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Complex brain disorders such as dementia and epilepsy as well as sleep disorders are lifelong conditions that interfere with memory, thinking, mood, independence and quality of life. They frequently coincide, and share overlapping disruptions to brain rhythms and structure.
“Because they have common, intertwined biological and social causes and often appear in combination rather than in isolation, these disorders are challenging to accurately diagnose and treat,” explains Christos Ntanos, research director at the National Technical University of Athens.
The MES-CoBraD project grew out of an idea that Ntanos developed with neurologists Elissaios Karageorgiou from the Neurological Institute of Athens (NIA) and Ioannis Stavropoulos from King’s College London, to use emerging technologies and big data to help clinicians better diagnose and manage complex brain disorders.
Simple, rapid diagnoses
Mild cognitive impairment (MCI) is defined as the stage between normal ageing and dementia where people experience noticeable declines in memory or thinking, such as frequent forgetfulness or trouble finding words, but can still manage daily activities independently.
“A short, self-completed questionnaire that we developed based on pre-existing knowledge proved capable of reliably flagging those most likely to have significant cognitive problems as well as which domains of thinking will be most affected,” says Ntanos. The questionnaire matched specialist clinical assessment with 90 to 95 % accuracy.
The project developed a patient assessment protocol that brings together data from a wide range of sources, including sleep studies, electroencephalograms, MRIs and bio-samples, as well as wearable devices such as smartwatches.
An advanced research platform
The project also built an advanced and secure research platform where neuroscientists can collect real-world data, perform analyses, build diagnostic and treatment workflows, and test hypotheses.
“This platform helps researchers propose and test new methods for diagnosing and treating complex brain disorders,” notes Ntanos. “In the future, it will also allow clinicians to directly use these methods to diagnose and treat their patients.”
Researchers can also use the platform to train and apply artificial intelligence (AI). MES-CoBraD was one of the first EU-funded projects to pivot part of its research towards AI ethics and produce concrete guidance on implementing ethical AI in healthcare, as well as recommendations for reducing bias in AI-enabled care.
New insights into neurology
Using the collected data and the innovative MES-CoBraD platform, researchers have already delivered new insights into neurology – including the big impact sleep can have.
“Our data shows that poor and fragmented sleep is linked to poorer memory and lower performance of the executive function,” remarks Ntanos.
NIA researchers combined the MES-CoBraD diagnostic protocol with a therapeutic protocol for a trial comparing the therapeutic benefit of cognitive behavioural therapy for insomnia (CBTi) with sleep hygiene recommendations for patients with MCI.
“Not only does CBTi resolve chronic insomnia, in more than half of patients this was achieved while tapering off the sedatives which they had been using for years and which are known to accelerate cognitive decline,” adds Ntanos.
The project also found that insufficient or disrupted sleep is associated with changes in blood tests tied to cardiovascular and metabolic risks. Furthermore, analysis on the dynamics of neurodegenerative biomarkers revealed that collecting plasma in the morning rather than the evening can impact the accuracy of an Alzheimer’s diagnosis.
Earlier interventions, fewer mistakes
The MES-CoBraD platform can help clinicians diagnose conditions such as Alzheimer’s, as well as identify what diagnostic data is lacking. Once clinicians have that information, they can discuss available next steps with the patient.
Ntanos concludes: “People with complex brain disorders are more prone to neuropsychiatric symptoms including sleep disorders, and by helping clinicians make accurate and early diagnoses, the MES-CoBraD platform allows for correct interventions earlier, and fewer mistakes due to wrong therapeutic choices later.”