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Alsuhaibani M, Dodge HH, Mahoor MH. Mild cognitive impairment detection from facial video interviews by applying spatial-to-temporal attention module. EXPERT SYSTEMS WITH APPLICATIONS 2024; 252:124185. [PMID: 38881832 PMCID: PMC11174143 DOI: 10.1016/j.eswa.2024.124185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Early detection of Mild Cognitive Impairment (MCI) leads to early interventions to slow the progression from MCI into dementia. Deep Learning (DL) algorithms could help achieve early non-invasive and low-cost detection of MCI. This paper presents the detection of MCI in older adults using DL models based only on facial features extracted from video-recorded conversations at home. We used the data collected from the I-CONECT behavioral intervention study (NCT02871921), where several sessions of semi-structured interviews between socially isolated older individuals and interviewers were video recorded. We develop a framework that extracts holistic spatial facial features using a convolutional autoencoder and temporal information using transformers. We proposed the Spatial-to-Temporal Attention Module (STAM) to detect the I-CONECT study participants' cognitive conditions (MCI vs. those with normal cognition (NC)) using facial and interaction features. The interaction features of the facial features improved the prediction performance compared with applying facial features solely. The detection accuracy using this combined method reached 88%, whereas the accuracy without applying the segments and sequences information of the facial features within a video on a certain theme was 84%. Overall, the results show that spatiotemporal facial features modeled using DL algorithms have a discriminating power for the detection of MCI.
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Affiliation(s)
- Muath Alsuhaibani
- Department of Electrical and Computer Engineering, University of Denver, Denver 80208, CO, United States
- Department of Electrical Engineering, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Hiroko H. Dodge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, MA, United States
| | - Mohammad H. Mahoor
- Department of Electrical and Computer Engineering, University of Denver, Denver 80208, CO, United States
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Mois G, Lydon EA, Mathias VF, Jones SE, Mudar RA, Rogers WA. Best practices for implementing a technology-based intervention protocol: Participant and researcher considerations. Arch Gerontol Geriatr 2024; 122:105373. [PMID: 38460265 DOI: 10.1016/j.archger.2024.105373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 11/17/2023] [Accepted: 02/18/2024] [Indexed: 03/11/2024]
Abstract
Technology-based interventions present a promising approach to support health and wellness for older adults with a range of cognitive abilities. Technology can enhance access to interventions and support scaling of programs to reach more people. However, the use of technology for intervention delivery requires particular attention to users' needs and preferences and ensuring the materials are adaptable and supportive of a diverse range of technology proficiency levels. We share best practices based on lessons learned from the deployment of a randomized controlled trial (RCT) wherein we delivered an 8-week social engagement intervention through a video technology platform called OneClick for older adults with varying cognitive abilities. We developed a set of best practices and guidelines informed by the lessons learned through this RCT implementation. Technology-based interventions require attention to the application (e.g., video calls), system requirements (e.g., system memory, broadband internet), training (e.g., adaptability based on user competency), and support (e.g., handouts, live contact). These best practices relate to user needs; training design; personnel responsibility; structuring delivery and content; and evaluating success. These research-based best practices can guide the design, development, and implementation of technology-based interventions to support older adults with varying cognitive abilities.
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Affiliation(s)
- George Mois
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, 1206 S Fourth St., Champaign, IL 61820, United States.
| | - Elizabeth A Lydon
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, 1206 S Fourth St., Champaign, IL 61820, United States
| | - Vincent F Mathias
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, 1206 S Fourth St., Champaign, IL 61820, United States
| | - Sarah E Jones
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, 1206 S Fourth St., Champaign, IL 61820, United States
| | - Raksha A Mudar
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, 1206 S Fourth St., Champaign, IL 61820, United States
| | - Wendy A Rogers
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, 1206 S Fourth St., Champaign, IL 61820, United States
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Lydon EA, Mois G, Shende SA, Myers D, Danilovich MK, Rogers WA, Mudar RA. Methods and baseline characteristics for a social engagement technology-based randomized controlled trial for older adults. Contemp Clin Trials Commun 2024; 39:101308. [PMID: 38841566 PMCID: PMC11152901 DOI: 10.1016/j.conctc.2024.101308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/29/2024] [Accepted: 05/12/2024] [Indexed: 06/07/2024] Open
Abstract
Background Growing evidence suggests that increasing opportunities for social engagement has the potential to support successful aging. However, many older adults may have limited access to in-person social engagement opportunities due to barriers such as transportation. We outline the development, design, methodology, and baseline characteristics of a randomized controlled trial that assessed the benefits of a social engagement intervention delivered through the OneClick video conferencing platform to older adults with varying levels of cognitive functioning. Methods Community-dwelling older adults with and without cognitive challenges were randomly assigned to a social engagement intervention group or a waitlist control group. Participants were asked to attend twice-weekly social engagement events for 8 weeks via OneClick. Outcomes included social engagement and technology acceptance for both groups at baseline, week-4, and week-8 assessments. As an extension, the waitlist control group had an opportunity to participate in the intervention, with outcomes assessed at weeks 12 and 16. Results We randomly assigned 99 participants (mean age = 74.1 ± 6.7, range: 60-99), with 50 in the immediate intervention group and 49 in the waitlist control group. About half of the participants reported living alone (53.5%), with a third (31%) falling into the cognitively impaired range on global cognitive screening. The groups did not differ at baseline on any of the outcome measures. Conclusions Outcomes from this study will provide important information regarding the feasibility and efficacy of providing technology-based social engagement interventions to older adults with a range of cognitive abilities.
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Affiliation(s)
- Elizabeth A. Lydon
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - George Mois
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Shraddha A. Shende
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | | | | | - Wendy A. Rogers
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Raksha A. Mudar
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, IL, USA
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Pourramezan Fard A, Mahoor MH, Alsuhaibani M, Dodge HH. Linguistic-based Mild Cognitive Impairment detection using Informative Loss. Comput Biol Med 2024; 176:108606. [PMID: 38763068 DOI: 10.1016/j.compbiomed.2024.108606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/17/2024] [Accepted: 05/11/2024] [Indexed: 05/21/2024]
Abstract
This paper presents a deep learning method using Natural Language Processing (NLP) techniques, to distinguish between Mild Cognitive Impairment (MCI) and Normal Cognitive (NC) conditions in older adults. We propose a framework that analyzes transcripts generated from video interviews collected within the I-CONECT study project, a randomized controlled trial aimed at improving cognitive functions through video chats. Our proposed NLP framework consists of two Transformer-based modules, namely Sentence Embedding (SE) and Sentence Cross Attention (SCA). First, the SE module captures contextual relationships between words within each sentence. Subsequently, the SCA module extracts temporal features from a sequence of sentences. This feature is then used by a Multi-Layer Perceptron (MLP) for the classification of subjects into MCI or NC. To build a robust model, we propose a novel loss function, called InfoLoss, that considers the reduction in entropy by observing each sequence of sentences to ultimately enhance the classification accuracy. The results of our comprehensive model evaluation using the I-CONECT dataset show that our framework can distinguish between MCI and NC with an average area under the curve of 84.75%.
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Affiliation(s)
- Ali Pourramezan Fard
- Ritchie School of Engineering and Computer Science, University of Denver, Denver, CO 80208, USA.
| | - Mohammad H Mahoor
- Ritchie School of Engineering and Computer Science, University of Denver, Denver, CO 80208, USA; DreamFace Technologies LLC, Centennial, CO 8011, USA.
| | - Muath Alsuhaibani
- Ritchie School of Engineering and Computer Science, University of Denver, Denver, CO 80208, USA; Department of Electrical Engineering, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia.
| | - Hiroko H Dodge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Tokunaga S, Sekiguchi T, Watanabe Miura K, Sugimoto H, S Abe M, Tamura K, Kishimoto T, Kudo T, Otake-Matsuura M. Home-Based Cognitive Intervention for Healthy Older Adults Through Asking Robots Questions: Randomized Controlled Trial. JMIR Aging 2024; 7:e47229. [PMID: 38647260 PMCID: PMC11058555 DOI: 10.2196/47229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 04/25/2024] Open
Abstract
Background Asking questions is common in conversations, and while asking questions, we need to listen carefully to what others say and consider the perspective our questions adopt. However, difficulties persist in verifying the effect of asking questions on older adults' cognitive function due to the lack of a standardized system for conducting experiments at participants' homes. Objective This study examined the intervention effect of cognitive training moderated by robots on healthy older adults. A focus on the feasibility of the intervention at participants' homes was also maintained. Feasibility was evaluated by considering both the dropout rate during the intervention and the number of questions posed to each participant during the experiment. Methods We conducted a randomized controlled trial with 81 adults older than 65 years. Participants were recruited through postal invitations and then randomized into 2 groups. The intervention group (n=40) received sessions where participants listened to photo-integrated stories and posed questions to the robots. The control group (n=41) received sessions where participants listened to photo-integrated stories and only thanked the robots for confirming participation. The participants participated in 12 dialogue sessions for 2-3 weeks. Scores of global cognitive functioning tests, recall tests, and verbal fluency tasks measured before and after the intervention were compared between the 2 groups. Results There was no significant intervention effect on the Telephone Interview for Cognitive Status-Japanese scores, recall tests, and verbal fluency tasks. Additionally, our study successfully concluded with no participant dropouts at follow-up, confirming the feasibility of our approach. Conclusions There was no statistically significant evidence indicating intervention benefits for cognitive functioning. Although the feasibility of home-based interventions was demonstrated, we identified areas for improvement in the future, such as setting up more efficient session themes. Further research is required to identify the effectiveness of an improved cognitive intervention involving the act of asking questions.
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Affiliation(s)
- Seiki Tokunaga
- Center for Advanced Intelligence Project, RIKEN, Tokyo, Japan
| | | | | | - Hikaru Sugimoto
- Center for Advanced Intelligence Project, RIKEN, Tokyo, Japan
| | - Masato S Abe
- Center for Advanced Intelligence Project, RIKEN, Tokyo, Japan
- Faculty of Culture and Information Science, Doshisha University, Kyoto, Japan
| | - Kazuhiro Tamura
- Center for Advanced Intelligence Project, RIKEN, Tokyo, Japan
| | - Taishiro Kishimoto
- Center for Advanced Intelligence Project, RIKEN, Tokyo, Japan
- Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Takashi Kudo
- Center for Advanced Intelligence Project, RIKEN, Tokyo, Japan
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Osaka, Japan
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Dodge HH, Yu K, Wu CY, Pruitt PJ, Asgari M, Kaye JA, Hampstead BM, Struble L, Potempa K, Lichtenberg P, Croff R, Albin RL, Silbert LC. Internet-Based Conversational Engagement Randomized Controlled Clinical Trial (I-CONECT) Among Socially Isolated Adults 75+ Years Old With Normal Cognition or Mild Cognitive Impairment: Topline Results. THE GERONTOLOGIST 2024; 64:gnad147. [PMID: 37935416 PMCID: PMC10943511 DOI: 10.1093/geront/gnad147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Social isolation is a risk factor for cognitive decline and dementia. We conducted a randomized controlled clinical trial (RCT) of enhanced social interactions, hypothesizing that conversational interactions can stimulate brain functions among socially isolated older adults without dementia. We report topline results of this multisite RCT (Internet-based conversational engagement clinical trial [I-CONECT]; NCT02871921). RESEARCH DESIGN AND METHODS The experimental group received cognitively stimulating semistructured conversations with trained interviewers via internet/webcam 4 times per week for 6 months (induction) and twice per week for an additional 6 months (maintenance). The experimental and control groups both received weekly 10 minutes telephone check-ins. Protocol modifications were required due to the coronavirus disease 2019 pandemic. RESULTS A total of 186 participants were randomized. After the induction period, the experimental group had higher global cognitive test scores (Montreal Cognitive Assessment [primary outcome]; 1.75 points [p = .03]) compared with the control group. After induction, experimental group participants with normal cognition had higher language-based executive function (semantic fluency test [secondary outcome]; 2.56 points [p = .03]). At the end of the maintenance period, the experimental group of mild cognitive impairment subjects had higher encoding function (Craft Story immediate recall test [secondary outcome]; 2.19 points [p = .04]). Measure of emotional well-being improved in both control and experimental groups. Resting-state functional magnetic resonance imaging showed that the experimental group had increased connectivity within the dorsal attention network relative to the control group (p = .02), but the sample size was limited. DISCUSSION AND IMPLICATIONS Providing frequent stimulating conversational interactions via the internet could be an effective home-based dementia risk-reduction strategy against social isolation and cognitive decline. CLINICAL TRIALS REGISTRATION NUMBER NCT02871921.
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Affiliation(s)
- Hiroko H Dodge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
| | - Kexin Yu
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Chao-Yi Wu
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
| | - Patrick J Pruitt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Meysam Asgari
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeffrey A Kaye
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Benjamin M Hampstead
- Michigan Alzheimer’s Disease Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- Research Program on Cognition and Neuromodulation Based Interventions, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura Struble
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Kathleen Potempa
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Peter Lichtenberg
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Raina Croff
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Roger L Albin
- Michigan Alzheimer’s Disease Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- GRECC & Neurology Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Lisa C Silbert
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- VA Portland Healthcare System, Portland, Oregon, USA
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Chen S, Niu M, Ngai CSB. What is the next step of ICT development? The changes of ICT use in promoting elderly healthcare access: A systematic literature review. Heliyon 2024; 10:e25197. [PMID: 38371988 PMCID: PMC10873661 DOI: 10.1016/j.heliyon.2024.e25197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/20/2024] Open
Abstract
The objective of this study was to undertake a comprehensive review of the evidence published, with a focus on understanding the experiences of the elderly in leveraging Information and Communication Technology (ICT) for their healthcare needs during the COVID-19 period. In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this review scrutinized all peer-reviewed articles in English sourced from PubMed, PsycINFO, Scopus, and Web of Science, targeting studies that focused exclusively on the elderly within the COVID-19 timeframe, incorporated ICT-based technology as intervention, and were associated with the assessment of the process of employing ICT for healthcare needs. The search strategy identified 1752 records, of which 34 studies met the inclusion criteria. The functionality of ICT was categorized, types of barriers were identified, and the subsequent changes that the elderly population underwent were synthesized and deliberated. This review offers valuable insights into the elderly's subjective experiences in utilizing ICT, which may offer guidance for future ICT development geared towards enhancing the well-being of the elderly. Future research should incorporate the perspectives of relevant healthcare providers in evaluating the effectiveness of ICT usage. Further studies are also needed on underserved elderly groups to provide a more holistic view.
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Affiliation(s)
- Sihui Chen
- The Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hong Kong
| | - Mengyuan Niu
- Division of Public Policy, The Hong Kong University of Science and Technology, Hong Kong
| | - Cindy Sing Bik Ngai
- The Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hong Kong
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Wu CY, Yu K, Arnold SE, Das S, Dodge HH. Who Benefited Most from the Internet-Based Conversational Engagement RCT (I-CONECT)? Application of the Personalized Medicine Approach to a Behavioral Intervention Study. J Prev Alzheimers Dis 2024; 11:639-648. [PMID: 38706280 PMCID: PMC11061034 DOI: 10.14283/jpad.2024.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/09/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Many Alzheimer's Disease (AD) clinical trials have failed to demonstrate treatment efficacy on cognition. It is conceivable that a complex disease like AD may not have the same treatment effect due to many heterogeneities of disease processes and individual traits. OBJECTIVES We employed an individual-level treatment response (ITR) approach to determine the characteristics of treatment responders and estimated time saved in cognitive decline using the Internet-based Conversational Engagement Clinical Trial (I-CONECT) behavioral intervention study as a model. DESIGN AND SETTING I-CONECT is a multi-site, single-blind, randomized controlled trial aimed to improve cognitive functions through frequent conversational interactions via internet/webcam. The experimental group engaged in video chats with study staff 4 times/week for 6 months; the control group received weekly 10-minute check-in phone calls. PARTICIPANTS Out of 186 randomized participants, current study used 139 participants with complete information on both baseline and 6-month follow-up (73 with mild cognitive impairment (MCI), 66 with normal cognition; 64 in the experimental group, and 75 in the control group). MEASUREMENTS ITR scores were generated for the Montreal Cognitive Assessment (MoCA) (global cognition, primary outcome) and Category Fluency Animals (CFA) (semantic fluency, secondary outcome) that showed significant efficacy in the trial. ITR scores were generated through 300 iterations of 3-fold cross-validated random forest models. The average treatment difference (ATD) curve and the area between the curves (ABC) were estimated to measure the heterogeneity of treatment responses. Responder traits were identified using SHapley Additive exPlanations (SHAP) and decision tree models. The time saved in cognitive decline was explored to gauge clinical meaningfulness. RESULTS ABC statistics showed substantial heterogeneity in treatment response with MoCA but modest heterogeneity in treatment response with CFA. Age, cognitive status, time spent with family and friends, education, and personality were important characteristics that influenced treatment responses. Intervention group participants in the upper 30% of ITR scores demonstrated potential delays of 3 months in semantic fluency (CFA) and 6 months in global cognition (MoCA), assuming a 5-fold faster natural cognitive decline compared to the control group during the post-treatment period. CONCLUSIONS ITR-based analyses are valuable in profiling treatment responders for features that can inform future trial design and clinical practice. Reliably measuring time saved in cognitive decline is an area of ongoing research to gain insight into the clinical meaningfulness of treatment.
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Affiliation(s)
- C-Y Wu
- Chao-Yi Wu, 149 13th floor, 10-003C, Boston, MA, USA, , 02129; 617-724-2428
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Struble LM, Potempa K, Lichtenberg PA, Croff RL, Ellis A, Dodge HH. Including Socially Isolated Black, Older Old Adults (Aged 80 and Above) with and without Mild Cognitive Impairment in a Clinical Trial: Recruitment Strategies and Perspectives. J Multidiscip Healthc 2023; 16:3663-3673. [PMID: 38046050 PMCID: PMC10693244 DOI: 10.2147/jmdh.s427946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023] Open
Abstract
Objective This study describes strategies for the recruitment of socially isolated older old Black individuals to participate in the "Internet-based conversational engagement clinical trial (I-CONECT)" (Clinical Trial.gov: NCT02871921) and lessons learned in this critical population segment. Methods Best practice strategies to recruit the target population included mass mailings, advertisements, and direct community outreach, including the collaboration with a community group created to reach Black individuals interested in research participation. We also made protocol changes to measure recruitment criteria for older old Black adults more accurately and to increase their participation. Results Descriptive data related to the challenges and successes in recruiting Black participants compared to the White participants is presented. The primary site contacted 17,523 primarily White potential participants and enrolled/randomized 145 White and 2 Asian/mixed race participants (0.8%). The Midwest site contacted 12,141 Black potential participants and enrolled/randomized 39 (0.3%) participants. Discussion While best practices were employed, several factors complicated recruitment, including the need to adjust recruitment criteria, navigate regional regulations, and respect diverse community preferences. Conclusion Older old African Americans are reachable and willing to participate in research when considering their beliefs and practices, influenced by their community and experience.
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Affiliation(s)
- Laura M Struble
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Kathleen Potempa
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Peter A Lichtenberg
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Raina L Croff
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Alexis Ellis
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Hiroko H Dodge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Yuan F, Zhou W, Dodge HH, Zhao X. Short: Causal structural learning of conversational engagement for socially isolated older adults. SMART HEALTH (AMSTERDAM, NETHERLANDS) 2023; 28:100384. [PMID: 37065441 PMCID: PMC10101035 DOI: 10.1016/j.smhl.2023.100384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Social isolation has become a growing public health concern in older adults and older adults with mild cognitive impairment. Coping strategies must be developed to increase social contact for socially isolated older adults. In this paper, we explored the conversational strategy between trained conversation moderators and socially isolated adults during a conversational engagement clinical trial (Clinicaltrials.gov: NCT02871921). We carried out structural learning and causality analysis to investigate the conversation strategies used by the trained moderators to engage socially isolated adults in the conversation and the causal effects of the strategy on engagement. Causal relations and effects were inferred between participants' emotions, the dialogue strategies used by moderators, and participants' following emotions. The results found in this paper may be used to support the development of cost-efficient, trustworthy AI- and/or robot-based platform to promote conversational engagement for older adults to address the challenges in social interaction.
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Affiliation(s)
- Fengpei Yuan
- Department of Mechanical, Aerospace and Biomedical Engineering, The University of Tennessee Knoxville, 1512 Middle Drive, Knoxville, TN, 37996, USA
| | - Wenjun Zhou
- Department of Business Analytics and Statistics, The University of Tennessee Knoxville, 916 Volunteer Blvd., Knoxville, TN, 37996, USA
| | - Hiroko H. Dodge
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Xiaopeng Zhao
- Department of Mechanical, Aerospace and Biomedical Engineering, The University of Tennessee Knoxville, 1512 Middle Drive, Knoxville, TN, 37996, USA
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Coley N, Giulioli C, Aisen PS, Vellas B, Andrieu S. Randomised controlled trials for the prevention of cognitive decline or dementia: A systematic review. Ageing Res Rev 2022; 82:101777. [PMID: 36336171 DOI: 10.1016/j.arr.2022.101777] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/02/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
Dementia prevention research has progressed rapidly in recent years, with publication of several large lifestyle intervention trials, and renewed interest in pharmacological interventions, notably for individuals with Alzheimer's disease biomarkers, warranting an updated review of results and methodology. We identified 112 completed trials testing the efficacy of single-domain pharmacological (n = 33, 29%), nutritional (n = 27, 24%), physical activity (n = 18, 16%) and cognitive stimulation (n = 13, 12%), or multidomain (n = 22, 20%) interventions on incident dementia, or a relevant intermediate marker (e.g. cognitive function, biomarkers or dementia risk scores) in people without dementia. The earliest trials tested pharmacological interventions or nutritional supplements, but lifestyle interventions predominated in the last decade. In total, 21 (19%) trials demonstrated a clear beneficial effect on the pre-specified primary outcome (or all co-primary outcomes), but only two (10%) were large-scale (testing blood pressure lowering (Syst-Eur) or multidomain (FINGER) interventions on incident dementia and cognitive change in cognitive function, respectively). Of the 116 ongoing trials, 40% (n = 46) are testing multidomain interventions. Recent methodological shifts concern target populations, primary outcome measures, and intervention design, but study design remains constant (parallel group randomised controlled trial). Future trials may consider using adaptive trials or interventions, and more targeted approaches, since certain interventions may be more effective in certain subgroups of the population, and at specific times in the life-course. Efforts should also be made to increase the representativeness and diversity of prevention trial populations.
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Affiliation(s)
- Nicola Coley
- Center for Epidemiology and Research in Population Health (CERPOP), University of Toulouse, INSERM UMR1295, UPS, Toulouse, France; Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France.
| | - Caroline Giulioli
- Center for Epidemiology and Research in Population Health (CERPOP), University of Toulouse, INSERM UMR1295, UPS, Toulouse, France; Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Paul S Aisen
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | - Bruno Vellas
- Center for Epidemiology and Research in Population Health (CERPOP), University of Toulouse, INSERM UMR1295, UPS, Toulouse, France; Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France; Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital, France
| | - Sandrine Andrieu
- Center for Epidemiology and Research in Population Health (CERPOP), University of Toulouse, INSERM UMR1295, UPS, Toulouse, France; Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France; Department of Internal Medicine, Division of General Internal and Geriatric Medicine, University of New Mexico, USA
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12
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Yu K, Wild K, Dowling NM, Kaye JA, Silbert LC, Dodge HH. Emotional characteristics of socially isolated older adults with MCI using tablet administered NIH toolbox: I-CONECT study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12372. [PMID: 36381558 PMCID: PMC9652485 DOI: 10.1002/dad2.12372] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 11/15/2022]
Abstract
Introduction Examining the emotional functioning of individuals with mild cognitive impairment (MCI) could help describe their cognitive status and inform the development of interventions. This study compared the emotional characteristics of socially isolated older adults with and without MCI. Methods We used baseline data from the Internet-based Conversational Engagement Clinical Trial. Emotional characteristics were assessed with the National Institutes of Health Toolbox Emotion Battery (NIHTB-EB). MCI status was determined with a consensus clinical diagnosis. Results This study included 163 participants (mean age = 81.2 years, non-Hispanic Black = 20.7%, MCI = 52.8%). MCI was associated with higher negative affect and lower psychological well-being. Non-Hispanic Black participants scored lower in sadness, higher in positive affect, and higher in meaning and purpose than non-Hispanic White participants. Conclusion Older adults with MCI experience more negative emotions and worse psychological well-being than those with normal cognition. The NIHTB-EB appears to be a sensitive tool to detect emotional characteristics associated with cognitive decline.
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Affiliation(s)
- Kexin Yu
- NIA‐Layton Aging and Alzheimer's Disease CenterOregon Center for Aging & TechnologyDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | - Katherine Wild
- NIA‐Layton Aging and Alzheimer's Disease CenterOregon Center for Aging & TechnologyDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | - N. Maritza Dowling
- Department of Acute and Chronic CareSchool of Nursingand Department of Epidemiology & BiostatisticsMilken Institute of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Jeffrey A. Kaye
- NIA‐Layton Aging and Alzheimer's Disease CenterOregon Center for Aging & TechnologyDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Portland Veterans Affairs Health Care SystemPortlandOregonUSA
| | - Lisa C. Silbert
- NIA‐Layton Aging and Alzheimer's Disease CenterOregon Center for Aging & TechnologyDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Portland Veterans Affairs Health Care SystemPortlandOregonUSA
| | - Hiroko H. Dodge
- NIA‐Layton Aging and Alzheimer's Disease CenterOregon Center for Aging & TechnologyDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Department of NeurologyHarvard Medical SchoolMassachusetts General HospitalBostonMassachusettsUSA
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13
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Wu CY, Mattek N, Wild K, Miller LM, Kaye JA, Silbert LC, Dodge HH. Can changes in social contact (frequency and mode) mitigate low mood before and during the COVID-19 pandemic? The I-CONECT project. J Am Geriatr Soc 2022; 70:669-676. [PMID: 34881436 PMCID: PMC8904274 DOI: 10.1111/jgs.17607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/27/2021] [Accepted: 11/23/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND/OBJECTIVES The coronavirus disease 2019 (COVID-19) global outbreak allowed a natural experiment to observe how older adults changed social patterns and how it affected their emotional well-being. We studied the frequency and modes of social contact and their effects on older adults' mood before and during the COVID-19 pandemic. DESIGN Phone-based surveys were administered weekly before and during the COVID-19 pandemic. SETTING Participants were recruited from Portland, Oregon, and Detroit, Michigan. PARTICIPANTS Older adults ≥75 years old (n = 155, age = 81.0 ± 4.5, 72.3% women) were included in a randomized controlled trial, the Internet-Based Conversational Engagement Clinical Trial (I-CONECT). MEASUREMENTS Low mood was self-reported as feeling downhearted or blue for three or more days in the past week. Social contact was self-reported by the amount of time spent in interactions, with whom (family, friends, others), and via which modes (in-person, phone/video call, text/email/letter). RESULTS A total of 5525 weeks of data were derived from 155 participants. Before the COVID-19 pandemic, average social interaction time spent in-person, on phone/video call, and via text/email/letter was 406, 141, and 68 min/week, respectively. During the COVID-19 pandemic, time spent in-person was reduced by 135 min/week, while time spent via phone/video call and writing increased by 33 and 26 mins/week, respectively. In-person family contact was associated with less low mood regardless of the pandemic (odds ratio = 0.92, p < 0.05). There was a COVID-19 × text/email/letter with friends interaction (odds ratio = 0.77, p = 0.03), suggesting that during the COVID-19 pandemic, an increase of 1 h of writing with friends per week was associated with a 23% decrease in the likelihood of experiencing low mood. CONCLUSION The lost in-person time relating to COVID-19 restrictions tended to be partially compensated for with increased calls and writing time, although overall social interaction time decreased. During the COVID-19 pandemic, at least two types of social interactions (writing to friends and in-person family time) showed promise for mitigating low mood for older adults with limited social resources.
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Affiliation(s)
- Chao-Yi Wu
- Department of Neurology, Oregon Health & Science University (OHSU), Portland, Oregon,Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon
| | - Nora Mattek
- Department of Neurology, Oregon Health & Science University (OHSU), Portland, Oregon,Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon
| | - Katherine Wild
- Department of Neurology, Oregon Health & Science University (OHSU), Portland, Oregon,Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon
| | - Lyndsey M. Miller
- Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon,School of Nursing, OHSU, Portland, Oregon
| | - Jeffrey A. Kaye
- Department of Neurology, Oregon Health & Science University (OHSU), Portland, Oregon,Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon
| | - Lisa C. Silbert
- Department of Neurology, Oregon Health & Science University (OHSU), Portland, Oregon,Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon,Department of Neurology, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Hiroko H. Dodge
- Department of Neurology, Oregon Health & Science University (OHSU), Portland, Oregon,Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon
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14
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Tang F, Chen J, Dodge HH, Zhou J. The Joint Effects of Acoustic and Linguistic Markers for Early Identification of Mild Cognitive Impairment. Front Digit Health 2022; 3:702772. [PMID: 35224534 PMCID: PMC8878676 DOI: 10.3389/fdgth.2021.702772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/27/2021] [Indexed: 12/14/2022] Open
Abstract
In recent years, behavioral markers such as spoken language and lexical preferences have been studied in the early detection of mild cognitive impairment (MCI) using conversations. While the combination of linguistic and acoustic signals have been shown to be effective in detecting MCI, they have generally been restricted to structured conversations in which the interviewee responds to fixed prompts. In this study, we show that linguistic and acoustic features can be combined synergistically to identify MCI in semi-structured conversations. Using conversational data from an on-going clinical trial (Clinicaltrials.gov: NCT02871921), we find that the combination of linguistic and acoustic features on semi-structured conversations achieves a mean AUC of 82.7, significantly (p < 0.01) out-performing linguistic-only (74.9 mean AUC) or acoustic-only (65.0 mean AUC) detections on hold-out data. Additionally, features (linguistic, acoustic and combination) obtained from semi-structured conversations outperform their counterparts obtained from structured weekly conversations in identifying MCI. Some linguistic categories are significantly better at predicting MCI status (e.g., death, home) than others.
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Affiliation(s)
- Fengyi Tang
- Department of Computer Science of Engineering, Michigan State University, East Lansing, MI, United States
| | - Jun Chen
- Department of Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | - Hiroko H. Dodge
- Department of Neurology, Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, United States
| | - Jiayu Zhou
- Department of Computer Science of Engineering, Michigan State University, East Lansing, MI, United States,*Correspondence: Jiayu Zhou
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