New tasks to assess flexibility and planning skills

Katrina Dick is an Alzheimer’s Society PhD student at the Dementia Research Centre, UCL Institute of Neurology. She is the co-ordinator for an international study of frontotemporal dementia, and is developing new tasks to assess flexibility and planning skills.

I have studied and worked in the field of dementia for the past four years, first becoming interested in dementia while studying undergraduate psychology and working as an assistant psychologist. During this time, I administered widely used tests of memory and thinking skills to people with different diagnoses of dementia. 

I now co-ordinate an international research project called GENFI – the Genetic Frontotemporal Dementia Initiative – looking at the rare genetic mutations that cause genetic frontotemporal dementia (FTD). 

FTD is the second most common form of dementia in people aged under 65, and often causes problems with behaviour, planning and language skills. For many people with FTD the cause is not known, but around a third of people develop FTD due to a specificgenetic problem.

We recruit participants who already have symptoms of FTD and also those who are likely to develop the disease. In genetic FTD, the risk of developing the disease is 50 per cent if your parent carries a problem mutation. 

Our project is particularly exciting, as we know what is causing dementia in this group of people and can explore ways to prevent symptoms developing or stop them getting worse. 

Using advanced brain scans, studies have revealed changes in the brain of at-risk participants up to 25 years before any obvious symptoms develop. This suggests the disease process starts many years earlier than expected and the ideal time to treat people is likely to be when the disease is in its earliest stages.

At present, traditional tasks, such as recalling lists of words or naming pictures, are almost always performed at a research centre by a trained psychologist. These assessments are not sensitive enough to detect early changes. There is therefore a need for new tasks to detect earlier cognitive changes in people with genetic FTD. This will require a new set of assessments performed in new ways. 

With the support of Alzheimer’s Society, my research is leading us to create assessments to reflect the subtle changes in the brain that we know exist years before symptoms develop.

These will be administered using a tablet computer, such as an iPad, so they can be performed at home without a psychologist present. They will also be more demanding than standard tasks in order to detect very subtle changes. The tasks will be short at 60–90 seconds each, and designed like enjoyable games to make them more stimulating.

Existing assessments often lack tasks that can pick up early FTD symptoms, which can be quite different to those of Alzheimer’s disease. Ours will include tasks relevant to FTD, such as flexibility of thinking, speed of processing and recognition of emotion.

The lack of detailed information about the earliest changes that occur in FTD is a major hurdle in the development of clinical drug trials. I am hopeful that the results of my research will be valuable in trials, to establish when treatments should be given and whether they are working. If such trials were to be successful, this may mean that the onset of symptoms could be delayed or even prevented.