Early Detection Technologies to Prevent Dementia

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It's estimated that every 3 seconds someone in the world develops dementia.

Doctors say the key is early detection, and particularly of something called MCI or mild cognitive impairment, which can be a precursor to dementia.

But identifying MCI can be incredibly challenging.

In today's program, we're going to focus on the latest Japanese technologies, which are aimed at detecting mild cognitive impairment.

In January 2023, the US Food and Drug Administration approved a new drug to treat Alzheimer's disease.

It was jointly developed by Japanese and US pharmaceutical firms.

Alzheimer's accounts for about 60 percent of dementia cases, according to Japan's health ministry.

Alzheimer's patients have abnormally high levels of a protein called amyloid beta in their brains.

These proteins clump together and form plaques, which lead to the death of nerve cells.

This is considered a cause of Alzheimer's disease.

The new drug has been shown to reduce amyloid beta levels.

However, it cannot regenerate neurons that have already been destroyed.

Therefore, it is important for people to start taking the drug in the stage of mild cognitive impairment, or MCI, which can be a precursor to dementia.

The difficulty remains that detecting MCI in time is a major challenge.

Dr. Imai, thank you so much for your time today.

Nice to meet you.

Imai Yukimichi has been treating and studying Alzheimer's disease for more than 40 years.

Now, a new drug is being developed.

What impact do you think it's going to have on treatment?

This drug targets the root cause of the disease.

It gives hope to those
suffering from Alzheimer's disease.

It's like a dream come true for them.

How early then, do you take it? What stage do you take it?

Amyloid β is a toxic protein.
The earlier it's removed, the better.

But it's hard to decide how early
the drug should be given to patients.

Imai says the drug should be given to patients in the stages before dementia.

This includes the MCI stage.

People with MCI can recognize
lapses in their memory.

They will notice if they
can't memorize new things, or if they can no longer recall
what happened a day earlier.

Those with MCI can describe their own symptoms.

An international team of British and other researchers says 40 percent of MCI patients develop dementia within five years.

To diagnose MCI, doctors analyze brain images taken with magnetic resonance imaging, or MRI.

They also administer the mini-mental state examination, a test to measure cognitive functions.

What is 100 minus 7?

93.

If you subtract 7 again?

86.

Doctors test memory, spatial perception, and other functions and analyze the results along with the brain scans to reach a diagnosis.

But Imai says it takes time because there is no clear benchmark for diagnosing MCI.

I conduct psychological tests
every 6 months to diagnose MCI.

The tests help me to see whether
a patient's cognitive function is worsening.

But diagnosing MCI is very difficult
for doctors in general.

To enable early detection, researchers in Japan are trying to develop technology that can identify MCI in a quick and easy way.

Mitsukura Yasue has been studying brain waves for over 20 years.

Brainwaves are patterns of neural activity occurring in the brain.

Mitsukura converted brainwaves into frequencies and analyzed them.

She discovered patterns that are characteristic of dementia and MCI.

Her research was published in an international journal in 2022.

I looked at all the frequencies
observed in the dementia patients, and I found a pattern that was common among them.

Mitsukura is on her way to a nursing home.

Carrying nothing but her handbag, she plans to measure the brainwaves of older people who have been diagnosed with dementia.

She visits many different places to gather brain wave data.

Thank you for your time today.
I will use this to measure your brain waves.

Mitsukura uses a simple brain wave-measuring device that she developed herself.

Let me put this on.

Sure.

The device weighs only 200 grams.

It's an interesting device.

Yes, it's the first in the world.

I see.

It's light and easy for older people to wear.

Brain waves are normally measured by attaching many electrodes to a person's scalp.

But Mitsukura's device has only two electrodes: one for the forehead and one for the earlobe.

Let's start measuring.
Please close your eyes and relax.

It's done.

Normally, it takes about 40 minutes to measure the brain waves.

But Mitsukura's device can finish the job in just 15 seconds.

The results are displayed on a tablet right after the examination.

The brain waves appear on the left, and their frequency equivalents are on the right.

When the device is used on a healthy person, it confirms that there is zero possibility of MCI.

If it detects a high likelihood of MCI, it suggests that the person seek medical attention.

Between 2016 and 2019, Mitsukura worked with many doctors to verify the validity of her device.

120 people took part in the study.

The results showed that her device was nearly 90 percent accurate at judging who was healthy, who had dementia, and who had MCI.

I believe that if people's conditions change,
so do their brainwaves.

Once dementia develops, it cannot be reversed.

I want to detect the early signs
to stop it before it develops.

This graph is a simplified representation of brain waves converted into frequencies.

The numbers indicate frequency bands from low to high, with 1 being the lowest and 8 the highest.

In healthy individuals, frequency bands 1, 2 and 8 predominated, while band 4 was least observed.

In people with dementia, frequency bands 1 and 8 appeared the most, while band 5 was the least generated.

In those with MCI, frequency bands 7 and 8 predominated, while bands 1 and 2 appeared the least.

In other words, it is possible to detect MCI by checking frequency patterns.

Caregivers have high hopes that the technology will enable early detection of dementia.

When people learn they have MCI,
they can take measures to prevent dementia.

I think caregivers will also come up with
new ideas and take action to help them.

Currently, most people start taking drugs
after being diagnosed with dementia.

But if early signs could be detected,
the progression to dementia could be slowed.

I think this will help improve patients' quality of life.

If places like gyms, cafes and hospitals
were to have the device freely available, people could measure their brain waves,
just like checking their blood pressure.

Anyone could use it anytime.

It's important to detect
deterioration in brain functions.

I think places like that would
be perfect for the device.

Other technology has also been developed to detect MCI early on.

This helmet-type device uses positron emission tomography, or PET.

PET visualizes the biochemical changes taking place in the body.

Standard PET scanners have a cylinder-like shape to capture images of the whole body.

They work by detecting the radioactive substance that is injected into the blood stream.

PET scanners are the only devices that can visualize amyloid beta, the protein that's one of the causes of dementia.

This PET scan image shows amyloid beta.

The redder the color, the larger the accumulation.

Yamaya Taiga has been conducting studies on PET at a national research organization.

He believes that by using PET to detect amyloid beta while people are still in the MCI stage, doctors can help slow the progress of the condition.

However, whole-body PET scanners are large and expensive.

It's not easy for hospitals to install more units.

PET scanners are mostly used for cancer.
There aren't enough for dementia patients.

I wanted a PET scanner especially for the brain
that's cheaper and high-performance.

Yamaya started developing a helmet-type PET scanner.

It involves a chair similar to a dentist's chair.

A helmet-like device is lowered around the head.

Standard PET scanners are cylindrical.
We made ours a hemisphere.

This reduced price and improved performance.

Yamaya managed to make the PET scanner compact by building one that focuses on the head.

He says that it takes up roughly only a quarter of the space occupied by a whole-body type.

He also succeeded in cutting costs by reducing the number of detectors to around a quarter.

Back in 2016, we introduced the scanner on this program.

It was a bulky, experimental helmet at the time.

But it was finally commercialized in 2022.

After successfully reducing its size, Yamaya set out to improve the resolution of its images.

These are the images that were captured by a whole-body scanner and the helmet-type scanner.

They show brain metabolism, with the red parts indicating high levels of activity.

The helmet-type PET scanner can generate sharper images showing more detail, with clearer outlines.

Yamaya was able to achieve better resolution by reducing the size of the PET device and shortening the distance between the affected areas and the detectors.

Clinicians who use images to diagnose patients are also feeling the necessity for PET scans.

Ishii Kenji has been researching diagnostic imaging for the brain for 30 years.

The accuracy of diagnoses based on
standard methods have been studied through pathological analyses on deceased patients' brains.

About 30% of Alzheimer's diagnoses
turned out to be inaccurate.

This research was conducted by the American Geriatrics Society and other groups.

They say postmortem pathological analyses show that roughly 30 percent of those who were diagnosed with Alzheimer's disease had received the wrong diagnosis.

Looking at the amount of amyloid β will help
to reduce the number of wrong diagnoses.

Currently, I think PET scans are the only way
to measure amyloid β in the brain.

MRI is often used to diagnose dementia.

These MRI images show changes in the brain of an Alzheimer's patient.

The part circled in orange handles memory.

It's called the hippocampus.

The patient's hippocampus is gradually shrinking as a result of the disease.

The size of the hippocampus varies from person to person.

Diseases other than Alzheimer's can also cause the hippocampus to shrink.

Doctors say this is why it's difficult and takes time to diagnose dementia using MRI.

With PET, a single scan is enough to judge whether the patient has Alzheimer's.

A healthy person's brain is mostly shown in green, indicating that there is little amyloid beta.

An Alzheimer's patient's brain has more red and yellow areas, meaning there are deposits of amyloid beta.

Just one scan is enough to know how much amyloid beta has accumulated in the brain.

This diagram depicts the relationship between the progression of dementia and the amount of amyloid beta.

It shows that amyloid beta starts accumulating before the appearance of symptoms such as memory impairment.

Alzheimer's is preceded by a
gradual accumulation of amyloid β.

This is said to start more than
20 years before symptoms appear.

PET scans make it possible to detect amyloid-beta accumulation much sooner than symptoms appear.

I believe that one day we'll have PET scanners
dedicated to detecting dementia.

We think that better machines
will lead to better drugs.

This is because pharmaceutical firms use
PET data to develop drugs to treat dementia.

For instance, they use PET to examine whether
their drug has reduced the amount of amyloid β.

A good PET scanner will improve data quality
and enable efficient development of drugs.

Imai provides advice on what to do if you're diagnosed with MCI.

Dementia is a disease.

More than 60% of people develop it
by the time they're 80 or 90 years old.

It's really a common disease.

It's a sign of aging, in a sense.

We must think harder about creating an
environment that's easy for patients to live in.

Imai describes four things that you should do if you are diagnosed with MCI.

One is to control your blood pressure and blood sugar levels.

It's important to make sure the blood is circulating well in the brain.

The second is to communicate, especially with people other than family members.

This will help to increase brain activity.

The third is to do what you love, whether it's drawing, dancing, or something else.

Could you tell us what you're doing
to prevent the disease?

These days, I'm into Ed Sheeran's songs.
I try to listen to his music and sing along.

Oh, so, finding something you love and passionate about.

It doesn't matter what it is, if you love it.

It's good to start things that
you can continue into your old age.

I want people to remember to
do things that they enjoy doing.

The last item on Imai's list is exercise.

He recommends what's called dual-task training.

This forces you to use your body and brain at the same time.

We'll show you some of the exercises that people with MCI do at this hospital to prevent the progression of their condition to dementia.

It's great to have you on the show.

Thank you.

What sort of effect or impact does this have?

Older people often have
problems processing information.

Doing something while thinking is said
to be effective in preventing dementia.

The first exercise uses a step platform.

Step up and down while clapping your hands
at multiples of 3, such as 3, 6 and 9.

Mathematics is involved? I'm terrible at math.

1, 2, 3...

As you count out loud from 1 to 30, clap your hands at multiples of 3.

Clapping along with the simple stepping movement makes your brain work harder.

1,2,3...

oops, 6,7,8...

11,12, no, I'm completely lost!

17.18.

No, I've completely lost it.

I was focusing on the pace!

29,30.

This one, I completely lost it halfway through because I think I was so focusing.

And am I speeding it up?

It's important to go through
trial and error and make adjustments.

So it doesn't matter if you make mistakes.

So what's next? I can see there's numbers again and a ladder.

Take steps in the order of the numbers.

Take steps in the order of the numbers displayed around the boxes.

Memorize the sequence and repeat the steps after the numbers disappear.

That was much easier.

So it's to get more complicated than this?

Next, repeat the exercise but clap your hands at numbers 3 and 6.

Then at number 8, say the name of a fruit.

1, 2, (clap), 4, 5, (clap), 7, apple.

1, 2, (clap), 4, 5, (clap), 7, pear.

It's not an easy exercise.

But making mistakes actually stimulates your brain.

1, 2...

Lemon.

2, 3, 4...

6, 7, 8...

Strawberry.

It's so complicated!

1, 2...

6... 8...

Pear.

This is really complicated too.

To prevent dementia, new stimuli are important.

You should use parts of the brain
that you don't usually use.

It's fun to do the exercises at home with others.

That's great because I made so many mistakes today.

So I think my brain is definitely being stimulated and activated.

So, you know, thank you so much.

Even if you're diagnosed with MCI, there is so much you can do to help reduce your chance of it progressing to dementia.

And it can be great to use this as an opportunity to make changes to your diet and lifestyle.

And it's clear that these groundbreaking technologies, along with the training programs that we introduced,

mean that patients can be incredibly hopeful about the future.