In 2017, prevalence of Alzheimer’s Disease (AD) was close to 50 million individuals, with this number predicted to double in the next 20 years. Importantly, the neurodegenerative processes associated with AD precede diagnosis by more than a decade, offering a critical window for preventative treatments. An ongoing challenge is how to best identify individuals in the clinically ‘silent’ stage of this disease.

Smartphones offer a unique opportunity for detecting early cognitive (i.e. thinking) and behavioural change. Traditionally cognition is assessed using pen-and-paper tests completed within a 20-minute clinical appointment. Smartphones have the advantage of being able to measure cognition remotely and frequently over dynamic time frames; for example, memory can be tested over a duration of days rather than minutes. In addition, smartphone sensors enhance sensitivity by using touch, audio, video and movement sensors to measure behaviour. Mezurio, a smartphone application (app), has been developed in a collaboration between the University of Oxford and industry (Roche and Eli-Lilly pharmaceuticals). Intended to be freely available, Mezurio contains a selection of tasks specifically designed to measure the processes first sensitive to change in AD.

The GameChanger study, ran in collaboration with the UK Alzheimer’s Society, will establish the profile of performance on tasks contained within Mezurio across a wide demographic of the adult lifespan. By establishing what ‘healthy’ cognition looks like, future research will be able to more effectively use the app to detect individuals showing early signs of cognitive impairment. In addition, GameChanger is working in close collaboration with UK-based research projects (The Avon Longitudinal Study of Parents and Children (ALSPAC), Generation Scotland, The Exeter 10,000, NIHR BioResource and UK Biobank). Volunteers who have already provided data to an existing research project will be able to enhance the value of their GameChanger participation by allowing us to link the data collected by the two research projects. This will allow us to further explore how factors associated with how well we age cognitively, for example genetics (specifically which copies of the APOE gene a volunteer carriers), health and lifestyle, influence performance on the Mezurio app.

Invitation to participate in GameChanger is public; any adult with access to an Apple or Android smartphone will be able to download the Mezurio app onto their personal device. Mezurio will prompt participants to complete daily tasks for a few minutes each day, for a month. These tasks may ask participants to: a) Learn associations between photos and arrow directions, b) Make similarity/dissimilarity judgments on groups of objects, c) Follow rules to move through sequences, d) Narrate and retell short comic strips aloud, e) Navigate through virtual mazes, f) Crack sequences of simple codes. In addition, volunteers will be asked to rate their mood and sleep each day. As a further optional component of GameChanger, participants can allow the app to passively collect data on their physical activity (movement and approximate location) during a 7-day lifestyle assessment. Each September for the next 2 years, GameChanger will ask participants to repeat the month’s activity. This will allow us to study change in cognition over time.