A dual-modal virtual reality kitchen for (re)learning of everyday cooking activities in Alzheimer's disease

Everyday action impairment is one of the diagnostic criteria of Alzheimer\u27s disease and is associated with many serious consequences, including loss of functional autonomy and independence. It has been shown that the (re)learning of everyday activities is possible in Alzheimer\u27s disease by using error reduction teaching approaches in naturalistic clinical settings. The purpose of this study is to develop a dual-modal virtual reality platform for training in everyday cooking activities in Alzheimer\u27s disease and to establish its value as a training tool for everyday activities in these patients. Two everyday tasks and two error reduction learning methods were implemented within a virtual kitchen. Two patients with Alzheimer\u27s disease and two healthy elderly controls were tested. All subjects were trained in two learning sessions on two comparable cooking tasks. Within each group (i.e., patients and controls), the order of the training methods was counterbalanced. Repeated measure analysis before and after learning was performed. A questionnaire of presence and a verbal interview were used to obtain information about the subjective responses of the participants to the VR experience. The results in terms of errors, omissions, and perseverations (i.e., repetitive behaviors) indicate that the patients performed worse than the controls before learning, but that they reached a level of performance similar to that of the controls after a short learning session, regardless of the learning method employed. This finding provides preliminary support for the value of the dual-modal virtual reality platform for training in everyday cooking activities in Alzheimer\u27s disease. However, further work is needed before it is ready for clinical application

Exploring the requirements for technology to support people with dementia in the home

This thesis explores the requirements of technology to support people with dementia in the home. More specifically, it aims to establish design requirements for systems that prompt people with mild to moderate dementia through multi-step tasks. Chapter 1 presents existing literature that is relevant to the development of cognitive prostheses for people with dementia. The review describes patterns of cognitive decline in dementia, the impact of these deficits on everyday tasks, and technological and non-technological methods of support. Chapter 2 presents the problems of dementia in the home from a professional carer perspective. Nine interviews and one focus group were conducted with 22 occupational therapists and professional carers. The transcripts were analysed using Grounded Theory Analysis (GTA), in accordance with Strauss and Corbin (1990). The analysis revealed three main themes: 'Problems in the home' (daily activities, risks, and interpersonal interaction), 'underlying deficits' (sequencing, memory/orientations, and learning), and 'consequences' for the person with dementia (physical wellbeing and control) and the informal caregiver (relationship and care demands). The implications of these themes for the design of assistive technology are discussed. Chapter 3 presents the problems of dementia from a patient-caregiver perspective. Eight home visits and two individual interviews were conducted with people with mild to moderate dementia and informal caregivers. GT A revealed four main themes: 'Problems in the home' (daily activities, domestic tasks, leisure, and interpersonal interaction), 'underlying deficits' (sequencing and memory/orientation), 'consequences' for the person with dementia (Physical wellbeing and control), and the informal caregiver (relationship and care demands), and 'situated factors' (verbal cues, visual cues, and familiarity). The perspective is compared to the professional carer perspective, and the design implications are discussed. Chapter 4 describes the types of problems people with dementia experience when performing kitchen tasks. Six people with mild to moderate dementia were video recorded performing activities in their own kitchen. These included making a cup of tea/coffee, a bowl of soup, beans on toast, and tea/coffee with toast. Twenty-two video recordings were transcribed and analysed. Errors that prevented task accomplishment were recorded and grouped to form error classifications. Eight error types were identified with four main themes: 'Sequencing' (intrusion, omission, and repetition), 'orientation' (locating and identifying), 'operation' of appliances, and 'incoherence' (toying and inactivity). The error types are discussed in relation to cognitive theory and the implications for designing prompting systems. Chapter 5 describes an experiment embedded in a real activity, designed to evaluate the effect of a novel cueing method. Eight participants with moderate dementia carried out real cooking activities (making porridge with syrup and chocolate comflake cakes) with a care worker. At certain points, the participants were required to tum on/off the cooker. Correct control selection was scored under three different cueing conditions that represented the association between hotplates and controls. Condition 1 used the original design (symbols), condition 2 used verbal (written) cues, and condition 3 used a lighting effect (hotplate and corresponding control would light up). The implications of the experiment for the design and evaluation of technological prompts are discussed. Chapter 6 describes future steps that should be taken to develop prompting systems for people with dementia. This includes a review of recent developments in pervasive computing that match the design requirements for prompting systems, and an interactive design framework that should be used to guide the design of prompting systems for domestic settings. Chapter 7 provides a summary of the thesis. This includes an overview of requirements for technology to support people with dementia at home. The methodological contributions of the thesis are also discussed

Deep and Frequent Phenotyping study protocol: an observational study in prodromal Alzheimer's disease.

INTRODUCTION: Recent failures of potential novel therapeutics for Alzheimer's disease (AD) have prompted a drive towards clinical studies in prodromal or preclinical states. However, carrying out clinical trials in early disease stages is extremely challenging-a key reason being the unfeasibility of using classical outcome measures of dementia trials (eg, conversion to dementia) and the lack of validated surrogate measures so early in the disease process. The Deep and Frequent Phenotyping (DFP) study aims to resolve this issue by identifying a set of markers acting as indicators of disease progression in the prodromal phase of disease that could be used as indicative outcome measures in proof-of-concept trials. METHODS AND ANALYSIS: The DFP study is a repeated measures observational study where participants will be recruited through existing parent cohorts, research interested lists/databases, advertisements and memory clinics. Repeated measures of both established (cognition, positron emission tomography (PET) imaging or cerebrospinal fluid (CSF) markers of pathology, structural MRI markers of neurodegeneration) and experimental modalities (functional MRI, magnetoencephalography and/or electroencephalography, gait measurement, ophthalmological and continuous smartphone-based cognitive and other assessments together with experimental CSF, blood, tear and saliva biomarkers) will be performed. We will be recruiting male and female participants aged >60 years with prodromal AD, defined as absence of dementia but with evidence of cognitive impairment together with AD pathology as assessed using PET imaging or CSF biomarkers. Control participants without evidence of AD pathology will be included at a 1:4 ratio. ETHICS AND DISSEMINATION: The study gained favourable ethical opinion from the South Central-Oxford B NHS Research Ethics Committee (REC reference 17/SC/0315; approved on 18 August 2017; amendment 13 February 2018). Data will be shared with the scientific community no more than 1 year following completion of study and data assembly.NIH

Immersive virtual reality methods in cognitive neuroscience and neuropsychology: the Virtual Reality Everyday Assessment Lab (VR-EAL).an immersive neuropsychological test battery of everyday cognitive functions

In cognitive neuroscience and neuropsychology, the collection of cognitive and behavioural data is predominantly achieved by implementing paper-and-pencil and computerized (i.e., 2D and 3D applications) assessments. However, these psychometric tools in clinics and/or laboratories display several limitations and discrepancies between the observed performance in the laboratory/clinic and the actual performance of individuals in everyday life. The functional and predictive association between an individual's performance on a set of neuropsychological tests and the individual's performance in various everyday life settings is called ecological validity. Ecological validity is considered an important issue that cannot be resolved by the currently available assessment tools. Virtual reality head-mounted displays (HMD) appear to be effective research tools, which may address the problem of ecological validity in neuropsychological testing. However, their widespread implementation is hindered by virtual reality induced symptoms and effects (VRISE) and the lack of skills in virtual reality software development. In this PhD, a technological systematic literature review of the reasons for adverse symptomatology was conducted and suggestions and technological knowledge for the implementation of virtual reality HMD systems in cognitive neuroscience provided. The review indicated features pertinent to display, sound, motion tracking, navigation, ergonomic interactions, user experience, and computer hardware that should be considered by researchers. Subsequently, a meta-analysis of 44 neuroscientific or neuropsychological studies involving virtual reality HMD systems was performed. The meta-analysis of the virtual reality studies demonstrated that new generation HMDs induce significantly less VRISE and marginally fewer dropouts. Importantly, the commercial versions of the new generation HMDs with ergonomic interactions had zero incidents of adverse symptomatology and dropouts. HMDs equivalent to or greater than the commercial versions of contemporary HMDs accompanied with ergonomic interactions are suitable for implementation in cognitive neuroscience. Another aim of this PhD was to devise a brief tool to appraise and report both the quality of software features and VRISE intensity quantitatively; such a tool does not currently exist. The Virtual Reality Neuroscience Questionnaire (VRNQ; Kourtesis et al., 2019) was developed to assess the quality of virtual reality software in terms of user experience, game mechanics, in-game assistance, and VRISE. Forty participants aged between 28 and 43 years were recruited (18 gamers and 22 non-gamers) for the study. They participated in 3 different virtual reality sessions until they felt weary or discomfort and subsequently filled in the VRNQ. The results demonstrated that VRNQ is a valid tool for assessing virtual reality software as it has good convergent, discriminant, and construct validity. The maximum duration of virtual reality sessions should be between 55 and 70 min when the virtual reality software meets or exceeds the parsimonious cut-offs of the VRNQ, and the users are familiarized with the virtual reality system. Also, gaming experience does not affect how long virtual reality sessions should last. Furthermore, while the quality of virtual reality software substantially modulates the maximum duration of virtual reality sessions, age and education do not. Finally, deeper immersion, better quality of graphics and sound, and more helpful in-game instructions and prompts were found to reduce VRISE intensity. The VRNQ facilitates the brief assessment and reporting of the quality of virtual reality software features and/or the intensity of VRISE, while its minimum and parsimonious cut-offs may appraise the suitability of virtual reality software for implementation in research and clinical settings. However, the development of virtual reality software is predominantly dependent on third parties (e.g., freelancers or companies) with programming and software development skills. A solution that will promote the adoption of immersive virtual reality as a research and clinical tool might be the in-house development of virtual reality research/clinical software by computer science literate cognitive scientists or research software engineers. In Chapter 4, guidelines are offered for the development of virtual reality software in cognitive neuroscience and neuropsychology, by describing and discussing the stages of the development of Virtual Reality Everyday Assessment Lab (VR-EAL), the first neuropsychological battery in immersive virtual reality. Techniques for evaluating cognitive functions within a realistic storyline are discussed. The utility of various assets in Unity, software development kits, and other software are described so that cognitive scientists can overcome challenges pertinent to VRISE and the quality of the virtual reality software. In addition, VR-EAL is evaluated in accordance with the necessary criteria for virtual reality software for research purposes. The virtual reality neuroscience questionnaire (VRNQ) was implemented to appraise the quality of the three versions of VR-EAL in terms of user experience, game mechanics, in-game assistance, and VRISE. Twenty-five participants aged between 20 and 45 years with 12–16 years of full-time education evaluated various versions of VR-EAL. The final version of VR-EAL achieved high scores in every sub-score of the VRNQ and exceeded its parsimonious cut-offs. It also appeared to have better in-game assistance and game mechanics, while its improved graphics substantially increased the quality of the user experience and almost eradicated VRISE. The results substantially support the feasibility of the development of effective virtual reality research and clinical software without the presence of VRISE during a 60-min virtual reality session. In Chapter 5, validation of VR-EAL as an assessment of prospective memory, episodic memory, attention, and executive functions using an ecologically valid approach is examined. Performance on the VR-EAL, an immersive virtual reality neuropsychological battery, is examined against an extensive paper-and-pencil neuropsychological battery. Forty-one participants (21 females) were recruited: 18 gamers and 23 non-gamers who attended both an immersive virtual reality and a paper-and-pencil testing session. Bayesian Pearson correlation analyses were conducted to assess construct and convergent validity of the VR-EAL. Bayesian t-tests were performed to compare virtual reality and paper-and-pencil testing in terms of administration time, similarity to real life tasks (i.e., ecological validity), and pleasantness. VR-EAL scores were significantly correlated with their equivalent scores on the paper-and-pencil tests. The participants’ reports indicated that the VR-EAL tasks were considered significantly more ecologically valid and pleasant than the paper-and-pencil neuropsychological battery. The VR-EAL battery also had a shorter administration time. The VR-EAL appears to be an effective neuropsychological tool for the assessment of everyday cognitive functions, and has enhanced ecological validity, a highly pleasant testing experience, and does not induce cybersickness. In the final part of this thesis, the preparatory attentional and memory (PAM) and the multiprocess theories of prospective memory are examined by attempting to identify the cognitive functions which may predict the individual’s performance on ecologically valid prospective memory tasks in the same group of participants described in Chapter 5. Bayesian t-tests were conducted to explore the differences among different prospective memory tasks (e.g., event-based and time-based) and prospective memory tasks with varying delays between encoding and the recall of the intended action (e.g., short-delay versus long-delay). Bayesian linear regression analyses were performed to examine the predictors of VR-EAL scores. The results revealed that the type of prospective memory task does not play a significant role in everyday prospective memory functioning, but instead the length of delay between encoding and retrieving the prospective memory intention plays a central role. Support for the PAM and MP frameworks was found in non-focal and focal event-based tasks respectively. However, the findings, inferring a dynamic interplay between automatic and intentional monitoring and retrieval processes, agree with the inclusive approach of the multiprocess framework. Also, the role of executive functions appears crucial in everyday PM. Finally, everyday PM is predominantly facilitated by episodic memory, visuospatial attention, auditory attention, and executive functions. In conclusion, this PhD thesis attempted to show how immersive virtual reality research methods may be implemented efficiently without the confounding effect of cybersickness symptomatology in order to enhance the ecological validity of neuropsychological testing and contribute to our understanding of everyday cognitive ability

Validation d'une tâche de classement à l'intérieur du Virtual Multitasking Test (VMT-2) et effets du vieillissement normal

Essai doctoral présenté à la Faculté des arts et des sciences en vue de l'obtention du grade de Doctorat en psychologie - Option neuropsychologie clinique (D. Psy)Le vieillissement normal est un processus évolutif caractérisé par des changements cognitifs, fonctionnels et neuroanatomiques. Les fonctions exécutives (FE), associées à l’autonomie dans les activités instrumentales de la vie quotidienne (AIVQ), sont particulièrement sensibles aux effets de l’âge. À l’heure actuelle, l’évaluation neuropsychologique de type « papier-crayon » est l’approche la plus utilisée pour décrire le profil cognitif d’une personne, toutefois, sa faible validité écologique est souvent critiquée. La réalité virtuelle (RV) est une alternative intéressante, car elle évalue le degré de fonctionnalité en reproduisant plus fidèlement la réalité du quotidien. Son utilisation auprès des aînés en est pourtant à ses débuts. Les objectifs de l’étude étaient donc (1) de différencier le comportement des adultes (18-45 ans) et des aînés (65 ans et +) cognitivement sains dans une tâche de classement intégrée dans un nouvel outil technologique d’évaluation neuropsychologique, le Virtual Multitasking Test (VMT-2) et (2) d’étudier la validité de la tâche indépendamment de l’âge des participants (d’une part) et en contrôlant pour l’effet de l’âge (de l’autre). L’échantillon final (n = 25) comportait 14 participants « jeunes » et 11 participants « âgés ». Les résultats indiquent que les aînés prennent plus de temps pour réaliser la tâche que les jeunes adultes, mais qu’ils ne font pas plus d’erreurs dans la réalisation de la tâche. De plus, les indices retenus dans le VMT-2 corrèlent avec certaines variables issues du bilan neuropsychologique standard, en particulier celles qui évaluent les FE. Des nuances dans l’interprétation des résultats doivent toutefois être apportées lorsque nous considérons l’effet de l’âge sur les données obtenues. En somme, le VMT-2 semble offrir la possibilité d’une évaluation valide des fonctions cognitives selon l’âge. Des travaux futurs pourraient s’intéresser à son utilisation auprès d’aînés à risque de développer un trouble neurocognitif (TNC) pour intervenir précocement et ainsi prolonger leur indépendance fonctionnelle.Normal aging is a natural process characterized by cognitive, functional and neuroanatomic changes. Executive functions (EF) are sensible to age effects. A dysfunction in this area is closely related to impairment in instrumental activities of daily living (IADL). To date, traditional neuropsychological evaluation is the most widely used approach for cognitive assessment. However, its low ecological validity is often questioned. Virtual reality (VR) is presented as an interesting alternative because it evaluates the degree of functionality by reproducing more accurately real-life situations. The use of VR technology in the field of cognitive aging is still at its early stages. Thus, the objectives of this research were the following: (1) to differentiate healthy younger and older adults in a sorting task of the Virtual Multitasking Test (VMT-2) and (2) to study the validity of the sorting task regardless of participants’ age, on the one hand, and by controlling for age effect on the other hand. The final sample size (n = 25) included 14 “younger adults” participants and 11 “older adults” participants. Results suggest that elderly took more time to complete the task than younger adults. Significant correlations were also found between VMT-2 measures and performance on neuropsychological measures, especially on executive functioning. However, nuances must be made when we consider the age effect. In conclusion, VMT-2 seems to be a valid tool for cognitive and functional assessment in normal aging. Future research should investigate its utilization with elderly at risk of developing a neurocognitive disorder. This can promote early intervention and thus help maintain functional independence

A detailed exploration of changes in everyday task performance in people with dementia

For most people, everyday tasks, such as tea making, are familiar, routine tasks that are normally performed without effort. A diagnostic feature of dementia, however, is an insidious decline in the ability to perform everyday tasks. Through a series of six studies, I examined how everyday task performance changes in people with dementia and I piloted two behavioural strategies that might enhance memory for everyday tasks in people with dementia. Study 1 developed a detailed error and error-monitoring taxonomy to explore the minutia of everyday task performance in healthy ageing. The study demonstrated that older adults without dementia rarely make errors in everyday tasks, even when conditions are manipulated to reduce cognitive resources. Study 2 documented errors and error-monitoring of everyday task performance in individuals with a developing dementia, using archive data to chart performance change over 5 years. While errors increased with dementia progression, there was no reactive increase in error-monitoring, suggesting a lack of awareness characterises the breakdown of task performance. Study 3a explored the impact of verbally instructing another person how to perform an everyday task on recall of an everyday task. People with dementia were able to do this surprisingly well, appearing to use both visual and motor cues to support recall. Study 3b piloted the impact of verbal self-explanation on everyday task performance, in four people with dementia. Self-explanation did not benefit recall and implementation of a familiar task. Study 4a compared observation with verbal instruction on acquisition of a novel routine. Results showed that people with mild-moderate dementia learned a new routine better under observation compared to verbal instruction. Study 4b tested observational learning of an everyday task over five weeks in three people with dementia. The initial benefit over verbal instruction was sustained, but did not increase over time. These studies constitute a detailed and meticulous exploration of everyday task performance in people with dementia and provide pilot evidence of a potential strategy that could support memory of everyday tasks in people with dementia

A window of opportunity: Describing and developing an evidence, theory, and practice-informed occupational therapy intervention for people living with early-stage dementia

Aim There is a scarcity of evidence generated in a UK context to inform the practice of occupational therapists working with people living with early-stage dementia. This Thesis’ overarching aim was to describe and develop an evidence, theory, and practice-informed occupational therapy intervention for people living with early-stage dementia. Methods In accordance with the MRC Framework for the Development and Evaluation of Complex Interventions, an Intervention Mapping approach was utilised to guide the development process. Thesis Objectives were developed based on Intervention Mapping Steps 1 – 3, and to meet these Objectives, this Thesis consists of three studies. Study 1 (a two-stage mixed methods evidence synthesis) and Study 2 (semi-structured interviews with people affected by dementia and occupational therapy practitioners) sought to understand the intervention population and context, as well as identify existing research and practice-based interventions. Study 3 involved describing and developing an intervention programme theory and programme design. Findings Studies 1 and 2: Multiple personal and environmental (social, physical, and occupational) determinants associated with the occupational performance problems that people living with early-stage dementia may experience were identified. Existing research and practice-based interventions were heterogenous in nature and no programme theories were reported; however, strategies that problem-solve occupational performance problems were identified as a primary intervention component. In practice contextual barriers were associated with resources, other professionals’ awareness and understanding of occupational therapy, and a lack of control and influence over service development and policy. Study 3: A logic model of the problem and population, matrices of change, and a simple intervention logic model were developed to articulate a proposed programme theory. A broad overview of the proposed interventions’ design, including components and context, were specified and key uncertainties outlined. Conclusion This research has developed a robust foundation for further development work at Intervention Mapping Steps 4 – 6, including developing theoretically informed implementation strategies and producing materials in preparation for a feasibility evaluation

Entwicklung und Validierung innovativer Assessmentstrategien zur Erfassung trainingsbezogener Leistungen nach motorisch-kognitiven Training bei Menschen mit Demenz

Demenzspezifische Symptome sind durch bestimmte pharmakologische und nichtmedikamentöse Interventionen beeinflussbar, vor allem dann, wenn die Erkrankung durch geeignete diagnostische Verfahren frühzeitig erkannt wird. Aufgrund zunehmender Aufmerksamkeit in der Interventionsforschung und geriatrischen Rehabilitation mit Blick auf Fragen zur Effektivität körperlichen Trainings bei Menschen mit Demenz, war es ein erstes Ziel der vorliegenden Forschungsarbeit, den bisherigen Forschungsstand zur Wirksamkeit körperlicher Aktivität und körperlichen Trainings bei diesem Patientenkollektiv zu eruieren: Eine Übersichtsarbeit (Schrift 1) und zwei ausführliche Buchkapitel (Schrift 2 und 3) stellen dar, dass für Menschen mit kognitiver Beeinträchtigung und Demenz nur wenige qualitativ hochwertige Arbeiten (randomisierte, kontrollierte Studien [RCTs]) vorliegen, welche die Effektivität körperlichen Trainings auf psychische Symptome wie Sturzangst und Depressionen sowie auf die kognitive Leistungsfähigkeit belegen. Mit Blick auf die Reduktion kognitiver Defizite, die mit dem Mobilitätsverhalten und der Selbstständigkeit älterer Menschen assoziiert sind, zählen motorisch-kognitive Trainingsprogramme zu besonders ausrichtsreichen Interventionsstrategien. Sie führen zu spezifischen Effekten auf Mehrfach- bzw. Dual-Task Leistungen, welche bereits in frühen Stadien der Demenz beeinträchtigt sind und eine besondere Al ltagsrelevanz besitzen. Übergeordnetes Ziel war daher die Weiterentwicklung und Evaluierung eines demenzspezifischen, motorisch-kognitiven Trainingskonzepts bei Menschen mit Demenz. Für die Evaluierung eines motorisch-kognitiven Trainings werden spezifische Testverfahren benötigt. Auch wenn in der Forschungsliteratur bereits einige Assessmentstrategien zur Abbildung von Trainingseffekten auf alltagsrelevante, motorisch-kognitiver Leistungen vorliegen, sind diese Testverfahren im Bereich des geriatrischen Assessments bislang nicht gut etabliert. Es mangelt an Validierungsstudien zur Überprüfung relevanter Testgütekriterien insbesondere bei kognitiv beeinträchtigten Menschen. Zudem bedarf es neuartiger, motorischkognitiver Testverfahren, die das geriatrische Assessment um wesentliche Elemente ergänzen. Die vorliegende Arbeit thematisiert daher primär die Entwicklung und Validierung von Assessmentstrategien zur Erfassung motorisch-kognitiver Leistungen bei Menschen mit beginnender bis mittelschwerer Demenz, die in dem weiterentwickelten, demenzspezifischen Trainingsprogramm trainiert wurden: Schrift 4 umfasst die Validierung einer innovativen Assessmentstrategie, die direkt in ein computergestütztes Bewegungsspiel (Physiomat®) zur Erfassung trainingsbezogener, motorisch- kognitiver Leistungen integriert wurde. Das Physiomat®-Assessment weist gute bis ausgezeichnete Testgütekriterien (Konstruktvalidität, Test-Retest Reliabilität, Veränderungssensitivität und Durchführbarkeit) bei Menschen mit Demenz auf und ermöglicht die Erfassung motorisch-kognitiver Leistungen während des Spielverlaufs. Das Physiomat®- Assessment wurde zur Abbildung von Effekten eines entwickelten Physiomat®-Trainings als ein Baustein des demenzspezifischen Trainingskonzepts genutzt. Schrift 5 stellt dar, dass Menschen mit beginnender bis mittelschwerer Demenz in der Lage sind, eine signifikante Steigerung bezüglich der Schnelligkeit und Exaktheit der Aufgabenbewältigung des Bewegungsspiels sowie eine Zunahme an erfolgreich durchgeführten Aufgaben zu erzielen. Die Trainingseffekte lassen sich auch in nicht-trainierten Physiomat® Aufgaben finden und bleiben teilweise auch noch drei Monate nach Interventionsende (Follow Up) erhalten. Schrift 6 behandelt die Validierung von klassischen Dual-Task Testverfahren (z. B. der Kombination Gehen und Rechnen). Die Ergebnisse zeigen moderate bis ausgezeichnete psychometrische Eigenschaften (Konstruktvalidität, Test-Retest Reliabilität, Veränderungssensitivität und Durchführbarkeit) und weisen somit auf eine gute Anwendbarkeit dieser Testverfahren zur Erfassung motorisch-kognitiver Funktionen bei Menschen mit Demenz hin. Aufgrund der fehlenden Existenz von Instrumenten zur Erfassung qualitativer Aspekte des Sitzen-Stehen-Transfers, war die Entwicklung und Validierung eines innovativen Beobachtungsinstruments (ACSID: Assessment of Compensatory Sit-to-stand maneuvers In people with Dementia), das motorische und kognitive Aspekte eines kompensatorischen Bewegungsmaneuvers beim Sitzen-Stehen-Transfer erfasst, ein weiteres Ziel der Dissertation (Schrift 7). Die Ergebnisse zeigen gute bis sehr gute psychometrische Eigenschaften (konkurrente Validität, Intra- und Interrater-Reliabilität, Veränderungssensitivität und Durchführbarkeit) und weisen daher auf eine gute Anwendbarkeit des ACSID bei Menschen mit Demenz im klinischen Kontext hin. Die vorliegende Arbeit leistet einen Beitrag zu Fragen der Trainierbarkeit motorischkognitiver Leistungen unter Verwendung innovativer Methoden bei multimorbiden, geriatrischen Patienten mit beginnender bis mittelgradiger Demenz. Zudem trägt der Inhalt dieser Arbeit dazu bei, ein bislang eher ungenutztes Potenzial motorisch-kognitiver Anforderungen verstärkt in den Blick zu nehmen, nämlich deren Einsatz im Bereich des geriatrischen Assessments, um alltagsrelevante, motorisch-kognitive Defizite identifizieren oder Effekte demenzspezifischer, motorisch-kognitiver Trainings abbilden zu können