Machine learning for the detection and diagnosis of cognitive impairment in Parkinson’s Disease: a systematic review

Background: Parkinson's Disease is the second most common neurological disease in over 60s. Cognitive impairment is a major clinical symptom, with risk of severe dysfunction up to 20 years post-diagnosis. Processes for detection and diagnosis of cognitive impairments are not sufficient to predict decline at an early stage for significant impact. Ageing populations, neurologist shortages and subjective interpretations reduce the effectiveness of decisions and diagnoses. Researchers are now utilising machine learning for detection and diagnosis of cognitive impairmentbased on symptom presentation and clinical investigation. This work aims to provide an overview of published studies applying machine learning to detecting and diagnosing cognitive impairment, evaluate the feasibility of implemented methods, their impacts, and provide suitable recommendations for methods, modalities and outcomes.Methods: To provide an overview of the machine learning techniques, data sources and modalities used for detection and diagnosis of cognitive impairment in Parkinson's Disease, we conducted a review of studies published on the PubMed, IEEE Xplore, Scopus and ScienceDirect databases. 70 studies were included in this review, with the most relevant information extracted from each. From each study, strategy, modalities,sources, methods and outcomes were extracted.Results: Literatures demonstrate that machine learning techniques have potential to provide considerable insight into investigation of cognitive impairment in Parkinson's Disease. Our review demonstrates the versatility of machine learning in analysing a wide range of different modalities for the detection and diagnosis of cognitive impairment in Parkinson's Disease, including imaging, EEG, speech and more, yielding notable diagnostic accuracy. Conclusions: Machine learning based interventions have the potential to glean meaningful insight from data, and may offer non-invasive means of enhancing cognitive impairment assessment, providing clear and formidable potential for implementation of machine learning into clinical practice

The investigation of treatment outcomes for adults with chronic brain injury following intensive multidisciplinary treatment

Although communication sciences and disorders (COMD) research supports intensive treatment for individuals with chronic brain injury, funding to provide these services is limited. This study explored the use of interdepartmental university resources to provide an intensive, multidisciplinary chronic brain injury program. Methodologically, treatment regimes were designed with clinical faculty as practicum experiences for COMD master’s degree students. Subjects with a single onset head injury or cerebral vascular accident greater than one year were recruited to participate in the Intensive Treatment, Weekly Treatment or Control Groups. Pre, Post, and Post-Post Testing were used to measure cognitive-linguistic, quality of life and physical function. Additionally, treatment groups participated in electronic Experience Sampling Method (ESM) probes which queried their perception of happiness, tiredness, stress, and communication satisfaction throughout treatment using a Palm Zire 31 Personal Data Assistant. Both treatment programs were contextually-oriented, stressing functional multi-modality communication and compensatory techniques. Three hours of small and medium group COMD treatment were administered to the Weekly Group once weekly. The six subjects in the Intensive Group received a 35 hour weekly program including: COMD (12 hours), modified Tai Chi (3 hours), and psychological support for them and caregivers (4 ¼ hours). One-way repeated measures analysis of variance with partial eta squared effect size was used to analyze measures in the standardized battery. Intensive Group cognitive linguistic function appeared to significantly differ from the other groups on the Communication Activities of Daily Living-2 and Aphasia Diagnostic Profile Writing subtest suggestive of functional communication gains. Results of the ESM probes indicate that the Intensive Group was reportedly more happy and satisfied with their communication than the Weekly Group. The participants of the Intensive Group appeared to physically benefit from 3 weeks of modified Tai Chi in rate of ambulation. Limitations of the study, including self selection of treatment condition and differing severity across treatment groups, must be addressed by expanding the subject pool in follow-up research

Feasibility-Usability Study of a Tablet App Adapted Specifically for Persons with Cognitive Impairment—SMART4MD (Support Monitoring and Reminder Technology for Mild Dementia)

Population ageing within Europe has major social and economic consequences. One of the most devastating conditions that predominantly affects older people is dementia. The SMART4MD (Support Monitoring and Reminder Technology for Mild Dementia) project aims to develop and test a health application specifically designed for people with mild dementia. The aim of this feasibility study was to evaluate the design of the SMART4MD protocol, including recruitment, screening, baseline examination and data management, and to test the SMART4MD application for functionality and usability before utilization in a full-scale study. The feasibility study tested the protocol and the app in Spain and Sweden. A total of nineteen persons with cognitive impairment, and their informal caregivers, individually performed a task-based usability test of the SMART4MD app model in a clinical environment, followed by four-week testing of the app in the home environment. By employing a user-centered design approach, the SMART4MD application proved to be an adequate and feasible interface for an eHealth intervention. In the final usability test, a score of 81% satisfied users was obtained. The possibility to test the application in all the procedures included in the study generated important information on how to present the technology to the users and how to improve these procedures

Factors Related to Self-Identification of Candidacy, Device Selection, and Self-Fitting of Over-The-Counter Hearing Aids

Purpose: The Over-The-Counter (OTC) Hearing Aid Act was introduced in an effort to make hearing aids more accessible and affordable. Implementation of this law will go into effect in 2020. It is assumed that the average consumer will be able to self-navigate an OTC hearing aid fitting. In the OTC hearing aid model consumers are expected to self-diagnose, self-treat, and self manage their hearing loss. The purpose of the present study was to assess how well the average consumer can perform each step in the OTC hearing aid model, and identify factors related to self-identification of candidacy, device selection, and self-fitting of an OTC hearing aid. Method: Participants included 52 adults who were 40 years of age and older, self-reported having trouble hearing and were interested in trying an OTC hearing aid. They had to have owned a smartphone and had no prior hearing aid experience. Data was collected over two tests sessions. During the first session all participants were asked to report their degree of hearing loss, identify if they thought they were at risk for having ear disease, and completed questionnaires related to demographics, health literacy, hearing aid self-efficacy, health locus of control, and technology commitment and usage. Also, participants completed three cognitive tasks and were given a hearing test and administered three cognitive measures: the Reading-SPAN, Digit Symbol Substitution Task, and the Simon task. During the second test session participants were asked to browse three different OTC hearing aids online and select the device they preferred. They were asked to complete a questionnaire regarding potential reasons for why they selected a particular device. The OTC hearing aid they selected was given in its original packaging, and participants were asked to set the device up without any assistance. The Practical Hearing Aid Skills Test- Revised (PHAST-R) along with three questions related to Bluetooth connectivity was used to evaluate the participants’ hearing aid handling skills. Real-ear verification was performed to assess how closely the participant’s settings were to NAL-NL2 prescriptive targets. Last, participants completed the Consumer Ear Disease Risk Assessment (CEDRA) to determine if participants correctly self-identified the risk for ear-disease. Results: Only 38% of participants were able to correctly classify their hearing status in both ears, with pure tone average being a significant predictor of correct hearing status classification. A majority of the participants who misclassified their hearing status had normal hearing, but self-reported they had a hearing loss. Eighty-eight percent of the participants who were identified for being at risk for ear disease misclassified their risk for ear disease. Years of education was inversely related to correctly self-identifying risk for ear disease. Sixty percent of the participants who were flagged by the CEDRA and 30% of normal-hearing participants indicated that they would purchase an OTC hearing aid at the end of the study. Participants’ scores ranged from 45-100% on the PHAST-R and Bluetooth connectivity assessment. The type of the manufacturer’s instructional material was significantly associated with participants’ hearing aid and Bluetooth connectivity skills. For the normal-hearing participants all of the OTC devices attenuated speech, and none of the devices met NAL-NL2 targets in the high frequencies for the hearing-impaired participants. Income status and technology commitment was not predictive of OTC hearing aid device selection and all participants ranked ‘easy to read descriptions’ and ‘website appearance’ as the main factors that influenced their decision to select a device. Conclusions: Most participants were unable to successfully navigate all of the steps in the OTC hearing aid model. Some of the participants who had normal hearing but self-reported a hearing loss and the participants who were at risk for ear disease said they would purchase an OTC hearing aid as a treatment option. Unfortunately, both groups are not the intended user of an OTC hearing aid. Manufacturer instructional material can impact set up and programming of an OTC device. However, users may still run into fitting and programming challenges that will require the assistance of a hearing health care professional

Music and Dementia: A Caregiver’s Perspective of the Effects of Individualized Music Programming on Quality of Life for Seniors Living in Assisted Living Environments

For senior-care and service providers, the issue of quality of life has moved beyond marketing to, in effect, the measuring of health-related outcomes. Particularly when the challenge of caring for those with Alzheimer’s disease and related dementias is daunting, as it cannot be prevented or cured and treatment possibilities are framed in a broader perspective to include alternative interventions such as music. Through the eyes of the caregivers, this 6-week, longitudinal quantitative study investigated individualized (passive) music programming and its effect on the health-related quality of life of residents in assisted living. The Alzheimer’s Disease Related Quality of Life instrument (ADRQL) was used to assess quality of life, and the importance of music was captured by the Assessment of Personal Music Preference. The data revealed an increase in quality of life from baseline through the final assessment; and when using only the home health aide staff, a series of multivariate repeated-measures analysis of variance found statistically significant improvements in overall quality of life and in all five ADRQL domain subscales (F = 9.54, p = 000, η2 = .52). The data also showed no significant correlation between the importance of music prior to cognitive impairment and quality of improvements (r = –.09, p = .786). The study had limitations, most importantly the small convenience sample (N = 11); therefore, a formal inductive inference concerning the population cannot be made. More rigorous studies increasing the sample size, using a control group, including confounding variables, and qualitative interviews are recommended

Common Issues of Virtual Reality in Neuro-Rehabilitation

2010-2011 > Academic research: not refereed > Chapter in an edited book (author)201803 bcwhVersion of RecordPublishe

Living with Alzheimer’s Disease: A Study of Adult Day Health Services in Massachusetts

The role of adult day health care (ADHC) is gaining increased attention as the nation prepares for the large cohort of baby boomers entering their later years. Many boomers are aging with physical and cognitive impairments, including Alzheimer\u27s disease and related dementias. Projections indicate that Massachusetts, along with the nation as a whole, is experiencing an increasing rate of older persons as baby boomers enter late-life. The Commonwealth can expect that persons with Alzheimer\u27s disease and their care partners will need community-based services that are specifically designed for adults with cognitive impairments. However, a report by the Robert Wood Johnson Foundation found that there is a serious lack of adult day care services for the state\u27s elderly population. The 2003 report found that Massachusetts is only meeting 62% of needs for adults with physical and cognitive impairments, and at least 78 more programs are needed in the state. Yet, programs in Massachusetts continue to close. The specific objectives of the study were to: (1) describe existing practices of adult day health care services in Massachusetts for persons living with Alzheimer\u27s disease and related dementias, (2) explore programs that are specifically designed for participants who are in late-stage dementia, (3) address challenges that adult day health care services are now encountering, and (4) envision new paradigms for meeting the needs of persons with early-stage and early-onset dementia

Design of a Framework for Cognitive Support in Dementia Care for the Elderly

Dissertation presented as the partial requirement for obtaining a Master's degree in Information Management, specialization in Knowledge Management and Business IntelligenceThis section provides an overview of the magnitude of dementia care in communities and health care systems. It introduces the background and context for the utilization of technology and digital solutions to address mental health issues in the elderly, specifically focusing on dementia. The objective is to propose a design framework for the development of health technology that caters to caregivers of individuals living with dementia. A brief review of the latest studies related to the successful adoption of technology for dementia and cognitive impairment decline will serve as the foundation for the proposal of this thesis. The following paragraphs approach the background and context of the healthcare problems related to ageing and introduce dementia from a technological perspective. The research question is presented, along with the proposed objectives to address that question. Furthermore, the relevance of this study within the context of information management is summarized

Metabolic Agents that Enhance ATP can Improve Cognitive Functioning: A Review of the Evidence for Glucose, Oxygen, Pyruvate, Creatine, and L-Carnitine

Over the past four or five decades, there has been increasing interest in the neurochemical regulation of cognition. This field received considerable attention in the 1980s, with the identification of possible cognition enhancing agents or “smart drugs”. Even though many of the optimistic claims for some agents have proven premature, evidence suggests that several metabolic agents may prove to be effective in improving and preserving cognitive performance and may lead to better cognitive aging through the lifespan. Aging is characterized by a progressive deterioration in physiological functions and metabolic processes. There are a number of agents with the potential to improve metabolic activity. Research is now beginning to identify these various agents and delineate their potential usefulness for improving cognition in health and disease. This review provides a brief overview of the metabolic agents glucose, oxygen, pyruvate, creatine, and L-carnitine and their beneficial effects on cognitive function. These agents are directly responsible for generating ATP (adenosine triphosphate) the main cellular currency of energy. The brain is the most metabolically active organ in the body and as such is particularly vulnerable to disruption of energy resources. Therefore interventions that sustain adenosine triphosphate (ATP) levels may have importance for improving neuronal dysfunction and loss. Moreover, recently, it has been observed that environmental conditions and diet can affect transgenerational gene expression via epigenetic mechanisms. Metabolic agents might play a role in regulation of nutritional epigenetic effects. In summary, the reviewed metabolic agents represent a promising strategy for improving cognitive function and possibly slowing or preventing cognitive decline