What if your phone can help predict the early signs of Alzheimer’s?

Dr. Rhoda Au, a neuropsychologist at Boston University, can assess your brain health and if you have early signs of Alzheimer’s; all she needs is your smartphone. The future of healthcare, she says, is literally in our hands.

According to the Alzheimer’s Association, in the US alone, 5 million people currently suffer from Alzheimer’s, the degenerative brain disease that causes dementia. As the sixth-leading cause of death, Alzheimer’s kills more people than breast cancer and prostate cancer combined, making Dr. Rhoda Au’s effort to better understand the disease more important than ever.

With more than 83% of the US population owning a smartphone, Rhoda sees its potential in personal, predictive healthcare. Imagine each of us having our own health monitoring system quietly running in the background, alerting us when our behaviors point to possible health risks.

Ding! You’re not sleeping as much as you used to.

Buzz! You’re exercising less frequently.

Chirp! You seem to be taking longer to accomplish simple tasks.

It’s the automated equivalent of, “Maybe you should get that checked out,” a vision of a new era for healthcare where we as individuals have more control.

Early detection of diseases like Alzheimer’s can result in higher quality of life, less stress for the family and an opportunity to plan for the future. Some symptoms may even be reversible or treatable. Early detection can also qualify you for clinical trials that advance research and help the world learn more about the disease.

Through a combination of what she calls active testing and passive engagement monitoring tools installed on a smartphone, Rhoda bypasses and improves upon the old—and often biased—methods of testing patients in a lab.

Your smartphone is the new laboratory

Historically, for doctors to gather meaningful information about an individual’s brain health—such as symptoms of Alzheimer’s or Parkinson’s disease—patients would need to visit a lab and undergo numerous in-person tests over a series of months.

“We used to have people sit for hours at a time with paper and pencil,” says Rhoda. “We’d have you look at a picture and describe it. ‘What do you see?’ And then we’d take that voice information and we’d analyze it. We’d look at the words you chose, how many words you chose, how redundant those words were, how many pauses, hesitations, fragments. Doing this took a long time and we were missing a lot of information, like what about the pitch change in your voice?”

Neuroscientists have long known that these active engagement tests are flawed. “They’re not an accurate way of measuring people’s cognitive capabilities,” says Rhoda, “because our cognitive capabilities change all the time. If you’re tired that day, if you’re aggravated, if you’re sick, if someone walks in the door during the test, you don’t do as well.”

Personal bias comes into play in these tests, as well. “With the elderly, for instance,” she says, “did they hear you, can they see you, do they have physical limitations for writing? It can all affect how well someone does on that particular test at that particular time. I’m trying to get away from that. I want to go from this active engagement testing to passive engagement monitoring.”

This is where your smartphone comes in. Instead of inviting you into the lab, Rhoda’s going to ask that you download one or more apps on your phone, and give her permission to track your behaviors in the background. Then, she’s going to leave you alone for a while.

On your average smartphone, there are around 30 sensors that constantly measure and respond to things like your location, acceleration, tilt, light, tapping and pressure. For Rhoda, these measurement tools—and the data they capture—are the secret to detecting early signs of Alzheimer’s. “I am working with data scientists to find ways to accurately interpret this data,” she says, “and determine when someone is starting to have memory problems, without giving them a memory test.”

Finding technologies in far-flung fields

Rhoda doesn’t develop the technology, she finds it. Far from her lab at Boston University, in other industries, she sees how technology is being used, envisions its use in her field and then applies it in new ways.

One of her favorite technologies is a passive engagement monitoring app that was originally developed by a security company through the Defense Advanced Research Projects Agency (DARPA), an arm of the US Department of Defense whose purpose is to develop military technologies.

“This is the part of the government that funds the most out-of-mind kind of research, pie-in-the-sky stuff,” says Rhoda. “This is where the internet came from. The purpose of commissioning this technology originally, I don’t know, and probably never will know.” But after the original commission runs its course, the companies that develop the technology often try to repurpose it for the commercial market in the hopes of finding alternate uses.

Rhoda proposes slight adjustments to the original app technology to better suit research needs for brain health monitoring. In this case, the app is designed to capture information from your phone’s multiple sensors and contextualize it. “So one set of signals means that you’re walking quickly,” says Rhoda, “whereas another set means you’re riding in a car. From looking at different ways in which you are moving, some signals can suggest you have a tremor, but another set suggests you’re going down a bumpy road.”

Having deployed the app to more than 2 million people, the company called Kryptowire has been able “to contextualize 99 behaviors with 81–100% accuracy,” says Rhoda. Everything from walking, eating, sleeping, running, jumping. “I can take that information and infer people’s cognitive capabilities, uncovering early signs of Alzheimer’s,” she says, “because everything we do, we do through our brain. We’re always reflecting our cognitive status.”

While the Kryptowire app called ThinkSense isn’t ready for the public yet, it’s headed there, quickly.

Rhoda is also tapping into other public-facing apps like Discovery by Mindstrong, which focuses more on capturing phone interaction behaviors, things like texting and scrolling, measuring your speed and pauses. Originally developed for mental health, Rhoda is applying it to cognitive health research.

Monitoring your behavior, drawing conclusions, all in the background

Here’s how Rhoda is using smartphone sensors to find early signs of Alzheimer’s:

• GPS: “Maybe you’re not going out as often or as far as you used to. You’re now socially isolating much more often.” She can also look at the diversity of your destinations. “When you do go out, where do you spend your time? Are you restricting yourself only to highly familiar areas?”

• Accelerometer: Rhoda can flag things like repeat or redundant behaviors. “Are we seeing some slowing in your behavior? Is there hesitation suddenly? Maybe we’re recording more falls or balance issues.” 

• Inactivity: Phones are great at monitoring sleep, says Rhoda. And sleep can be a key indicator of cognitive function. Sleeping longer lately? That could be a sign of depression. 

• Pressure: Then there’s the physical activity on your screen: behaviors like texting, scrolling and swiping. Rhoda is measuring that too. “Do you spend longer on a page; do you go back to that page often? Do you mistype?”

Rhoda compares these passive monitor findings with the results of an active memory test.

“For instance,” she says, “we know that people who score poorly on a memory test likely have poor cognitive health. So from there, we can look at their phone and see that their behavior patterns correlate highly with someone who has memory problems.” Overlaying the data from both methods helps Rhoda interpret and arrive at more detailed conclusions.

Mimic the clinic: Remote research on the rise

Rhoda’s passion for remote research is now converging with the growing trend of remote healthcare resulting from the COVID-19 pandemic. According to Rhoda, the largest hospital system in the Boston area grew their telehealth care from 3% to 85% seemingly overnight. The entire research industry is now reaching for ways to test without the ability to see subjects in the clinic. “Everybody’s converted to some sort of remote monitoring basis,” says Rhoda. “There’s now this rush to technology and the idea that this pandemic might not be the only time we face this situation.”

The convergence of tech and healthcare is evident in industry conferences too. For years, one of the biggest healthcare conferences in the country—JP Morgan Healthcare—and the largest tech conference—Consumer Electronics Show—were held in the same week. But in the last couple of years, the booming interest grew so much, the conferences changed their dates so that people could attend both.

The Dream: Personal, private health information in real time

Rhoda knows exactly what this means for the future of healthcare. She calls it the dream.

“The dream is we have this set of tools that monitor your brain health from birth,” she says, “because aging is what you do from conception to death, it’s not just what happens when you’re old. We want to optimize brain health across our entire lifespan.”

Here, in our phones, are the digital tools to help us do that. “We can monitor our sleep, diet, social activity, physical activity, the whole realm,” she says. And then, when the technology detects changes that are impacting our brain health, it can make recommendations. “‘Get some more sleep, change your diet, increase your physical activity,’ all things to get your brain health back to optimal level,” says Rhoda.

As new technologies like 5G and IoT become more widespread, remote patient monitoring devices could gather and transmit complex clinical data in real time. This could create a better link between doctor and patient, potentially decreasing medical costs and quickening both treatment and diagnosis. It’s a perfect convergence with Rhoda’s vision for the future.

The dream is preventative healthcare that equips every individual on the planet with personal health information in real time. According to Rhoda, it’s about “giving you feedback on a continuous basis so that you can then decide when things are not optimal for you. Then you can choose what you want to do with it. You can share the data with your clinician or your family members or you can keep it to yourself and do nothing if you really wanted to.”

“It’s sort of like me walking on a treadmill,” says Rhoda. “What are some things that I can implement into my everyday life that tips the balance of risk away from disease and toward health? Those little tweaks add up over time. So, it’s not me walking today, it’s the fact that I’m doing things on a continual basis. If I walk less today, I’ll eat a little less today. I really want that ice cream cone? All right, I’ll put in a couple more miles.”

It’s putting the power and control of healthcare into the hands of the individual. “We can take the control away from the physician or the researcher,” she says. “It is always better to give people more control over their lives.”

The smartphone as an instrument for public health

This shift from clinician-centered care is even more important when considering access to healthcare. “In the US, we have all sorts of healthcare limitations and gaps in access,” says Rhoda. “And that doesn’t even compare to what’s going on globally. The ratio of patients to trained doctors in other parts of the world is abysmal. So we can’t depend on the model that we have if we’re thinking about global health. We have to find solutions that put it in the hands of the people.

“For the average person, if they have that power of knowledge, they have the ability to help themselves. It’s just another form of education. Education is always about giving people the tools to help themselves.

“The smartphone is the most penetrating technology in the world. In the US, you have 83.3% of the population with a smartphone, of which—according to a 2019 study by AARP—77% of the elderly are using smartphones, up from 70% last year. Globally, 3.5 billion people are using a smartphone. In the next three years, it’s estimated to be 7.33 billion. That’s almost the entire population of the world. If you think about that, the smartphone becomes an extraordinary instrument for public health.”