Impact case study database

Facilitated by an expanding body of rigorous validation research, CANTAB’s reach has been continually extending, with impacts ranging from improving health outcomes and patient management, contributions to pharmaceutical practice, to generating financial and commercial opportunities on a global scale. The rising prominence of the CANTAB battery was recognised in Prime Minister David Cameron’s speech at the G8 Dementia Summit on 11 December 2013, acknowledging the “ extraordinary work of UK life sciences companies, like .. Cambridge Cognition,..working with others to develop new tests for Alzheimer’s Disease” [A].

Figure 1 Cumulative CANTAB-Mobile patient assessments 2013-2020.

Uptake of CANTAB worldwideCANTAB tests have been approved as medical devices by various regulatory authorities. These approvals, which have been facilitated by the underpinning research described above, have enabled uptake of CANTAB tests in clinical settings and pharmaceutical practice worldwide. Both CANTAB Mobile (PAL plus) for depression screening for older adults and CANTAB-Insight (PAL, Spatial Working Memory, Matching-to-Sample cognitive assessments in adults of all ages) are CE-marked (class 1, since 2017) [B] and TGA-approved (Therapeutic Goods Administration, Australia) since 2017 [B], allowing them to be sold on the EEA and Australian markets respectively. CANTAB Mobile has additionally received FDA (Food and Drug Administration; USA) clearance since 2017 [B].

CANTAB-Mobile has been adopted in a large number of patient assessments, totalling 33,803 between August 2014 and January 2020 in primary and private health care [C] (Figure 1). The tool is currently available in almost 50 languages and has been used in over 100 countries (Figure 2).

Figure 2. Map of the global locations of CANTAB pharmaceutical (green dots) and academic (pink dots) applications August 2013-present [C].

Informing patient management across the UK

CANTAB revolutionises the detection of cognitive impairment in routine clinical care by replacing traditional paper-and-pencil-based cognitive testing with a computerised "objective' mode of measurement. The introduction of CANTAB by clinical practices has translated into improved triage and diagnosis rates for patients. From a Dementia Programme manager from a Clinical Commissioning Group (CCG):“Our dementia diagnosis rate has improved from 39% to over 46%. CANTAB Mobile has raised awareness of mild cognitive impairment in primary care and acted as a stimulus to actively encourage practices to assess patients at an early stage”. As one of a growing number of CCGs aiming to improve dementia diagnosis rates, NHS Bedfordshire CCG announced in May 2019 that it was introducing CANTAB Mobile as an early detection triage tool in a total of 50 general practices, following a successful year-long trial [D]. CANTAB Mobile “has been tested extensively throughout the NHS and was found to be 99% accurate for negative dementia diagnoses, so many patients will now avoid having to wait for a hospital appointment with a neurologist that can cause anxiety for them and their families” [D].

Working as Specialist Practitioner in Mental Health Nursing in Swansea (Wales), Clive Thomas purchased CANTAB Mobile licences for use within his Dementia Support Teams, enabling team members “ to address memory concerns with the public in a knowledgeable and professional manner [and] ‘triage in’ for significant memory problems whilst ‘triaging out’ those that needed support for other reasons” [E]. To date, 170 people in Swansea have had a triage assessment using CANTAB Mobile. “ This success has enabled the team to offer a far greater depth of scope in terms of triage than was originally envisaged and CANTAB Mobile allows team members to signpost to the conventional memory assessment pathway with confidence and has also allowed us to explore diagnosing dementia ‘closer to the patient’ and in collaboration with GPs when deemed appropriate. So, from our original intention of offering early information and advice for memory changes, CANTAB Mobile has helped our team to deliver so much more, including the accurate identification and even diagnosis of non-complex dementias at Primary Care level.” [E].

Changing practice in the pharmaceutical industryBetween August 2013 and November 2020 CANTAB platforms have been used in 261 clinical trials worldwide (ClinicalTrials.gov) [F]. For example, AMGEN have adopted CANTAB in their 2017 Ebbinghaus Trial to monitor cognition function during treatment for cardiovascular disease with the human monoclonal antibody evolocumab [G]. Arising from the underpinning research on CANTAB in the MRC Deep and Frequent Phenotyping Study [5], PAL has been used in two major Phase III clinical trials using a new web-based product CANTAB Recruit, for screening of Mild Cognitive Impairment in the community [H]. Facilitating the recruitment of such early prodromal patients is now seen to be vital for testing novel preventative drug treatments. CANTAB use in clinical trials is economically significant as recruitment costs are often 33% of trial costs; under-recruitment is a major cause of trial delays costing USD8M per day [H].

Professor Sir Simon Lovestone (University of Oxford), one of the most respected clinician scientists in the field of Alzheimer's Disease, has “found CANTAB PAL to be a sensitive test in the context of detecting memory problems in the elderly and in mild cognitive impairment”, and considers it “would make an excellent outcome measure in the early detection and assessment of cognitive deficits essential in trials of new agents for the treatment of early Alzheimer’s disease and Mild Cognitive Impairment” [I].

Cassava Sciences chose the CANTAB battery “because of its documented sensitivity” for their Phase 2b clinical trial of their novel therapeutic drug candidate in mild-to-moderate Alzheimer’s patients. They stated that “the sensitivity afforded by CANTAB will allow smaller, faster clinical trials for this disease so urgently in need of new treatments” [J]. Greenfield BioVentures are also conducting a clinical trial using CANTAB as the primary measure of efficacy for their therapeutic candidates, due to its “superior sensitivity” [K].

During the Covid-19 pandemic, in efforts to curb COVID-19 transmission rates, the pharmaceutical industry has reduced site visits for their clinical trials and in some cases temporarily suspended patient recruitment. CANTAB Connect has enabled continuation of trials allowing patients to contribute data remotely [L].

Generating increasing revenue and developing commercial opportunities globallyCANTAB (including the PAL test) was commercialised after licensing to Cambridge Cognition Holdings plc which was listed on London Stock Exchange (AIM) in 2013. Currently employing over 70 people, Cambridge Cognition’s total revenues increased by approximately 40% between 2013 and 2019, amounting to a sum of GBP39.77 million [L]. There have been over 500 CANTAB Mobile accounts set-up since January 2014 including in Germany, Greece, Sweden, the Netherlands and the USA. In 2014, Cambridge Cognition licensed four of the EMOTICOM tests of emotion and social cognition via Cambridge Enterprise for the University of Cambridge [L].

After announcing a partnership with a major pharmaceutical company to provide cognitive testing for neurological patients in India [L], Cambridge Cognition announced its expansion to the Chinese market following the development of CANTAB task variants in the key spoken (Cantonese and Mandarin) and written (Chinese simplified) languages in 2019 [L], thus furthering global reach and commercial opportunities.