An electronic memory aid to support prospective memory in patients in the early stages of Alzheimer's disease: a pilot study

A Systematic Review of Prospective Memory Interventions Across Stages of Dementia-Related Disorders

BACKGROUND

There is a critical need to develop effective interventions for cognitive impairments associated with dementia-related disorders (i.e., Alzheimer's disease, frontotemporal dementia, mild cognitive impairment). Prospective memory (PM), or the ability to create and carry out future intentions, is one cognitive domain that is impaired in individuals with dementia-related disorders. Effective treatment of PM could significantly improve daily functioning, level of independence, and quality of life.

OBJECTIVE

To date, there have been a number of studies investigating potential interventions, but these interventions have not been comprehensively reviewed and compared across the stages of dementia-related disorders, as is the aim of the current review.

METHODS

This review examined 21 studies on the success of intervention strategies for prospective memory in patients with dementia-related disorders.

RESULTS

All the studies demonstrated positive effects of intervention on PM abilities, but there are questions concerning ecological validity, length of positive effects on PM, and a lack of diversity of interventions across the different stages of dementia-related disorders.

CONCLUSION

Future research should address these issues by incorporating daily functioning activities and caregiver support into the intervention process, as well as investigating these interventions at more severe stages of dementia-related disorders.

Remind Me To Remember: A pilot study of a novel smartphone reminder application for older adults with dementia and mild cognitive impairment

The SmartPrompt is a smartphone-based reminder application informed by a neuropsychological model of functional disability. This laboratory-based pilot study examined the SmartPrompt feasibility, efficacy, and subjective usability using a within-participant, counterbalanced, cross-over design. Ten participants (M age = 80.3 + 8.2; M education = 15.7 + 2.5; 60% female) with mild cognitive impairment or mild dementia completed the Remember to Drink Test, which required preparing a glass of water at four predetermined times, in a SmartPrompt (SP) and Unprompted condition (UP). Written cues and a clock were available in both conditions; however, in the SP, the smartphone presented auditory alarms and visual reminders to obtain the water at specified times and required photo logging. In a separate session, caregivers were trained and tested on configuring the SmartPrompt. Overall, caregivers and participants learned to effectively use the SmartPrompt. Caregivers achieved near-perfect scores on the configuration quiz and responded well to training. Participants completed significantly more Remember to Drink tasks in the SP (93%) than UP (56%); checking the cues/clock decreased by 87% in the SP. Usability ratings were excellent among caregivers and fair among participants. Results indicate that the SmartPrompt holds promise for reducing functional disability in older adults with cognitive difficulties in at-home contexts.

Adapting behavioural interventions to compensate for cognitive dysfunction in persons with opioid use disorder

Treatment for opioid use disorder (OUD) is often in the context of biobehavioural interventions, consisting of medication for OUD (for example, methadone and buprenorphine), which is accompanied by psychoeducation and/or behavioural therapies. Patients with OUD often display weaknesses in cognitive function that may impact the efficacy of such behavioural interventions. A review of the literature was conducted to: (1) describe common cognitive dysfunction profiles among patients with OUD, (2) outline intervention approaches for patients with OUD, (3) consider the cognitive demands that interventions place on patients with OUD and (4) identify potential accommodation strategies that may be used to optimise treatment outcomes. Cognitive profiles of patients with OUD often include weaknesses in executive function, attention, memory and information processing. Behavioural interventions require the patients' ability to learn, understand and remember information (placing specific cognitive demands on patients). Accommodation strategies are, therefore, needed for patients with challenges in one or more of these areas. Research on accommodation strategies for patients with OUD is very limited. We applied research from populations with similar cognitive profiles to form a comprehensive collection of potential strategies to compensate for cognitive dysfunction among patients with OUD. The cognitive profiles and accommodation strategies included in this review are intended to inform future intervention research aimed at improving outcomes among patients with OUD.

Training persons with early-stage Alzheimer’s disease how to use an electronic medication management device: development of an intervention protocol

Background/Objectives:

Medication management is challenging for persons with Alzheimer’s disease (AD) and their caregivers. Electronic medication management devices (eMMDs) are specifically designed to support this task. However, theory-driven interventions for eMMD training with this population are rarely described. This study aimed to develop and assess the appropriateness of an intervention protocol to train persons with early-stage AD how to use an eMMD.

Methods:

Interviews with three categories of participants [persons with early-stage AD (n = 3), caregivers (n = 3), and clinicians (n = 3)] were conducted to understand medication management needs, perceived usefulness of an eMMD, and to explore training strategies. Subsequently, this knowledge was integrated in an intervention protocol which was validated with the three clinicians. A content analysis led to iterative modifications to maximize the acceptability and coherence of the intervention protocol in a homecare context.

Results:

The final intervention protocol specifies the expertise required to provide the training intervention and the target population, followed by an extensive presentation of eMMD features. Specific learning strategies tailored to the cognitive profile of persons with AD with step-by-step instructions for clinicians are included. Finally, it presents theoretical information on cognitive impairment in AD and how eMMDs can support them.

Conclusions:

This intervention protocol with its theoretical and pragmatic foundation is an important starting point to enable persons with early-stage AD to become active users of eMMDs. Next steps should evaluate the immediate and long-term impacts of its implementation on medication management in the daily lives of persons with AD and their caregivers.

MindMate: A single case experimental design study of a reminder system for people with dementia

Prospective memory difficulties are commonly reported in people with dementia. The evidence supporting the use of prospective memory devices among the dementia population remains limited. MindMate is a recently developed smart device application that aims to support individuals with a diagnosis of dementia, improving self-management skills and quality of life. This study investigated the effectiveness and usability of the reminder tool on the MindMate application as a memory aid. Three participants with a diagnosis of Alzheimer's disease were recruited to this multiple baseline single-case experimental design study. Partners of the participants recorded their performance on everyday tasks on weekly monitoring forms during a baseline phase (between five and seven weeks) and during the intervention phase (five weeks) whilst using MindMate. Two participants successfully used the app throughout the intervention weeks and gave positive usability ratings. Tau-U analysis showed a significant increase in memory performance between baseline and intervention phase (Tau-U = 1, 0.94, p < .01). A third participant withdrew from the intervention phase following difficulties turning off the reminders and frustrations with the reminder alert sound. For two of the three participants, use of MindMate was feasible and effective in supporting remembering of everyday tasks compared to practice as usual.

Technology-Based Behavioral Interventions for Daily Activities and Supported Ambulation in People With Alzheimer's Disease

OBJECTIVES

These 2 studies evaluated technology-based behavioral interventions for promoting daily activities and supported ambulation in people with mild-to-moderate and moderate-to-severe Alzheimer's disease, respectively.

METHODS

Study 1 included 8 participants who were taught to start and carry out daily activities on their own using a tablet or smartphone device, which provided activity reminders, step instructions, and praise. Study 2 included 9 participants who were taught to engage in brief periods of ambulation using a walker combined with a tilt microswitch and a notebook computer, which monitored step responses and provided stimulation and prompts.

RESULTS

The participants of study 1 succeeded in starting the activities independently and carrying them out accurately. The participants of study 2 largely increased their ambulation levels and also showed signs of positive involvement (eg, smiles and verbalizations).

CONCLUSION

The aforementioned technology-based interventions may represent practical means for supporting people with Alzheimer's disease.

Mild cognitive impairment and prospective memory: translating the evidence into neuropsychological practice

OBJECTIVE

There has been a recent rapid development of research characterizing prospective memory performance in mild cognitive impairment (MCI) in older age. However, this body of literature remains largely separated from routine clinical practice in neuropsychology. Furthermore, there is emerging evidence of effective interventions to improve prospective memory performance. Therefore, our objective in this article was to offer a clinical neuropsychological perspective on the existing research in order to facilitate the translation of the evidence-base into clinical practice.

METHOD

By conducting a critical review of the existing research related to prospective memory and MCI, we highlight how this data can be introduced into clinical practice, either within diagnostic assessment or clinical management.

CONCLUSIONS

Prospective memory is impaired in older adults with MCI, with a pattern of performance that helps with differential diagnosis from healthy aging. Clinical neuropsychologists are encouraged to add prospective memory assessment to their toolbox for diagnostic evaluation of clients with MCI. Preliminary findings of prospective memory interventions in MCI are promising, but more work is required to determine how different approaches translate to increasing independence in everyday life.

Assistive Technology for Cognition and Health-related Quality of Life in Huntington's Disease

Background: Assistive technology for cognition (ATC) can be defined as external devices aimed at supporting cognitive function. Studies in neurological populations suggest that use of ATC is a promising strategy to ameliorate negative effects of cognitive impairment and improve Health-related Quality of Life (HRQoL). There is a lack of studies on the effects of ATC in HD.

Objective: This study aimed to describe the use of ATC in patients with HD, and to investigate the association between ATC and HRQoL.

Methods: A cross-sectional population-based study, including eighty-four patients with a clinical HD diagnosis (stages I–V). Socio-demographic and clinical data were collected, including information regarding various aspects of ATC use and an evaluation of cognitive impairment was performed. The Unified Huntington’s Disease Rating Scale (UHDRS) Total Functional Capacity scale (TFC) and the EQ-5D Visual Analogue Scale were used to evaluate functional ability and HRQoL. Descriptive analyses were conducted to describe ATC use and regression analyses to investigate associations between ATC and HRQoL.

Results: Thirty-seven percent of the patients had ATC, and ATC was used most frequently in stages I-III. Information about ATC, needs evaluation and training was provided to 44%, 32.1% and 20.2% respectively. The regression analysis showed a significant association between TFC and HRQoL (β value = –0.564, p = 0.001), but there was no association between ATC and HRQoL.

Conclusions: One-third of all patients used ATC, mainly those with mild to moderate cognitive impairment (stage I –III). No association between ATC and HRQoL was found. More research is needed to investigate effects of ATC in HD.

Electronic memory aids for people with dementia experiencing prospective memory loss: A review of empirical studies

This paper details a review of the literature on the use of electronic aids for prospective memory for people with dementia. Key findings of the review are that: electronic memory aids show potential for supporting people’s prospective memory but the devices and software applications need further development in order to function reliably; sample sizes of studies are often very small, limiting the generalisability of their findings; few studies of devices are conducted in users’ home environments; and most of the studies focus on the effectiveness of the electronic memory aid, rather than outcomes for users, such as improved daily functioning, quality of life, or social connectedness. The review concludes that future studies with robust devices are required that explicitly focus on the varying needs and capacities of people with dementia, in order to generate additional evidence for the effectiveness of electronic memory aids for this cohort.

A technology-aided program for helping persons with Alzheimer’s disease perform daily activities

Purpose

Persons with mild and moderate Alzheimer’s disease experience increasing activity engagement failures, with consequent cognitive, social, and physical drawbacks. The purpose of this paper is to assess a technology-aided program to help these persons to independently start and carry out daily activities at the appropriate times.

Design/methodology/approach

The program was implemented with eight participants according to an adapted non-concurrent multiple baseline design across participants. The program provided each participant with: timely reminders about the activities to carry out, verbal instructions about the activity steps, and brief encouragements and praise.

Findings

All participants showed improvement during the program, that is, they managed to independently start the activities at the scheduled times and perform those activities with satisfactory levels of accuracy (i.e. with mean percentages of correct steps nearing or exceeding 90).

Originality/value

A technology-aided program, such as that used in this study, may help persons with mild and moderate Alzheimer disease engage in daily activities, with possible benefits for their cognitive functioning, social image, and physical condition.

Computer-based cognitive interventions for people living with dementia: a systematic literature review and meta-analysis

OBJECTIVES

To estimate the efficacy of computer-based cognitive interventions for improving cognition in people with dementia (PWD).

METHOD

Online literature databases were searched for relevant studies. Interventions were categorised as follows: cognitive recreation, cognitive rehabilitation, cognitive stimulation or cognitive training. A systematic review, quality assessment and meta-analyses were conducted.

RESULTS

Twelve studies were identified. Their methodological quality was acceptable according to Downs & Black criteria, the weakest methodological area being the external validity. The meta-analyses indicated cognitive interventions lead to beneficial effects on cognition in PWD (SMD 0.69; 95% CI = 1.02-0.37; P < 0.0001; I(2) = 29%), [corrected] depression (SMD 0.47; 95% CI = 0.16-0.78; P = 0.003; I(2) = 0%) and anxiety (SMD 0.55; 95% CI = 0.07-1.04; P < 0.03; I(2) = 42%). [corrected]. They benefited significantly more from the computer-based cognitive interventions than from the non-computer-based interventions in cognition (SMD 0.48; 95% CI = 0.09-0.87; [corrected] P = 0.02; I(2) = 2%).

CONCLUSION

Computer-based cognitive interventions have moderate effects in cognition and [corrected] anxiety and small effects in depression in PWD. No significant effects were found on activities of daily living. They led to superior results compared to non-computer-based interventions in cognition. Further research is needed on cognitive recreation and cognitive stimulation. There is also a need for longer term [corrected] follow-up to examine the potential retention of treatment effects, and for the design of specific outcome measures.

Technologies to Support Community-Dwelling Persons With Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and Cost-Effectiveness, Deployment, and Ethics

BACKGROUND

With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge.

OBJECTIVE

The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research.

METHODS

Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases.

RESULTS

According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies.

CONCLUSIONS

Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them.

ICT-based applications to improve social health and social participation in older adults with dementia. A systematic literature review

OBJECTIVES

Information and communication technologies (ICT) developers, together with dementia experts have created several technological solutions to improve and facilitate social health and social participation and quality of life of older adults living with dementia. However, there is a need to carry out a systematic literature review that focuses on the validity and efficacy of these new technologies assessing their utility to promote 'social health' and 'active ageing' in people with dementia.

METHOD

Searches in electronic databases identified 3824 articles of which 6 met the inclusion criteria and were coded according to their methodological approach, sample sizes, type of outcomes and results.

RESULTS

Six papers were identified reporting the use of 10 different interventions with people with dementia. Qualitative studies (four) showed a benefit of the use of technologies to foster social participation in people with dementia. At the same time, barriers to a widespread use of these technologies in this population were identified. A quantitative study and a mixed-method study with quantitative outcomes showed that ICT-based interventions promote more social behaviours than non-technology-based interventions.

CONCLUSIONS

In the last years, several technological devices for living independently and fostering social health and social participation in people with dementia have been developed. However, specific outcome measures to assess social health and social participation are needed. Even though the analysed studies provided some evidence-base for the use of technology in this field, there is an urge to develop high quality studies and specific outcome measures.

Impact of AP@LZ in the daily life of three persons with Alzheimer's disease: long-term use and further exploration of its effectiveness

AP@LZ is an electronic organiser that was designed to support the day-to-day activities of persons with Alzheimer's disease. To assess the potential of this technology, three participants (NI, JB, RD) were approached to take part in the study. They benefited from a structured cognitive intervention to learn how to operate AP@LZ; the intervention included the following learning stages: Acquisition, Application and Adaptation. Pre- and post-intervention measures were collected. NI, for whom a longitudinal study was conducted, still continued to use AP@LZ 24 months post-intervention. JB and RD also showed a gradual improvement in their performance throughout the intervention phase (sessions 1 to 19 for JB: performance increased from 50 to 100%; sessions 1 to 25 for RD: from 56 to 89%). The results of the use of AP@LZ in activities of daily living suggest that the application was beneficial for three persons with Alzheimer's disease whose profiles differed notably (age, cognitive and social profiles). Thus, results indicate that they were all able to learn how to operate AP@LZ's functions and to use them in their activities of daily living. Cognitive intervention appears to play an important role for the promotion of learning and adoption of such technology.

The CARE pathway model for dementia: psychosocial and rehabilitative strategies for care in young-onset dementias

The goal of the Care Pathway Model for Dementia (CARE-D) is to improve quality of life and daily functioning both for individuals diagnosed with dementia and for their families or other caregivers. This is accomplished by developing individualized recommendations focused on a person's strengths and weaknesses as determined by formal neurocognitive and psychosocial evaluations. Careful attention is given to the stage of illness and an individual's stage in life, to connecting families with services that target an individual's cognitive and behavioral symptoms, and to providing education and emotional support specific to symptoms, clinical diagnosis, and prognosis.

Empirical studies on the effectiveness of assistive technology in the care of people with dementia: a systematic review

Purpose

– The purpose of this paper is to assess the empirical support for the use of assistive technology in the care of people with dementia as an intervention to improve independence, safety, communication, wellbeing and carer support.

Design/methodology/approach

– A total of 232 papers were identified as potentially relevant. Inclusion criteria were: studies published between 1995 and 2011, incorporated a control group, pre-test-post-test, cross sectional or survey design, type of interventions and types of participants. The 41 papers that met criteria were subjected to an assessment of their validity using the model provided by Forbes. Following the assessment seven papers were considered as strong, ten moderate and 24 weak. The review is presented around the following topics: independence, prompts and reminders; safety and security; leisure and lifestyle, communication and telehealth; and therapeutic interventions.

Findings

– The literature exploring the use of assistive technologies for increasing independence and compensating for memory problems illustrate the problems of moving from the laboratory to real life. The studies are usually limited by very small samples, high drop-out rates, very basic statistical analyses and lack of adjustment for multiple comparisons and poor performance of the technology itself.

Originality/value

– Research to date has been unable to establish a positive difference to the lives of people with dementia by the general use of the assistive technology reviewed here.

Aging society and gerontechnology: a solution for an independent living?

Recent studies report that the majority of older adults wish to live in their own homes, for as long as possible. This creates a growing interest in technologies to enable older people to remain living independently at home. The purpose of this article is to provide a narrative review of current technology appropriate for older adults' home use. The key research questions were as follow: 1- What is the evidence demonstrating that gerontechnologies are effective in enabling independent living? 2- What are devices designed specifically for frail elderly persons ? Several publications were identified about devices targeting social isolation (videophonic communication, affective orthotic devices or companion-type robots, personal emergency response systems [security]), autonomy loss (technologies for maintenance of autonomy in the activities of daily living) and cognitive disorders (cognitive orthotics, wandering management systems, telemonitoring). Very few articles dealt specifically with the frail older person. In particular, there was extremely limited evidence on use and efficacy of these devices within this population. There is a need to obtain a consensus on definition of the technologies, and also to revisit work strategies and develop innovative business models. To meet this goal, we need to create a network of technological companies, aging services organizations, end-users, academics, and government representatives to explore the real needs of the frail older population and to develop and validate new devices promoting aging at home.

Experiences of using a memory aid to structure and support daily activities in a small-scale group accommodation for people with dementia

BACKGROUND

Use of technology to structure and support the daily activities of the residents in a small-scale group accommodation (SSGA) for dementia is a new innovation in the Netherlands. This paper presents the process of development of this new way of structuring activities and the findings of a pilot study looking at the experiences of using this device in people with dementia.

METHOD

A qualitative method was chosen, data were collected using individual interviews with the residents (n = 6), focus groups interviews with informal carers (n = 5) and members of staff (n = 6). Data were analysed using Ritchie & Spencer's framework (1994).

FINDINGS

Three main themes emerged: issues regarding the implementation, needs for further development and the learning experiences acquired during the development. The majority of the residents were happy with the use and function of the memory aid. However, the occurrence of installation errors, limited ease of use and a lack of knowledge regarding the function and use of the memory aid were issues that prevented a successful implementation. Findings highlighted shared views about ways of improving through adaptation of the software program and additional technological applications; internet connectivity, improving its accessibility by using a remote control and adding videos and photos.

CONCLUSION

Lessons are learned about the use and transferability of this innovation in people with dementia and other vulnerable target groups including those with learning disabilities as well as its limitation and the needs for further development.

An evidence-based systematic review on cognitive interventions for individuals with dementia

PURPOSE

To evaluate the current state of research evidence related to cognitive interventions for individuals with Alzheimer's disease or related dementias.

METHOD

A systematic search of the literature was conducted across 27 electronic databases based on a set of a priori questions, inclusion/exclusion criteria, and search parameters. Studies were appraised for methodological quality and categorized according to intervention technique and outcome (e.g., cognitive-communication impairment or activity limitation/participation restriction). Results were summarized and, when possible, analyzed quantitatively using indicators of treatment effect size.

RESULTS

Forty-three studies met criteria for inclusion in the review. The most commonly used cognitive intervention techniques used were errorless learning, spaced-retrieval training, vanishing cues, or verbal instruction/cueing. Most treatment outcomes were measured at the cognitive-communication impairment level of functioning and were generally positive. However, results should be interpreted cautiously because of methodological limitations across studies.

CONCLUSIONS

Research evidence to support the use of cognitive interventions for individuals with dementia is accumulating. Researchers are beginning to evaluate treatment efficacy, yet the focus tends to be on discovery, specifically, refining intervention variables that will facilitate optimal outcomes. Implications for clinical practice and avenues for future research are discussed.

Electronic reminding technology for cognitive impairment

Demographic changes highlight the need to address disabilities associated with the costly morbidities of old age, such as dementia. Memory impairment associated with dementia represents a significant challenge for many older people. Difficulties occur in carrying out activities in their entirety or in commencing them at all. Technology has the potential to help individuals overcome the barriers created by cognitive disability in terms of performing activities of daily living and therefore help to maintain independence and enhance quality of life (Czaja, 2005). This literature review examines the current reported research, which employs electronic reminding technology to support individuals with cognitive impairment. These devices range from everyday technologies, such as phones, to sophisticated interactive devices with specifically designed software. A summary of the current evidence base is presented and recommendations for future practice are made.

Automated activity-aware prompting for activity initiation

Performing daily activities without assistance is important to maintaining an independent functional lifestyle. As a result, automated activity prompting systems can potentially extend the period of time that adults can age in place. In this paper we introduce AP, an algorithm to automate activity prompting based on smart home technology. AP learns prompt rules based on the time when activities are typically performed as well as the relationship between activities that normally occur in a sequence. We evaluate the AP algorithm based on smart home datasets and demonstrate its ability to operate within a physical smart environment.

PUCK: An Automated Prompting System for Smart Environments: Towards achieving automated prompting; Challenges involved

The growth in popularity of smart environments has been quite steep in the last decade and so has the demand for smart health assistance systems. A smart home-based prompting system can enhance these technologies to deliver in-home interventions to users for timely reminders or brief instructions describing the way a task should be done for successful completion. This technology is in high demand given the desire of people who have physical or cognitive limitations to live independently in their homes. In this paper, with the introduction of the "PUCK" prompting system, we take an approach to automate prompting-based interventions without any predefined rule sets or user feedback. Unlike other approaches, we use simple off-the-shelf sensors and learn the timing for prompts based on real data that is collected with volunteer participants in our smart home test bed. The data mining approaches taken to solve this problem come with the challenge of an imbalanced class distribution that occurs naturally in the data. We propose a variant of an existing sampling technique, SMOTE, to deal with the class imbalance problem. To validate the approach, a comparative analysis with Cost Sensitive Learning is performed.

Cognitive function and assistive technology for cognition: a systematic review

The relationship between assistive technology for cognition (ATC) and cognitive function was examined using a systematic review. A literature search identified 89 publications reporting 91 studies of an ATC intervention in a clinical population. The WHO International Classification of Functioning, Disability and Health (ICF) was used to categorize the cognitive domains being assisted and the tasks being performed. Results show that ATC have been used to effectively support cognitive functions relating to attention, calculation, emotion, experience of self, higher level cognitive functions (planning and time management) and memory. The review makes three contributions: (1) It reviews existing ATC in terms of cognitive function, thus providing a framework for ATC prescription on the basis of a profile of cognitive deficits, (2) it introduces a new classification of ATC based on cognitive function, and (3) it identifies areas for future ATC research and development.

Application of cognitive rehabilitation theory to the development of smart prompting technologies

Older adults with cognitive impairments often have difficulty performing instrumental activities of daily living (IADLs). Prompting technologies have gained popularity over the last decade and have the potential to assist these individuals with IADLs in order to live independently. Although prompting techniques are routinely used by caregivers and health care providers to aid individuals with cognitive impairment in maintaining their independence with everyday activities, there is no clear consensus or gold standard regarding prompt content, method of instruction, timing of delivery, or interface of prompt delivery in the gerontology or technology literatures. In this paper, we demonstrate how cognitive rehabilitation principles can inform and advance the development of more effective assistive prompting technologies that could be employed in smart environments. We first describe cognitive rehabilitation theory (CRT) and show how it provides a useful theoretical foundation for guiding the development of assistive technologies for IADL completion. We then use the CRT framework to critically review existing smart prompting technologies to answer questions that will be integral to advancing development of effective smart prompting technologies. Finally, we raise questions for future exploration as well as challenges and suggestions for future directions in this area of research.

Nonpharmacological treatment of Alzheimer disease

OBJECTIVE

To review the key nonpharmacological treatment approaches to the cognitive and functional symptoms of Alzheimer disease (AD).

METHODS

We searched and critically analyzed the most recent relevant literature pertaining to the nonpharmacological treatment of AD.

RESULTS

There is evidence from a modest number of well-conducted randomized controlled trials (RCTs) that various nonpharmacological approaches, including cognitive training, cognitive rehabilitation, and cognitive stimulation therapy (CST), confer modest but significant benefits in the treatment of cognitive symptoms in people with AD, and that there may be additive benefits in combination with cholinesterase inhibitor therapy. Cognitive rehabilitation also appears to result in functional benefits in AD. The modest number of RCTs focusing on cognitive training in AD is consistent with the results of larger cognitive training trials in healthy older people. however, there is no convincing evidence of any benefits associated with brain training games.

CONCLUSION

An emerging evidence base indicates that different approaches to cognitive training and cognitive stimulation in people with AD confer modest but significant benefits. The best evidence base is for CST, although this approach is labour-intensive, and requires further evaluation of cost-effectiveness. There is currently no evidence that brain training games provide any significant benefit to people with AD.

Evidence supporting technology-based interventions for people with early-stage Alzheimer's disease

Innovative uses of technology offer many exciting possibilities for better care and improved quality of life for people with Alzheimer's disease and their families. This article provides empirical evidence through a systematic review of 10 studies involving technological advances. Although the studies reported have a small number of participants, the early results are positive. We believe the use of technology has the potential to save health care costs, ease caregiver stress, and help people with dementia live better, safer, and more fulfilling lives.

Efficacy and usability of assistive technology for patients with cognitive deficits: a systematic review

Objective: To determine the efficacy of portable electronic aids such as personal digital assistants (PDAs), pagers or mobile phones for patients with cognitive deficits by means of a systematic review. The usability of these aids is also briefly discussed.

Data sources: PubMed, CINAHL, PsychINFO, EMBASE and MEDLINE were searched up to February 2009. The references of identified and relevant articles were scanned to find additional relevant titles.

Review methods: Papers referring to ‘electronic aids’, ‘cognition’ and ‘brain injury’ were included. The population had to be adult and have cognitive impairments as a result of acquired brain injury. Outcome measures were change in cognitive or occupational performance or the level of participation in daily life. The criteria of Cicerone et al. were used to evaluate the quality of the retrieved studies.

Results: Twenty-eight papers presenting 25 studies were reviewed. The total number of participants was 423. Most identified papers described case reports or non-randomized clinical trials. Only one randomized controlled trial was identified, in which the NeuroPage proved effective in supporting prospective memory. Other kinds of assistive technology such as PDAs and voice recorders showed positive results in supporting retrospective and prospective memory.

Conclusion: The efficacy of assistive technology in general is not yet sufficiently studied in randomized controlled trials, although promising results has been reported. Furthermore, several survey studies established that both potential users and clinicians have optimistic expectations about the usability of assistive technology.

Review of exemplar programs for adults with early-stage Alzheimer's disease

In response to the need to develop evidence-based best practices interventions and services for individuals in the early stages of Alzheimer's disease (AD), the authors conducted an interdisciplinary literature review of exemplar programs, defined as those including multimodal or unimodal interventions; shown to be appropriate for individuals in the early stages of AD; demonstrating promise to support, maintain, and improve independent functioning; and shown to have positive effects for a variety of outcomes, including quality of life. This article examines evidence from five kinds of programs: (a) multimodal interventions, (b) programs developed by the Southwest Florida Interdisciplinary Center for Positive Aging, (c) sleep enhancement interventions, (d) managed care programs, and (e) technology-based interventions. Evidence from the review suggests that a number of programs can support functioning and improve quality of life for adults living with the early stages of memory loss. The article concludes with recommendations to advance a national research agenda in this area.

What do community-dwelling people with dementia need? A survey of those who are known to care and welfare services

BACKGROUND

The aging society will bring an increase in the number of people with dementia living in the community. This will mean a greater demand on care and welfare services to deliver efficient and customized care, which requires a thorough understanding of subjective and objective care needs. This study aims to assess the needs of community-dwelling people with dementia as reported by themselves and by their informal carers. The study also aims to give insight into the service use and gaps between needs and the availability of services.

METHODS

236 community-dwelling people with dementia and 322 informal carers were interviewed separately. (Un)met needs were assessed using the Camberwell Assessment of Needs for the Elderly (CANE).

RESULTS

Most unmet needs were experienced in the domains of memory, information, company, psychological distress and daytime activities. People with dementia reported fewer (unmet) needs than their carers. Type and severity of dementia, living situation and informal carer characteristics were related to the number of reported needs.

CONCLUSIONS

This study showed a large number of unmet needs in dementia. Reasons for unmet needs are lack of knowledge about the existing service offer, a threshold to using services and insufficient services offer. These results provide a good starting point for improving community care for people with dementia.

Review of ICT-based services for identified unmet needs in people with dementia

Some of the needs that people with dementia and their informal carers currently perceive as insufficiently met by regular care and support services might be alleviated, or even be met, using modern Information and Communication Technology (ICT). The study described in this paper was designed to provide an insight into the state of the art in ICT solutions that could contribute to meet the most frequently mentioned unmet needs by people with dementia and their informal carers. These needs can be summarized as (1) the need for general and personalized information; (2) the need for support with regard to symptoms of dementia; (3) the need for social contact and company; and (4) the need for health monitoring and perceived safety. Databases that were searched include: PubMed, Cinahl, Psychinfo, Google (Scholar), INSPEC and IEEE. In total 22 websites and 46 publications were included that satisfied the following criteria: the article reports on people with dementia and/or their informal carers and discusses an ICT-device that has been tested within the target group and has proven to be helpful. Within the first need area 18 relevant websites and three studies were included; within the second need area 4 websites and 20 publications were included. Within the third and fourth need area 11 and 12 publications were included respectively. Most articles reported on uncontrolled studies. It is concluded that the informational websites offer helpful information for carers but seem less attuned to the person with dementia and do not offer personalized information. ICT solutions aimed at compensating for disabilities, such as memory problems and daily activities demonstrate that people with mild to moderate dementia are capable of handling simple electronic equipment and can benefit from it in terms of more confidence and enhanced positive effect. Instrumental ICT-support for coping with behavioral and psychological changes in dementia is relatively disregarded as yet, while support for social contact can be effectively realized through, for example, simplified (mobile) phones or videophones or (entertainment) robots. GPS technology and monitoring systems are proven to result in enhanced feelings of safety and less fear and anxiety. Though these results are promising, more controlled studies in which the developed ICT solutions are tested in real life situations are needed before implementing them in the care for people with dementia. It is recommended that future studies also focus on the integration of the current techniques and solutions.

Outcomes of a computer-based cognitive rehabilitation program on Alzheimer's disease patients compared with those on patients affected by mild cognitive impairment

The aim of the present study is to evaluate the outcomes of a computer-based cognitive training on patients affected by Alzheimer's disease (AD) compared with the outcomes on patients affected by mild cognitive impairment (MCI), multiple system atrophy (MSA). Ten AD patients aged 74.1+/-5.6 years, with mini-mental state examination (MMSE) score at baseline of 23.9+/-2.4, and 10 MCI patients aged 70.6+/-6.0 years, with MMSE score of 28.0+/-1.4, attending our day-hospital of neurorehabilitation were selected for the study. Three MSA patients aged 69.0+/-9.5 years, MMSE scores 26.7+/-2.3 were selected from the same setting in order to have a different control group. Each patient attended two training programs and was evaluated according to cognitive and non-cognitive functions at baseline at the end of the second training program. The AD group showed a significant MMSE score improvement (p=0.010). On the contrary, MMSE scores at baseline and at follow-up remained quite stable in the other two groups. AD patients also showed significant improvement in the areas of verbal production (p=0.036) and executive functions (p=0.050). MCI patients significantly improved in behavioral memory (p=0.017; p=0.011). No significant improvement was observed in MSA group. Our data seem to indicate that the same individualized rehabilitative intervention could have different effects according to patient's diagnosis. MCI and AD patients had significant improvements in global cognitive status and/or in specific cognitive areas. On the contrary, MSA patients did not benefit at all.

Prospective memory in HIV-1 infection

The cognitive deficits associated with HIV-1 infection are thought to primarily reflect neuropathophysiology within the fronto-striato-thalamo-cortical circuits. Prospective memory (ProM) is a cognitive function that is largely dependent on prefronto-striatal circuits, but has not previously been examined in an HIV-1 sample. A form of episodic memory, ProM involves the complex processes of forming, monitoring, and executing future intentions vis-à-vis ongoing distractions. The current study examined ProM in 42 participants with HIV-1 infection and 29 demographically similar seronegative healthy comparison (HC) subjects. The HIV-1 sample demonstrated deficits in time- and event-based ProM, as well as more frequent 24-hour delay ProM failures and task substitution errors relative to the HC group. In contrast, there were no significant differences in recognition performance, indicating that the HIV-1 group was able to accurately retain and recognize the ProM intention when retrieval demands were minimized. Secondary analyses revealed that ProM performance correlated with validated clinical measures of executive functions, episodic memory (free recall), and verbal working memory, but not with tests of semantic memory, retention, or recognition discrimination. Taken together, these findings indicate that HIV-1 infection is associated with ProM impairment that is primarily driven by a breakdown in the strategic (i.e., executive) aspects of retrieving future intentions, which is consistent with a prefronto-striatal circuit neuropathogenesis.