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Matchmaking Israeli BusinessesGreen Business Development LTD.VMTNeurological Evaluation by Visuo-Motor TestingVMTNeurological Evaluation by Visuo-Motor Testing

VMTVMTDiagnostic of Parkinson Diagnostic of Parkinson

DiseaseDisease

You do not have to be a famous boxer or a

successful movie star to be concerned about Parkinson

Matchmaking Israeli BusinessesGreen Business Development LTD.VMTNeurological Evaluation by Visuo-Motor TestingVMTNeurological Evaluation by Visuo-Motor Testing 2

HighlightsHighlights

• Medical device - Diagnostic, simple PC based + internet analysis.

• Addressing the dire need for effective PD screening test.• Early diagnosis leads to drug treatment that may delay the

deterioration of life quality.• Competitive advantage over current manual solutions.• Strong value proposition for patients, neurologists and

payers (deferring costly care). • Large target market- many billions in direct and indirect

cost.• US Patent 5,772,611, approved in 1998.• FDA clearance 510(k) - “evaluation of visuo-motor

performance disturbances”. • Working Prototype• Extensive data base with hundreds of test results• Time to Market – Less then a year.


BackgroundBackground

• VMT (Visuo-Motor-test) method was developed by Prof. Hocherman, of the faculty of medicine at the Technion.

• Prof. Hocherman has been involved in basic brain research for over 25 years.

• VMT was developed within the framework of his research on neurological motor control.

• The technology and the IP rights are owned by a group of four individuals, Prof. Hocherman included.


Parkinson Disease Parkinson Disease

• Parkinson’s disease is the second most common progressive neurodegenerative disorder, after Alzheimer’s disease.

• ~1.5 million Americans are currently diagnosed with PD and 60,000 new cases are diagnosed each year.

• More than 2% of the population aged over 65 years are affected.

• 5%-10% of patients with PD are misdiagnosed (have Parkinson's but are told they have something else),


Cost of PD - direct and Cost of PD - direct and indirectindirect

• The financial cost of Parkinson’s Disease to individuals, government and society combined is in the order of $24 billion per year.

• The study finds that indirect costs - e.g. disability payments by government and insurance plans and lost income due to forced early retirement are $15,000 per patient per year.

• The direct costs of medicines, surgery, doctor visits, hospitals and nursing homes are $8,800 per patient per year.


Parkinson Parkinson Neurological Neurological

Degenerative DiseaseDegenerative Disease• The

dopaminergic neurons in the Substantia Nigra are gradually depleted and the levels of Dopamine secretion are diminishing.

• The lack of Dopamine hormones has a devastating effect on motor, cognitive functions & emotional state.


VMT Product - Overview

• The enclosure holds the digitizer at elbow’s level and supports the computer monitor, bringing it to eye level.

• It is designed to allow free hand movement across the digitizer’s plane, while hiding the subject's hand from view.


The product - operationThe product - operation

• TRACING: o A path is displayed on screen. o The subject moves the cursor along the

entire path, as accurately as possible.

• TRACKING: o A target circle moves along the path, at

a predetermined speed. o The subject has to maintain the cursor

within the moving target.


The product - operationThe product - operation

Matchmaking Israeli BusinessesGreen Business Development LTD.VMTNeurological Evaluation by Visuo-Motor TestingVMTNeurological Evaluation by Visuo-Motor Testing3/08 10

Data Analysis - complex Data Analysis - complex parametersparameters

• The algorithm analyzes and scores the performance in independent tests, comparing Left & Right arms:o Test Time.o (*)Directional Error (DirEr).o (*)Mean percent time of DirEr>50%. o Distance from Path.o Velocity of hand movement.o (*)Number of tracking interruptions.

• While some of these parameters are standard, the marked (*) measures are unidue to the present system and are protected by patent.


Differential diagnosis of PDDifferential diagnosis of PD

• The VMT was tested on various groups:o Early vs. advance

PD patientso PD Vs. Essential

Tremor patientso PD Vs. Normal

subjects


Current methods for Current methods for diagnosis of PDdiagnosis of PD

UPDRS is the standard manual scale based on

performance and cognitive tasks. It takes 20-30 min of the neurologist time to complete the test.

SPECT ImagingDopamine uptake ligand beta-CIT, a SPECT agent is the most sensitive of biomarkers for the diagnosis of Parkinson's disease. Beta-CIT targets the dopamine transporter on the dopamine neuronal terminals and quantifies the loss of those terminals.


Clinical Clinical ApplicationsApplications

•Parkinsono Screening for early phase PD patients.o Differential diagnosis of PD Vs.

Essential Tremor and potentially other cognitive & motor dysfunctions.

o Optimization of drug treatment for PD patients.

•Non-Parkinsono Evaluation of attention disorders

(ADD/ADHD).


Neuroprotection in Neuroprotection in ParkinsonParkinson’’s Diseases Disease

• Written by Prof. Shraga Hocherman, :If a “holy grail” exists in the context of Parkinson’s disease (PD) there is no doubt that it would be a treatment that can slow, stop or even reverse the degeneration of neurons whose death causes the disease

• Drugs that treat PD symptoms are available, which offer small to modest degree of neuroprotection.

• New approaches that offer great promise are currently being tested, based on cell biology and genetic engineering.


15

Drug Treatment - Disease Drug Treatment - Disease ModificationModification

Early diagnosis of PDDrug treatment

delays symptoms Months/years of active life

Care giver or Nursing home


Conclusions from Conclusions from HochermanHocherman’’s Publicationss Publicationsbased on more then 400 based on more then 400

patientspatients• VMT test requires high-level motor planning and cognitive

capabilities that are not assessed by the standard diagnostic test - the UPDRS.

• VisuoMotor coordination of hand movements requires complex cognitive skills, controlling movement direction and velocity. A failure of these high-level motor control systems may occur early in the disease and may even precede the occurrence of motor symptoms.

• The performance in visuo motor coordination test (VMT) is impaired in early PD patients, either pharmacologically treated or untreated.

• VMT system may differentiate between Essential Tremor patients who may later develop PD and those who wouldn’t.

• Impaired VMT is a pertinent indication for further SPECT imaging in patients with ET, in order to establish a diagnosis of incipient PD.

• VMT appears to be a promising, inexpensive and friendly adjunct to the diagnosis of PD.


Interviews with 3 experts on PD

• Prof. M Youdim - Technion Pharmacology: “Drugs for slowing the deterioration of PD are expected soon (Rasagiline), early detection and treatment are critical”.

• Prof. H. Bergman - Neurological Physiology, Hadassah: “out of all possible indication, early detection is most important”.

• Dr. Sharon, Neurologist , Shiba Medical center, Movement Disorders “for PD patients, no single diagnostic modality can replace all other tests, but for monitoring the effects of medicated PD patients, VMT may serve as a objective quantitative tool”.


Competitive landscape Competitive landscape (preliminary)(preliminary)

• No commercial products for the diagnosis or screening of PD.

• Existing methods :o UPDRS - is the standard manual

scale based on performance and cognitive tasks.

o SPECT & pet CT - both imaging modalities are suggested for evaluating the # of lost neurons.

o Olfactory - research level claiming that the lost of smelling capability is indicative to PD.


Advantages

• VMT is a breakthrough computer based diagnostic procedure encompasses a highly desirable diagnostic tool in the movement disorders clinic. There is not a similar system in the market and the comparison is made vs. the traditional diagnostic methods which are time consuming, less accurate and do not provide quantified results:o Sensitive and objective system that minimizes false first

and second degree errors.o Reliable differential diagnosis between PD and its main

alternative condition (essential tremor).o Provides quantitative estimation of the patient's

condition.o Cost and time savings - Can be operated by a

nurse/technician. o Desk top and inexpensive.o Easy to install and use.


ADHD - Attention DisorderHow VMT Technology can

be used for such an application

Shraga Hocherman, Emanuel Tirosh, Sharon Dobrovski

Technion, Faculty of Medicine


ADHD Future DevelopmentBackground 1

• Inattention is one of the basic components of ADHD pathology.

• ADHD diagnosis relies on daily parents\teachers observations of the child’s behavior, and on a clinical interview, but does not include specific testing of attentional functionality.

• Behavioral impairments that lead to a diagnosis of ADHD derive in many cases from deficits that are not related to attention.


Basic-Test description

• Basic Test: Move a “mouse” controlled cursor so that it remains within a 1cm target circle that moves along a sinusoidal path from one end of the screen to the other.

• Loss of the target causes the later to stop in place until re-entered by the cursor.

• Performance Criteria:Number of target-losing events (Tracking interruptions).Cumulative time of tracking interruptions.Distance from target center.Lateral deviation from the target’s path.Instantaneous directional error.

• Measurements resolution: 1 millisecond; 0.05 millimeter.


Testing with distraction

• Performance under distraction: Target distracters & Cursor distracters.

• The number and combination of distracters determines the attentional demand of the subject.

• Assessment of the cost imposed by the attentional load by computing the performance difference between the distracted and the basic task.

• Low distraction level: 1 target distracter + 1 cursor distracter.

• High distraction level: 3 target distracters + 3 cursor distracters.

matchmaking israeli businesses green business development ltd. vmt diagnostic of parkinson disease...

Documents

parkinson slide

alzheimer s disease

cost of pd

vmt product

background vmt visuomotor

digitizer s plane

elbow s level

indirect costs