Persons with Alzheimer's disease perform daily activities using verbal-instruction technology: a maintenance assessment

Diagnostic and interventional implications of telemedicine in Alzheimer's disease and mild cognitive impairment: A literature review

INTRODUCTION

Worldwide, life expectancy, and aging-related disorders as mild cognitive impairment (MCI) and Alzheimer disease (AD) are increasing, having a rising impact on patients' quality of life and caregivers' distress. Telemedicine offers many possibilities, such as remote diagnosing and monitoring of patients.

OBJECTIVE

The purpose of this study is to provide a narrative synthesis of the literature about the implementation of telemedicine for diagnosis, treatment, and follow-up of patients with AD and MCI and their caregivers.

METHODS

A systematic literature review was conducted on MEDLINE, EMBASE, and the Cochrane Library databases up to September 2018. MCI or AD diagnoses were the conditions of interest. We excluded other dementias.

RESULTS

Fifty-six articles met inclusion criteria. We identified two main categories: diagnosis group (DG) and follow-up/interventional group (FIG). Fifteen articles suggested how to make a remote or earlier diagnosis: four were case-control accuracy studies, nine were paired comparative accuracy studies, and two were prospective single-arm accuracy studies. Among these, four focused on MCI, six on AD, and five on both. Forty one focused on supporting patients during the stages of the disease (28 articles), patient's caregivers (nine articles), or both (four articles).

CONCLUSIONS

The rising use of telemedicine could actively improve AD and MCI patients' lives, reduce caregivers' burden, and facilitate an early diagnosis if patients live in remote places. However, as some studies report, it is relevant to take into account the emotional impact of telemedicine on patients and not only on the effectiveness.

Toward the Development of SMART Communication Technology: Automating the Analysis of Communicative Trouble and Repair in Dementia

BACKGROUND AND OBJECTIVES

Communication difficulties have been reported as one of the most stress-inducing aspects of caring for people with dementia. Notably, with disease progression comes an increase in the frequency of communication difficulty and a reduction in the effectiveness of attempts to remedy breakdowns in communication. The aim of the current research was to evaluate the utility of an automated discourse analysis tool (i.e., Discursis) in distinguishing between different types of trouble and repair signaling behaviors, demonstrated within conversations between people with dementia and their professional care staff.

RESEARCH DESIGN AND METHODS

Twenty conversations between people with dementia and their professional care staff were human-coded for instances of interactive/noninteractive trouble and typical/facilitative repair behaviors. Associations were then examined between these behaviors and recurrence metrics generated by Discursis.

RESULTS

Significant associations were identified between Discursis metrics, trouble-indicating, and repair behaviors.

DISCUSSION AND IMPLICATIONS

These results suggest that discourse analysis software is capable of discriminating between different types of trouble and repair signaling behavior, on the basis of term recurrence calculated across speaker turns. The subsequent recurrence metrics generated by Discursis offer a means of automating the analysis of episodes of conversational trouble and repair. This achievement represents the first step toward the future development of an intelligent assistant that can analyze conversations in real time and offers support to people with dementia and their carers during periods of communicative trouble.

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.

Indicators of perceived useful dementia care assistive technology: Caregivers' perspectives

AIM

The study aims to investigate the caregivers' context-specific perceived usefulness of available assistive technology (AT) devices and the professionals' perspectives on the usefulness indicators of AT devices for home-dwelling individuals with mild-to-moderate dementia.

METHODS

A total of 72 caregivers completed a questionnaire rating 82 AT devices with a high-perceived usefulness (HPU) or low-perceived usefulness (LPU). A total of 21 experts rated 10 usefulness indicators of these devices. We compared the mean of each indicator between the HPU and LPU groups.

RESULTS

Most caregivers, who are generally amenable to using AT devices, thought they were useful for helping to care for home-dwelling older adults with mild-to-moderate dementia. The level of perceived usefulness from the experts' perspectives depends on specific design indicators (e.g. familiarity) and the context in which the AT is used (e.g. in everyday life or in emergencies). Indicators for HPU devices were: allows selective accident prevention, has an intuitive interface, is familiar, offers ease of use and simplifies activities. LPU devices featured client prompting. There were no significant differences between HPU and LPU devices with indicators of: is automated, informs caregiver, preserves privacy and preserves autonomy. Safety issues were considered important, and sometimes overshadowed ethical dilemmas, such as privacy and autonomy concern.

CONCLUSIONS

The present study provides insight into how caregivers perceived the usefulness of AT devices, and how that varied with context. Indicators of devices perceived as useful can serve as guidelines for modifying existing devices and designing new devices. Future application could also incorporate the points of view from the persons with dementia.

Intervention strategies for spatial orientation disorders in dementia: a selective review

PURPOSE

This article provides a brief overview of the intervention strategies aimed at reducing spatial orientation disorders in elderly people with dementia.

METHODS

Eight experimental studies using spatial cues, assistive technology programs, reality orientation training, errorless learning technique, and backward chaining programs are described. They can be classified into two main approaches: restorative and compensatory, depending on whether they rely or not on residual learning ability, respectively.

RESULTS

A review of the efficacy of these intervention strategies is proposed. Results suggest that both compensatory and restorative approaches may be valuable in enhancing correct way-finding behavior, with various degrees of effectiveness. Some issues concerning (a) variability in participants' characteristics and experimental designs and (b) practicality of intervention strategies do not permit to draw a definite conclusion.

CONCLUSIONS

Future research should be aimed at a direct comparison between these two strategies, and should incorporate an extensive neuropsychological assessment of spatial domain.

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.

Video prompting versus other instruction strategies for persons with Alzheimer's disease

BACKGROUND/AIM

Two studies assessed the effectiveness of video prompting as a strategy to support persons with mild and moderate Alzheimer's disease in performing daily activities.

METHODS

In study I, video prompting was compared to an existing strategy relying on verbal instructions. In study II, video prompting was compared to another existing strategy relying on static pictorial cues. Video prompting and the other strategies were counterbalanced across tasks and participants and compared within alternating treatments designs.

RESULTS

Video prompting was effective in all participants. Similarly effective were the other 2 strategies, and only occasional differences between the strategies were reported. Two social validation assessments showed that university psychology students and graduates rated the patients' performance with video prompting more favorably than their performance with the other strategies.

CONCLUSION

Video prompting may be considered a valuable alternative to the other strategies to support daily activities in persons with Alzheimer's disease.

A computer-aided telephone system to enable five persons with Alzheimer's disease to make phone calls independently

This study extended the assessment of a computer-aided telephone system to enable five patients with a diagnosis of Alzheimer's disease to make phone calls independently. The patients were divided into two groups and exposed to intervention according to a non-concurrent multiple baseline design across groups. All patients started with baseline in which the technology was not available, and continued with intervention in which the technology was used. The technology involved a net-book computer provided with specific software, a global system for mobile communication modem (GSM), a microswitch, and lists of partners to call with related photos. All the patients learned to use the system and made phone calls independently to a variety of partners, such as family members, friends, and caregivers. A social validation assessment, in which care and health professionals working with persons with dementia were asked to rate the patients' performance with the technology and with the help of a caregiver, provided generally more positive scores for the technology-assisted performance. The positive implications of the findings for daily programs of patients with Alzheimer's disease are discussed.

A verbal-instruction system to help persons with multiple disabilities perform complex food- and drink-preparation tasks independently

In a recent single-case study, we showed that a new verbal-instruction system, ensuring the automatic presentation of step instructions, was beneficial for promoting the task performance of a woman with multiple disabilities (including blindness). The present study was aimed at replicating and extending the aforementioned investigation with three adults with multiple disabilities. During Part I of the study, the new instruction system was compared with a system requiring the participants to seek instructions on their own. Two tasks were used, one per system. During Part II of the study, the new system was applied with two additional tasks. The results of Part I showed that (a) the participants had a better performance (i.e., in terms of correct steps or task execution time) on the task carried out with the new system than on the task carried out with the comparison/control system, and (b) the performance of this latter task improved rapidly when the new system was used with it. The results of Part II showed satisfactory performance with each of the two tasks carried out directly with the new system. The implications of these data were discussed.

Linguistic development in Alzheimer's disease: 12 months language training including use of a personal computer system: a pilot study

OBJECTIVE

To assess linguistic development in patients with mild and moderate Alzheimer's disease (AD) who underwent treatment with a drug and regularly performed language activities.

METHODS

For 12 months, five patients with mild-to-moderate AD participated in a Stimulation-Activation-Training programme (SAT) including pragmatic, semantic, writing, conversation and counting sessions. A computer with exercise programs and a keyboard with a printer were used as complements to ordinary stationery. The linguistic competence was assessed using a standardized assessment tool.

RESULTS

The assessment indicated preservation or slight changes of the patients' linguistic competence over the period and greater confidence in the management of the language. The personal computer system was a well accepted novelty.

CONCLUSION

The documented approach, SAT training interlaced with everyday life tasks, may be helpful in maintaining and improving remaining language functions in patients with mild or moderate AD.

A Verbal-Instruction System to Help a Woman With Intellectual Disability and Blindness Manage Food- and Drink-Preparation Tasks

A new verbal-instruction system, which ensured the presentation of step instructions automatically, was used to help a woman with moderate intellectual disability and blindness perform food- and drink-preparation tasks. During Part I of the study, this system was compared with a system requiring the woman to seek instructions on her own. Two tasks were used, one with each system. During Part II of the study, the new system was applied with four additional tasks. The results of Part I showed the following: (a) the woman’s level of correct performance on the task carried out with the new system was higher than the level on the other task and (b) performance of this latter task improved when the new system was used with it. The results of Part II showed satisfactory performance with all four tasks carried out with the new system. The implications of these data were discussed.