Meaningful use of computers has a potential therapeutic and preventative role in dementia care: A systematic review

Entertainment activities and the risk of Alzheimer's disease: a Mendelian randomization analysis

Background

Effective prevention is key to addressing the increasing prevalence and mortality of Alzheimer's disease. Assessing the causal relationship between modifiable entertainment activity factors and the risk of Alzheimer's disease is important for developing public health measures, but establishing causal relationships in epidemiological data may be challenging.

Methods

This study using the two-sample Mendelian randomization analysis aimed to investigate the causal effect of entertainment activity factors on the risk of Alzheimer's disease. Summary statistics from publicly available genome-wide association studies were used to analyze 14 modifiable entertainment activity. The inverse variance weighted random effects method as the primary analytical method to estimate causal effects was used. Additionally performed MR-Egger, weighted median and weighted model methods to assess the robustness of the results. The reliability of our findings was validated through systematic sensitivity analyses and tests for heterogeneity.

Results

We found significant correlation between time spent using computer (odds ratio 0.998; 95% confidence interval 0.996-0.999; p = 0.013) and Alzheimer's disease, compared to other studied entertainment activities that had no significant causal relationship with Alzheimer's disease.

Conclusion

Our findings support the hypothesis that increased computer use may reduce the risk of Alzheimer's disease, providing potential strategic directions for the prevention of neurodegenerative diseases.

Postmenopausal women's cognitive function and performance of virtual reality tasks

OBJECTIVE

This study aimed to assess whether prior knowledge of computer use determines performance of virtual reality tasks by postmenopausal women and whether menopausal symptoms, sociodemographic factors, lifestyle and cognition modify or interfere with their performance.

METHOD

This cross-sectional study included 152 postmenopausal women divided into two groups: computer users and non-users. Age, ethnicity, time of menopause, menopausal symptoms, female health status, level of physical activity and cognitive function were considered. The participants played a virtual reality game and were assessed for hits, errors, omissions and game time. The Mann-Whitney, chi-square and Fisher exact tests and multivariate linear regression analysis were used.

RESULTS

Postmenopausal computer users play virtual reality games (p = 0.005) better than postmenopausal non-users of computers. Vasomotor symptoms were high in women who used computers compared to those who did not (p = 0.006). Multivariate linear regression analysis found that the best-fitting predictors for the number of hits - that is, age (p = 0.039), Mini-Mental State Examination score (p = 0.006) and the headache symptom (p = 0.021) - influence the performance of virtual reality tasks.

CONCLUSION

Computer users performed virtual reality tasks better than non-users. Headache and age but not vasomotor symptoms negatively affected the postmenopausal women's performance.

Effects of technology-assisted interventions for people with dementia: A systematic review and meta-analysis

PURPOSE

The use of technology-assisted interventions in dementia care contributes to increased communication, reduced burden on the caregivers, improved health outcomes, and improved expense management. Technology-assisted interventions can be provided remotely to monitor, improve, and enable home care, benefiting the health of both patients and caregivers. Despite increasing use, the effectiveness of technology-assisted interventions for dementia care remains uncertain, with studies reporting inconclusive findings subject to interpretation. Therefore, the current study investigated the available evidence to explore the efficacy of technology-assisted interventions for people with dementia.

DESIGN

Systematic review and meta-analysis.

METHODS

The study was preregistered with the PROSPERO international prospective register of systematic reviews using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided protocol. The primary search was conducted in eight databases from database inception to January 29, 2022. Using a random-effects model, the standardized mean differences (SMDs) with 95% confidence intervals (CIs) were synthesized to obtain pooled effect sizes (using Stata 16.0). The updated Cochrane Risk of Bias 2 tool (RoB-2) was used to evaluate the methodological quality of the studies.

FINDINGS

A pooled analysis of 12 trials, including 584 people with dementia, showed more improvement associated with technology-assisted interventions compared with standard care, including in the domains of cognitive function (SMD = 0.39; 95% CI: 0.14 to 0.64; p < 0.001) and depression (SMD = -0.75; 95% CI: -1.33 to -0.17; p = 0.01). However, no significant effects were observed for activities of daily living (ADL) or quality of life.

CONCLUSION

Technology-assisted interventions appear to improve cognitive function and reduce depression in people with dementia compared with standard care.

CLINICAL RELEVANCE

This study may be used to demonstrate that interventions incorporating many modalities or technologies can be used to enhance dementia care, which may improve favorable outcomes when using technology-assisted interventions to remotely initiate appropriate activities for people with dementia. Because technology allows for simultaneous communication and access to shared multimedia, it removes environmental constraints and allows treatment to be administered remotely.

Longitudinal Relationship between Cognitive Function and Health-Related Quality of Life among Middle-Aged and Older Patients with Diabetes in China: Digital Usage Behavior Differences

BACKGROUND

Cognitive function and health-related quality of life (HRQoL) are important issues in diabetes care. According to the China Association for Aging, it is estimated that by 2030, the number of elderly people with dementia in China will reach 22 million. The World Health Organization reports that by 2044, the number of people with diabetes in China is expected to reach 175 million.

METHODS

Cohort analyses were conducted based on 854 diabetic patients aged ≥45 years from the third (2015) and fourth (2018) survey of the China Health and Retirement Longitudinal Study (CHARLS). Correlation analysis, repeated-measures variance analysis, and cross-lagged panel models were used to measure the difference in digital usage behavior in the established relationship.

RESULTS

The results show that the cognitive function of middle-aged and older diabetic patients is positively correlated with HRQoL. HRQoL at T1 could significantly predict cognitive function at T2 (PCS: B = 0.12, p < 0.01; MCS: B = 0.14, p < 0.01). This relationship is more associated with individual performance than digital usage behavior.

CONCLUSIONS

Unidirectional associations may exist between cognitive function and HRQoL among middle-aged and older Chinese diabetes patients. In the future, doctors and nurses can recognize the lowering of self-perceived HRQoL of middle-aged and older diabetic patients, and thus draw more attention to their cognitive function, in turn strengthening the evaluation, detection, and intervention of their cognitive function.

Computer use and cognitive decline among Japanese older adults: A prospective cohort study

INTRODUCTION

This study aimed to examine the prospective association between computer use and cognitive decline among community-dwelling Japanese older adults, considering the characteristics of computer users.

METHODS

This four-year prospective cohort study was conducted in Obu, Japan. Participants who were cognitive intact at Wave 1 (2011-2012) were followed through the study period. Cognitive decline was defined as scoring below the standard threshold in at least one of four neuropsychological tests at Wave 2 (2015-2016). The association between computer use at Wave 1 and cognitive decline was examined using logistic regression for complete samples (n = 2010, 52.5% female, mean 71.0 ± 4.7 years) and imputed samples (n = 3435, 51.8% female, mean 71.5 ± 5.3 years).

RESULTS

The computer use group had a reduced adjusted odds ratio (aOR) of cognitive decline, after adjustment for covariates, in both the complete and imputed samples (complete samples: aOR 0.71, 95% confidence interval [CI] 0.52-0.97, p = 0.030; imputed samples: aOR 0.67, 95% CI 0.51-0.88, p < 0.003). Stratified analysis of both samples showed that computer users with ≥ 10 years' education, a GDS score of < 6, or a walking speed of ≥ 1.0m/s, showed reduced aOR for cognitive decline (aOR 0.61 to 0.69, p < 0.05). Those with < 10 years of education years, GDS scores ≥ 6 of GDS, or walking speed < 1.0m/s did not show significant association.

CONCLUSION

Computer use is longitudinally associated with protected cognitive function, based on computer user characteristics.

The association between Internet use and health-related outcomes in older adults and the elderly: a cross-sectional study

Background

Older adults and elderly persons can experience a significant digital divide. However, there are many studies reporting that the use of the Internet has benefits related to a person’s health status and social inclusion. It is not fully clear if Internet use and health-related outcomes share common antecedents or if using the Internet may have a favourable effect on the determinants responsible for good health. The main aim of this study was to assess the relationship between the use of the Internet and health-related outcomes in older adults and elderly people in Poland.

Methods

The effect of the use of the Internet was analysed with regression models after adjusting for sociodemographic factors. The data used for the analysis were obtained through a telephone-based survey on a representative sample of Polish adults at least 50 years of age.

Results

By categorising the frequency of Internet use by the respondents, it was found that some categories were significantly related to less favourable health behaviours. Rare Internet users were less likely to undertake physical activity than nonusers (odds ratio, OR, 95% confidence interval, 95%CI 0.48, 0.28–0.83). Those using the Internet every day less frequently consumed fruit and vegetables (OR, 95%CI 0.64, 0.42–0.99). Internet use was also associated with more frequent consumption of alcohol (OR, 95%CI 1.65, 1.09–2.50 comparing nonusers with those accessing the Internet several times a week). Persons rarely using the Internet, but not those who accessed it at least a few times a week, possessed a lower health literacy than nonusers (OR, 95%CI 0.71, 0.52–0.97). Internet users were also more likely to assess their health status as unsatisfactory (OR, 95%CI 0.59, 0.42–0.82 comparing nonusers with those using the Internet daily). Finally, the use of the Internet was consistently associated with a lower prevalence of chronic conditions and disability, as well as less frequent visits to health care facilities.

Conclusions

In conclusion, in contrast to earlier findings, Internet use is not associated with favourable patterns of lifestyle or higher self-rated health in older Polish adults. However, persons with chronic conditions or disabilities less frequently declare the use of the Internet. It was also revealed that older adults and the elderly who make use of the Internet are less likely to utilise health services.

Assistive Technologies in Dementia Care: An Updated Analysis of the Literature

Objectives: Technology can assist and support both people with dementia (PWD) and caregivers. Recently, technology has begun to embed remote components. Timely with respect to the pandemic, the present work reviews the most recent literature on technology in dementia contexts together with the newest studies about technological support published until October 2020. The final aim is to provide a synthesis of the timeliest evidence upon which clinical and non-clinical decision-makers can rely to make choices about technology in the case of further pandemic waves.

Methods: A review of reviews was performed alongside a review of the studies run during the first pandemic wave. PsycInfo, CINAHL, and PubMed-online were the databases inspected for relevant papers published from January 2010.

Results: The search identified 420 articles, 30 of which were reviews and nine of which were new studies meeting the inclusion criteria. Studies were first sorted according to the target population, then summarized thematically in a narrative synthesis. The studies targeting technologies for PWD were categorized as follows: monitoring and security purposes, sustaining daily life, and therapeutic interventions. Each category showed potential benefits. Differently, the interventions for caregivers were classified as informative, psycho-education programs, psychosocial-supportive, therapeutic, and cognitive/physical training. Benefits to mental health, skills learning, and social aspects emerged.

Conclusions: The evidence shows that technology is well-accepted and can support PWD and caregivers to bypass physical and environmental problems both during regular times and during future pandemic waves. Nevertheless, the lack of a common methodological background is revealed by this analysis. Further and more standardized research is necessary to improve the implementation of technologies in everyday life while respecting the necessary personalization.

In Quest of Tablet Apps for Elders With Alzheimer's Disease: A Descriptive Review

Caregivers search for mobile device apps that offer meaningful and enjoyable activities to simultaneously enhance the preserved cognitive and functional abilities of those in their care. The purpose of this review article was to describe the current state of tablet apps with which elders with Alzheimer's disease and related forms of dementia may engage as users. Using the keywords "app," "Alzheimer's," and "dementia," a sample of 83 apps was selected from the iTunes Store, Google, and discussion boards of Apple Support Communities. A descriptive content analysis was conducted using a coding scheme on the characteristics of tablet app activity and the requirements for functional abilities of the users. This review found that the activities of the selected apps included games, simple watching and viewing, music and sounds, memory training, learning and information, and social interaction starters. A high-level cognitive and physical ability such as eye-hand coordination is often required to play the majority of the game apps. A few apps are designed specifically for the population. Individuals' variability in cognitive and functional abilities necessitates a person-centered approach in designing and selecting games and activities for apps in order to increase engagement and promote positive experiences in older adults.

Cognitively stimulating activities and risk of probable dementia or cognitive impairment in the English Longitudinal Study of Ageing

Objectives

To examine the association between cognitive stimulating activities (CSA) in later life (internet/email use, employment, volunteering, evening classes, social club membership and newspaper reading) and risk of cognitive impairment or dementia using marginal structural models to account for time-varying confounding affected by prior exposure.

Methods

Data were used from the English Longitudinal Study of Ageing waves 1 (2002) to 7 (2014), a nationally representative sample of adults in England aged ≥50. Self-reported participation in CSAs were measured as binary exposures from waves 2 (2004) to 6 (2012), with final sample sizes between n = 3937 and n = 2530 for different CSAs. Baseline exposure and covariates were used to create inverse probability of treatment and censoring weights (IPTCW). IPTCW repeated measures Poisson and linear regression were used to estimate each CSAs effect on risk of probable cognitive impairment or dementia at wave 7 (defined as a score of ≤11/27 on a modified telephone interview for cognitive status (TICS-27)). Results were compared to standard regression adjustment.

Results

Internet use at any wave (Risk ratios between 0.62 and 0.69) and volunteering in waves 3 to 6 (RRs between 0.516 and 0.633) were associated with reduced risk of cognitive impairment in IPTCW models. Standard estimates were similar for both internet use and volunteering.

Newspaper reading (RR 95% Confidence interval 0.74–0.99) and social club membership (RR 95% CI 0.54–0.86) at wave 6 were significantly associated with risk of cognitive impairment in standard models, but not in the IPTCW models (RR 95% CI 0.82–1.11 and 0.60–1.08 respectively). Employment and evening classes were not associated with cognitive impairment in either model.

Conclusions

We found that volunteering and internet use were associated with reduced risk of cognitive impairment. Associations between newspaper reading or social club membership and cognitive impairment may be due to time-varying confounding affected by prior exposure.

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Confounding affected by past exposure is a problem in studies of cognitive function.

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We addressed this using inverse probability weighted marginal structural models.

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Volunteering and internet use were protective against cognitive impairment.

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Other cognitively stimulating activities were protective with standard regression.

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But these associations were non-significant in the marginal structural models.

The Association of Internet Use with Wellbeing, Mental Health and Health Behaviours of Persons with Disabilities

Introduction: There is strong evidence that people with disabilities suffer from a significant digital divide. However, there are reports indicating that Internet use may result in many benefits for those with disabilities. The aim of the study was to assess the impact that the use of the Internet has on the wellbeing and health behaviours of persons with disabilities. Methods: An analysis was carried out using the dataset obtained from Social Diagnosis, a panel study undertaken on a nationally representative sample. The records of persons with disabilities were retrieved from the dataset which was established in 2015. An analysis of the association between Internet use and the wellbeing, mental health and health behaviours of the respondents was undertaken. The variables reflecting the self-assessment of their own life and experience of loneliness were treated as being indicators of their wellbeing and the prevalence of suicidal thoughts or making use of psychological help as indicators of mental health. The health behaviours analysed in the study included smoking, excessive consumption of alcohol and undertaking physical activity. For all these variables, multivariate logistic regression models were developed. The effect of Internet use was adjusted for sociodemographic variables and the degree of disability. An analysis was performed after applying post-stratification weights available from the Social Diagnosis study. Results: The weighted study group consisted of 2529 people having a mean age of 59.33 ± 16.89 years. The group included 20.71% (N = 524) respondents with a mild, 41.58% (N = 1052) with a moderate, and 26.54% (N = 671) with a severe disability. The proportion of Internet users was 37.07% (N = 937). In all the regression models, Internet use had a significant impact on the dependent variables. After adjustment for sociodemographic variables and the degree of disability, the Internet users more frequently assessed their lives as happy (odds ratio, 95% confidence interval: 1.86, 1.47–2.37) and less frequently experienced loneliness (0.63, 0.49–0.81) or suicidal thoughts (0.47, 0.35–0.65). In addition, they needed psychological help less frequently (0.50, 0.35–0.72). Interestingly, Internet users undertook some form of physical activity or sport more often (2.41, 1.87–3.13) and fewer smoked cigarettes (0.70, 0.54–0.91) or consumed alcohol excessively (0.32, 0.19–0.56). Conclusions: The use of the Internet by people with disabilities was associated with improved wellbeing, better mental health and more beneficial health behaviours. These findings support the development of intensive actions to reduce the digital divide for the population of people with disabilities.

Effects of Digital Device Ownership on Cognitive Decline in a Middle-Aged and Elderly Population: Longitudinal Observational Study

Background

Cognitive decline is a major risk factor for disability and death and may serve as a precursor of dementia. Digital devices can provide a platform of cognitively stimulating activities which might help to slow cognitive decline during the process of normal aging.

Objective

This longitudinal study aimed to examine the independent protective factors of desktop and cellphone ownership against cognitive decline in mid-life and older adulthood and to examine the combined effect of desktop and cellphone ownership on the same outcome.

Methods

Data was obtained from a China Health and Retirement Longitudinal Studies (CHARLS) cohort made up of 13,457 community-dwelling adults aged 45 years or above in 2011-2012. They were followed for 4 years, with baseline measurements taken as well as 2 two-year follow-up visits. Cognitive function was tested during the baseline test and follow-up visits. A global cognition z-score was calculated based on two domains: word recall and mental intactness. The key independent variables were defined as: whether one had desktops with internet connection at home and whether one had a cellphone. An additional categorical variable of three values was constructed as: 0 (no desktop or cellphone), 1 (desktop or cellphone alone), and 2 (desktop and cellphone both). Mixed-effects regression was adjusted for demographic and health behavior as well as health condition risk factors.

Results

Adjusted for demographic and health behavior as well as health condition risk factors, desktop and cellphone ownership were independently associated with subsequent decreased cognitive decline over the four-year period. Participants without a desktop at home had an adjusted cognitive decline of –0.16 standard deviations (95% CI –0.18 to –0.15), while participants with a desktop at home had an adjusted cognitive decline of –0.10 standard deviations (95% CI –0.14 to –0.07; difference of –0.06 standard deviations; P=.003). A similar pattern of significantly protective association of 0.06 standard deviations (95% CI 0.03-0.10; P<.001) between cellphone ownership and cognitive function was observed over the four-year period. Additionally, a larger longitudinal protective association on cognitive decline was observed among those with both of the digital devices, although the 95% CIs for the coefficients overlapped with those with a single digital device alone.

Conclusions

Findings from this study underscored the importance of digital devices as platforms for cognitively stimulating activities to delay cognitive decline. Future studies focusing on use of digital devices are warranted to investigate their longitudinal protective factors against cognitive decline at mid- and later life.