 year olds who were not responding to antidepressants. Eight out of ten of these patients showed significant improvements in their symptoms when prescribed computer exercises were added to their treatment.
Neuroracer is another good example of a cognitive training game, tailored to specific cognitive deficits, which has been shown to improve memory, focus and multitasking ability in elderly players, with results translating into everyday life and still evident after six months.
Though it may seem obvious, it is worth mentioning that the sooner people start cognitive training the better as our brain relies on repetition and reinforcement for the growth which bolsters our cognition.
Screening for dementia with cognitive assessment tools, whilst useful at any age especially when screening for depression, is most effective before 65 after which point the risk of developing dementia increases significantly.
Clearly, whilst more research and trials investigating the benefits of cognitive training and assessment are needed, these two interventions are already showing great promise, not only in picking up on cognitive health issues which might be early indicators of dementia and depression, but also in improving cognitive function and keeping mental illness at bay.