Information and communication technology solutions for outdoor navigation in dementia

INTRODUCTION: Information and communication technology (ICT) is potentially mature enough to empower outdoor and social activities in dementia. However, actual ICT-based devices have limited functionality and impact, mainly limited to safety. What is an ideal operational framework to enhance this field to support outdoor and social activities? METHODS: Review of literature and cross-disciplinary expert discussion. RESULTS: A situation-aware ICT requires a flexible fine-tuning by stakeholders of system usability and complexity of function, and of user safety and autonomy. It should operate by artificial intelligence/machine learning and should reflect harmonized stakeholder values, social context, and user residual cognitive functions. ICT services should be proposed at the prodromal stage of dementia and should be carefully validated within the life space of users in terms of quality of life, social activities, and costs. DISCUSSION: The operational framework has the potential to produce ICT and services with high clinical impact but requires substantial investment

Brain Training and Meditation’s Effects on Memory in Subjects with Vascular Cognitive Impairment

Vascular Dementia (VaD) is an important public health concern, which causes significant morbidity and mortality amongst populations around the world. With the increases in average age of individuals and prevalence of cardiovascular risk factors, the incidence of vascular cognitive impairment (VCI) and VaD are on the rise. Most of this increase will come from cerebral small vessel disease (CSVD) as treatment for large vessel disease improves. Yet, very few interventions are recommended for CSVD beyond control of risk factors. In this thesis, we propose a non-pharmacological intervention, which we believe may address executive dysfunction in VCI due to CSVD. CSVD impairs functional frontal-subcortical connectivity and results in cognitive and functional impairments. Given the plasticity in these circuits, despite old age, cognitive training may be a good candidate for improving cognition in CSVD. However, previous studies have suffered from heterogeneity of pathologies in VCI by including both large and small vessel disease. Furthermore, they have often not considered the effects of anxiety and depression, which we aim to exclude from the study. Finally, these studies do not use validated composite scores as a primary endpoint and currently do not use any biomarkers to follow the progress of subjects. In this study, we aim to partially address these shortcomings and offer a more rigorous approach to cognitive training

The effect of simple and complex dual-tasks on ambulation in individuals with Alzheimer's disease and healthy older adults: the role of divided attention and other higher brain functions in gait dual-task performance

Research using gait-dual task methodology suggests that the ability to divide attention during walking appears to be particularly vulnerable to the effects of Alzheimer’s disease (AD), even in the earliest stages of the illness. However, these previous studies are limited by the variability in the types of gait-dual tasks employed, as well as by the inclusion of heterogeneous groups of patients at different stages of disease severity. Study 1 aimed to address these methodological concerns by examining the effects of a simple and complex counting task on gait speed in healthy older adults and individuals with early stage AD. In contrast to previous findings reported in the literature, Study 1 found that when compared to an age appropriate control group individuals with early stage AD were not differentially impaired by a gait dual-task, regardless of the level of task complexity. Study 2 was designed to be a replication and extension of Study 1. In Study 2, sixteen individuals diagnosed with amnestic Mild Cognitive Impairment (aMCI; Petersen, 1999; 2001), 15 individuals with early-stage AD, 17 individuals with moderate stage AD, and 27 healthy older adults performed a timed walking task and simple and complex verbal counting tasks in single and dual-task combinations. In keeping with the results of Study 1, there were no significant differences among the early stage AD group, aMCI group, and healthy older adults on the gait dual-task, regardless of task complexity. However, significant differences were detected between the moderate AD group and the healthy normal control group on the complex dual-task. Study 3 examined the relationship between other higher brain functions and gait speed, with and without interference, in the same group of participants as Study 2. Neuropsychological test scores were used to create theoretically derived cognitive composite scores (i.e., Executive Functioning/Attention/Speed; Episodic Memory; Language) that were used as predictors of gait speed, with and without interference. As expected, The Executive Functioning/Attention/Speed composite was the most potent predictor of gait speed across conditions; however this relationship varied as a function of task complexity and all three factors predicted gait interference in the complex condition, even after controlling for disease severity. In contrast to previous gait dual-task studies, the current research suggests that aMCI and early stage AD are not associated with impaired gait dual-task performance. Rather, these results suggest that when overall degree of dementia severity is controlled for by subdividing patients based on diagnostic criteria, the specific deficit in attention appears later in the progression of AD than previously theorized. Furthermore, these results provide evidence that the relationship between cognition and gait is likely built upon components of cognitive, physical and task prioritization processes that appear to be modulated by task complexity and disease severity

Future directions for ICT in aphasia therapy for older adults: enhancing current practices through interdisciplinary perspectives

Growing numbers of older adults requiring aphasia therapy create challenges for the health care system. Information and communication technology (ICT) has the potential to provide computer-mediated, self-administered aphasia therapy that complements conventional therapy. We explore overlaps in ICT for older adults and aphasia therapy applications with the goal of integrating innovative ICT in aphasia therapy. Based on a case study, we explain how results of different disciplines developing ICT for older adults can be transferred in order to better support older adults with aphasia. We conclude with future directions for ICT in aphasia therapy by surveying interdisciplinary approaches that integrate best practices from conventional therapy, interface design, tracking technologies, user modelling, adaptation algorithms, playful design, user empowerment, and community interaction

Distinguishing Performance on Tests of Executive Functions Between Those with Depression and Anxiety

Objective: To see if there are differences in executive functions between those diagnosed with Major Depressive Disorder (MDD) and those with Generalized Anxiety Disorder (GAD).Participants and Methods: The data were chosen from a de-identified database at a neuropsychological clinic in South Florida. The sample used was adults diagnosed with MDD (n=75) and GAD (n=71) and who had taken the Halstead Category Test, Trail Making Test, Stroop Test, and the Wisconsin Card Sorting Test. Age (M=32.97, SD=11.75), gender (56.7% female), and race (52.7% White) did not differ between groups. IQ did not differ but education did (MDD=13.41 years, SD=2.45; GAD=15.11 years, SD=2.40), so it was ran as a covariate in the analyses. Six ANCOVAs were run separately with diagnosis being held as the fixed factor and executive function test scores held as dependent variables. Results: The MDD group only performed worse on the Category Test than the GAD group ([1,132]=4.022, p\u3c .05). Even though both WCST scores used were significantly different between the two groups, both analyses failed Levene’s test of Equality of Error Variances, so the data were not interpreted. Conclusions: Due to previous findings that those diagnosed with MDD perform worse on tests of executive function than normal controls (Veiel, 1997), this study wanted to compare executive function performance between those diagnosed with MDD and those with another common psychological disorder. The fact that these two groups only differed on the Category Test shows that there may not be much of a difference in executive function deficits between those with MDD and GAD. That being said, not being able to interpret the scores on the WCST test due to a lack of homogeneity of variance indicates that a larger sample size is needed to compare these two types of patients, as significant differences may be found. The results of this specific study, however, could mean that the Category Test could be used in assisting the diagnosis of a MDD patient

Effects of Diversity and Neuropsychological Performance in an NFL Cohort

Objective: The aim of this study was to examine the effect of ethnicity on neuropsychological test performance by comparing scores of white and black former NFL athletes on each subtest of the WMS. Participants and Methods: Data was derived from a de-identified database in South Florida consisting of 63 former NFL white (n=28, 44.4%) and black (n=35, 55.6%) athletes (Mage= 50.38; SD= 11.57). Participants completed the following subtests of the WMS: Logical Memory I and II, Verbal Paired Associates I and II, and Visual Reproduction I and II. Results: A One-Way ANOVA yielded significant effect between ethnicity and performance on several subtests from the WMS-IV. Black athletes had significantly lower scores compared to white athletes on Logical Memory II: F(1,61) = 4.667, p= .035, Verbal Paired Associates I: F(1,61) = 4.536, p = .037, Verbal Paired Associates: II F(1,61) = 4.677, p = .034, and Visual Reproduction I: F(1,61) = 6.562, p = .013. Conclusions: Results suggest significant differences exist between white and black athletes on neuropsychological test performance, necessitating the need for proper normative samples for each ethnic group. It is possible the differences found can be explained by the psychometric properties of the assessment and possibility of a non-representative sample for minorities, or simply individual differences. Previous literature has found white individuals to outperform African-Americans on verbal and non-verbal cognitive tasks after controlling for socioeconomic and other demographic variables (Manly & Jacobs, 2002). This highlights the need for future investigators to identify cultural factors and evaluate how ethnicity specifically plays a role on neuropsychological test performance. Notably, differences between ethnic groups can have significant implications when evaluating a sample of former athletes for cognitive impairment, as these results suggest retired NFL minorities may be more impaired compared to retired NFL white athletes

The Effect of Ethnicity on Neuropsychological Test Performance of Former NFL Athletes

Objective: To investigate the effect of ethnicity on neuropsychological test performance by specifically exploring differences between white and black former NFL athletes on subtests of the WAIS-IV. Participants and Methods: Data was derived from a de-identified database in Florida consisting of 63 former NFL athletes (Mage=50.38; SD=11.57); 28 white and 35 black. Participants completed the following subtests of the WAIS-IV: Block Design, Similarities, Digit Span, Matrix Reasoning, Arithmetic, Symbol Search, Visual Puzzles, Coding, and Cancellation. Results: One-Way ANOVA yielded a significant effect between ethnicity and performance on several subtests. Black athletes had significantly lower scaled scores than white athletes on Block Design F(1,61)=14.266, p\u3c.001, Similarities F(1,61)=5.904, p=.018, Digit Span F(1,61)=8.985, p=.004, Arithmetic F(1,61)=16.07, p\u3c.001 and Visual Puzzles F(1,61)=16.682, p\u3c .001. No effect of ethnicity was seen on performance of Matrix Reasoning F(1,61)=2.937, p=.092, Symbol Search F(1,61)=3.619, p=.062, Coding F(1,61)=3.032, p=.087 or Cancellation F(1,61)=2.289, p=.136. Conclusions: Results reveal significant differences between white and black athletes on all subtests of the WAIS-IV but those from the Processing Speed Scale and Matrix Reasoning. These findings align with previous literature that found white individuals to outperform African-Americans on verbal and non-verbal tasks after controlling for socioeconomic and demographic variables (Manly & Jacobs, 2002). These differences may also be a reflection of the WAIS-IV’s psychometric properties and it is significant to consider the normative sample used may not be appropriate for African-Americans. This study highlights the need for future research to identify how ethnicity specifically influences performance, sheds light on the importance of considering cultural factors when interpreting test results, and serves as a call to action to further understand how and why minorities may not be accurately represented in neuropsychological testing

Do informal caregivers of people with dementia mirror the cognitive deficits of their demented patients?:A pilot study

Recent research suggests that informal caregivers of people with dementia (ICs) experience more cognitive deficits than noncaregivers. The reason for this is not yet clear. Objective: to test the hypothesis that ICs ‘mirror' the cognitive deficits of the demented people they care for. Participants and methods: 105 adult ICs were asked to complete three neuropsychological tests: letter fluency, category fluency, and the logical memory test from the WMS-III. The ICs were grouped according to the diagnosis of their demented patients. One-sample ttests were conducted to investigate if the standardized mean scores (t-scores) of the ICs were different from normative data. A Bonferroni correction was used to correct for multiple comparisons. Results: 82 ICs cared for people with Alzheimer's dementia and 23 ICs cared for people with vascular dementia. Mean letter fluency score of the ICs of people with Alzheimer's dementia was significantly lower than the normative mean letter fluency score, p = .002. The other tests yielded no significant results. Conclusion: our data shows that ICs of Alzheimer patients have cognitive deficits on the letter fluency test. This test primarily measures executive functioning and it has been found to be sensitive to mild cognitive impairment in recent research. Our data tentatively suggests that ICs who care for Alzheimer patients also show signs of cognitive impairment but that it is too early to tell if this is cause for concern or not

Regional Cerebral Blood Flow Patterns in Children vs. Adults with ADHD Combined and Inattentive Types: A SPECT Study

Objective: The current study sought to determine whether ADHD Combined Type (ADHD-C) and ADHD Primarily Inattentive Type (ADHD-PI) showed differential regional cerebral blood flow (rCBF) patterns in children vs. adults. Participants and Methods: The overall sample (N=1484) was effectively split into four groups: adults with ADHD-PI (n=519), adults with ADHD-C (n=405), children with ADHD-PI (n=192), children with ADHD-C (n=368). All participants were void of bipolar, schizophrenia, autism, neurocognitive disorders, and TBI. The data were collected from a de-identified archival database of individuals who underwent SPECT scans at rest. Results: Using αConclusions: Overall, the current study suggested that children may show rCBF differences between different ADHD subtypes, but adults may not. The current study did not find significance in any of the 17 brain regions examined when comparing adults with ADHD-C to adults with ADHD-PI. All significant findings were attributed to the children with ADHD-C group showing aberrant blood flow rate than at least one other group. Previous research has supported that the differentiation of these subtypes as distinctive disorders is difficult to make in adults (Sobanski et al., 2006). Other research has indicated the potential of imaging techniques to differentiate the two in children (Al-Amin, Zinchenko, & Geyer, 2018). The current findings support nuanced ways in which rCBF patterns of ADHD-C and ADHD-PI differ between children and adults