IT Application in Alzheimer's disease

management
Author : Abhimanyu yadav (9810003)
Department of Management studies, Indian Institute of Technology, Roorkee

Abstract –With the Advances in information technology provide multiple

opportunities for the improvement of healthcare delivery in diagnosis,
management, and support of disease. Improved automated decision support
systems, coupled with evidence based medicine, form the basis for important aids
that assist the physician in the diagnostic process. In addition, telemedicine
provides the ability to monitor and evaluate treatment effectiveness for patients
who have difficulty visiting the physician and is particularly useful for healthcare
follow up in rural areas. Web-based information sources can benefit all patients
and their caregivers. Online support groups as well as web-based sources of
support can ease the burden of caregivers. Combinations of technologies that
address the delivery of healthcare from diagnosis to management permit the
development of patient-specific models that can impact disease management from
the patient's perspective. Transfer of these techniques into clinical practice is
illustrated here for diagnosis, management, and support of dementia(Alzheimer
disease).

Introduction :

The health sector has always relied on technologies. According to WHO (2004),
they form the back- bone of the services to prevent, diagnose, and treat illness and
disease. Given the right policies, organization, resources, and institutions, ICTs can
be powerful tools in the hands of those working to improve health. Many aspects
of information technology have advanced rapidly over the last few years resulting
in an impressive array of new applications. Due to inherent complexities, medical
applications have lagged behind. The stage is now set for the rapid application of
new technologies to healthcare delivery, resulting in improved paradigms in
diagnosis, treatment, and management of disease.

Traditionally, medical decision support systems have focused on development of

automated aids for diagnosis of disease. While new methodologies have led to the
development of more comprehensive diagnostic tools, this is but one area in which
information technology can be used in disease management. From the patient per-
spective, diagnosis is only the first stage of healthcare. Management of disease
encompasses not only direct therapy but also coping mechanisms for the patient
and caregivers. Telemedicine and web-based services can contribute to effective
disease management by providing enhanced monitoring capabilities, detailed
disease information, and access to external support mechanisms. These capabilities
are particularly important in rural areas where medical professionals may be
located at a substantial distance from the patient . The overall structure for
incorporation of emerging technologies in healthcare delivery at all stages for the
diagnosis, staging, and management of dementia(Alzheimer disease), an area that
involves more complex structures, as the patient is often unable to participate
directly in the process can be described and simplified by use of IT application in
healthcare.

The following steps will describe how information technology interacts diagnosis,
patient management, and social support.
 Figure 2 :
Computational architecture for diagnosis of disease in patient.

Figure 1 : IT model for diagnosis, treatment and support(grey area represents

IT use).

Cooperative systems based on intelligent agents can seamlessly incorporate a

variety of techniques to aid in the overall process as well as provide the ability to
include additional methodologies that customize the approach for each particular
problem.

In the diagnostic model(fig. 2), an intelligent agent approach is used. Intelligent

agents had their origins in distribute artificial intelligence and have been used
success- fully in specific medial applications. Each agent is an independent
methodology with reasoning capabilities working on a prescribed task. The goal of
the overall system is to provide a cooperative environment in which two or more
agents can be combined to solve a problem through the use of a mediator or
facilitator. A major role of the facilitator is to provide a common means of
communication. The intelligent agent approach is a natural extension of hybrid
systems for combining various methodologies without altering the independent
agents or algorithms.
The various intelligent agents are medical professional (MP), knowledge based
system (Emerge), Neural network model(hypemet), Chaotic Analyser(CATS).

Patient Management comprises direct treatment of disease, communication with

the patient and/or caregiver, and patient evaluation either in person or using
telemedicine.
Treatment
Established protocols are used in the evaluation of treatment modalities as well as
evidence-based medicine as a tool for searching and evaluating recent results.
Patient Communications
Disease-specific information can be found on the web, but it is important for the
physician to identify reliable sources to assist the patient in acquiring accurate
information. List-serves also exist for communication among individuals with
similar diagnoses.
Patient Monitoring and Evaluation
The progress of the patient can be monitored through the use of a simplified
telemedicine set-up.

Social Support - In addition to communications listed above, many support

organizations exist for patients and family members with specific diseases.
Extensive information on these resources is available on the web, including both
governmental and non-profit organizations.

Application in Alzheimer's disease

With our increasingly aging population, cortical dysfunction due to AD and stroke
is becoming increasingly common. Alzheimer's (AD) afflicts its patients with a
dementia that increases in malignance over time: the older an AD patient is, the
worse the dementia is. Dementia is a result of the loss of neurons in the brain that
assist in engagement of intellectual activities. The loss of neurons specifically
affects the hippocampus, which is a central region for memory operation, and the
cerebral cortex. The cerebral cortex is also involved in memory functions, but also
works to accomplish reasoning and language functions.
Memory loss is the most common and well known symptom for Alzheimer's
disease. Other symptoms include loss of cognitive abilities, judgment, thinking and
disorientation to place and time.

The diagnosis in alzheimer’s disease is done by Intelligent agent systems. In

addition to disease-specific agents, appropriate sources of information must be
developed. These fall into two categories: expert-supply information and informa-
tion extracted from data .

Figure : Agent Information flow

Emerge combines input from CATS and Hypemet using expert-supplied rules to
identify complex events in the electroencephalogram (EEG) analysis as well as to
combining symbolic and numeric input to form an overall decision. Hypemet
combines clinical parameters with EEG parameters to develop a decision model.
CATS identifies events in the EEG and determines the degree of variability in each
channel of the time series. The information is sent to Emerge, which does channel
comparisons and correlates brain wave activity with level of patient activity and
also to Hypemet that develops an overall model based on channel activity.

For Treatment and Patient management in alzheimer’s disease models are

complicated by the varying levels of cognitive functioning of the patients. In early
stages of dementia, the patient may function quite well and be able to participate in
technologybased aspects of care. In above figure for Agent information flow,
dotted arrows indicate links that may or may not be suitable for the patient. Family
members andor caregivers can take over these activities when the patient is unable
to participate directly. Online support groups are of particular importance for care
givers of dementia patients as they are often confined due to the need to provide
24-hour care. This group can substantially benefit from interactions with others
facing similar circumstances.

Future Trends :
The model described for Dementia(AD) has two basic components: establishment
of techno- logical implementation and definition of disease-specific attributes and
knowledge bases. The second component must be addressed for each disease.
Future work includes further development of expert-supplied knowledge and
accumulation of larger databases for use in the refinement of data-based models
with a final evaluation of overall effectiveness for each of the three stages:
diagnosis, treatment, and support.

Conclusion :

Information technology plays a vital role in identification of the genes that are
causing AD, disease management, progression and online data collection using
electronic medical records for future research. The use of technology has the
potential to help the patients to be more independent and reduce stress on the care
giver. The use of Information technology is might be worth pursuing if technology
advances faster than a treatment or cure.
The shift in focus of online systems from concentration on only the diagnostic
phase to addressing the broader problem of effective patient-specific healthcare
delivery has the potential for more effectively reducing the burden of disease from
the patient’ s perspective.