Queen Mary-led digital listening test to be trialled across NHS to help improve dementia diagnosis

The Digital Assessment of Auditory Perception in Dementia (DIADEM) uses a series of short listening tests to identify changes in how the brain processes sound – functions that can be affected early in dementias such as Alzheimer’s disease.

Led by Professor Charles Marshall at Queen Mary University of London, DIADEM is being delivered by researchers at Queen Mary and University College London (UCL). It is one of nine projects selected for real-world testing in the NHS through UK Research and Innovation’s (UKRI) Dementia Challenge, part of its NHS Fit for the Future Health Mission.

The wider Dementia Challenge, backed by up to £80 million, aims to accelerate the development and adoption of new approaches that could enable earlier and more accurate dementia diagnosis and help people better understand how their condition is likely to progress.

Listening to how the brain works

DIADEM is based on the principle that understanding complex sounds places significant demands on the brain. Everyday tasks such as following a conversation in a noisy restaurant rely on brain processes that can be affected at an early stage of dementia.

The digital assessment consists of four listening tests taking around 20 minutes in total. They examine abilities including understanding numbers against background noise, adapting to distorted speech and processing different sounds presented to each ear.

The tests run through a website using a standard computer and headphones, without the need for specialist equipment or expertise, potentially allowing DIADEM to be used widely across NHS settings. One of the tests uses everyday non-verbal sounds and requires no English or literacy skills, which could help make assessment more accessible to people from different cultural and linguistic backgrounds.

In a four-year study across 17 NHS clinics in England, the researchers found that DIADEM could accurately identify dementia. When it was used alongside a new blood test for Alzheimer’s disease, diagnostic accuracy increased from 88 per cent to 97 per cent.

Professor Charles Marshall, Professor of Clinical Neurology at Queen Mary University of London and lead for the DIADEM project, said:

“Getting an accurate dementia diagnosis can still take far too long, leaving people and their families living with uncertainty and delaying access to the support and treatment they need.

“DIADEM takes a different approach by looking at how the brain processes sound – something we know can change early in diseases such as Alzheimer’s. Because the tests can be completed using an ordinary computer and headphones, they have the potential to provide a simple, accessible and objective way of helping clinicians identify people who need further investigation.

“Through the Dementia Challenge, we now have an important opportunity to test DIADEM rigorously across the NHS and establish whether it can become part of routine dementia assessment, helping more people get the right diagnosis at the right time.”

Testing DIADEM across the UK

The next stage will include a prospective validation study at NHS sites in England, Scotland, Wales and Northern Ireland. The team will also work towards UK regulatory approval and develop the health-economic evidence needed to assess the case for wider NHS adoption.

DIADEM could ultimately be used to help clinicians decide which people with memory concerns require urgent specialist investigation and which can safely be reassured. The researchers also hope it could be used to monitor people who have already been diagnosed, including assessing how their condition progresses and whether treatments are working.

The UKRI Dementia Challenge will test nine new technologies and approaches in real NHS settings. Projects will have to demonstrate that they are meeting agreed milestones to progress to further stages of funding, with the aim of accelerating the most promising innovations towards adoption in the NHS.

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