Monday, September 3, 2012

CogNotes – Early Alzheimer’s Detection Approach

CogNotes can be summed up as “Alzheimer’s Disease assessment embedded in the creative act of music composition.” Together, with partners the Lincoln Park Performing Arts School and the Yamaha Corporation, a group of seniors are going through a multi-month composition workshop that’s outfitted with cognitive measures that are sensitive to the earliest transition to Alzheimer’s Disease.

Early Alzheimer’s Detection

There are two problems with Alzheimer’s Diagnosis, right now.
  • The education problem: As we get older, the brain changes.  There is healthy cognitive decline and something more.  It is difficult, especially in the early stages, to discern the difference.
  • The prognosis problem:  Even if you could identify the early stages of Alzheimer’s, how difficult would it be to accept?  I’ve heard older adults say things like, “I’d rather just die than know I had Alzheimer’s Disease.”  There is a general feeling of hopelessness that accompanies the disease making it exceptionally difficult for at-risk individuals to be proactive.

CogNotes tackles these problems by building cognitive assessment into the creative process.  Rather than waiting for patients to cross the chasm and self-select to get a check-up, researchers are proposing a simple, disease relevant, cognitive metrics embedded into the activities. Now Hyperscore, and incredibly powerful music composition technology, is outfitted with a companion to perform cognitive assessment as part of the creative process.

About CogNotes

This innovative program works by having the user compose a song and then play a Concentration-like memory game that takes place in a virtual living room and involves recalling excerpts of melody pairs and other associative memory tasks. CogNotes is actually a first cognitive diagnostic tool to perform daily assessments, or at least with enough frequency that an individual can flag initial signs of Alzheimer’s disease soon enough to start effective treatment.

The ability to self-identify the disease early is what the researchers say is ground breaking; the symptoms of Alzheimer’s disease—memory loss, forgetfulness, trouble finding the right words—are so similar to those associated with natural aging they often go unnoticed. “The common scenario is a family member brings someone for testing two years after symptoms have started and the disease is already so advanced it’s too late to do much about it,” says Adam Boulanger, CogNotes’ creator and a post doctoral associate at the MIT Media Lab.

CogNotes’ other advantage over conventional cognitive tests is that it tracks an individual over time, all the time. “Alzheimer’s disease affects people slowly, symptoms change and worsen, and can span decades. By offering people a diagnostic tool that is intellectually rewarding and creatively stimulating, it becomes something they want to do every day,” says Boulanger, who is a musician and composer. “Today they use droll pencil and paper tests developed in the ’50s that are conducted in one sitting.”

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About Hyperscore

Designed by Mary Farbood and Tod Machover during the Toy Symphony Project, Hyperscore is a graphical computer-assisted composition program intended to make composing music accessible to users without musical training as well as experienced musicians. The software maps complex musical concepts to intuitive visual representations. Color, shape, and texture are used to convey high-level musical features such as timbre, melodic contour, and harmonic tension.

One of the interesting things about music is that it touches on just about every aspect of human cognition. From memory to motor, emotion, planning, execution… music is everywhere in the brain. I imagined a version of Hyperscore where the discrete elements being used to compose become probes for cognitive performance. CogNotes takes musical snippets from the Hyperscore environment and uses them to engage memory in a way that targets the kind of memory that is at risk in the earliest phases of Alzheimer’s Disease.

The result has implications far beyond music.  The games we play, the mobile applications we use, the way we are social online – all of these technology enabled environments structure the way we engage with our environments and one another.  By examining those structures with an eye for research-based mechanisms of information manipulation, activity, perception, decision making, and behavior, probes for health metrics can be built into many activities of daily life.  Music is just such a great place to start because people love it.


Boulanger enlisted students and teachers from the Lincoln Park Performing Arts Charter School in Midland, Pennsylvania to mentor 18 subjects between 50 and 65. “They started by doing baseline memory tests,” recalls Russell. “We started with 100 and then counted backward by sevens. Then we were given a list of numbers verbally, then they’d talk to us for awhile and asked if we could repeat the numbers.”

Russell and her fellow subjects couldn’t view their results; they had to be blinded to the data for it to be valid. “While we were testing other aspects of reliability and accuracy, we found the data remained consistent even as the participants mastered the application and developed creatively,” says Boulanger. They also found musicians appeared to have no advantage. “We found it bizarrely counterintuitive. People scored equivalently no matter what their musical background. Now that we know the data is reliable, the next step is to give users visibility to their own information”. Exactly how that will be delivered is still in development. They’re plan is to use social media to facilitate communication between CogNotes users and their peers and doctors.

Within the year, Boulanger’s goal is to make CogNotes and other software available to the public via hospitals, doctors’ offices and online. His vision is to embed cognitive assessment tools into a variety of social and creative endeavors like piano lessons, games and writing and social media apps “that people have always wanted to learn anyway.“

If Alzheimer’s can be detected early, medication and mental exercises have a better chance of stabilizing memory loss or at least slowing down the progression. “Our goal is to offer these applications to healthy adults so they can look out for beginning symptoms that might be otherwise undetected,” says Boulanger. “The current climate is for individuals to be more responsible for their own healthcare and this speaks to that.”

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How it works?

When a user first boots up CogNotes on the heels of a Hyperscore composition session, they start at level 1 of the test.  They will hear a 1.5 second sample from their composition work revealed at a location on the screen.  Locations either light up or “flip open and closed” while the audio snippet plays.  After a brief pause, the user will hear only the audio snippet, and will have to locate the place that flipped open to release the sound.

At the second level, the user will get two totally new locations and two new samples from their composition work.  Audio-location pairs are randomly distributed before test iterations. Furthermore, during testing, the order of presentation of the audio cues is also randomized, making it unlike “Simon” or other games where you chain one new audio-location pair after another in a single, persistently lengthening sequence. The sequence in our assessment is different each iteration. The test focuses on novel pairs of associations, rather than the memory of a sequence of associations.

If you make a mistake, all is not lost.  The test follows a three-strike you’re out rule.

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