we are very excited to share that our paper on An exploratory study integrating Deep Learning in digital Clock Drawing Tests on consumer platforms for enhanced detection of mild cognitive impairment will be shared at the 26th International Conference on Human-Computer Interaction (HCI).
this year, the conference will be held in Washington DC from the 29th of June till the 4th of July. my co-authors are Bryan Z W Kuok and Malcolm H S Koh.
the abstract reads:
Dementia is a medical condition characterised by cognitive functional decline that affects daily life and social activities (National Institute On Aging, 2022). It is currently the seventh leading cause of death worldwide.
This paper describes an independent research project conceptualised, designed and enacted by a pair of high school students under the mentorship of a senior research scientist at the National Institute of Education in Singapore, from April 2023 to March 2024. The paper documents the development of a prototype of an instrument for the early detection of mild cognitive impairment.
Early detection and diagnosis of cognitive decline is critical to the development and deployment of novel therapeutic intervention for patients with dementia due to Alzheimer’s disease. Clinical detection of dementia currently relies largely on reports from patients, family members or based on cognitive reports from screening tests such as the Mini-Mental State Examination (Folstein, Folstein, & McHugh (1975)) or the Montreal Cognitive Assessment (Nasreddine, et al. (2005)).
These tests however have shown to be relatively insensitive to milder impairments, thus requiring conventional hand-scoring and administration by trained professionals, which brings about subjectivity in the scoring. CANTAB Mobile (Barnett, et al. (2016)) and Cogstate Brief Battery (Maruff, et al. (2013)) are computerised tests that have shown to tackle the problems through automation of the administration and scoring processes. Nonetheless, the process is unnatural and distant from daily life, and combined with lengthy screening sessions, may limit the use of technology, especially for older or uneducated individuals. There exists more invasive and costly methods such as the Cerebrospinal Fluid and Positron Emission Tomography (PET), which provides suboptimal accuracy in prediction of cognitive impairment and limited information.
The Clock Drawing Test (CDT) is a simple pen and paper test that has been used for over 50 years due to its ease of administration (Heerema, 2022). It is non-invasive and inexpensive, yet providing valuable clinical information and diagnostic utility (Shulman, 2000). However, due to its nature of physical administration, it brings about issues such as that of consistency and subjectivity. Digitising the tool would assuage this concern. Indeed, in 2005, Penney and Davis developed a digital clock drawing test, which was subsequently branded as DCTclock (Linus Health, 2022).
While Penney’s & Davis’s (2005) DCTclock offered a significant improvement of detection of early cognitive impairment (Souillard-Mandar, et al. (2021)), development of such proprietary technology tends to be expensive. It was from this framing that the authors explored the prototyping of a digital Clock Drawing Test (dCDT) application on platforms appropriate for non-specialist devices (such as iOS and Android) in order to enable timely information updates and subsequent analysis of data.
Thus far, the application integrates various functions, including patient information input, the Clock Drawing Test, image classification using machine learning models, result output, and data logging. The aim is to simplify the screening process for both patients and medical professionals, thereby aligning with the Human-Computer Interaction (HCI) principle of simplicity.
To extend the affordance structures of the application, the authors simulated drawing on pen and paper by utilising Apple Pencil as the digital stylus and iPad as the drawing canvas. As is well known, the stylus and the tablet are equipped with sensors capable of collecting a sufficient amount of information from which to glean meaningful conclusions regarding patients’ drawings. Additionally, the authors established a database using Realm Studio, which is a visual tool enabling medical professionals to intuitively view, edit and model patients’ data.
To maintain design consistency, the authors studied the Human Interface Guidelines (Apple (2023)). This approach ensures that the application aligns with best practices across the industry, making it user-friendly and familiar to users while differentiating elements that serve specific functions, such as text boxes and action buttons.
At the time of writing, the authors are actively exploring advanced machine learning models to analyse additional parameters, improving the evaluation of cognitive impairment.
The significance of this work lies in addressing the general lack of awareness of dementia due to a dearth of education (Sharp & Gatz (2011)). In addition, social perception arising from negative depiction of dementia in popular culture and cultural stigma (Low & Purwaningrum (2020)), and lower socioeconomic status (Petersen et al. (2021)) have also been identified as risk factors for dementia.
A study published in The Lancet Public Health reported that the number of adults aged forty years and older living with dementia worldwide is expected to nearly triple from an estimated 57 million in 2019 to 153 million in 2050 given the projected trend in population ageing and population growth (Nichols et al. (2021)). Therefore, healthcare systems must prepare to provide timely and accurate diagnoses and have the resources in place for efficient care. This paper describes one such possible aspect through which this may be achieved.