An iPad-based game is pointing the way to the future of digital medicine.
Video games are often dismissed as mindless child’s play, but for some adults they might just lead to a life-changing diagnosis.
Some five million Americans are living with Alzheimer’s disease, a condition typically detected when memory issues start to interfere with daily tasks. But scientists now believe it may be possible to spot the disease 20 years before the first clinical symptoms arise. And some think video games may hold a key to making that possible.
"Scientists feel there are other aspects of cognition, beyond memory, that may be affected by Alzheimer’s, but are not so obvious," said Claire Leurent, Director of Clinical Neuroscience Research at Pfizer in Kendall Square, Cambridge. “We’re interested in the potential for developing — or co-developing — a new tool that would detect signals, or cognitive changes, that might just fly under the radar in normal life.”
Since 2014, Pfizer has been studying this issue in collaboration with Akili Interactive Labs, a maker of a medical device platform that provides cognitive therapeutics, assessments, and diagnostics in the form of action video games. Founded by leading neuroscientists, health technologists, and entertainment software creators, the company's first platform, Project: EVO, is designed to measure and improve the capacity of individuals to handle cognitive interference (including distractions and interruptions), which can impact their ability to pay attention.
Multitasking Benefits of Gaming
Akili’s underlying technology, which was developed in the research lab of Dr. Adam Gazzaley at the University of California, San Francisco, first grabbed the interest of the scientific world when it graced the cover of the journal Nature in September 2013. In the article, Dr. Gazzeley and his colleagues demonstrated how a game they developed, called NeuroRacer, could help older people improve their ability to multitask in real life.
Since then, Akili, which was co-founded by Dr. Gazzeley, has been working with a range of partners to build clinically validated, FDA-approved digital products that could help patients with ADHD, autism, Alzheimer’s disease, depression, and other neurological conditions.
“The science is based on activating the interference processing system in the brain, or the brain’s ability to constantly monitor and filter incoming information in real time,” said Eddie Martucci, CEO of Akili. “Our platform directly targets that system functionally, pushing it to its breaking point and, over time, strengthening it.”
As the participants play the driving-like game, which is set in a constantly changing environment that is “pseudo-real, pseudo-alien,” Martucci said, its algorithms work to adjust the complexity to each user’s skill level. In addition to navigating the dynamic landscape, users are increasingly tasked with reacting to the environment, identifying objects and making incrementally more difficult decisions.
For Pfizer, Leurent explained, Akili’s data-driven approach and clear focus on a specific area of cognition made the game maker an ideal partner for Alzheimer’s research.
“They’re very focused on monitoring and training a very specific area of cognition, which is divided attention … and that’s the hypothesis we’re testing. We’re looking at whether there is a correlation between some factors of Alzheimer’s risk and difficulties with multitasking,” she said.
Beyond the Doctor’s Office
Together, the two companies are conducting a study of 97 healthy adults over the age of 60. Some participants show no biomarkers for Alzheimer’s disease, while others have tested positive for the presence of amyloid (a potential early indicator of Alzheimer’s) on Positron Emission Tomography (PET) scans.
As the participants play Akili’s iPad-based game over a 28-day period, the scientists monitor the data remotely to determine how well the different groups are able to multitask and how their abilities improve. The initial goal is to assess whether the game could serve as a diagnostic alternative to more expensive and less accessible tests.
“You can imagine that a video game can be done in any place. It doesn’t have to be with a doctor,” said Leurent, adding that another key benefit is that the technology also engages people in an enjoyable, non-intimidating way.
Following Data to Additional Applications
By the end of the year, the companies expect to be able to release the results of their study. From there, depending on what the data shows, they’ll begin to determine whether the game can be used as a tool for diagnosis, monitoring, potential therapy, or all of the above.
While the immediate results would inform products for Alzheimer’s disease, the implications could extend to other cognitive areas — and beyond.
In a 10-year time horizon, Martucci said, he believes the field of digital medicine will evolve to a point where doctors prescribe software-based diagnostics and treatments for a wide range of conditions.
“The definition of medicine is evolving,” he said. “Many hundreds of years ago, medicine was not defined as a pill. It was defined as care for patients that changed and improved life. Today, we are reincorporating that approach into the ways we advance modern medicine.”