Usability testing of the first prototype of the Memento system: a technological device to promote an independent living in people with dementia

PURPOSE

Assistive technologies have the potential for supporting people with memory complaints in their daily life. User-centered interaction design research helps developers to create systems that are suitable for users. The aim of this work is to describe the methodology and the results of the usability test for the first Memento prototype involving users.

MATERIALS AND METHODS

In each country, 5 subjects with different levels of cognitive reserve and technical proficiency were enrolled in Italy, Austria and Spain, respectively (15 subjects; 6 M; 9 F, age 72.8 ± 10.8 years, MMSE score 25.6 ± 1.6). Observation methods, performance metrics and the System Usability Scale were used to collect data.

RESULTS

The results are presented in terms of design, technical problems, target-group-related challenges and usability perception from the participant perspective. Suggestions for improvement were pointed out by the users. Considering the usability scores interpretation, the first prototype was classified as "OK" and "Good" by users.

CONCLUSIONS

The results of the Lab Trials provide important information on usability and the users' needs in order to improve the Memento prototype and to create a final system to be evaluated during the Field Trials phase of the project.Implication for rehabilitationThe MEMENTO project mission is to improve the quality of life of people in the early and middle stages of dementia, by supporting the management of daily activities that are usually affected by the loss of memory and cognition. The Lab Trial phase is essential to have feedback on the usability of the Memento prototype to allow a better understanding of users' needs and expectations.

The Potential of Fasting-Mimicking Diet as a Preventive and Curative Strategy for Alzheimer's Disease

This review examines the potential of fasting-mimicking diets (FMDs) in preventing and treating Alzheimer's disease (AD). FMDs are low-calorie diets that mimic the physiological and metabolic effects of fasting, including the activation of cellular stress response pathways and autophagy. Recent studies have shown that FMDs can reduce amyloid-beta accumulation, tau phosphorylation, and inflammation, as well as improve cognitive function in animal models of AD. Human studies have also reported improvements in AD biomarkers, cognitive functions, and subjective well-being measures following FMDs. However, the optimal duration and frequency of FMDs and their long-term safety and efficacy remain to be determined. Despite these uncertainties, FMDs hold promise as a non-pharmacological approach to AD prevention and treatment, and further research in this area is warranted.

DMapp: a developing promising approach to monitor symptoms progression and stimulate memory in Italian people with cognitive impairments

BACKGROUND

Based on recent researches on the use of natural language processing techniques for very early detection of cognitive decline and the benefits of cognitive stimulation for people with cognitive impairments, the Dementia Monitoring application (DMapp) is developed inside the Memento project.

AIMS

The aims of this work are: (1) to present DMapp; (2) to report the results of two preliminary studies on DMapp; (3) to describe the clinical and experimental potentiality of DMapp.

METHODS

Italian people with the diagnosis of mild cognitive impairment due to Alzheimer's disease or dementia due to Alzheimer's Disease with a Mini-Mental-State-Examination between 24 and 28 (inclusive) were involved in the DMapp development prototype during the Lab Trial (4 subjects) and Filed Trial (5 subjects) of the Memento project. Qualitative and quantitative data were collected to evaluate participants' opinions, the DMapp ability to perform the automatic analysis of the speech and participants' visible emotional state effective. Ad hoc interviews, the Observed Emotion Rating Scale and performance metrics to solve different tasks were used. The relation between cognitive measures (global cognitive measures) and linguistic indexes values was considered using Euclidean distances between the participants.

RESULTS

Linguistic indexes were calculated and seemed to classify the participants' performance as expected from cognitive measures. The DMapp was appreciated by people with cognitive impairment. Positive emotions were present.

CONCLUSION

DMapp seems an interesting approach to monitor dementia symptoms progression and stimulate memory. Possible developments and open questions are discussed.

Fasting-mimicking diet cycles reduce neuroinflammation to attenuate cognitive decline in Alzheimer's models

The effects of fasting-mimicking diet (FMD) cycles in reducing many aging and disease risk factors indicate it could affect Alzheimer's disease (AD). Here, we show that FMD cycles reduce cognitive decline and AD pathology in E4FAD and 3xTg AD mouse models, with effects superior to those caused by protein restriction cycles. In 3xTg mice, long-term FMD cycles reduce hippocampal Aβ load and hyperphosphorylated tau, enhance genesis of neural stem cells, decrease microglia number, and reduce expression of neuroinflammatory genes, including superoxide-generating NADPH oxidase (Nox2). 3xTg mice lacking Nox2 or mice treated with the NADPH oxidase inhibitor apocynin also display improved cognition and reduced microglia activation compared with controls. Clinical data indicate that FMD cycles are feasible and generally safe in a small group of AD patients. These results indicate that FMD cycles delay cognitive decline in AD models in part by reducing neuroinflammation and/or superoxide production in the brain.

User experience and acceptance of a device assisting persons with dementia in daily life: a multicenter field study

Background

Assistive technologies have the potential to facilitate everyday life of people with dementia and their families. Close collaboration with affected people and interdisciplinary research are essential to understand and address the needs of prospective users. In this study, we present the results of the evaluation of such an assistive system prototype.

Aims

Challenges from the patient and caregiver side, technical and design problems and acceptance and usability with regard to our special target group were evaluated.

Methods

MEMENTO, a system of two e-ink tablets and a smartwatch, was tested in the domestic environment of dementia patients. Thirty participants from Italy, Spain and Austria took part in a 3-month field trial and compared the MEMENTO system to traditional strategies in everyday life. Quantitative and qualitative data were collected and frequency of use of the system was monitored.

Results

There were no significant changes in quantitative measurements, such as activities of daily living and caregiver burden over the duration of the 3-month field trial. More frequent usage was significantly correlated with positive attitude towards technology (r = 0.723, p < 0.05), but not with age. The design of the system was positively emphasized, reducing fear of the technology on the one hand and stigmatization on the other.

Conclusion

We show that a positive attitude towards technology is the essential variable for successful implementation of such systems, regardless of age. Participants showed great interest in digital solutions and agreed that technological systems will help in maintaining independency of persons with cognitive dysfunction in the future.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-02013-8.

Harmonizing neuropsychological assessment for mild neurocognitive disorders in Europe

INTRODUCTION

Harmonized neuropsychological assessment for neurocognitive disorders, an international priority for valid and reliable diagnostic procedures, has been achieved only in specific countries or research contexts.

METHODS

To harmonize the assessment of mild cognitive impairment in Europe, a workshop (Geneva, May 2018) convened stakeholders, methodologists, academic, and non-academic clinicians and experts from European, US, and Australian harmonization initiatives.

RESULTS

With formal presentations and thematic working-groups we defined a standard battery consistent with the U.S. Uniform DataSet, version 3, and homogeneous methodology to obtain consistent normative data across tests and languages. Adaptations consist of including two tests specific to typical Alzheimer's disease and behavioral variant frontotemporal dementia. The methodology for harmonized normative data includes consensus definition of cognitively normal controls, classification of confounding factors (age, sex, and education), and calculation of minimum sample sizes.

DISCUSSION

This expert consensus allows harmonizing the diagnosis of neurocognitive disorders across European countries and possibly beyond.

Age-related decline in interhemispheric transfer of tactile information: The fingertip cross-localization task

According to the disconnection hypothesis of cognitive aging, cognitive deficits associated with brain aging could be a result of damage to connective fibres. It has been suggested that the age-related decline in cognitive abilities is accompanied by age-related changes in interhemispheric communication ensured by commissural fibres. This study aimed to contribute to this topic by investigating the effects of aging on the efficiency of interhemispheric transfer of tactile information. A total of 168 right-handed subjects, aged 20-90 years, have been tested using the fingertip cross-localization task: the subject must respond to a tactile stimulus presented to one hand using the ipsilateral (uncrossed condition) or contralateral hand (crossed condition). Because the crossed task requires interhemispheric transfer of information, the value of the difference between the uncrossed and crossed conditions (CUD) can be deemed to be a reliable measure of the efficiency of the interhemispheric interactions. The uncrossed condition was more accurate than the crossed condition for all ages. However, the degree of the CUD was significantly age-dependent. The effectiveness of the interhemispheric transfer of tactile information decreased significantly with age and may indicate the occurrence of age-related changes of the corpus callosum. Considerably, performance appears to decline around the seventh decade of life with the fastest decline in the subsequent decades. The results suggest a relationship between brain aging and the efficiency of the interhemispheric transfer of tactile information. The findings are discussed in relation to the strategic role of white matter integrity in preserving behavioural performances.

Improvement in cognitive performance and mood in healthy older adults: a multimodal approach

The aim of this research was to evaluate if being involved in a programme that integrates physical, mental, and social activities could help to reduce the impacts of cerebral ageing on cognitive functions. Fifty healthy adults over 65 years of age and without cognitive impairment were randomly assigned to either an experimental or a control group; subjects were equally divided by age, sex, schooling, physical health, mood, and social integration. For 6 months, the experimental group had biweekly meetings, participating in a multimodal approach based on a combination of simultaneous physical, mental, and social activities. At pre-test and post-test, both experimental and control subjects underwent a neuropsychological assessment, including tests to measure attention, verbal and spatial memory, language, constructional praxis, executive functions, processing speed, and intelligence. Furthermore, a visual analogue scale was used to examine well-being and mood states. Compared to the pre-test levels and the control subjects, the performance of subjects in the experimental group significantly improved in several neuropsychological tests, including attention, processing speed, memory, and executive functions, as well as mood state. Even in older subjects without cognitive impairments, a multimodal approach based on simultaneous physical, mental, and social activity can be a useful strategy that has beneficial effects on mood and cognition. The results suggest that an active lifestyle may protect against cognitive decline in ageing.

Validation study of the Italian version of Communication Activities of the Daily Living (CADL 2) as an ecologic cognitive assessment measure in older subjects

INTRODUCTION

Communication can be affected by age related cognitive decline and mental deterioration. The second edition of the Communication Activities of the Daily Living (CADL 2) appears as an interesting ecological assessment tool of cognitive functions in old age.

OBJECTIVE

The aim of this work is to (1) develop an Italian version of CADL 2, (2) to test its psychometric properties in terms of reliability and validity, and (3) to measure CADL 2 discriminative capacity between cognitively healthy and cognitively impaired older subjects.

METHOD

One hundred and eleven subjects were enrolled (36 M; 75 F, age 80, 80.85 ± 7 years, education 9.3 ± 4.7 years). The CADL 2 was administered together with a standard neuropsychological battery.

RESULTS

The CADL 2 showed good reliability and correlates with all the cognitive evaluation tests. The CADL 2's area under the curve was equal to 0.80, index of good diagnostic accuracy.

CONCLUSIONS

The CADL 2 is an appropriate assessment tool for communication skills in aging.

Enhancing Psychological Sexual Health of People With Spinal Cord Injury and Their Partners in an Italian Unipolar Spinal Unit: A Pilot Data Study

Like the slogan of the American Consortium for Spinal Cord Medicine says, “No injury, no matter how serious, can take away your ability to have a relationship, experience love, and experience the attraction between two people.” However, people with spinal cord injury (SCI) have to fight with their own and societal attitudes and stereotypes that limit sexuality to the physiological functions of genitalia, phallocentric primacy of sexual pleasure, and sexual attractiveness of perfect bodies. The scope of the present study is to evaluate the impacts of a psychoeducational intervention in a personal growth group on the sexual life of seven people with SCI and four of their partners particularly their sexual interest and satisfaction, depression, and anxiety. Due to the small samples size, nonparametric statistical tests were used to compare pre- and post-outcome measures for all participants: patients and the partners group. Possible effects of gender were also considered. The effectiveness of the psychoeducational intervention was clearly apparent, showing a high effect size in improving sexual interest and satisfaction, and the opportunity and ability to enjoy sexuality. A reduction of anxiety was also observed for all participants, although it may not have been related to the psychoeducational intervention. Moreover, the intervention significantly improved the opportunity and ability to enjoy sexuality for the partner and patient group. No effect was found on depression. This was the first initiative in Italy aiming to address the sexual life and not only to cure the sexual dysfunction of people with SCI. The positive, clear evidence of the validity of the Love & Life project’s intervention bodes well for new psychoeducational initiatives that in Italy meet the sexual needs of people with SCI and their partners, providing adequate education and psychological support, involving partners, and creating a space to talk among peers.

The "Artwork Effect" paradigm: A model for planning and assessing cognitive stimulation for people with dementia through museum visits

This paper proposes a paradigm ("Artwork Effect" paradigm) to study the impact of museum stimulation programs for people with dementia. The literature concerning viewing and making art is considered. The paradigm, comprising qualitative and quantitative measures, is illustrated. The implementation of a shared paradigm of assessment can contribute to the validation of an assessment model to evaluate museum stimulation programs for people with dementia: a low-cost nonpharmacological intervention useful for the stimulation of cognitive functions and for increasing the well-being of people with dementia and their caregivers.

Is the 15-item Geriatric Depression Scale a Fair Screening Tool? A Differential Item Functioning Analysis Across Gender and Age

The 15-item version of the Geriatric Depression Scale (GDS-15) is widely employed to assess depression in old people, but it is unclear if there are biases in the total score depending on respondents' gender and age. In the current study, we investigated the measurement equivalence of the GDS-15 to provide evidence that the test is a fair screening tool when administered to young-old, old-old, and oldest-old men and women. Item Response Theory-based Differential Item Functioning analyses were applied on a large sample of Italian old people. One item exhibited Differential Item Functioning when comparing men and women, and one item showed Differential Item Functioning across different age-groups. Nonetheless, the magnitude of Differential Item Functioning was small and did not produce any differential test functioning. The gender and age measurement equivalence of the GDS-15 confirms that the test can be used for clinical and research screening purposes.

The local reliability of the 15-item version of the Geriatric Depression Scale: An item response theory (IRT) study

The 15-item version of the Geriatric Depression Scale (GDS-15) is a self-report screening instrument widely used. The current study aimed at providing evidence of the measurement precision of the GDS-15 applying Item Response Theory (IRT). The relative contribution of each item and the reliability of the whole scale in measuring the trait level around the cutoffs were investigated employing data collected from a sample consisting of 1344 old people (M=76.44years, SD=5.13; 58.7% women) involved in a large gerontological research project. The unidimensional two-parameter (2PL) logistic model was employed to item estimate location and slope parameters as well as the Test Information Function (TIF). Nine out of fifteen items were located around the cutoffs and the slopes showed that the majority of the items had substantial discrimination ability. The TIF peaked in correspondence of the cutoffs attesting the good local reliability of the scale. These findings support to the utility of the GDS-15 in detecting depression among older people.

Validation study of the Italian Addenbrooke's Cognitive Examination Revised in a young-old and old-old population

AIMS

The main aims of the study were the translation and the subsequent validation in Italian of the Addenbrooke's Cognitive Examination Revised (ACE-R), and the evaluation of its usefulness in discriminating cognitively normal subjects from patients with mild dementia in an elderly population.

METHODS

The ACE-R was translated and adapted into Italian. The Italian ACE-R was administered to a group of 179 elderly subjects (72 cognitively healthy and 107 subjects with mild dementia, mean age 75.4±6.4 years). The group was stratified into two subsamples according to age, i.e. a young-old (<75 years) and an old-old (≥75 years) group, in order to evaluate the sensitivity and specificity of the test in detecting dementia in different age strata of elderly subjects.

RESULTS

The reliability of the Italian ACE-R was extremely good (α-coefficient=0.85). Two different cutoffs were identified for young-old (cutoff 79; sensitivity 90% and specificity 80%) and old-old subjects (cutoff 60; sensitivity 82% and specificity 100%).

CONCLUSIONS

The Italian ACE-R is a valid screening tool to detect dementia, especially in the old-old population, which represents not only the fastest growing age group but also the group at the highest risk of dementia in Western countries.

Tocopherols and tocotrienols plasma levels are associated with cognitive impairment

Vitamin E includes 8 natural compounds (4 tocopherols, 4 tocotrienols) with potential neuroprotective activity. α-Tocopherol has mainly been investigated in relation to cognitive impairment. We examined the relation of all plasma vitamin E forms and markers of vitamin E damage (α-tocopherylquinone, 5-nitro-γ-tocopherol) to mild cognitive impairment (MCI) and Alzheimer's disease (AD). Within the AddNeuroMed-Project, plasma tocopherols, tocotrienols, α-tocopherylquinone, and 5-nitro-γ-tocopherol were assessed in 168 AD cases, 166 MCI, and 187 cognitively normal (CN) people. Compared with cognitively normal subjects, AD and MCI had lower levels of total tocopherols, total tocotrienols, and total vitamin E. In multivariable-polytomous-logistic regression analysis, both MCI and AD cases had 85% lower odds to be in the highest tertile of total tocopherols and total vitamin E, and they were, respectively, 92% and 94% less likely to be in the highest tertile of total tocotrienols than the lowest tertile. Further, both disorders were associated with increased vitamin E damage. Low plasma tocopherols and tocotrienols levels are associated with increased odds of MCI and AD.

Fetal variant of circle of the Willis and bilateral symmetrical parietal stroke

We described a rare case in which a congenital abnormal vascular structure associated with mild hyperhomocysteinemia could have caused an ischemic stroke, with an unusual localization in the border-zone of MCA and PCA. We think that the lack of compensatory flow distribution from the right vertebral artery and the right posterior communicating artery probably determined the bilateral ischemic lesions in a patient, who possibly had hypotensive crisis.