NON-INVASIVE MONITORING OF NEUROLOGICAL DISORDERS USING SMARTPHONES

Does that title sound like science fiction? I kid you not! I picked up a magazine at the doctor's office yesterday (granted it was from Nov/Dec 2013 and definitely non-medical) and read this brief article on a "genius," Max Little, He received his doctorate from Oxford in applied mathematics but his work has been across disciplines. A TEDGlobal 2012 Fellow and a Wellcome Trust-MIT Postdoctoral Fellow, he is now working on non-invasive monitoring of neurological disorders using smartphones, including the Parkinson's Voice Initiative, in which he and his team developed a cheap and simple tool that uses voice analysis software to detect Parkinson's - a disease with no known biomarkers - with 99 % accuracy in a 30 sec, phone call STRELLEY, YOUR HELP HERE, PLEASE! Is this for real? Will it have any value for PSP patients? The big caveat is that this information came from The Saturday Evening Post.

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  • Hi Caroline

    Good to know you are reading the Saturday Evening Post!

    You have caught me on the hop with this one! I've had a quick look at the researchers' latest scientific paper, and made this quick review (although the technical details are beyond my knowledge).

    They say, Parkinson's (PD) may present with voice changes some 5 years prior to clinical diagnosis. (Mind you, this is not always the case and 10% PD patients do not have this symptom).

    In PD there is dysphonia (inability to produce normal vocal sounds) and dysarthria (inability to produce words). Their study mainly centred around dysphonia.

    The researchers used 10 dysphonic measures (? types of sounds) from a database of 263 samples from 43 people (33 had PD and 10 were controls. The PD people had the disease over a range of 0-28years). They predicted the PD with 99% accuracy using their voice testing techniques.

    The researchers note:

    1. They need to establish/verify the results by using 10,000 voices, and are proceeding to compile such data.

    2. They cannot differentiate PD from other Parkinson-type diseases (so that will include PSP)

    3. They used vowel sounds rather than running speech (removing certain interfering linguistic factors)

    4. They need to study people having PD-like vocal symptoms but not have PD.

    5. They need to use voices from other diverse diseases that have voice changes.

    6. They need more realistic environments (e.g.at home) to test the voices rather than the controlled lab environment of their studies.

    7. They need independent testers to prevent any bias in their own experienced testers.

    Just some thoughts.

    If they can detect PD earlier than other clinical signs with this voice test, how will this affect management, especially medication? I don't think L-Dopa would be given until certain symptoms (motor, tremor, gait problems) eventuated.

    With most neurological diseases like PD and PSP/CBD, the earlier the intervention the better. So those new research drugs ( In the case of PSP, those used stopping toxic tau forming or removing it etc etc) could be tried. However, which neurologist would take that chance on a voice test?

    If someone had voice changes, would they go their GP early or later? Would their GP recognise it as a PD symptom (on voice change alone)? I doubt it. Even if a neurologist had positive results from this voice test, would they act upon it immediately, or wait for other symptoms?

    Again, perhaps I am being a bit harsh. It is good research, but the final effective practicalities of using this test in the general population may meet some obstacles, even when an App for a smartphone is available.

    All the best

    T.

    (I am open for anyone to correct my understanding of this research, and of course, my opinions!)

  • Dear Strelley, re testing opportunities/equipment - such as the EVestG

    Any thoughts, information on this one - yes more food for thought...

    abc.net.au/tv/newinventors/...

    neuraldiagnostics.com/index...

    Regards, Alana

  • Hi Alana

    I saw the invention EvestG (electrovestibulography) on the New Inventors programme but not heard much since. It appears there has been some more research done, initially to distinguish Schizophrenia from major depression. It's also been mentioned with Alzheimer's diagnosis. A 2012 paper talks about a 95% accuracy for diagnosing Parkinson's in a small study of 48 people (20 with PD and the rest contro;s). This latter study has a lot of statitics involved in obtaining their conclusion, and I would have to wait for others to repeat the study many times with larger numbers to evaluate its real value.

    It seems this version of the science is still in its early days, but it looks quite promising if it can be made available at a low cost (which they claim) to the diagnostic centres around the world. It is quick and painless, so will be popular!

    This is the limit of my quick review.....so we'll have to keep a look out for more work with EvestG (and it's companion electrocochleography) and Parkinson's.

    Cheers

    T.

  • Thank you, Strelley! I think I understand all of what you said. It still seems amazing that your voice can be used to diagnose one of these disorders so early. Where do you go to do your researching - like for this question and the one from Alana? And what type of training/education do you have? You are so knowledgeable on so many things and can bring them down to layman's terms. I really appreciate all of your posts.

    Did ;you read anymore about our genius, Max Little? Just curious.

    Thank you, Caroline

  • Hello again Caroline

    I've just come across a video of Max Little (YouTube -Google "Max Little- A test for Parkinson's with a phone call") - Have you seen it? The interesting thing is the comments/questions on the same page as the video - they raise some of issues I addressed in my post to you.

    Interestingly, Max is not offering a diagnosis with this test yet (even though the word "diagnosed" occured in his scientific paper). He also says he does not know if it is possible to diagnose Parkinson's any earlier through the voice than current methods of diagnosis! He says the PVI (Parkinson's Voice Inititative) is not a diagnostic service, it is a clinical trial.

    To answer your question about my researching. It's simple - I have Google!!!!! (like most of you). I also have access to current medical information through sites like "Medscape".

    I do have a bit of an advantage in being able to quickly review the most current scientific papers (if published on the web) and evaluate their contents.Then I try and simplify them (sometimes difficult) for general consumption (even though I may not have the in-depth knowledge of the particular research material being described). Since I was employed all my life in a scientific/medical background, and been involved in publishing a couple of dozen scientific papers over the years, I'm familiar with evaluating other people's research.

    Now for the boring bit of your question (my mini CV).....

    My training and education commenced in the UK initially in the field of Applied Biology. I specialised in radioactive tracer work in drug research (I was actually a young laboratory technician working with the team that discovered and were evaluating Ibuprofen, known now as Advil or Neurofen).

    This was followed by further training in Australia in the field of Medical Technology (mainly Biochemistry - but again with clinical diagnostic tests using radioisiotopes). Then I specialised for 37 years in Nuclear Medicine (in radiopharmacy and radiation safety).

    Take care

    T.

  • Hello Strelley,

    After my last comment, someone sent me a message saying why didn't I just Google Max Little. So I did - and found several videos and watched them all. There was an interview which I was impressed with. Funny, I had assumed that Max was an American. So it was a surprise to hear him speak. Obviously British. His bio told about how he had not been all that interested in math initially. And that he was initially interested in video gaming. He then decided to do something more important with his life. All very good for the PD community.

    My own background had me taking an undergraduate degree in history and political science. After teaching for a few years I started taking a program that would have led into Respiratory Therapy. I hated that field but I love the Anatomy & Physiology classes, lung functions, medications, etc. I eventually became an Ex. Director for our local hospice about the time of the AIDS crisis - 1980 - and for 18 years got to sit in on in-services by physicians on all kinds of topics. Just hanging around the medical field has given me the tools to read your posts intelligently even though I skip over some of the "big words!"

    I am long retired now and have been the caregiver for my PSP afflicted husband. He is now in a private home where the couple takes care of him beautifully. Even though for nearly two years his only sustenance was through a JPEG tube, he recently was able to eat some soft foods. In fact, today I was over visiting and the caregiver had made a huge pot of chili. I was eating some and my husband was eying it enviously so I gave him a spoonful of the liquid. He wound up eating all the liquid and I had the meat and veggies.

    I read all your posts on this site and feel I am still being educated about many interesting things. I am so sorry that your wife has this horrible PSP but she certainly has the best caregivers possible - someone who loves her dearly and is so knowledgeable about the disease process. Thank you from all of us who lean toward you for more knowledge and understanding. You do us a great service!

    Your CV is very interesting! And Ibuprofen was always my go to drug of choice for my many aches and pains. That is until I was forced to stop using it because of a bad liver. There is very little that I can take for that reason and my arthritis is very bothersome as a result. That is the main reason my husband is being cared for by someone else. I could not find suitable help for in my home. It was too expensive and the pump was too difficult for most of those I interviewed. We are so fortunate to have found the place where he is now - less than half the cost of a nursing home and so very much more suitable. He gets ALL the attention from this couple and there are many hospice people who go in with their various skills. We are so, so lucky.

    This post is entirely too long. I apologize. Thank you so much for all the time you spend researching things and then sharing them on this site. God bless you and your wife!

    Caroline

  • Thanks Caroline for your kind words, and also for describing your own background. I am so pleased that your husband is receiving such wonderful care.

    All the best.

    T.

  • Strelly, you are right on mate. In particular questions about how Neurologists would handle the test results (treatment, medications, etc.).

    My wife's voice was always soft, really soft, and now very, very, soft but still there. She has some slurring due to saliva buildup. If she swallows it makes a huge difference. If anyone is having trouble understanding their PSP loved one try having them swallow and say again. Don't know if anyone noticed a difference in her speech in the early days of PSP.

    Jimbo

  • Thanks to all for discussion & input - y brain is still 'functioning' as best it can! I play bridge on Mondays but had a fall recently going for my taxi I was aware of the effects of that fall last Monday trying to play bridge but I will keep trying as long as possible. I see my neurologist in April so will report back after that Mary in Perth Western Australia

  • H all

    I'm impressed by. Your cvs

    I was an economist and taught inthe UK for most of my work

  • Ing life and had to retire aged r47 with anxiety and depreession

    The,job was undoable inn effect and ,I was a perfectionist (no longer tho!)

    IHa d a good retirement but split from my husband of z33 years and divorced.

    Then immemt my. Partner adm we moved in together may 2012

    Since being dxd wwith PSP in dec 2010 we have,some idea of what's in store but imhave the slow type,of,PSP,so,will be around fora bit yet

    Loljil

    :-)

  • Ps Ii don't have children to watch my decline

    For,the 1\st time ever i Am glad of this

    Jiłll

    :-)

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