Researchers in several countries are beginning to explore new uses for digital technology in treating Alzheimer's and other forms of dementia and the University of Toronto is playing an important part.
Devices resulting from this line of inquiry are sometimes known as "cognitive prosthetics," a name intended to communicate their true ability: not rehabilitation, merely assistance. Dementias, including Alzheimer's, remain incurable.
Eight years ago, Dr. Ronald Baecker initiated cognitive prosthetics research at the University of Toronto's Knowledge Media Design Institute (KMDI), of which he is the founder and, currently, the interim director.
At KMDI's offices on St. George Street, Masashi Crete-Nishihata, a research assistant, shows off a cognitive prosthetic. It's a palm-sized, square, black object with an optical lens on the front. Next to the lens, there was a grey, bulbous protrusion, the size of half a grape. A loop of string had been attached to the top of the object's plastic casing.
It's a SenseCam, a Microsoft prototype with which Mr. Crete-Nishihata and his colleagues at KMDI, under Dr. Baecker and in collaboration with the Sunnybrook Health Sciences Centre, have been experimenting. SenseCam consists of a light sensor, an infrared sensor (the grape), temperature sensors, an accelerometer, and, naturally, a low-resolution digital camera with a wide-angle lens.
SenseCam, designed to be worn around a patient's neck during outings, co-ordinates input from all of its "senses" to snap a continuous stream of legible (if not exactly beautiful) photos. Microsoft hopes, and researchers at KMDI hope to prove, that SenseCam images and sense data can be used to jog the memories of patients suffering from different kinds of cognitive impairment, including Alzheimer's.
Though SenseCam is Microsoft's alone, Intel and IBM have also explored forms of cognitive aids.
There is a certain sense of urgency to this research. Alzheimer's and other dementias are debilitating, and are poised to become much more prevalent in coming years.
The United Nations' latest projections show that the world's population of individuals over sixty will nearly triple over the next four decades, from approximately 759 million at present, to over two billion in 2050. This increase will occur faster than overall population growth, owing to a near-universal decrease in fertility, coupled with a near-universal increase in life expectancy.
Since risk for dementias increases with age, an older world populace means, inevitably, more diagnoses. The Alzheimer Society of Canada expects, twenty-five years from now, that there will be at least one million cases of Alzheimer's disease in Canada alone - up from 500,000 today.
There will be a concomitant increase in the need for elder care, only some of which will be provided by health care professionals. A report by Statistics Canada says that in 2007, approximately 2.7 million Canadians aged forty-five or older provided some kind of care to a senior who was a friend or close family member. These caregivers shoulder the emotional and logistical burdens of attending to the needs of loved ones, who in some cases no longer have the wherewithal to express gratitude.
It is this breakdown in communication between patient and caregiver that cognitive prosthetics have so far shown themselves to be most effective at remediating.
Michael Massimi, a PhD candidate in computer science and a researcher at KMDI, adapted a touch-screen computer about the size of a picture frame for use as a cognitive prosthetic while working for a summer at Microsoft Research in Cambridge, England. The device was installed in the home of an Alzheimer's patient. Using a piece of software authored by Mr. Massimi, the frame would cycle through SenseCam images captured during an outing with the patient, of which there were hundreds.
Researchers encouraged the patient to tap the screen whenever an interesting image appeared. The patient's caregivers also interacted with the device.
Researchers loaded the pictures that were "tapped" onto another touch-screen computer, which ran another program of Mr. Massimi's own making, called "Biography Theatre." The touch-screen, displaying Biography Theatre, was installed on the patient's kitchen table, where it continually looped the selected SenseCam images, along with family photographs and other biographical materials, in a kind of ambient display, along with music and narration.
Researchers hoped that since the patient had helped to select the images for inclusion, that the resulting display would improve his memory of the depicted people and events.
It didn't, but psychological evaluations after the trial indicated that the device had contributed to a general improvement in the patient's mood and sense of self. Most importantly, it had provided a focus for conversation between the patient and his daughters, who had been caring for him.
"It really faded into the background, and provided a sense of comfort," said Mr. Massimi.