Use of nonintrusive sensor-based information and communication technology for real-world evidence for clinical trials in dementia

Cognitive function is an important end point of treatments in dementia clinical trials. Measuring cognitive function by standardized tests, however, is biased toward highly constrained environments (such as hospitals) in selected samples. Patient-powered real-world evidence using information and communication technology devices, including environmental and wearable sensors, may help to overcome these limitations. This position paper describes current and novel information and communication technology devices and algorithms to monitor behavior and function in people with prodromal and manifest stages of dementia continuously, and discusses clinical, technological, ethical, regulatory, and user-centered requirements for collecting real-world evidence in future randomized controlled trials. Challenges of data safety, quality, and privacy and regulatory requirements need to be addressed by future smart sensor technologies. When these requirements are satisfied, these technologies will provide access to truly user relevant outcomes and broader cohorts of participants than currently sampled in clinical trials

Design of VR app applied to cognitive training

L’objectiu principal d’aquest projecte és el disseny d’una aplicació de realitat virtual per millorar el tractament dels pacients amb deteriorament cognitiu lleu, així com estudiar els possibles avantatges que aquesta tecnologia pot proporcionar en aquest camp. Es va escollir la realitat virtual perquè permet augmentar la sensació d’immersió pel que fa a les tecnologies actuals. Actualment la realitat virtual s’està utilitzant amb aquest tipus de tractament i està aconseguint gran resultats amb els pacients. A més, mitjançant l’ús d’aquesta tècnica d’immersió visual, s’espera que ajudi a millorar la capacitat dels pacients davant nous problemes, com pot ser la iniciació a la realitat virtual, una qüestió fonamental que ajuda a la millora dels pacients que es troben en les primeres etapes de la malaltia. L’aplicació consisteix en un entorn de supermercat virtual on el pacient pot realitzar diverses proves. En aquesta hi haurà diferents nivells amb diverses complexitats, sempre després d’haver realitzat un tutorial previ. L’aplicació s’ha realitzat en dues fases diferents: primer es va crear el guió, amb col·laboració amb la unitat d’Alzheimer de l’Hospital Clínic. Els nivells de l’aplicació es van definir aquí. El següent va ser la realització de l’aplicació amb col·laboració amb la companyia Vysion 360. Per a la seva utilització per la unitat d’Alzheimer de l’Hospital Clínic, l’aplicació tenia que complir diferents criteris. En primer lloc, els nivells de dificultat tenen que ser suficients per realitzar un tractament a llarg termini. En segon lloc, per crear una bona experiència de immersió, l’entorn creat té que ser el més realista possible. Finalment, s’ha creat una base de dades local per guardar la informació de totes les sessions, utilitzat posteriorment en l’anàlisi de evolució dels pacients. Amb aquesta aplicació, s’espera que els resultats en els pacients amb deteriorament cognitiu lleu milloren respecte a les tècniques anteriors. Especialment gràcies a la gran experiència d’immersió aconseguida amb la realitat virtual, la qual ajuda a la concentració dels pacients durant el tractament

Tangibot: A tangible-mediated robot to support cognitive games for ageing people A usability study

[EN] The ever increasing elderly population requires a revision of technology to make it usable and meaningful for them. Most applications take into account their reduced physical and cognitive abilities in order to provide assistive services, but this paper focuses on building technology to improve these capacities through cognitive games. We present Tangibot, a tangible-mediated robot aimed at enabling more intuitive and appealing interactions. A usability study conducted on subjects at three different levels of cognitive impairment (none, mild, and severe) reveals that it is usable and engaging for users with no or mild cognitive impairment, and even though it is less usable for persons with severe impairment, it triggers positive emotional reactions among them, which makes it promising for their use in therapeutic activities.This work is supported by Spanish Ministry of Economy and Competitiveness and funded by the European Development Regional Fund (EDRF-FEDER) with Project TIN2014-60077-R. It is also supported by fellowship ACIF/2014/214 within the VALi+d program from Conselleria d'Educacio, Cultura i Esport (Generalitat Valenciana), and by fellowship FPU14/00136 within the FPU program from Spanish Ministry of Education, Culture, and Sport.García Sanjuan, F.; Jaén Martínez, FJ.; Nácher-Soler, VE. (2017). Tangibot: A tangible-mediated robot to support cognitive games for ageing people A usability study. Pervasive and Mobile Computing. 34:91-105. doi:10.1016/j.pmcj.2016.08.007S911053

Visualization and Interaction Technologies in Serious and Exergames for Cognitive Assessment and Training: A Survey on Available Solutions and Their Validation

Exergames and serious games, based on standard personal computers, mobile devices and gaming consoles or on novel immersive Virtual and Augmented Reality techniques, have become popular in the last few years and are now applied in various research fields, among which cognitive assessment and training of heterogeneous target populations. Moreover, the adoption of Web based solutions together with the integration of Artificial Intelligence and Machine Learning algorithms could bring countless advantages, both for the patients and the clinical personnel, as allowing the early detection of some pathological conditions, improving the efficacy and adherence to rehabilitation processes, through the personalisation of training sessions, and optimizing the allocation of resources by the healthcare system. The current work proposes a systematic survey of existing solutions in the field of cognitive assessment and training. We evaluate the visualization and interaction technologies commonly adopted and the measures taken to fulfil the need of the pathological target populations. Moreover, we analyze how implemented solutions are validated, i.e. The chosen experimental designs, data collection and analysis. Finally, we consider the availability of the applications and raw data to the large community of researchers and medical professionals and the actual application of proposed solutions in the standard clinical practice. Despite the potential of these technologies, research is still at an early stage. Although the recent release of accessible immersive virtual reality headsets and the increasing interest on vision-based techniques for tracking body and hands movements, many studies still rely on non-immersive virtual reality (67.2%), mainly mobile and personal computers, and standard gaming tools for interactions (41.5%). Finally, we highlight that although the interest of research community in this field is increasingly higher, the sharing of dataset (10.6%) and implemented applications (3.8%) should be promoted and the number of healthcare structures which have successfully introduced the new technological approaches in the treatment of their host patients is limited (10.2%)

Approaches to cognitive stimulation in the prevention of dementia

The prevalence of dementia and age-related cognitive impairment is rising due to an aging population worldwide. There is currently no effective pharmacological treatment, but cognitive activity programs could contribute to prevention and risk reduction. However, the results of intervention studies are inconclusive, which may be related to methodological issues. For example, the inconsistent use of umbrella categories to describe cognitive intervention strategies, such as cognitive training or cognitive rehabilitation, has led to confusion regarding their respective contents and efficacies. The interventions studied so far draw on a pool of common basic ingredients. Therefore, rather than focusing on a few high-level categories, it might be beneficial to examine the efficacy of more basic cognitive intervention ingredients, which form the building blocks of complex multi-strand cognitive intervention strategies. Here we suggested a novel format of collating basic cognitive intervention ingredients. Using a representative sample of review articles and treatment studies, we attempted to inventory the most commonly encountered ingredients. Finally, we discuss their suitability for individualized and group-based approaches, as well as the possibility for computerization

Categorizing Health Outcomes and Efficacy of mHealth Apps for Persons With Cognitive Impairment: A Systematic Review

Background Use of mobile health (mHealth) apps is growing at an exponential rate in the United States and around the world. Mild cognitive impairment (MCI), Alzheimer disease, and related dementias are a global health problem. Numerous mHealth interventions exist for this population, yet the effect of these interventions on health has not been systematically described. Objective The aim of this study is to catalog the types of health outcomes used to measure effectiveness of mHealth interventions and assess which mHealth interventions have been shown to improve the health of persons with MCI, Alzheimer disease, and dementia. Methods We searched 13 databases, including Ovid MEDLINE, PubMed, EMBASE, the full Cochrane Library, CINAHL, PsycINFO, Ei Compendex, IEEE Xplore, Applied Science & Technology Source, Scopus, Web of Science, ClinicalTrials.gov, and Google Scholar from inception through May 2017 for mHealth studies involving persons with cognitive impairment that were evaluated using at least one quantitative health outcome. Proceedings of the Annual ACM Conferences on Human Factors in Computing Systems, the ACM User Interface Software and Technology Symposium, and the IEEE International Symposium on Wearable Computers were searched in the ACM Digital Library from 2012 to 2016. A hand search of JMIR Publications journals was also completed in July 2017. Results After removal of duplicates, our initial search returned 3955 records. Of these articles, 24 met final inclusion criteria as studies involving mHealth interventions that measured at least one quantitative health outcome for persons with MCI, Alzheimer disease, and dementia. Common quantitative health outcomes included cognition, function, mood, and quality of life. We found that 21.2% (101/476) of the fully reviewed articles were excluded because of a lack of health outcomes. The health outcomes selected were observed to be inconsistent between studies. For those studies with quantitative health outcomes, more than half (58%) reported postintervention improvements in outcomes. Conclusions Results showed that many mHealth app interventions targeting those with cognitive impairment lack quantitative health outcomes as a part of their evaluation process and that there is a lack of consensus as to which outcomes to use. The majority of mHealth app interventions that incorporated health outcomes into their evaluation noted improvements in the health of persons with MCI, Alzheimer disease, and dementia. However, these studies were of low quality, leading to a grade C level of evidence. Clarification of the benefits of mHealth interventions for people with cognitive impairment requires more randomized controlled trials, larger numbers of participants, and trial designs that minimize bias. Trial Registration PROSPERO Registration: PROSPERO 2016:CRD42016033846; http://www.crd.york.ac.uk/PROSPERO/ display_record.asp?ID=CRD42016033846 (Archived by WebCite at http://www.webcitation.org/6sjjwnv1M

Design and Rationale of the Cognitive Intervention to Improve Memory in Heart Failure Patients Study

BACKGROUND: Memory loss is an independent predictor of mortality among heart failure patients. Twenty-three percent to 50% of heart failure patients have comorbid memory loss, but few interventions are available to treat the memory loss. The aims of this 3-arm randomized controlled trial were to (1) evaluate efficacy of computerized cognitive training intervention using BrainHQ to improve primary outcomes of memory and serum brain-derived neurotrophic factor levels and secondary outcomes of working memory, instrumental activities of daily living, and health-related quality of life among heart failure patients; (2) evaluate incremental cost-effectiveness of BrainHQ; and (3) examine depressive symptoms and genomic moderators of BrainHQ effect. METHODS: A sample of 264 heart failure patients within 4 equal-sized blocks (normal/low baseline cognitive function and gender) will be randomly assigned to (1) BrainHQ, (2) active control computer-based crossword puzzles, and (3) usual care control groups. BrainHQ is an 8-week, 40-hour program individualized to each patient's performance. Data collection will be completed at baseline and at 10 weeks and 4 and 8 months. Descriptive statistics, mixed model analyses, and cost-utility analysis using intent-to-treat approach will be computed. CONCLUSIONS: This research will provide new knowledge about the efficacy of BrainHQ to improve memory and increase serum brain-derived neurotrophic factor levels in heart failure. If efficacious, the intervention will provide a new therapeutic approach that is easy to disseminate to treat a serious comorbid condition of heart failure

Brain training using cognitive apps can improve cognitive performance and processing speed in older adults.

Managing age-related decrease of cognitive function is an important public health challenge, especially in the context of the global aging of the population. Over the last years several Cognitive Mobile Games (CMG) have been developed to train and challenge the brain. However, currently the level of evidence supporting the benefits of using CMG in real-life use is limited in older adults, especially at a late age. In this study we analyzed game scores and the processing speed obtained over the course of 100 sessions in 12,000 subjects aged 60 to over 80 years. Users who trained with the games improved regardless of age in terms of scores and processing speed throughout the 100 sessions, suggesting that old and very old adults can improve their cognitive performance using CMG in real-life use

Enhancing Cognitive Performance and Monitoring through a Mobile App: Insights from the Rodi Study

The prevalence of neurocognitive disorders has led to increased interest in mobile health applications (mHealth apps) for detection and training. However, there’s a need for apps that integrate comprehensive cognitive training, assessment, and monitoring in personalized contexts. The RODI app was meticulously developed with the objective of catering to individuals with deficits as well as healthy adults. In this study, 11 participants without diagnosed impairments used the app twice weekly for eight weeks. Results show a consistent enhancement in cognitive performance within the app over time. Notably, a discernible divergence is observed, with the rate of improvement appearing to be comparatively slower in the younger age group in contrast to their older counterparts. Furthermore, the study assesses the reliability of the application using the intraclass correlation coefficient (ICC), confirming its consistent performance across repeated administrations. Finally, the app’s capacity to monitor participants’ cognitive status across various domains is investigated, unveiling controlled variations that indicate foreseeable outcomes within defined parameters. These findings underscore RODI’s potential for cognitive enhancement and monitoring, offering insights into user needs and the broader significance of mobile app interventions for cognitive well-being and future research in this field