Expression Recognition for Severely Demented Patients in Music Reminiscence-Therapy

International audienceRecognizing expressions in severely demented Alzheimer's disease (AD) patients is essential, since such patients have lost a substantial amount of their cognitive capacity, and some even their verbal communication ability (e.g., aphasia). This leaves patients dependent on clinical staff to assess their verbal and non-verbal language, in order to communicate important messages, as of the discomfort associated to potential complications of the AD. Such assessment classically requires the patients' presence in a clinic, and time consuming examination involving medical personnel. Thus, expression monitoring is costly and logistically inconvenient for patients and clinical staff, which hinders among others large-scale monitoring. In this work we present a novel approach for automated recognition of facial activities and expressions of severely demented patients, where we distinguish between four activity and expression states, namely talking, singing, neutral and smiling. Our approach caters to the challenging setting of current medical recordings of music-therapy sessions, which include continuous pose variations, occlusions, camera-movements, camera-artifacts, as well as changing illumination. Additionally and importantly, the (elderly) patients exhibit generally less profound facial activities and expressions in a range of intensities and predominantly occurring in combinations (e.g., talking and smiling). Our proposed approach is based on the extension of the Improved Fisher Vectors (IFV) for videos, representing a video-sequence using both, local, as well as the related spatio-temporal features. We test our algorithm on a dataset of over 229 video sequences, acquired from 10 AD patients, with promising results, which have sparked substantial interest in the medical community. The proposed approach can play a key role in assessment of different therapy treatments, as well as in remote large-scale healthcare-frameworks

BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA: AN OVERVIEW OF THEORETICAL FRAMEWORKS AND ASSOCIATED NONPHARMACOLOGICAL TREATMENTS FOR BPSD

Behavioural and Psychological Symptoms of Dementia (BPSD) such as agitation and aggression are core symptoms of dementia and affect almost everyone with the condition. Such symptoms cause distress to the person with dementia and their caregivers and have also been found to predict early institutionalisation as well as death. Historically, BPSD have been managed with medication, typically using anti-psychotic drugs. However, recent data show that anti-psychotic medications increase mortality and the risk of stroke in people with dementia. On the other hand, non-pharmacological interventions such as sensory manipulation, psychological therapies and providing training and psychoeducation for caregivers, present more encouraging results. Consequently, there is a need to explore the potential impact of non-pharmacological interventions on BPSD

Bridging art therapy and neuroscience: Facilitation of art expression of an individual with late stage Alzheimer's disease.

This research paper aims to examine whether art therapy interventions can encourage communication and self-expression of an individual with late stage Alzheimer’s disease (AD) if they are adapted to the disease related visual deficits and directed on utilizing remaining visual capabilities of this individual. A crucial component of caring for individuals with late stage AD is maintaining their dignity and individuality. Art therapists advocate that art making can be beneficial to individuals affected by AD as it facilitates their self-expression through sensory stimulation, creativity, and social interaction (Stewart, 2004; Ehresman, 2014). Unfortunately, research that validates interventions directed toward maximizing the remaining capacities of individuals with late stage AD and promotion of the adaptation to their disease-related deficits remains scarce. This research based enquiry presents a unique multidisciplinary approach to creating art therapy interventions that may be beneficial and therapeutic to clients with late stage AD. The enquiry resulted in a case study that adopted a qualitative research methodology. It demonstrated that art therapy interventions that address disease-related visuospatial deficits of an individual with late stage AD can produce a positive change in their ability for self-expression and promote communication with the outside world. Although the study has significant limitations, it can be viewed as a pilot study and further research is necessary to empirically demonstrate the effectiveness of such interventions

Non-biomedical aspects of Alzheimers Disease and related disorders : a comprehensive bibliography, 1960-1988

This bibliography includes references to over 1600 books, articles, theses and dissertations published in English from 1960 to 1988. Emphasis is given to works dealing with non-biomedical aspects of dementia, particularly to research concerned with the development and evaluation of programs, facilities and services designed to enhance the functional status and quality of life of Alzheimer\u27s victims and their caregivers. Bibliography Arrangement: Following an overview chapter concerned with review articles(Chapter 1), references are arranged topically into twelve subject groupings: Symptoms, Assessment and Diagnosis (Chapter 2); Stages of Deterioration (Chapter 3); Case Studies (Chapter 4); Epidemiology (Chapter 5); Pre-Dementia History (Chapter 6); Etiology (Chapter 7); Health Care System (Chapter 8); Treatment and Management (Chapter 9); Environmental Design (Chapter 10); Caregiver Support (Chapter 11); Education (Chapter 12); and Legal, Ethical and Research Issues (Chapter 13)

Development and validation of the Music Cognitive Test: a music-based cognitive screening test

Specific tools to measure the cognitive benefits of music therapy and music-rehabilitation training available to music therapists are few and empirically weak: they are mostly psychometrically unrefined or based on unclear tasks and scoring protocols; they do not take into consideration distinct cognitive functions or are based on exclusively observational protocols. To overcome these limitations, we developed a 15-min cognitive screening tool suitable for music therapists, MCT (Music Cognitive Test), which assesses cognitive abilities stimulated by music-making activities (e.g., attentional, verbal and executive functions, short- and long-term memory) by including music-based items. MCT was validated with 335 participants (aged 18-100y.o.) presenting a range of cognitive levels, from healthy cognition to severe impairment. MCT correlated strongly and positively with well-known tests: MMSE (Mini-Mental State Examination), MoCA (Montreal Cognitive Assessment) and SMMSE (Severe Mini-Mental State Examination). MCT also displayed excellent sensitivity in identifying impaired individuals according to both MMSE and MoCA diagnostic criteria (99.4% and 93.0%, respectively), and excellent specificity in identifying healthy participants based on MMSE (93.5%) and MoCA (97.8%) criteria. Overall, results highlight the reliability of this novel brief music-focused cognitive screening test, to enable music therapists to independently and consistently monitor the effectiveness of their intervention on cognitive functions

Interior Design as a tool for dementia care

This book investigates the role of interior design in the enhancement of the effectiveness of Non-Pharmacological therapies for Alzheimer’s disease care. The author presents the conceptual model for an environmental system called “Therapeutic Habitat”, meant as a system of environmental interventions, based on tangible and intangible aspects, products and furniture, objects and services. Its aim is to enhance the well-being of people with dementia and stimulate recognition and interaction with the surrounding environment

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