Michael Hornberger is a professor of applied dementia research at the University of East Anglia who developed Sea Hero Quest, a mobile game for studying spatial navigation that was downloaded more than 4 million times. In this conversation, we talk about Sea Hero Quest, how Michael (together with Hugo Spiers) developed it, the first findings, and dementia in general.
BJKS Podcast is a podcast about neuroscience, psychology, and anything vaguely related, hosted by Benjamin James Kuper-Smith. New conversations every other Friday. You can find the podcast on all podcasting platforms (e.g., Spotify, Apple/Google Podcasts, etc.).
Timestamps
00:04: How Michael started doing research on dementia
02:32: What is Sea Hero Quest?
05:18: How Sea Hero Quest got started and developed
31:45: Start discussing some results from Sea Hero Quest
38:16: How does Sea Hero Quest relate to Michael's work on dementia?
43:16: How far are we from using (something like) Sea Hero Quest as an early biomarker for Alzheimer's?
45:36: What is dementia and how can we prevent it? Discussing Michael's new book about Alzheimer's 'Tangled Up'
Podcast links
Website: https://geni.us/bjks-pod
Twitter: https://geni.us/bjks-pod-twt
Michael's links
Website: https://geni.us/hornberger-web
Google Scholar: https://geni.us/hornberger-scholar
Twitter: https://geni.us/hornberger-twt
Ben's links
Website: https://geni.us/bjks-web
Google Scholar: https://geni.us/bjks-scholar
Twitter: https://geni.us/bjks-twt
References
Alzheimer (1906). Uber einen eigenartigen, schweren Erkrankungsprozess der Hirnrinde. Neurol. Cbl..
Alzheimer, Förstl, & Levy (1991). On certain peculiar diseases of old age. History of psychiatry.
Anguera, Boccanfuso, Rintoul, Al-Hashimi, Faraji, Janowich, ... & Gazzaley (2013). Video game training enhances cognitive control in older adults. Nature.
See also: https://en.wikipedia.org/wiki/NeuroRacer
Coughlan, Coutrot, Khondoker, Minihane, Spiers & Hornberger (2019). Toward personalized cognitive diagnostics of at-genetic-risk Alzheimer’s disease. Proceedings of the National Academy of Sciences.
Coughlan, Laczó, Hort, Minihane, & Hornberger (2018). Spatial navigation deficits—overlooked cognitive marker for preclinical Alzheimer disease?. Nature Reviews Neurology.
Coughlan, Puthusseryppady, Lowry, Gillings, Spiers, Minihane, & Hornberger (2020). Test-retest reliability of spatial navigation in adults at-risk of Alzheimer’s disease. Plos one.
Coutrot, Schmidt, Coutrot, Pittman, Hong, Wiener, ... Hornberger, & Spiers (2019). Virtual navigation tested on a mobile app is predictive of real-world wayfinding navigation performance. PloS one.
Coutrot, Silva, Manley, de Cothi, Sami, Bohbot, ... Hornberger, & Spiers (2018). Global determinants of navigation ability. Current Biology.
Fold.it game: https://fold.it/
Hornberger (2021). Tangled up. The science and history of Alzheimer's disease.
Kunz, Schröder, Lee, Montag, Lachmann, Sariyska, ... & Axmacher (2015). Reduced grid-cell–like representations in adults at genetic risk for Alzheimer’s disease. Science.
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[This is an automated transcript with many errors]
Benjamin James Kuper-Smith: [00:00:00] So I kind of looked at what you, uh, I guess like a brief CV kind of thing. And it seemed to me that you did your PhD with Rick Hanson, I think at UCO. Is that correct or?
Michael Hornberger: Well, yeah. Originally I did it with Mick Rug, actually, I dunno if you know Mick Wright? No, I dunno. He's more an ERP specialist. But Mick, he left at that time.
He left from from UCL then to, to, at that time, to uc, Irvine, he's now in Dallas. And uh, then Rick took me, paced me on I guess. And uh, so I did a lot of my PhD with Rick. Yeah.
Benjamin James Kuper-Smith: Okay, so I was just curious because, uh, it seemed like when you look at your early publications, it seems like after your PhD you made a switch to dementia work.
Right. Um, so how did, how did that come about?
Michael Hornberger: Yeah. Oh yeah. Okay. So the reason, well, okay, this is a, a long story I guess, but in essence, so I started a job with in, [00:01:00] in, at UCL with Mrag as a research assistant. And he said, well, why don't you do a PhD at the same time? So that's what I did. But then Mick left to the US um, as I said, and, um, Rick kindly took me under the, his kind of, you know, in his lab.
But unfortunately my job was gone without as well. And at that time, I didn't have any funding for my PhD. So I literally had to find another job to fund my PhD. So I found a job in the end, in actually in Cambridge. And we to work much more in memory research in. Memory and dementia research. And that suited me really well because there was a strong overlap between that.
And um, that's how I, I guess, um, and I should have said for my master's, I did already work in mild cognitive impairment and dementia, so I had already in connection to that. But, so this was always these kind of two areas I kind of straddled quite a lot.
Benjamin James Kuper-Smith: Okay. So it wasn't as much of a change as it seems from just the publication [00:02:00] history?
Michael Hornberger: Yes. Yeah, the publication history is always a very interesting, uh, trajectory, isn't it? If I look at some things which I've published, I think, I'm not sure I would call myself an expert in that topic, but it's just studies you get involved in, I think, which are interesting at that time. And, you know, can be a lot of fun of course to explore other things.
Benjamin James Kuper-Smith: Yeah, definitely. Yeah, I mean, I've, I think I basically spent like the first few years of my like bachelor's, masters and that kinda stuff, just doing different topic after different topic, just working my way through the department more or less. Okay, so, uh, as I mentioned before we started recording, I'd really like to talk about Quest and I actually played Serial Quest a few years ago.
Oh, fantastic. Um,
Michael Hornberger: love to hear that.
Benjamin James Kuper-Smith: Yeah, I, I so may, maybe my data is in some of the publications. I dunno. I guess it should be, guess it might be definitely. Well, I guess you can't actually download it anymore, right?
Michael Hornberger: So it has changed. Now it's again, very, you know, it's a great timing. We are talking because the public version of Sea Quest Yes.
Uh, doesn't exist [00:03:00] anymore. However, we have now with our charity partner, Alzheimer Research uk, we've created a new platform which just launched, I think three weeks ago. And that allows now researchers to still use, see, request for research studies or for larger studies if you want to. So it's a complete online platform where you can use, see, request, and we have lots of people still using it in very different populations and, you know, studies we would have never dreamt of doing.
Uh, loads of people are using it for very different purposes these days, which I, I think is fantastic and is really exciting to hear.
Benjamin James Kuper-Smith: That's cool. Yeah. So I mean, maybe for the people who, dunno, it's a game where you, uh, well it's actually, it's a game game, not like experiment game. It's an actual game that you used to be able to download on the app store or whatever.
And I guess you're like on a little boat driving around the, uh, not ocean, but like rivers and lakes and that kinda stuff kind of thing. And you have to like, I can't remember exactly, like memorize where things are or find ways. You see a map before [00:04:00] I think, and then you have to like, find places and that kinda stuff.
Right.
Michael Hornberger: In essence, well, you're right. You know, this is what it is. It's, it's a game we designed for measuring navigation behavior and people in a, you know, in a game environment and has different levels of the game. So we have different, what we call, I guess, navigation tasks, which are underlying that, which people don't need to know when they're playing it.
That's really, that was the one of the key aspects. When we developed it, I never wanted to develop a gamified experiment, which, you know, I've done as well, and that can be interesting. Instead, I wanted to create a game which has valid signs under that, which bizarrely turned out to, to be the more controversial one.
And still, uh, we get a lot of people pushing back and saying it's just a game without them knowing how much science and how much work is actually under, because on the surface, it is a casual mobile game, and that's what it's meant to be. And that's why I think it was successful because people love casual mobile games, obviously.
That's,
Benjamin James Kuper-Smith: yeah, I mean the, the, the [00:05:00] number I think is like two and a half or 3 million downloads or something like
that?
Michael Hornberger: No, well, in the end we had nearly 4.3 million people. Oh,
Benjamin James Kuper-Smith: okay.
Michael Hornberger: Yeah. Okay. So there you go. So we have a huge, enormous data set, um, and across 160 countries. Most countries, of course, are quite small, but we still have an enormous global representation.
But, you know, it's, I think the, the whole story started in a way. Me going to a a, a workshop to the Welcome Trust. The Welcome Trust is one of the large charities here in the uk and there was a, there was a workshop on, uh, gaming and science, which I thought, oh wow, great. I have a half day off. Go to this workshop, just listen to some interesting things.
And this afternoon literally changed my life, I guess, because coming to this workshop and meeting, so at this workshop there were different scientists and there were different games developers. And for me at that time, I was already very interested in, in spatial orientation, spa navigation. So [00:06:00] when
Benjamin James Kuper-Smith: was this property?
Michael Hornberger: This was. 2015, if I remember correctly. Mm-hmm. Yeah. Um, yeah, 2015. And, uh, when I, when I, again, talked to the games designers, they, of course, they, they work all the time in virtual environments and I thought, well, this is perfect actually for this. So I came really excited back from this workshop, but as always in science, you know, you don't have funding for doing anything like this.
And, um, um, you have to wait for the opportune moment. To come. And I think what was really interesting, I received one day a phone call, which was a very strange phone call because was somebody saying, well, I'm currently canvassing for a very large corporation, which they didn't tell us at the time, which there was to do some research into dementia.
Do you have any idea what to do? And I first thought, really it was a hoax call. You [00:07:00] know, like some people just sometimes call me up and wanting to some kind of very strange, kind of either want to endorse their products or anything like that. And, but I just came back from this workshop and I said, well, you know what would be really cool would to create a game which could collect signs, which could help dementias with the, uh, dementia research.
Okay, great. And then that person hang, you know, hung up and said, okay, I might call you back. And I thought, I never heard anything. So a month later, and I suddenly get another phone call, I said, okay, um, they liked your, your proposal. Can you put them together like a two, three page proposal and this will be then a short list and this will be decided.
So I thought, okay, well now I have to actually think what I'm going exactly do. And, uh, so I started drafting it. Then what I thought I wanted, and then I submitted this. And again, I thought I would never hear anything because at that time I also, I asked them who were the other competitors and there were some major other places involved in this.
And I thought, I, well, I will have never a chance against them. And then a [00:08:00] month later again, they called me and said, well congratulations, your project has been chosen. And my first thought was, what am I going to do now? I need to actually come up with something. So my first call was an actually to my good friend and colleague Hugo Spears, who's a at UCL.
Um, and I said, well, hugger, do you want to take, you know, be a lead on this project with me together? You do the navigation side. And I did the dementia side because he knew much more about the navigation aspect than I did. And that's how the whole project really then came together and was a, I think, really bizarre coincidence.
And then we found only out that, yeah, the sponsor was Deutsche Telecom, basically who did this at their as their corporate social responsibility project. And it was very, very excited. And to, they, they invited us then for loads of meetings. And you know, they have, of course, you know, they had, uh, incredible resources basically, and we couldn't choose a, [00:09:00] we, we had a short listing then of games companies who basically, uh, attended for this and made pitches to us.
Uh, met some incredible games developers. Then in the end we decided for one, and then we started developing the game, which was extremely exciting and extremely stressful because there was a very short timeline. We had to develop the game, finish it in a kind of a six month period, which for industry people is quite a long time.
But as anybody in research knows, if you start something from scratch, that's actually very, very pressured if you have to come up with everything. And the key, as I said for you go, and myself from the beginning was we wanted to create a game that feels like a game, uh, but underneath a science, so not a gamified experiment.
And that was the hardest to do. It was a constant discussion between us and the games developers that we would say, no, no, no. We can't do it this way. It needs to be this and this and this way. And then the games developers say, yeah, yeah, that's all good, but [00:10:00] this is really boring. Nobody will play this.
And so I think it was this constant. Discussion, which was, as I said, I've learned so much about games and gamification. And in the end, also adding a lot of the elements for See request into, which had no relevance to the science. So for example, we found that very quickly that people love to personalize games.
So in See request, you can personalize your boat, can have different flags or different colors. It has no relevance at all to the signs, but people love it. And so you need to add these. The same with the stars that you can collect. Stars again has no relevance to the signs, but it is really, really important for the gamification of the, uh, you know, for the game experience, I guess, of the people using it.
And that's what they're expecting of a game as well. So it was, was incredible. And then when it started, we then, the funders, I remember there was a very awkward conversation when the funders asked us what sample size we would [00:11:00] expect to collect which data. And, uh. We, but looking at each other and just coming up with this number, well, we, we are thinking a hundred thousand people in Western Europe because, I dunno, at that time I thought of big epidemiological studies and I thought about, you know, if we are hitting that I would be incredible.
And then, uh, but what it showed is actually we completely underestimated the gaming market. You know, and this was, the game was launched in the end in 2016. And now of course the gaming market has even bigger ground. But just, we said we want to collect a hundred thousand people. We collected a hundred thousand people in the first two days.
It was incredible. We were just blown away by this, how big it became, and just snowballed into a bigger thing than we ever anticipated, so, which is really, really exciting. And we had such positive feedback from [00:12:00] people. And I can talk a bit more what, what's in the game Actually, the most interesting aspect has been really more the scientific community who's been really, really skeptical.
And as I said before, who think very often it's just a game, but it's not real science. And that's a really, really interesting aspect because whether people really accept this kind of using games for science. I personally, I'm a big convert to this obviously in a way, and I'd love to do more, but it's, so far we found it, uh, very, very difficult to get.
Anything funded through the regular research funding routes where people would just say, no, this is just not science. And only, you know, with our publications coming out and there's lots more coming now out actually, uh, hopefully we can break through that barrier, but I think there's a whole research area to establish, frankly, using games for science.
Benjamin James Kuper-Smith: Yeah, I know that's really interesting and I, what I especially find interesting is that it seems, I mean just from what you [00:13:00] just mentioned at the end, that. I guess this is like the ultimate somewhat, I mean, not exactly someone gives you money to do something crazy, but it sounds like, you know, relative to, it's a bit like that relative to like, I mean, I'm a PhD student, I dunno how grounds applications work, but from what I heard is you don't get a call and then four months later you get lots of money.
Michael Hornberger: It's very
Benjamin James Kuper-Smith: true. It's very
Michael Hornberger: unusual and
Benjamin James Kuper-Smith: um, and, but it seems like that kind of thing might have been like a really cool starting point for now that you are kind of in the process of establishing these kind of games as a real way to do science that I'm assuming that in the future, actually, you know, the, the formal.
Grant giving, so what's the word? Like charities or whatever, that they will be more likely to actually fund this in the future based on this like crazy experience you
Michael Hornberger: felt? I hope so. Yeah. It was clearly, it was clearly blue sky and high risk. And for Doche Telecom, I think it was much more because it was a corporate social responsibility, it was for them a much more [00:14:00] public engagement exercise than anything else.
And for us, that worked of course, beautifully because gaming is great for that. Um, so we of course wanted the science to be really solid. Underneath it, and that was from the beginning. There was crystally clear between Yougo and myself. We need to have really, really solid science underneath it. Otherwise this is just a, you know, wasting our time and wasting everybody's time.
It kind of, so, and I think that's, that's what we need to convince people that you can use. Games, uh, and gaming for, for doing really cool signs. And of course, you know, we're not the first ones to, to, to think of that. Let's be honest. There are other people who, who thought already about this and have done very successful.
So for example, uh, very famous as of course Neuro Racer by Adam G from University of, of, um, California, San Francisco. He was, I think the, really, the first one I would say who, who created a [00:15:00] game for this is, I think mostly for children with A DHD to control their, their. Or manage their behavior, let's put it this way.
And that's been, uh, I think even licensed now for potentially treatment of A DHD in the US as far as I know. So he's used that, which is fantastic. And then of course there's all these, I dunno if you've ever heard of Folded, which is basically, it's a, it's a puzzle game. So people love puzzles and online puzzles and fold.
It is how proteins basically built together and protein blocks fit together is a very difficult puzzle. And scientists put these puzzles out there and then. The community out there tries to solve these puzzles. Um, which I think, um, again, is, is one example. So there are several approaches like this out there.
One just really needs to convince, I guess, people that it's really, it really makes a, I guess, a difference for us, it was that we could, I think we took it another level, of course, so that we really wanted people to collect [00:16:00] valid data, not only to analyze and our data or, yeah.
Benjamin James Kuper-Smith: So a brief question. So you, you know, this was, as you said, like such a surprisingly huge success in terms of, I mean, this must have been a very big game by gaming standards also to have that many, that's what we
Michael Hornberger: found out.
Exactly.
Benjamin James Kuper-Smith: How did, like, did you do any advertising for this or like, how did people find out about this game?
Michael Hornberger: So, um, again, Dr. Telecom was amazing with this. They had a whole public relations team with that, which really, you know, helped us obviously publish, you know, put it out there. But I think the other key part that we had, which we got on board, was actually then, uh, a dementia charity, Alzheimer Research uk.
And that really helped us a lot for, with the credibility. And that gave us the initial push, I guess. But then the, you could see there was a, you know, we had this initial push, but, and then we thought, well, this was, maybe it, you know, but we could see then. The gaming community itself was picking it up and it really was [00:17:00]gathering momentum and that's what we didn't expect.
And at that time, of course, you know, the whole live streaming of games was still pretty new at that time as well. Not new, but new-ish I guess. And, uh, not as mainstream
Benjamin James Kuper-Smith: as it
is
Michael Hornberger: now. Yeah. And yeah, now it's really, you know, everybody I guess knows about. So it's, and then we could see that people were picking this up and we're talking about it and we're saying, Hey, this is really, you know, you can, and I think Doko made this very clever that they created this slogan called Gaming for Good.
You can game. And at the same time you do something good, actually, you help dementia research. And that was really great. And people loved that concept. They didn't need to pay for the game and they could play it a few minutes on their mobile and they would contribute to the dementia research. So we could see this.
This was kind of really gathering momentum and then it was kind of, uh, taking itself over. And then you had, of course, at that time, again, influences were not such a big thing. But we could always see when influencers picked it up and then it basically got [00:18:00] another, uh, boost. So we were lucky that some influencer, whatever, retweeted at that time, Instagram didn't exist, I think retweeted it and, um, we could see the numbers shot up again.
So it's really where these things take their own kind of life and for us, we, you know, our sample size, we were already so happy with whatever we had at that stage. It wasn't, yeah, I guess just the
Benjamin James Kuper-Smith: first day would've been enough. Exactly. Just the initial
Michael Hornberger: telecom
Benjamin James Kuper-Smith: thing.
Michael Hornberger: Exactly. Exactly.
Benjamin James Kuper-Smith: Yeah. But, um, so just, can I ask like a very boring question.
From a practical perspective, how much does it cost to develop this kind of game? Or maybe not necessarily this one, but like, let's say you want to apply for a new game. How much would you, what kind of ground, like what kind of proportions are we talking about here?
Michael Hornberger: And this has changed again, I think now these days it, it's much cheaper to develop this of course, because the, the games engines are much more widely distributed and you can develop it.
So it's a very difficult question to answer because it depends a lot what you want to do. So [00:19:00] again, I had to learn a lot about this. Do you want to do a 2D game, a 3D game? Do you want a single player? Do you want a multiplayer game? And each, do you want to have it, you know, standard desktop, vr, ar, all those decisions make a huge difference to the budget.
So it's very difficult to put this on. But I think, I dunno, we thought, you know, if you wanted to develop a kind of a 2D very simple game, you don't need, uh, I dunno, maybe something like 50,000 pounds, $50,000 I think, maximum. Uh, so the development of the
Benjamin James Kuper-Smith: game. Yeah.
Michael Hornberger: Yeah. If you want to have a 3D multiplayer game.
Yeah, would case you maybe several hundred thousand. I don't know. You see, it's really just varies enormously how, how, how slick you wanted as well to be and how much you want to invest in the graphics and so on.
Benjamin James Kuper-Smith: Yeah. I mean, if I remember yours was 3D, right? Like it, yeah, yours was definitely 3D and had some complicated or more advanced graphics.
[00:20:00] But it wasn't multiplayer or
Michael Hornberger: Yeah, no, it wasn't multi multiplayer. We thought about it, but it was just too difficult because you need to, for multiplayer games are a whole nother level. I found out, because of course you need to anticipate what other players could do, and within the development framework we had was just not possible.
And the science for us, we realized very quickly the science would be very difficult to control what people would do then as well. You know?
Benjamin James Kuper-Smith: Yeah, that's, yeah. That's one thing that I was also curious about, like from, I mean, I guess to some extent, you know, that people want to get into the points and get to the next level and that kind of stuff, but like.
I mean, can you maybe just elaborate a bit more on this process between having a fun game and getting actual scientific data out of it? Like how do. Like, did you already know, like what analysis you wanted to do, I guess, or, yeah, kind of how,
Michael Hornberger: yes. I think this is, I guess this is how we started really, that we knew we wanted, um, so for this patient navigation that we [00:21:00] wanted to have certain elements of, you know, allocentric and egocentric navigation.
So if, if listeners don't know what that means, allocentric is usually more map based kind of navigation. Egocentric is more a perspective of viewpoint based navigation. And then we also wanted some levels which look more at memory, uh, how people use that. And so we dev, we developed, therefore we wanted different levels who had an, um, different difficulty levels for that, where we would make either the, for example, the environment more difficult, either a more complex pathway people have to take, or in some levels what we had, we had what we call like a fog.
Benjamin James Kuper-Smith: Yeah. That was, that was difficult.
Michael Hornberger: Yeah. Which was basically obscuring than the landmarks that people wouldn't see. And so this was, these were all manipulations we did in the background. And then the same with the maps. Sometimes we gave people a map before the game, but sometimes the map was half obscured.
Again, we wanted to have different, I guess, um, you know, experimental conditions, [00:22:00] I guess if you were to call it that way, but in a very different, different way because we, we wanted then to modulate the difficulty. And gaming, of course, is perfect for that because you usually start with easy levels and you go to harder levels.
And I think see her request in the end, in total, I think at 54 levels or something like this. The, the end levels are really, we, we just had a lot of fun designing the end levels. I remember because, uh, we could just go crazy literally because we ran out of ideas at that stage and we thought nobody would ever play it.
But of course now we know that several thousand people have played. I think we have several 10,000 people who have played the game twice or three times. So we even have repetition data, which is also another kind of a learning effect kind of data, which we also wanted to look at. Of course. So this is in the best way I how I can explain it.
So we started from that framework and then the game designer started putting together levels and how we would display that, and that it would not feel like just a maze you would have to navigate. But it would [00:23:00] feel more naturalistic, but within confines, if that makes sense. Like experimental confines?
Benjamin James Kuper-Smith: Mm-hmm. I mean, for example, like the, the whole boat scenario, is that something where you like figured out, should we do it land, boat or flying or whatever? Or was it just
Michael Hornberger: We explored different things. We explored cars, we explored a, a person, um, we explored, um, I don't think we explored airplanes because of three them.
Yeah. That you can move in three dimensions, but the boat was in the end, turned out well. We did a lot of user experience then. Um, and the key was that the boat was also the most gender neutral. So the cars, uh, lots of women would never download, uh, a car game, for example. We've learned this very quickly from the games people, and this was again, for us, we, we wanted of course to have a representative data set.
You see, this is the other thing. We wanted a data set which could be played by equal. Men and women, and we have a fairly equal data, uh, gender split actually in our data, which I'm, I'm really happy about. [00:24:00]But at the same time, we wanted also to have a good age range that we, you know, it wouldn't be the classic only 18 to 25-year-old males playing basically.
And I guess
Benjamin James Kuper-Smith: having like a car game does sound like a racing game or something, so then it does Exactly. That doesn't sound very much like teenage boys basically playing something.
Michael Hornberger: Exactly. Or first person shooter. Well, usually, of course, you know, that's what we learned from the games companies again, what they showed us from their research is that the women were more interested in more kind of a social aspect and having kind of more.
A puzzle kind of approach. So we had to think like that as well and really try to find a balance.
Benjamin James Kuper-Smith: So it's a bit of a like adventure puzzle kind of
Michael Hornberger: thing. Exactly. That's kind of like the vibe you went from. Exactly. That's what we came very quickly to that we wanted to have some kind of adventure game. Um, but yeah, again, with the development time, you can't develop a huge adventure game, obviously.
So it needed to be quite confined and it needed to be, we wanted it to be playable on the mobile and at that time as well. Mobile screens were not that, [00:25:00] you know, big as you can have them now. So it needed resolution wise, you needed to also, there were so many, I dunno, I can talk all day about this because we had all kinds of aspects of also how the data would be saved, how much data would be generated, that it wouldn't be too expensive if people lost connectivity of their mobile, what would happen with the data.
So we had all kinds of contingencies in place for that. It was, as I said, it was extremely steep learning curve, but extremely exciting. I found it. I
Benjamin James Kuper-Smith: mean, I guess this was also, I mean, I guess Skype obviously was around for quite a while, but you are in, uh, Norridge, right? Or that you c and Hugo at UCL and the gaming company is, I dunno where, maybe assuming London, but
Michael Hornberger: they were at that time in London.
Yeah, and I actually, at the beginning I was still, I was living in Cambridge still, so I was at Cambridge at that time still. Yeah. We were having lots of
Benjamin James Kuper-Smith: just like,
Michael Hornberger: conversations basically day and night. Had the feeling sometimes and lots of meetings then as well. Um, which most of them happened in London.
I [00:26:00] just went down to London. That was okay. It's not too far for me to go, but it's, um, yeah. Yeah,
Benjamin James Kuper-Smith: as you said, I guess there's lots of enough you could talk about, about the development, but, um, maybe as one, like kind of last question about that, is there just anything that you thought, basically you had a certain expectation going in and that was just completely blown away?
Some, I'm assuming you had some sort of assumption of like, oh yeah, now I, now I'm gonna make this game, it's gonna be like this and that, but then when you actually did it. I was like, oh, uh, this is something I didn't see happening or expect.
Michael Hornberger: Yeah, I think this was a daily occurrence, frankly, for me. Uh, 'cause again, the learning curve was so steep, but I think I really have to give credit to Doge Telecom.
They really gave us very, you know, free reign. They just told us, uh, you know, we want you to create the best game with the best signs. The most discussion and conversations were really with the, with the games developers. And my expectation at the beginning, I guess, was that we [00:27:00] could develop this. And it would be fairly, you know, straightforward.
But then I learned very quickly that it was, it was far, far more complex. And then the other thing, I think what I completely underestimated as well, and I, that made me really, really happy was then that the charity as well, who was on board insisted that there was a kind of, so it was all enveloped in a, in a story basically in the end.
So, see, her Quest had a story around it as well, and people while playing the game could find out more about the story or they could find out more about dementia. And we didn't realize how impactful that would be actually as a public engagement, um, type or exercise. So many younger people who would never talk about dementia because they think it's an oldest people disease, what has it to do with me?
They were really engaged with this and they learn so much about it. And I think this is, again, using gaming to reach people and maybe even, you know, [00:28:00] if they're not, you know, I dunno how much they contributed to the game, but if they've learned something about the disease and what it is and what it means, I think made it all worthwhile.
And I, I completely underestimated that in terms of comments and feedback. What we got back from people, they really loved that aspect as well, that it could do help something, it empowered them to help something and contribute to dementia research and at the same time they'll learn something about dementia.
Benjamin James Kuper-Smith: That's pretty cool. Um, to get more to the scientific part. I'm just curious, um, is there anything that you wanted to test but couldn't, like, as part of the game thing? Like something you really went like, oh, this was like one of my favorite things I wanted to test or something, but then it turned out it was super boring to do, or it was too difficult or I don't know what.
Michael Hornberger: Oh wow. This is, again, a very good question to answer. Um, I can tell you the, the first time we actually looked at the data, so we had, um, the first time we were sent some [00:29:00] data from Dou Telecom. I remember we were anxiously looking at because we wanted to find out actually what the data looked like, and we opened the, the data file and it was empty and we had nearly a heart attack.
That afternoon, I remember was one of the worst ever that we basically ran this huge experiment and there's no data collected. It's such a classic, of course, scientific kind of experience. But luckily we found out that basically something happened on the server, which basically the transfer of the data didn't happen.
So it was all there. But I can tell you this afternoon was absolute horror. Basically, we thought, oh wow, we've done everything for nothing, basically. But I think what, what happened then in terms of, in retrospect, you of course you always have 2020 vision. So we always, we. You know, thinking back hug and I, we talked about this over all these years, we thought, oh, we could have done this better.
We could have done that better, we could have added this, but you don't know at that stage. So I think we were really, really proud how we designed it. And [00:30:00] in the end, actually it delivered more than we expected it to do. So we had a, we had a kind of a contingency plan, and which we talked about very brutally honest, right from the beginning between Hugo and myself.
And we said, okay, so what happens if the data is all basically the, you know, timestamp data is not there. What are we doing with the data? What if we don't have any accuracy data? What happens then? What if all the data is garbage? What are we doing then? So we had all these contingency plans, which were built in the game that we could at least collect a minimal viable data set itself.
And that was really, that was a really great step because in the end we were actually exceeded what we did and. We, you know, that's always a good place to be in, I guess. Um, yeah. And in, in terms of science, I think after, you know, these five years, it's incredible. Time flies, we've only really scratched the surface of serial quest.
It's because it just generated such an enormous data set that you need to be, now [00:31:00] we are quite, you need to be quite careful how you phrase your research questions around it. People always talk about big data. That's great and it is great, but you need to be very careful which questions you're asking of the big data set.
Not that you're just finding spurious effects, which you know, are not relevant really. And that's a really important. I think thing we, we discuss a lot, what, what will be the next, you know, publication on how do we, what do we want to look at? What do we have a good rationale for? That's not just by being, you know, completely opportunistic and just analyze, you know, the classic for students that what, what we always tell the students, don't correlate everything with everything, because you will always find something, you know, that's not good science.
Benjamin James Kuper-Smith: I mean, this leads perfectly to what I wanted to talk about next, which is the actual few papers that I have already come out of it. But maybe to, to start off that discussion, my first question kind of was gonna be how do you deal with the data set that large? Because [00:32:00] I'm, I'm assuming you had lots and lots of, you could have analyzed independent of, you know, the millions of people you had, but just the, the data you could get out of each participant basically.
How do you, how do you approach like a data set this big? Like, I mean, it seems maybe, it seems to me that the first few publications that came out were often, it seemed to me the general goal was to establish that this data set is a good data set scientifically.
Michael Hornberger: Yeah, absolutely. Yeah.
Benjamin James Kuper-Smith: So was that the beginning, kind of like just,
Michael Hornberger: it was really the beginning that we, because what, that's what we realized very quickly after the game was launched, that the public reception was really very, you know, positive.
The scientific reception was quite muted and then, and quite skeptical. And as I said, it still is in some quarters that people think it's just a game. So we realized very quickly, well the first thing we need to do is actually look, if this is, is this validator? Literally, and that's what we started. So the, I think the first, you know, [00:33:00]publications are maybe not.
I, well, for me, I think we, we are learning so much more about this data that what is, you know, coming out now. So over the next year we have some really exciting things coming out, which that's where we're really going into. I think the, the beauty of the data and where we can really explore what's happening, but it is what you alluded to as well, is at the beginning we also didn't know how to really go about with such a large data set.
So we talked to, of course we worked with, you know, computational. We have collaborators who are computational epidemiology. They, they know how to work with very large data sets, but it's still, it was such a huge data set that very of even they struggled with that. Because not only do we have, of course, single points for each individual, we have time, serious data, we have all the trajectories of each player, and that is then becomes very, very large.
So for us, it was therefore to start very descriptive and try to validate it. And now we are moving much more into the [00:34:00] trajectory data. So there's some very exciting work we're doing at the moment with, you know, people who are more, uh, mathematicians in particular who really know how to deal with, with this kind of trajectory data or geographies who know more about the environment, how people move through that.
And I think that's super exciting. There's some really, really exciting stuff coming out and I hope that will convince people again that there is something worth in doing gaming and science, I guess.
Benjamin James Kuper-Smith: Yeah, because I mean, as far as I can tell the, I mean the, one of the papers that came out, the plus one paper was basically seeing whether your gaming relates to real world navigation.
Yeah. And the answer's yes. It seems to actually measure something meaningful.
Michael Hornberger: Exactly. I think this, this was a critical question. Lots of people asked us, they say, well, this is navigating in a game. This is completely different to, to real world navigating. So this is one question we wanted to answer, you know, 'cause, which is, you know, it's a very simple paper in the end, but thankfully it showed that, you know, it relates to that.
And we, we expected that, uh, to happen. And we've [00:35:00] replicated this now in several data sets already. So that's really great.
Benjamin James Kuper-Smith: And then in the PNS paper, you kind of say that we already know that the risk carriers have worse performance, sorry, risk carriers for Alzheimer's disorder disease, um, have worse performance in special navigation tasks.
And I guess you test whether that comes out in your data also. Right.
Michael Hornberger: Exactly. Again, this was really much more validation kind of paper because this was the great work by Nico SMAs group, of course, you know, who's already, who published this in, in in Science, which we said, can we replicate this actually with our data?
And we did well, and that's, that's really great if you can replicate a high impact study that's really, really good. But it, as you said, it was really, we did another paper, which you might not have seen, which looked at test retest reliability of, of, of s hero quest. You see, it's, again, not a very exciting kind of research paper, but I think it's really just to show that this is real data.
This is not just a [00:36:00] game and it can replicate, you know, itself and it can replicate other existing studies. And then now we can move to the much more exciting new research, I think, which this game can answer.
Benjamin James Kuper-Smith: Yeah, good. Um, just to mention for the people who don't know, I have an episode with Nicola Ax Maha about those studies, so if that's interesting, then
Michael Hornberger: yeah, listen to it.
He's fantastic. He's amazing.
Benjamin James Kuper-Smith: So, I mean, can you say a bit more, uh, I mean, if if you can't then that's fine. Uh, but can you say a bit more about the stuff that is coming up? But it seems like you're, you're pretty excited about some of the studies.
Michael Hornberger: Yes, it is very exciting because we, we get more and more excited by it.
I think I can't, well, in general terms, I think it's much more, uh, as we said, uh, in looking at trajectory analysis. How do actually people move through space and can we potentially predict who is good and poor navigating just from their trajectories, for example. So it goes into very exciting areas and that in a fairly kind of.
Naturalistic ecological way, and [00:37:00] of course we want to use that then as well for potential disease prediction in, in the future. I think, and as I said this is, is really, but there's so many, as I said, there will be hopefully, you know, a few papers now coming out over the next year or two, which all look at different aspects.
For example, the environment or the memory and so on. We can really now in interrogate the data with the questions we actually put there at the beginning, but it took us such a long time because as I, as you, you know, it's a long, long time, but as you say, getting the handle of this big data and understanding this data.
Uh, and then showing that it's valid, that those were the first steps and it just took a long, long time for us to even develop, you know, our, the methods, how to look at this. But now I think we're in a really, really good spot. And of course, computational, we also, again, we are in a different world these days, five years later, you can run much, much more sophisticated algorithms, I guess, on this data set.
Benjamin James Kuper-Smith: So I guess now would be a good time to join your lab. [00:38:00] If
Michael Hornberger: please, please come in right at
Benjamin James Kuper-Smith: the right time.
Michael Hornberger: Please, please do. We're always looking for, for people if they want to join us, we'd love that. I think, you know, we have plenty of data. That's what I always say. There's no shortage of data with us.
Benjamin James Kuper-Smith: Yeah.
Yeah. You're probably, yeah, I mean, I guess, so as we, you know, mentioned in the beginning, you are kind of, as far as I understand, your main research before doing seizure quest was dementia, right. Or Alzheimer's disease. Um, and it still is,
Michael Hornberger: I have
Benjamin James Kuper-Smith: to say, or yeah. So how does. I dunno. I mean, it seems like, I mean, is the, are you doing lots of Alzheimer's stuff with the See Her Quest still or is that kind of a separate you, you kind of have like two parts to your research now.
One is the See Her Quest spa navigation in general and then the dementia stuff, or how do you think about that?
Michael Hornberger: So I think there was always been a bit of a misconception that Zero Request would be used for, you know, in Alzheimer's patients or dementia patients, different dementia patients. But [00:39:00] it was never designed for that because, you know, people who have dementia, Alzheimer's, we have already existing clinical tests, which we can determine them, you know, that's very straightforward.
Instead, it's much more about shifting the goalpost. I always call this that. We want to detect people much, much earlier. And we know, of course, you know, from all the work in, in the animals, um, you know, for example, Karen Duff's work, um, and, and Nico's work, I guess that, you know, the, the people who are at risk of dementia, that they're already showing navigation deficits a long time before they develop memory deficits.
But there at the moment, there are no tests out there for the clinical populations. So a lot of the, my research is based on these risk groups who are at risk of developing dementia and using Quest in one element. But we also now develop much more clinical tests, I guess, based on s Hero quest, and then validated against the big data set, which I think that's fair.
That's really exciting. But then as I mentioned before, [00:40:00] now lots of people use c requests in completely different populations, which we never anticipated. So we have everything from people, you know, doing intracranial recording while playing c request to, uh, developmental, to hydrocephalus, to, I dunno, epilepsy, traumatic brain injury.
I dunno so many cohorts who use it, which we never designed it for, but what everyone likes of course, is that the patients, they love it because it's not, they don't feel like they're doing a test, they're playing a game. And I think that's really great. Again, for, even for cognitive rehabilitation, I think, again, the gaming has been completely, you know, some people have tried to gamify that, but I think these are not real games.
So there is huge potential still. So we are still collecting enormous amount of data. We're doing other studies, which are more looking at birth cohorts, so people who have been followed up for a long, long time. And if we can use them all for, uh, [00:41:00] one aspect we're currently exploring to really do much more work in children.
So for us, we haven't really done much work in children with C Hero Quest.
Benjamin James Kuper-Smith: So I have a question that just occurred to me. Whilst you're talking about different populations, I wonder whether you can look at this or not. One thing that's, I guess noticeable is that I guess people who are kind of my generational younger, often, I guess I still had in my childhood to memorize a lot how to get from A to B because we didn't have mobile phones where we could just check how we get somewhere.
Um, do you notice like a shift or something in like that? The people who basically grew up with mobile phones and never really had to memorize, you know, you never had to like look at a car map and memorize where you had to go. Did you notice like any differences there or.
Michael Hornberger: Yeah, it's, well, we don't, we haven't published anything on this, but you can clearly see how much people use GPS will make a big difference on their, on their navigation behavior.
You know, and I, my myself, I noticed this always, I'm, I'm a very, I'm a keen [00:42:00] cyclist. I love cycling, you know, and I've, if I go a new route and I just look at my, you know, my navigation computer, I guess, and I've just followed the arrow. That's what I do on my bike. I'm not really navigating. Yeah. But you can, the good thing is you can train it of course, for people.
And that's what we found in our first study activity here, quest. We found that the Nordic countries always came out top in terms of navigation. And what we found out, um, which we didn't know at that time, is that, uh, the Nordic countries, they do a lot of orienting in school, and they're also always the world champions in orienteering.
So people are trained to navigate and obviously you do a much better navigation.
Benjamin James Kuper-Smith: I was, I, I was wondering, I think I looked at the, the map you had and I think, or the, the, one of the graphs, and I think Finland was like far better than anyone else or something.
Michael Hornberger: Yeah. Yeah. Finland, Sweden and, uh, Norway, they were always top in all of this.
And you know, the media made this completely ridiculous arguments that maybe because they're [00:43:00]vikings, that's why they're good at navigation. Oh, because of the
Benjamin James Kuper-Smith: seafaring.
Michael Hornberger: Yeah. Yes.
Unlike
Michael Hornberger: the other countries. But then we said, well, well how about then the British? And how about the Spanish and the politics?
Who were all big seafaring nations.
Benjamin James Kuper-Smith: Yeah, yeah, yeah. So I, yeah. So you mentioned that, I guess like the one kind of big problem with Alzheimer's is that. Or, I guess you didn't mention this, but one of the problems with Alzheimer's, I guess, is that you don't have early biomarkers that much, right? Like or tests to figure out who's going to develop it later on.
But it's more like people have problems and then it's too late to do anything about it. And you mentioned that the spatial navigation problems might occur before the memory problems occur.
Michael Hornberger: They definitely do. We know
Benjamin James Kuper-Smith: that
Michael Hornberger: just to detect them, that's the heartbeat, basically.
Benjamin James Kuper-Smith: Okay. Okay. So how, I mean, I'm just curious, like how far do you think are you from using.
Anything like, see not, you know, not see request per se, but something like, see request as a kind of clinical mark or something like [00:44:00] that.
Michael Hornberger: I think we're pretty close, frankly, to this. I think, you know, and I think several groups in the world work on this now. You know, there are several really good tests now out there, which, which look very, very promising.
Now, just to say we don't, we wouldn't of course, diagnose anybody just on doing kind of a navigation test. And of course, what we've see now, there are the blood biomarkers coming out for Alzheimer's disease who look very, very promising. And you can detect therefore whether the proteins start to accumulate in the brain.
But I think there's no, what we call a functional readout. So what does it actually matter? And in terms of the functional changes, and that's really where the, where they're interesting. Uh, I think development is, but I think within the next two to three years, hopefully we'll have a really, we have a great test then for that.
And I would be really keen for that to be used as an outcome measure in clinical trials, but also for diagnostics. And then potentially, you know, if you can stop the disease eventually for some kind of rehabilitation because it's spurred of a whole other [00:45:00] research for myself that I got really involved into the other side than once people have dementia and they're getting lost.
So we did a lot of work in people getting lost once they have the disease and how does it, can we actually predict earlier on who's at a higher risk of getting lost or not? And then can we put better safeguarding in place for those patients? I
Benjamin James Kuper-Smith: see. Okay. So using it. Yeah,
Michael Hornberger: exactly. I think you, you see there's so many use cases because the area, you know, is so, there's so little done still.
Uh, so it's extremely exciting area to work in, uh, which I think, you know, it's really fascinating.
Benjamin James Kuper-Smith: So, as I said before we started recording, I found out you have a book out a few days ago, I think, or weeks ago or something like that, which is as far as I can tell, like a general public explanation or overview.
This is Alzheimer's disease, something like that. Um, can you maybe Yeah. Say a bit more what the, what the book is about and. Maybe why you wrote it and, uh, maybe who should read it or who shouldn't, or I don't know.
Michael Hornberger: Well, please do [00:46:00] read it. Of course, everyone.
Benjamin James Kuper-Smith: Okay.
Michael Hornberger: But, uh, I think it's a book written really for anybody who wins and wants to find out more, more about Alzheimer's disease.
So I've done for many, many years public engagement with different groups and I always, always surprised how few people actually know. What's actually happening in Alzheimer's disease? How, you know, they don't know. Um, why are these specific symptoms occurring in memory and spatial navigation? What is happening to the proteins?
And then many people are worried about the genetics. Obviously, you know, can I inherited from my grandmother? My grandmother had dementia. Will I develop dementia? Those kind of, you know, which I can say because my grandmother had dementia. But you know, I, I can tell you the short answer is very unlikely.
So that's the good news. But, and on the other hand, you can actually do change your lifestyle, can you, via lifestyle changes, you can reduce your risk of Alzheimer's by nearly 40%. So people don't know that they're very worried about the genetics, but not about [00:47:00] the lifestyle, I guess.
Benjamin James Kuper-Smith: So lifestyle means what?
Like eating better, exercising and doing something interesting in their lives or.
Michael Hornberger: Yes. I think it's, it's a combination of all those, you know, but a lot of it is down to physical activity and then that relates to, for example, obesity, insulin resistance, or uh, type two diabetes. Then eating well, obviously, and then staying cognitively clearly active is a, is a key aspect for that as well.
Sleep as well. There there are multiple factors you could actually look at and in the book I go through the major, major ones.
Benjamin James Kuper-Smith: I guess if the, if we're talking about like staying cognitively active in old age and you have a game, uh, about special navigation, uh, does, does any, do any of those games actually do anything that people are like,
Michael Hornberger: well, this is a really interesting question.
I had a student working on actually, um, I, I would, I said, can we actually change people's navigation? Uh, potentially be, you know, behavior and with that, can we modulate their risk? But the [00:48:00] short, I don't have the answer to this other at the moment, but it is very interesting because you can actually change people how they, how they navigate.
You can, um, teach them different strategies or keep them cognitively engaged. So this is, I'd love to, to do a grant on this. As I said at the moment, I don't, uh, I don't have a grant on this, but I think I agree with you. It's a, a really, really interesting question to look at. Yeah,
Benjamin James Kuper-Smith: but I meant it, I meant it also more, more broadly in terms of, you know, when people play, like brain training games on their phone or anything like that, does that help in preventing dementia or something like that?
Or is that just all nonsense?
Michael Hornberger: Well, okay, so, uh, the brain training is a, is still a controversial topic. The problem with most of the brain training programs is that you become better at the actual program, but very little of it transfers to real life. And that's the, that's the, that's the pro where most brain training programs don't show that this transfer or far transfer, what it's really called, you know, into real life is very, is really minimal, basically.
We haven't looked at it for C [00:49:00] Hero, frankly. So I, because I never, we never intended it to be a brain training program, but could do, I guess in the future. But I think that's where the. We always say to people, it's better to learn something new. Whatever you can do to learn new. And ideally, you combine things.
So especially for older people or middle aged people, combine something which is, uh, you learn something new, which is very social and at the same time maybe gives you some kind of exercise. So for example, you know, you learn, you join a dance class, you know, you, it's very social, you move. So it's, it's not, of course you're not running a marathon, but for all the people again, that you're keeping active, or for example, here in the UK a very popular thing now is, uh, the Walking Football Association.
So this is, uh, what's that? Yeah, so it, so basically there was a realization that. Uh, lots of older men were still wanting to play football because they loved football, but they couldn't because their knees, their [00:50:00]back, whatever. So they designed a new league, which is basically in a very small, you know, five aside kind of game, played where nobody's allowed to run so you can only walk.
And this started very small, but now has its own national league. It's huge now and people love that. And that's great. Again, it has a social element. It has a physical element and that's, you know, the other thing is course learn an instrument or enjoy a band or anything like that. Join a choir. I think these are all things we recommend, which kind of combine these elements that you have a, either a social element or physical element or Yeah, any of those.
It's really good.
Benjamin James Kuper-Smith: So that means golfing is actually the perfect sport for all people.
Michael Hornberger: Well, yeah. It's for you. Perfect. Yes.
Benjamin James Kuper-Smith: I mean it's, it's social. It's, yeah, you're moving.
Michael Hornberger: Yes, exactly. It just depends what you're having afterwards in the clubhouse. I would always say.
Benjamin James Kuper-Smith: Ah, okay. Okay. Yeah.
Michael Hornberger: I always make this joke to my father, who is a very passionate tennis player for many years, but then he likes to BO two after that in the clubhouse, which, um, I [00:51:00] think, you know, maybe,
Benjamin James Kuper-Smith: yeah.
Michael Hornberger: It's not so good.
Benjamin James Kuper-Smith: Well, I guess at least, at least it's social rather than drinking at home in front of the
Michael Hornberger: tv. Exactly. Yeah. Yeah, yeah. Absolutely. Absolutely. So the book yeah. Was really meant to explain actually in detail this. So I really go into detail what, how, how are these proteins actually going wrong?
Where is this happening in the brain and why do they go wrong? What is the genetics? How does it actually work? What are these lifestyle factors? How do they work? And then have two other parts. One is more in the rarer forms of Alzheimer's disease, which people don't know as much about. And then, uh, actually the first part of the book is all about the history of Alzheimer's disease.
And again, that surprised me for so many years that so few people know actually about the history, about how it was discovered, who these people were and how, you know, yeah. Again, how, how did it come about? And for lots of people, that's, that's a real interest, uh, to even just, even most professionals don't know that.
So it was a lot of fun for me to go through, actually, the [00:52:00] very historic papers. I went through all the historic papers and really. Looked at what they actually did. And uh, I love to tell this to my students as well, that when, so Alzheimer, Alex, Alzheimer, when he, uh, had his first presentation of his first case, he presented this at a conference in tubing and, uh, to like psychiatrists, which were at that time the eminent psychiatrists of Southern Germany.
And he gave a presentation for half an hour on the case and made even, um, microscopic slices, which he showed and so on. And after his presentation, basically there were no questions. He was basically, his, his presentation was completely flat, so, and because there were no questions, there was actually, it was not meant to be included in the, the conference proceedings, which at that time was the main publication.
So it would have never made it actually as a publication. And then it was only intervened by his, at that time, by [00:53:00] his line manager, which was, uh, K Lin, that it was included. And that's basically that publication for these, this conference proceeding, which is just two pages long. It's still the foundation stone of Alzheimer's research, but it's, it's incredible Again.
To think about that he presented this and nobody thought it was of relevance or interest.
Benjamin James Kuper-Smith: It also makes you wonder what else like actually was not included.
Michael Hornberger: Yeah. I completely like other meetings. Completely agree. I completely agree. And the most, uh, that even Alzheimer himself doubted this. So his life actually, he was never, became, never famous for that.
And he always thought these were just some interesting cases, but they were not as special. So I think he himself, he would be amazed these days, is this major global disease basically, which carries his name
Benjamin James Kuper-Smith: and it's one of the main global diseases for all that Causes of death or
Michael Hornberger: something. Yeah. Top three.
Yes. Top three, absolutely. After cancer and heart disease.
Benjamin James Kuper-Smith: That's, [00:54:00] by the way, did he name it after himself or
Michael Hornberger: No, he didn't.
Benjamin James Kuper-Smith: Oh, that's a shame. I always love when people name stuff after themselves.
Michael Hornberger: True modesty. No he didn't. But as I said, he didn't think, he thought it was interesting, but he didn't think it was that special from, you can really kind of read this, uh, which, yeah, but it was named, so Klin, who was the main psychiatrist at that time?
Alzheimer at that time he was in Munich and um, he published a new monograph on psychiatric diseases and he included some of Alzheimer's cases and he called it, this was the first time it was referred to as Alzheimer's disease, basically. Mm-hmm.
Benjamin James Kuper-Smith: Okay.
Michael Hornberger: Yeah.
Benjamin James Kuper-Smith: Yeah. You mentioned some rare reforms of Alzheimer's disease and I think in on Twitter you said they also have like different symptoms or something like that?
Um, yeah, I was curious. So I don't really know, to be fair, actually. First before, can you, uh, what's the difference between dementia, Alzheimer's, and then what are these different, the rarer forms of Alzheimer's, and how are they like, uh, yeah, what, what differentiates them from the main? [00:55:00]
Michael Hornberger: Yes. I think it's the most common question I get when I do public talks.
What's the difference between Alzheimer and dementia? And so basically you have to think dementia is like an umbrella term, uh, like cancer, but underneath it's basically, there's several different diseases. And the top is basically, the most common form of dementia is Alzheimer's disease, which accounts for roughly 60 to 70% of all people with dementia.
And that's why people very often. Think dementia is Alzheimer's disease. The second, second most common form is vascular dementia, then dementia with Lewy bodies, frontotemporal dementia, and then there's several others. In total, there are around 15 type clinical subtypes of the, of dementia around now the rarer form of Alzheimer's disease.
Here they have the most common form, or if you might want the classic form of Alzheimer's disease, the protein accumulation of, of tau and amyloid. The two main proteins responsible for Alzheimer's disease happens in in the medial temporal lobe. And hence, those people have navigation and [00:56:00] memory deficits and problems.
But for other al the rarer Alzheimer form, these kind of parid depositions can happen in other areas of the brain. So for example, there's a form called posterior cortical atrophy, where these changes happen much more in the, in the parietal and occipital areas, and therefore people have much more visual, visual, spatial and visual, uh, deficits.
Oh,
Benjamin James Kuper-Smith: is that the people who have also sometimes like hallucinations or something, or
Michael Hornberger: rare hallucinations? There's usually more dementia with Lewy bodies, such as more related to Parkinson's disease. They have very vivid hallucinations. Yeah.
Benjamin James Kuper-Smith: Yeah, I, I once met a guy who had like, um, vision dementia or something, and he also just didn't recognize me or something like that.
Even though like he could do most, he could like perform pretty normally, but like recognizing stuff just was
Michael Hornberger: yes, a very difficult, very difficult. And then other forms you have frontal, so, which are much more called this executive Alzheimer's, where it's more the frontal, you know, lobes and they have usually more behavioral decision making problems.
Then you have one which is called, uh, [00:57:00] very long name lope progressive, uh, aphasia, which, uh, is basically a language form of Alzheimer's disease, which is very rare and very difficult to diagnose actually. And many people are never, you know, get very rarely spotted with that. So yeah, you have these different types, which as I said, you have a very different presenting symptoms, I guess to the classic Alzheimer's disease.
Benjamin James Kuper-Smith: So from the way it seemed is that, um, maybe I misunderstood this, but that. You know, different kinds of Alzheimer's can affect different areas and therefore the symptoms are different. Is it then actually a different disease disorder or do do the, does it just, you know, attack different? Areas of the brain, and therefore the symptoms are different.
Michael Hornberger: It's just because the different areas are attacked because the proteins are exactly the same attack. Those, okay. But for other dementia, so you have other, like dementia with Lewy body I mentioned, or frontotemporal dementia, they're caused by completely other different protein proteins in the brain and they can affect, again, different [00:58:00] areas and therefore cause different symptoms.
So it's a bit more complicated. I have a, I have this website called dementia science.org. If people want to find out more, I've always published articles on explaining this, or of course, read my book, which is called Tangled Up the Science in History of Alzheimer's Disease.
Benjamin James Kuper-Smith: Yeah, I'll put a link in the description for
Michael Hornberger: that would be great.
The
book
Benjamin James Kuper-Smith: and for everything we've discussed, papers and that
Michael Hornberger: kind of stuff. As I said, it's literal and folate people, but if you want to find out more how Alzheimer's disease is actually, you know, what happens in the brain, I think, you know, if I've tried very hard to give the essence of it without oversimplifying the science, that's a hard thing to do.
Benjamin James Kuper-Smith: Yeah, yeah, that's, yeah, that's a fine balance. Yeah. Okay. Yeah, I mean, I'll, I'll definitely check out the book. It's in the description for anyone else who's interested. Uh, I think I've run through my questions. I dunno whether you have anything to add any,
Michael Hornberger: no, I think we covered a lot, haven't we? Yes. I think, you know, in general, I always try to convince people that there is, especially [00:59:00] people who work more experimentally, I always try to convince students that it, it's, uh, very, very exciting to work with patients or clinical populations.
First of all, it gives, it gives you research, it gives a kind of, uh, I guess a real life relevance much more. And you can really make a difference to people. And I really love that. It's very humbling as well for our research. I think very often, um, and very often, of course, the, the patients are. Real world people.
So I see this so often that we get, for example, somebody developed a very clever, for example, cognitive test in un, you know, in undergraduate students. But once you try to introduce that into a clinic, it's very hard because of course people come to the clinic, they have very different educational backgrounds, very different backgrounds.
You might get very different results. So it's a real challenge always for, for coming up actually with something which is relevant for those people. But as I said, [01:00:00] one can make a really big difference and that's what really has motivated me always. This kind of balance between doing exciting experimental research, but then also being clinically or real world relevant.
I think that's a really great balance to strike.
Benjamin James Kuper-Smith: Yeah, I agree. There's lots of tasks that are so complicated. It takes like very educated people half an hour to understand what they're supposed to do.
Michael Hornberger: Yeah.
Benjamin James Kuper-Smith: Yes.
Michael Hornberger: Even I struggle with that.
Benjamin James Kuper-Smith: Yeah. Yeah, I mean I took part a study like, what do you want me to do?
I stood it, you know, so, but I guess maybe especially then getting back to the beginning, that's, I guess especially what these gamified versions might be particularly good for.
Michael Hornberger: I think that's my coming back to this games. Uh, I think it's such a, I dunno, I wish I could convince people more of this, but there's so much potential to use games.
As I said, the gaming market is enormous these days. There's an enormous resource out there for people wanting maybe to take part in research or help [01:01:00] research or, yeah, do just exciting things. Uh, and people love doing that. If you, if you can develop it and distribute it, of course you'll still need the funds for that.
Benjamin James Kuper-Smith: Yeah. Yeah, I mean, I mean, I don't really play many games on my phone or basically none, but occasionally I, you know, have this moment where I'll like, you know, whatever, bored and I'll download whatever game. And I've played like two or three games where I thought like, if you slightly change this and actually save the data, you could actually do science with this.
Like this is really, like some of them, I was such cool experiments for. Problem solving and uh, like planning and all these
Michael Hornberger: kind of things. I think puzzle games are perfect for that, frankly. You know, and I see this all with, with my children who of course, you know, who play, you know, I dunno, different, they play much more clearly.
You know, we do. But, um, and where I see a lot of games where I think, yeah, actually this could be one could just tweak this as you say and make it into something really exciting. Yeah. Which I should say, actually, this is a really interesting [01:02:00] tidbit. When we were developing C course, we had lots of different prototypes and I would always give my children, right?
Yeah. The prototype to plan without telling them that I developed it or co developed it. And I just, after you think they would've
Benjamin James Kuper-Smith: found that call if you did it?
Michael Hornberger: Well, I told them afterwards. I told them afterwards, but there, I wanted their immediate reaction because children, of course, are brutal in their judgment, and if they would've said, this is rubbish, or they said it many times, it's rubbish.
So we knew we had to change it. That's why. Yeah. Yeah. So this was, was a really great, always a really great test when they were thinking, oh, I'm not sure what I meant to do here. Okay, well we need to redesign that then, you know?
Benjamin James Kuper-Smith: Yeah. Yeah. So the kids do come in handy?
Michael Hornberger: Yes, they do. Finally, no, I'm joking.
Course.
Benjamin James Kuper-Smith: But yeah, I mean, I, I hope you are looking forward to the publications that come out of the serial request thing and then maybe, maybe some cool publications from they will maybe make funders also more likely to
Michael Hornberger: Yeah, I really hope so. [01:03:00] I really hope so. Yeah.