BOSTON — A simple, fast new test developed at Mass General Brigham can detect the earliest changes in daily functioning in people at risk of developing Alzheimer’s disease. This could potentially pave the way for a new way to detect and defend against dementia before it has a chance to take root in the mind. Researchers report that an older individual’s performance on the task, a brief test consisting of navigating a phone menu, displayed a connection to the hallmarks of Alzheimer’s disease pathology, such as amyloid and tau protein deposits in the brain.
“This test is a more objective assessment of an aspect of daily functioning as opposed to our typical way of using a questionnaire filled out by somebody who knows the individual well,” says Gad Marshall, M.D., the senior author on the paper and a neurologist and the Director of Clinical Trials at the Center for Alzheimer Research and Treatment at Brigham and Women’s Hospital, in a media release. “The implication is we may in fact detect a clinically meaningful change much earlier than we anticipate.”
To conduct this research, Marshall and co-authors, including Mass General Brigham investigators in the Departments of Neurology at Massachusetts General Hospital (MGH) and Brigham and Division of Geriatric Psychiatry at McLean Hospital, made use of the Harvard Automated Phone Task (APT).
This test entails three tasks an older person may encounter on a phone menu, such as refilling a prescription, calling a health insurance company to select a new primary care physician, and handling a bank transaction. The test was developed and validated at the Center for Alzheimer Research and Treatment at the Brigham and MGH and asks participants to navigate an interactive voice response system in order to complete assignments. The participants and their study partners, someone who knows them well, also completed other tests covering a variety of daily activities, as well as standard cognitive testing and brain scans revealing amyloid and tau pathology in different regions of the brain.
Just under a third of the participants who were clinically normal (without cognitive impairment) showed evidence of elevated amyloid and tau in their brains and had issues with the more challenging tasks of the phone test. This is important because most people who develop Alzheimer’s disease will start with short-term memory difficulties, word-finding difficulties, and issues with their sense of direction. They may also experience decreased motivation, depression, irritability, and anxiety.
Study authors admit the test only accounts for a small part of daily functioning that not everyone utilizes. Also, this study was somewhat limited by its lack of diversity among the people taking the test; 86 percent were White, and 97 percent were non-Hispanic. Future projects would help scientists determine if these results can be replicated across more representative study populations. It’s also possible that over a longer period, associations with difficulty completing the simpler tasks may emerge.
One of the study strengths was that most participants were able to complete the tasks on their own, outside of a clinical setting. Study authors conclude that assessing daily functioning in a more sensitive way, such as through the APT, may help identify Alzheimer’s disease before a patient actually develops more pronounced cognitive changes.
“Although these findings are preliminary, they signal that there is an association between an objective measurement of instrumental activities of daily living (i.e., the Harvard APT task) and the interaction of tau and amyloid in a sample of cognitively normal older adults,” concludes Chris Gonzalez, M.S., a first author on the study, former research assistant in the Department of Neurology at Brigham, and a fourth-year PhD student in clinical neuropsychology at Rosalind Franklin University of Medicine and Science.
“Having a task like the Harvard APT could better capture an individual’s overall ability to complete complex everyday tasks rather than the questionnaires that are given to patients and their informants to better understand the preclinical stages of Alzheimer’s disease.”
The study is published in the Journal of Alzheimer’s Disease.
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What was the age range of the test subjects?