In a really effective “roll down memory lane”, a treatment that features a cycling trip around virtual 3D Hong Kong measurably improves three out of four Alzheimer’s patients. James Ockenden reports.
A MAINLAND SCIENTIST’S unique Alzheimer’s Disease intervention therapy in Hong Kong is claiming remarkable results, with three out of four patients showing improvement after sessions on a special virtual bike ride evoking memories of Hong Kong streets.
Tapping the importance of spatial memories in the human brain, Professor Kan Ge-lin’s “Life Episode Echoer” system uses a specially designed “retroverse” bike to allow frail elderly, even wheelchair users, to cycle and steer a bike around a full-scale virtual Hong Kong.
Professor Kan, Thrust Head of Urban Governance and Design of the Society Hub at The Hong Kong University of Science and Technology (Guangzhou), shared his findings at a public lecture organised by the University of Hong Kong Social Sciences faculty yesterday (23 September).
Talking to a packed lecture hall, Professor Kan said “spatial thought” could be considered the foundation of all thought, with these mental abilities developing in children before language.
Spatial thought relates to the mental power of exploring the world around us: how we perceive and remember shapes, distances and dimensions, with these concepts developing into more complex brain functions such as route-finding.
Spatial memories are unique brain patterns, believed to be distinct from other memories, making them an interesting target for Alzheimer’s research.
Other research shows a loss of navigational skills – becoming unexpectedly lost – could even be an early indicator of Alzheimer’s.
The issue is urgent and pressing in Hong Kong, a city with the longest life expectancy in the world and with people over 65 expected to account for almost a third of the population by 2042. Today, around one in 10 people over 70 in Hong Kong suffer some form of dementia.
The world’s scientists are tackling the epidemic on all fronts, from drug trials to prevention regimes: but Professor Kan is clear in his approach that “memory is medicine”.
Tapping the brain power of spatial thought seems to have a big impact in memory recall, Kan has found.
Traditional “reminiscence therapy”, where Alzheimer’s patients are shown pictures or videos to evoke memories, is now proven to be largely ineffective, but Kan believes the magic of the spatial approach together with the physical aspect of the retroverse bikes offer a unique result.
“You can show the elderly pictures, ‘here is your dog’, a thousand times, nothing will change. Sitting there without physical activity does not help their memory recollection,” said the professor.
Kan and his team in Guangzhou specially developed the retroverse bike for the frail and elderly: his patients had an average age of 82, he said, and there was nothing on the market to suit them.
“Well, the market may have forgotten them, but researchers have not,” he said.
In Hong Kong, Kan worked on a pilot scheme in Shau Kei Wan and Kwu Tong, giving frail patients a way to tour their neighbourhoods with absolute freedom.
NEURON WARM-UP
It sounds simple, but getting Alzheimer’s patients, particularly those believed “lost”, to engage with researchers for even a few minutes is a huge challenge.
Kan said he needs 15 minutes for a research session to have any impact.
For one thing, he said, neurons take seven minutes to “warm up”: if the brain is not sufficiently warmed up, there’s less therapeutic effect from the subsequent cycling session.
“Seven minutes is the ‘magic marker’,” he said. “If you don’t wake up the neurons, you don’t get the effects.”
The therapy itself then would take around eight minutes.
And so the first part of the work was to extend dementia-sufferer attention spans from an average five minutes to the quarter-hour required for the session.
Kan’s approach was to tap the innate human interest in playfulness.
He contrasted how people (generally) treat seniors against the way parents play with babies: young children also have very short attention spans, but that attention is valued highly.
“If a baby opens their eyes for just a minute, the parents will get very excited, ‘here is a balloon, here is a toy’, but we don’t value [and grab] the elderly’s attention the same way,” said Kan.
With this insight, Kan regards any attention from the elderly, even a few minutes, as highly valuable. And with his “value and play” approach, Kan was able to extend elderly attention to the required 15 minutes and even beyond.
3D MAPPING COMES INTO ITS OWN
For the pilot cycling tours, researchers only coded selected parts of Hong Kong, but Kan says he’s inking a deal with Hong Kong’s Lands Department to put the city government’s impressive new 3D spatial map data to good use.
In fact, Kan said the government data would potentially allow a full 4D model of the city: three dimensional in space and one more dimension in time, allowing seniors to cycle freely around the streets as they remembered them – the time element being important, given the fast-changing Hong Kong landscapes.
For example, around 30% of shops changed between 2018 and 2021, said Kan when answering questions about how the landscapes changed and how researchers would tackle this aspect.
“But this 4D system is five years away,” he said.
EMPTY STREETS? ‘YOU’LL BE SHOT’
Elderly feedback has informed many improvements to the research and “Echoes” system.
For example, one very elderly patient became upset after cycling around the streets of Shau Kei Wan.
She refused to take part in any more sessions.
Talking with the patient and her daughter, the researchers found the issue: the streets in the “digital twin city” were empty. And for the patient, the last time the streets had been empty, even though she was very small at the time, was during the occupation of Hong Kong during World War II.
“She said, ‘if you go on the streets, [soldiers] will shoot you’,” said Kan.
Researchers then worked night and day to tackle this issue, developing wildlife and people to make a more realistic setting.
“Birds were easy,” said Kan. “People were more challenging!”
Others said they wanted to see family members on the ride with them, so Kan came up with a way to quickly add specific people to the game.
Adult children can now join, either in person or as avatars chatting through AI.
One interesting finding came from the “ChatGPT” conversations elderly could have with others on the street.
At the time, using older ChatGPT versions, there was something of a lag in chat response: but rather than being annoying, this accidentally added realism to the exchange. Patients thought it was quite right that someone further away on a bike would take longer to respond.
But when that same person was up close, the elderly found the lag annoying. “Why are they not responding, can they not hear me?”
With newer versions of the chat engine, now ChatGPT4.0, there’s no significant chat delay; but Kan said it was an interesting finding for researchers to consider.
The pilot ran with 13 patients and 13 control patients and was mainly a way to develop safety protocols and figure out how to get elderly engaged. The early papers published in Chinese have been hugely successful, with at least one national prize awarded to Kan’s team, he said.
In that national contest, the “Life Episode Echoer” research beat an AI lip-syncing Taylor Swift, surprising many contestants who’d assumed the fancy AI would have won. But Kan says the success is down to the real nature of the project: putting frail elderly onto bikes has not been done before.
“They said, ‘all you did was put people on the street’. But it had never been done before. And it totally changed their relationship with their adult children.”
HAPPINESS IS #1 PRIORITY
Kan has now scaled up and is aiming to complete a study with 30 patients.
The professor is philosophical about the use and aims of the research. He is strict with his team culture: they may be scientists, but they need to show heart. If any researcher fails to properly listen to an elderly patient, they’ll be shown the door.
While Kan talked briefly about technical benchmarks such as the “MoCA” (Montreal Cognitive Assessment) scale for dementia, he said the work had a new priority, based on its early success.
“Making [patients] happy is now our number one goal.”
“You make the patient happy, you make their adult children happy. You make their children happy, you make the nurses happy. You make the nurses happy, you make the organisation happy,” he said.
Image at the top generated by AI