Dementia 2.0 – article

By Dan Falk 

With young children and parents in their late 80s, Alex Mihailidis finds himself sandwiched between two generations who depend on him for care. 

“Managing all of that, together with my job here at the university, sometimes becomes very difficult,” says Mihailidis, a professor in the Temerty Faculty of Medicine’s Department of Occupational Science and Occupational Therapy, and an associate vice-president for international partnerships at the University of Toronto.

The number of people living with dementia is growing, and rapidly at that. Today, the condition affects almost 600,000 Canadians. By 2030, that figure will grow to almost 950,000, according to the Alzheimer Society of Canada.

Dementia — which the society defines as “a set of symptoms caused by specific disruptions to healthy brain functioning that reduce a person’s ability to perform everyday activities” — leads to attention difficulties, memory problems, behavioural and mood shifts, and other issues. 

It can cause people to forget when they ate their last meal, where they live and who their loved ones are. For Mihailidis, his family experiences have helped drive the overall goal of his research. He’s working with a team to create a system called COACH (Cognitive Orthosis for Assisting with aCtivities in the Home).

Developed at the Intelligent Assistive Technology and Systems Lab, COACH is a prototype of a “smart home system” that can help people with dementia perform everyday tasks with a greater degree of independence. It uses cameras and other sensors to track an individual as they go about activities around their home, and can provide verbal or visual reminders as needed. 

“Whether it’s washing their hands, brushing their teeth or making a meal, the system can provide the assistance and support that that person might need, just like a caregiver would,” says Mihailidis, who is also a professor at U of T’s Rehabilitation Sciences Institute and its Institute of Biomaterials and Biomedical Engineering, as well as the KITE Research Institute.

He says COACH’s goal is to allow older adults to spend more time at home and with their families, rather than in hospitals or care homes. COACH can also assist caregivers, many of whom may be experiencing stress and mental health challenges as a result of their responsibilities. 

Mihailidis mentions a colleague who installed an electronic medication device in his mother’s house, which lets him know that she has taken her medication. “He used to call her and start by saying, ‘Mom, have you taken your pills?’ Now he can start by saying, ‘Hey Mom, how’s your morning going?’ So instead of talking to her like a patient, he can talk to her like she’s his mom again,” he says.

COACH is still being tested, but Mihailidis has high hopes for the project. His ambition is to create a more advanced version of COACH that employs social robots that can speak, play a video, use gestures and make eye contact with the user. “That’s the latest version of the project that we’re testing,” he says. “We hope one day they will be able to play a role in the lives of older adults so they can remain at home, and stay healthy and well. That’s my ultimate goal.”

Other U of T researchers are also working to leverage technology to address issues related to memory disorders, such as dementia and Alzheimer’s disease. For geriatric psychiatrist Andrea Iaboni (MD ’06, PGME ’13), the focus is on wearable technology — such as a wrist device that a patient would wear to collect health data in real time.

“People with dementia can exhibit neuropsychiatric symptoms, and what we call ‘responsive behaviour,’” explains Iaboni, an associate professor in Temerty Medicine’s Department of Psychiatry and a senior scientist at the Toronto Rehabilitation Institute (TRI). “These are behaviours that are in response to some need or some trigger in the environment. And that can put people with dementia, and others, at risk.”

To track these potentially harm-causing behaviours, Iaboni and her colleagues at TRI’s specialized dementia unit are developing a device that tracks such variables as movement, heart rate and body temperature. Data from the device can be used to develop a profile of a person with dementia, which can then be used to improve their care. 

Iaboni believes that there’s a lot of data in health care that scientists have yet to take advantage of. “There are cameras in health care all over the place — in hospitals, in the common areas of nursing homes,” she says. “But a lot of these cameras just feed video to a monitor, and that’s it. The data never gets used.” 

Technology can play a crucial role in detecting diseases such as Alzheimer’s, says Sharon Cohen (DSP ’79, MD ’86, PGME ’91), the medical director of the Toronto Memory Program. Cohen has been working with the medical imaging company RetiSpec that has developed a retinal scan that can detect the signature of amyloid in the retina. Amyloid is a toxic protein that accumulates in the brain in Alzheimer’s and is present in the earliest stages of the disease. 

For the patient, the scan is similar to an ordinary eye exam, except that the system uses a camera that records light from a broad swath of the electromagnetic spectrum and uses AI to analyze the resulting data, says Cohen. At present, Alzheimer’s is typically diagnosed via positron emission tomography (PET) scans or a spinal tap. Even though there’s no cure for Alzheimer’s, early diagnosis is still valuable, she says. 

“Knowing what one’s dealing with and being able to plan ahead is helpful for both patient and family,” says Cohen. New technologies are continuing to be developed globally to help manage dementia care, agrees Sinjan Ghosh (PGME ’23), who is based at Fortis Hospital in Kolkata, India, and recently completed a clinical fellowship in behavioural neurology at Baycrest. While in Toronto, Ghosh worked with Morris Freedman, a neurology professor at Temerty Medicine and the medical director of Baycrest Health Sciences’ Pamela & Paul Austin Centre for Neurology and Behavioural Support. They treated patients with varying degrees of dementia, including those with behavioural issues like agitation and aggression.

Ghosh says AI tools are being created to read emotions and alert a physician if the patient shows symptoms of a mood change, such as depression, Ghosh says. Even so, he sees these technologies as aiding physicians and caregivers, not replacing them. “AI is not going to replace human beings,” Ghosh says. “But, a physician or a scientist who is proficient and has a sound knowledge of AI is going to replace someone who doesn’t have that knowledge.”

When it comes to improving dementia care, for Mihailidis, the matter is pressing. “As our population ages, we will need to implement better resources to care for people with dementia. They deserve it, and we must start to deliver,” says Mihailidis. •