AI tool improves diagnostic accuracy for dementia by 26%

Boston University researchers have developed an artificial intelligence tool designed to assist physicians in diagnosing the specific causes of cognitive decline. The findings were reported in Nature Medicine. While Alzheimer’s disease is the most recognized cause of dementia, it’s not the only one. The diagnostic challenge is compounded by the fact that multiple causes of dementia can occur simultaneously, making it difficult for physicians to arrive at a definitive diagnosis quickly. This delay often hampers timely intervention.

The researchers, led by Vijaya B. Kolachalama, PhD, an expert in using computational tools to aid in medical diagnoses, created an AI-driven platform capable of identifying up to 10 types of dementia, including vascular and frontotemporal dementia. This advanced tool integrates commonly collected patient data—such as medical history, medication use, demographic information, and scores from neurological and neuropsychological exams—with neuroimaging data like MRI scans. The AI then generates a prediction of the type of dementia a patient has, along with a confidence score, offering valuable insights to guide clinical decisions.

“Our goal is for AI to assist in identifying these disorders early, thereby enabling physicians to manage their patients more effectively and potentially prevent the diseases from worsening,” says Kolachalama, who serves as an associate professor of medicine and computer science at BU, in a statement.

The platform’s development represents a collaboration between BU researchers and external experts. Trained on data from over 50,000 individuals across nine global datasets, the AI tool has been rigorously tested, according to the researchers. In a study comparing neurologists working alone to those assisted by the AI, the tool improved diagnostic accuracy by 26%.

This AI tool is particularly valuable because it can function with limited data, which is crucial for health care providers in resource-constrained settings. Kolachalama said that in low-income regions, where MRI machines are less accessible, having a tool that can operate effectively with available clinical data is essential for expanding the reach of this technology.

Kolachalama also notes the increasing strain on health care systems due to a global shortage of neurology experts and a growing number of patients with neurological conditions. By enhancing diagnostic accuracy and efficiency, this AI tool has the potential to significantly alleviate the burden on physicians with limited time and resources.

Looking ahead, Kolachalama said he and his team are focused on bringing this AI platform into hospitals and clinics for real-world testing. The hope is that this technology will soon become an integral part of the diagnostic process, helping to improve outcomes for patients with dementia worldwide.

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Where a patient lives may be the biggest factor for a dementia diagnosis

A University of Michigan study found significant regional differences in the likelihood of receiving a dementia diagnosis in the United States, which could have profound implications for accessing new treatments for Alzheimer's disease and other forms of dementia. The research found that the percentage of people diagnosed with dementia each year varies widely across regions, with particularly stark differences for those aged 66 to 74 and individuals who are Black or Hispanic.

The study, published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association, suggests that where a person lives may play a more significant role in whether they receive a dementia diagnosis than individual risk factors. According to the findings, someone in one region of the U.S. could be twice as likely to be diagnosed with dementia as someone in another region.

Julie Bynum, M.D., a U-M Health geriatrician and lead author of the study, emphasized the need to address these disparities. "These findings go beyond demographic and population-level differences in risk and indicate that there are health system-level differences that could be targeted and remediated," said Bynum in a statement. She noted that the variation in diagnosis rates could be due to differences in health care practices, patient knowledge, and care-seeking behaviors.

The study analyzed data from 4.8 million Medicare beneficiaries aged 66 and older in 2019, focusing on "diagnostic intensity" across 306 hospital referral regions (HRRs). Researchers found that while nearly 7 million Americans currently have a dementia diagnosis, many more likely have symptoms but remain undiagnosed. Access to advanced dementia treatments, including new medications and diagnostic tests, requires a formal diagnosis.

The study found that the prevalence of diagnosed dementia ranged from 4% to 14% across HRRs, with new diagnoses in 2019 ranging from 1.7% to 5.4%. After adjusting for various factors, including education level, smoking rates, obesity, and diabetes, researchers calculated that people in low-intensity areas were 28% less likely to be diagnosed with dementia, while those in high-intensity areas were 36% more likely.

The concentration of dementia diagnoses was highest in the southern U.S., but this pattern shifted once researchers accounted for other risk factors. Bynum suggested that the variation could stem from differences in clinical practices, such as how frequently primary care physicians screen for dementia or the availability of specialists.

Bynum called for increased efforts to ensure early identification of cognitive issues, especially in younger Medicare populations. She also encouraged individuals to advocate for themselves to receive cognitive screenings, which are covered by Medicare during annual wellness visits.

Bynum highlighted Medicare's recent GUIDE model for dementia care as a potential avenue for improving care coordination and access. This new model incentivizes clinical practices to provide better dementia care and offer 24/7 access to trained providers.

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FDA approves new treatment for Alzheimer’s disease

Alzheimer’s disease currently affects more than 6.5 million Americans. The irreversible, progressive brain disorder slowly destroys memory, thinking skills, and overtime, the ability to carry out simple tasks. Even though the specific causes of the disease are not fully known, traits of Alzheimer’s are seen through changes in the brain, including amyloid beta plaques and neurofibrillary. These changes result in the loss of neurons and their connections, affecting a person’s ability to remember, think, and speak.

Recently, the US Food and Drug Administration approved Kisunla (donanemabazbt), an injection for the treatment of Alzheimer’s disease. The organization said the new treatment should be used in patients with mild cognitive impairment or at the mild dementia stage of the disease. Kisunla should also be administered as an intravenous infusion every four weeks.

The efficacy of the treatment was studied in a double-blind, placebo-controlled, parallel-group study in patients with Alzheimer’s disease. Before the start of the study, patients had confirmed presence of amyloid pathology and mild cognitive impairment or mild dementia stage of disease. The study population had a mean age of 73 years, with a range of 59 to 86 years. 57% of patients were female, 91% were White, 6% were Asian, 4% were Hispanic or Latino, and 2% were Black.

For the first three doses, 1,736 patients were randomized 1:1 to receive 700 mg of Kisunla every four weeks and then 1,400 mg every four weeks or placebo for a total of up to 72 weeks. The treatment was switched to placebo based at Weeks 24, 52, and 76 on a prespecified reduction in amyloid levels measured by positron emission tomography (PET).

Patients who were treated with Kisunla showed a significant reduction in clinical decline on the Integrated Alzheimer’s Disease Rating Scale (iADRS), the Alzheimer’s Disease Assessment Scale-Cognitive subscale (ADAS-Cog13), and the Alzheimer’s Disease Cooperative Study – instrumental Activities of Daily Living scale (ADCS-iADL), compared to placebo at Week 76. Patients with Kisunla also demonstrated a significant reduction in clinical decline on the Clinical Dementia Rating Scale, compared to placebo at Week 76.

While Kisunla has been approved, it’s safety information is important to note. When prescribed, the treatment comes with a boxed warning for amyloid-related imaging abnormalities (ARIA). ARIA presents itself as temporary swelling in areas of the brain, usually resolving over time. It also is accompanied by small spots of bleeding in or on the surface of the brain. Typically, ARIA does not have symptoms.

The most common side effects of Kisunla were ARIA and headache. The full prescribing information about Kisunla and its risks can be found here.

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New dementia cost model looks to lower financial toll for patients, families

Researchers from the University of Southern California (USC) are building a dementia cost model that will generate comprehensive national and annual estimates of the cost of dementia. With a five-year, $8.2 million federal grant from the National Institute of Aging, the new model could benefit patients and families by assisting families living with dementia by planning their budgets and support needs. It could also inform treatment and caregiving options, as well as shape health care policy.

Currently, the costs attributed with dementia drastically hurt families, draining their savings and causing caregivers to leave their jobs. In the US, the condition is an economic burden, with total health care and long-term care costs for individuals with Alzheimer’s or other dementias projecting to reach $360 billion this year. The Alzheimer Association even projects that this total will reach nearly $1 trillion by 2050.

Project advisor Maria Aranda, a professor at the USC Suzanne Dworak-Peck School of Social Work, said, “Other consequences may include caregivers’ lower retirement savings or limited ability to send their children to college. In turn, this leads to an intergenerational transmission of inequality and financial vulnerability for families of persons with dementia.”

The new model, known as a “dynamic microsimulation model,” will incorporate several data sets, including data from CMS. It will also account for costs across a range of disease stages, such as those acquired by the person living with dementia, their care partners and care givers, and their payers. Additionally, the model’s estimates will adjust for prevention and treatment innovations.

“Once you factor in the social costs of Alzheimer’s — how it affects family, caregivers and others — you quickly realize it is not just an illness but a social epidemic,” Dana Goldman, co-leader of the research team, said. “This project will help amplify the importance of finding treatments that forestall the devastation.”

USC Viterbi scientists will design an interface in the model, which will be available to the public and user-friendly. Researchers will be able to calculate numerous factors that affect dementia patients and their families, like the social and economic impact of drugs that treat the neuropsychiatric symptoms associated with advance dementia. This will keep patients out of hospitals and emergency rooms.

Interestingly, the tool may be able to measure cost savings provided by a new drug, Leqembi, delaying by two months the expense of 24-hour care.

Julie Zissimopoulous, a professor at the USC Price School of Public Policy and head leader of the project, said she and her research team want to know about the future implications of the drug, including its efficacy in patients overtime, particularly for 10 to 20 years.

“Leqembi is a great example,” Zissimopoulous said. “It’s a new FDA-approved treatment for early-stage Alzheimer’s; we have data from clinical trials that informs patients and the health care providers about safety and efficacy. But these data are not informative about the other outcomes patients and their families care about including quality of life impacts that may result from this slowing of cognitive decline. And we want to know about not just the 18 months of the clinical trial, but we want to know about them for 10 years, for 20 years.”

With this new infrastructure, researchers hope it’ll further understanding of dementia progression and how to delay its symptoms.

“Once you factor in the social costs of Alzheimer’s — how it affects family, caregivers and others — you quickly realize it is not just an illness but a social epidemic,” Goldman said. “This project will help amplify the importance of finding treatments that forestall the devastation.”

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