memento dx

Alzheimer’s disease is one of the greatest medical challenges of our time. In the United States, nearly 5 million patients are affected by Alzheimer’s disease. This number is expected to triple by 2050. While the rate of death caused by the other top leading causes of medical illness in the U.S have steadily declined, the number of deaths caused by Alzheimer’s disease is rapidly growing. Despite the imminent threat that Alzheimer’s poses to society, nearly half of people who have Alzheimer’s disease are undiagnosed.
Introduction
In June 2016, I joined a medical start up team called Memento Dx and was on-boarded as the group's lead product designer. However, since October 2015, the team has been aiming to address the critical need for early detection of Alzheimer’s disease in primary care settings. Our team has consulted with primary care physicians (PCPs), Alzheimer’s experts, patients, caregivers, and community advocates to better understand the scope and pain points of all stakeholders. The biggest reported concerns were the exorbitant amount of time spent making an accurate diagnosis and the long wait times to see specialists. Neurologists believed that PCPs had to act as a first line of defense for accurately assessing patients’ cognitive abilities. Health professionals suggested if PCPs had tools to better distinguish “worried wells” – individuals concerned about normal changes in memory with age – from patients who have pathological dementia, referrals would be more accurate, diagnosis times would be reduced, and patient outcomes and clinical throughput would improve. PCPs reaffirmed this concern, acknowledging their own lack of expertise in diagnosing early stage Alzheimer’s disease. Even with a tentative diagnosis and patient referral, PCPs had little knowledge of support groups, disease management practices, or appropriate patient and family counsel.

Concept Development
Our solution is Memento: a software suite that unites the diagnostic tools of the clinic with the reach of technology. Memento is the first of its kind to digitize the two-part holistic exam, a subjective collateral source interview and objective neuropsychometric testing, given by experts in leading clinics across the country. Using the same gold-standard clinical observation tools, we encapsulate the diagnostic utility of the specialty care exam in the form of a digitized app. This technology aims to empower PCPs with the expertise to confidently diagnose patients and refer them to specialists. 

To realize our solution, we identified the following specific goals:
1. Develop, test, and deploy a digitized collateral source survey that captures the same (or more) diagnostic information as compared to a collateral source interview with a dementia specialist
2. Develop, test, and deploy a digitized cognitive assessment that captures the same (or more) diagnostic information as compared to a clinically-administered neuropsychometric test (refer to "cognitive assessment" in menu for more information)
3. Enable immediate diagnostics using machine learning algorithms to detect risk factors
4. Deploy Memento’s software suite nationally to Alzheimer’s stakeholders at the academic, clinical, and community levels
Tools​​​​​​​
• Diagrams - Adobe Illustrator & Photoshop
A comparative patient diagnostic process chart of current procedures and the proposed Memento workflow. The diagnostic process leading from a primary care setting to a formal Alzheimer’s diagnosis is one of the primary pain points for providers, patients, and families. The complexity of the diagnostic process at the specialty level increases the total consultation time per patient, exacerbating a cumbersome patient backlog. Our solution is to design a suite of digitized cognitive assessments that mimic the gold-standard diagnostic process found in specialty clinics to provide PCPs with the confidence and expertise to refer and diagnose patients who are at high risk for Alzheimer’s disease.
The Memento Informant Survey brings the diagnostic utility of a neurologist-administered informant inter- view to the primary care setting. Select examples of screens in the Memento Informant Survey (MIS). 1. General patient information collected by the MIS. 2. Instruction page for the caregiver. 3. A question from the MIS. Other questions include consistent and inconsistent memory problems, functional change over time, and screens for other potential causes of memory impairment. 4. When caregivers need further explanation on a particular question, they can tap a “What do you mean?” button to receive clarification.
The Memento Cognition Report summarizes the most clinically useful information of the MIS for the PCP to review. Once a patient completes the MIS, the answers are automatically transcribed into natural language and outputted into a patient summary report. “Red-flags” and “green-flags” highlight markers of diagnostic concern and good health respectively.