Promoting the adoption of assistive technologies to aid with spatial orientation in dementia care

Introduction: In dementia care, locating technologies are a type of assistive technology that hold the potential to improve the quality of life of persons with dementia and their care partners by assisting in the management of spatial orientation impairments and wandering. Although many products are commercially available, their adoption remains low. To better understand how to promote their adoption, we examined user experience and clinical effectiveness resulting from product use and explored barriers to their adoption. Methods: In a first user experience study, a prototype locating technology was tested for four weeks by 17 dyads composed of persons with dementia and their care partners. In a second user experience study, two similar commercially available locating technologies were tested for four weeks each by another 17 dyads. User experience was examined with ratings of product usability, product functions and product features. Clinical effectiveness, frequency of use, purchase willingness, and product satisfaction were assessed with various scales. In a third qualitative focus group interview study with 22 interdisciplinary professional stakeholders, we explored views on the barriers to their adoption, as well as views on services and information dissemination strategies. Results: In the first study, the prototype was rated fairly in terms of usability, product functions and product features. However, usability ratings significantly decreased after four weeks. In the second study, ratings of usability, as well as of several product functions and product features were significantly more favourable for one of the two tested commercial products. Clinical effectiveness was not found in either study. In the third study, the main adoption barriers were based on unclear benefits and ethical concerns, as well as limitations in awareness, technology, product characteristics, and capital investments. Key services and information dissemination strategies centred on digital autonomy support, emergency support, information dissemination actors, product acquisition, and product advertising. Discussion: Results from both user experience studies indicate that focusing on specific product functions and features might substantially improve user experience. This might translate to measurable clinical effectiveness and higher adoption rates. Results from our qualitative study indicate that not only product characteristics and the technology itself impact adoption. Indeed, focusing on services and information dissemination strategies around products warrants closer attention as they might markedly improve adoption.Einleitung: Ortungssysteme in der Demenzversorgung gelten als eine vielversprechende Art von assistierender Technologie, um die Lebensqualität von Menschen mit Demenz und ihren Pflegepartnern zu verbessern, indem sie dabei helfen räumliche Orientierungsstörungen und Wanderungen zu bewältigen. Ihre Verwendung bleibt jedoch trotz der Verfügbarkeit vieler kom-merzieller Produkte gering. Um besser zu verstehen, wie ihre Verwendung gefördert werden kann, haben wir die Nutzererfahrung und klinische Wirksamkeit, die sich aus der Produktnutzung ergeben sowie die Barrieren für ihre Einführung untersucht. Methoden: In einer ersten Nutzererfahrungsstudie wurde ein Prototyp Ortungssystem vier Wo-chen lang von 17 Dyaden bestehend aus Menschen mit Demenz und ihren Pflegepartnern ge-testet. In einer zweiten Nutzererfahrungsstudie wurden zwei ähnliche kommerziell erhältliche Or-tungssysteme jeweils vier Wochen lang von weiteren 17 Dyaden getestet. Die Nutzererfahrung wurde mit Bewertungen der Benutzerfreundlichkeit, Produktfunktionen und Produkteigenschaften untersucht. Klinische Wirksamkeit, Nutzungshäufigkeit, Kaufbereitschaft und Produktzufrieden-heit wurden mit verschiedenen Skalen bewertet. In einer dritten qualitativen Fokusgruppeninter-viewstudie mit 22 interdisziplinären professionellen Stakeholdern untersuchten wir Ansichten zu den Barrieren für ihre Verwendung sowie zu Dienstleistungen und Strategien zur Informationsverbreitung. Ergebnisse: In der ersten Studie waren die Bewertungen der Benutzerfreundlichkeit, Produkt-funktionen und Produkteigenschaften mittelmäßig. Die Bewertung der Benutzerfreundlichkeit ging jedoch nach vier Wochen deutlich zurück. In der zweiten Studie fielen die Bewertungen der Benutzerfreundlichkeit sowie einiger Produktfunktionen und Produkteigenschaften bei einem der beiden getesteten Produkte deutlich besser aus. Klinische Wirksamkeit wurde in keiner der Studien gefunden. In der dritten Studie konzentrierten sich die wichtigsten Einführungsbarrieren auf unklare Vorteile und ethische Bedenken sowie auf bewusstseins-, technologisch-, produktmerkmal- und kapitalinvestitionsbasierte Einschränkungen. Dienstleistungen und Strategien zur Informationsverbreitung konzentrierten sich auf Unterstützung von digitaler Autonomie, Notfallunterstützung, Akteure der Informationsverbreitung, Produktakquisition und Produktwerbung. Diskussion: Die Ergebnisse beider Studien zur Nutzererfahrung zeigen, dass die Nutzererfah-rung durch die Optimierung bestimmter Produktfunktionen und Produkteigenschaften erheblich verbessert werden kann. Dies könnte zu einer messbaren klinischen Wirksamkeit und höheren Verwendung führen. Die Ergebnisse unserer qualitativen Studie zeigen, dass die Verwendung durch mehr als die Produktemerkmale und die Technologie selbst bestimmt wird. Deshalb ist eine gezielte Fokussierung auf Dienstleistungen und Strategien zur Informationsverbreitung rund um Ortungssysteme notwendig, da sie die Verwendung deutlich verbessern könnte

User experience and clinical effectiveness with two wearable global positioning system devices in home dementia care

Introduction: The user experience and clinical effectiveness with wearable global positioning system (GPS) devices for persons with dementia (PwDs) and caregivers (CGs) remain unclear although many are available. Methods: Using a crossover design, 20 dyads tested two similar commercial GPS watches (products A and B) at home for 4 weeks each. Usability, product functions, design features and product satisfaction at home and the clinic were investigated. Caregiver burden and quality of life assessed clinical effectiveness. Results: The final 17 dyads rated the usability, telephone function, overall design features, font, buttons, and battery life of B significantly better than A. PwDs rated the overall design features and buttons of A significantly better than CGs. Product satisfaction with both products was significantly lower at home. Clinical effectiveness was not found. Discussion: User experience can be improved by optimizing specific product details. This might translate to clinical effectiveness. Social desirability bias may explain different product satisfaction ratings

Brain reserve contributes to distinguishing preclinical Alzheimer's stages 1 and 2

BackgroundIn preclinical Alzheimer's disease, it is unclear why some individuals with amyloid pathologic change are asymptomatic (stage 1), whereas others experience subjective cognitive decline (SCD, stage 2). Here, we examined the association of stage 1 vs. stage 2 with structural brain reserve in memory-related brain regions.MethodsWe tested whether the volumes of hippocampal subfields and parahippocampal regions were larger in individuals at stage 1 compared to asymptomatic amyloid-negative older adults (healthy controls, HCs). We also tested whether individuals with stage 2 would show the opposite pattern, namely smaller brain volumes than in amyloid-negative individuals with SCD. Participants with cerebrospinal fluid (CSF) biomarker data and bilateral volumetric MRI data from the observational, multi-centric DZNE-Longitudinal Cognitive Impairment and Dementia Study (DELCODE) study were included. The sample comprised 95 amyloid-negative and 26 amyloid-positive asymptomatic participants as well as 104 amyloid-negative and 47 amyloid-positive individuals with SCD. Volumes were based on high-resolution T2-weighted images and automatic segmentation with manual correction according to a recently established high-resolution segmentation protocol.ResultsIn asymptomatic individuals, brain volumes of hippocampal subfields and of the parahippocampal cortex were numerically larger in stage 1 compared to HCs, whereas the opposite was the case in individuals with SCD. MANOVAs with volumes as dependent data and age, sex, years of education, and DELCODE site as covariates showed a significant interaction between diagnosis (asymptomatic versus SCD) and amyloid status (Ass42/40 negative versus positive) for hippocampal subfields. Post hoc paired comparisons taking into account the same covariates showed that dentate gyrus and CA1 volumes in SCD were significantly smaller in amyloid-positive than negative individuals. In contrast, CA1 volumes were significantly (p = 0.014) larger in stage 1 compared with HCs.ConclusionsThese data indicate that HCs and stages 1 and 2 do not correspond to linear brain volume reduction. Instead, stage 1 is associated with larger than expected volumes of hippocampal subfields in the face of amyloid pathology. This indicates a brain reserve mechanism in stage 1 that enables individuals with amyloid pathologic change to be cognitively normal and asymptomatic without subjective cognitive decline

Novelty-Related fMRI Responses of Precuneus and Medial Temporal Regions in Individuals at Risk for Alzheimer Disease

BACKGROUND AND OBJECTIVES: We assessed whether novelty-related fMRI activity in medial temporal lobe regions and the precuneus follows an inverted U-shaped pattern across the clinical spectrum of increased Alzheimer disease (AD) risk as previously suggested. Specifically, we tested for potentially increased activity in individuals with a higher AD risk due to subjective cognitive decline (SCD) or mild cognitive impairment (MCI). We further tested whether activity differences related to diagnostic groups were accounted for by CSF markers of AD or brain atrophy. METHODS: We studied 499 participants aged 60-88 years from the German Center for Neurodegenerative Diseases Longitudinal Cognitive Impairment and Dementia Study (DELCODE) who underwent task-fMRI. Participants included 163 cognitively normal (healthy control, HC) individuals, 222 SCD, 82 MCI, and 32 patients with clinical diagnosis of mild AD. CSF levels of β-amyloid 42/40 ratio and phosphorylated-tau181 were available from 232 participants. We used region-based analyses to assess novelty-related activity (novel > highly familiar scenes) in entorhinal cortex, hippocampus, and precuneus as well as whole-brain voxel-wise analyses. First, general linear models tested differences in fMRI activity between participant groups. Complementary regression models tested quadratic relationships between memory impairment and activity. Second, relationships of activity with AD CSF biomarkers and brain volume were analyzed. Analyses were controlled for age, sex, study site, and education. RESULTS: In the precuneus, we observed an inverted U-shaped pattern of novelty-related activity across groups, with higher activity in SCD and MCI compared with HC, but not in patients with AD who showed relatively lower activity than MCI. This nonlinear pattern was confirmed by a quadratic relationship between memory impairment and precuneus activity. Precuneus activity was not related to AD biomarkers or brain volume. In contrast to the precuneus, hippocampal activity was reduced in AD dementia compared with all other groups and related to AD biomarkers. DISCUSSION: Novelty-related activity in the precuneus follows a nonlinear pattern across the clinical spectrum of increased AD risk. Although the underlying mechanism remains unclear, increased precuneus activity might represent an early signature of memory impairment. Our results highlight the nonlinearity of activity alterations that should be considered in clinical trials using functional outcome measures or targeting hyperactivity

Musical Activity During Life Is Associated With Multi-Domain Cognitive and Brain Benefits in Older Adults

Regular musical activity as a complex multimodal lifestyle activity is proposed to be protective against age-related cognitive decline and Alzheimer’s disease. This cross-sectional study investigated the association and interplay between musical instrument playing during life, multi-domain cognitive abilities and brain morphology in older adults (OA) from the DZNE-Longitudinal Cognitive Impairment and Dementia Study (DELCODE) study. Participants reporting having played a musical instrument across three life periods (n = 70) were compared to controls without a history of musical instrument playing (n = 70), well-matched for reserve proxies of education, intelligence, socioeconomic status and physical activity. Participants with musical activity outperformed controls in global cognition, working memory, executive functions, language, and visuospatial abilities, with no effects seen for learning and memory. The musically active group had greater gray matter volume in the somatosensory area, but did not differ from controls in higher-order frontal, temporal, or hippocampal volumes. However, the association between gray matter volume in distributed frontal-to-temporal regions and cognitive abilities was enhanced in participants with musical activity compared to controls. We show that playing a musical instrument during life relates to better late-life cognitive abilities and greater brain capacities in OA. Musical activity may serve as a multimodal enrichment strategy that could help preserve cognitive and brain health in late life. Longitudinal and interventional studies are needed to support this notion

Mediterranean Diet, Alzheimer Disease Biomarkers, and Brain Atrophy in Old Age

Objective To determine whether following a Mediterranean-like diet (MeDi) relates to cognitive functions and in vivo biomarkers for Alzheimer disease (AD), we analyzed cross-sectional data from the German DZNE-Longitudinal Cognitive Impairment and Dementia Study. Method The sample (n = 512, mean age 69.5 +/- 5.9 years) included 169 cognitively normal participants and individuals at higher AD risk (53 with relatives with AD, 209 with subjective cognitive decline, and 81 with mild cognitive impairment). We defined MeDi adherence according to the food frequency questionnaire. Brain volume outcomes were generated via voxel-based morphometry on T1-MRI, and cognitive performance was assessed with an extensive neuropsychological battery. AD-related biomarkers (beta-amyloid(42/40) [A beta(42/40)] ratio, phosphorylated tau 181 [pTau181]) in CSF were assessed in n = 226 individuals. We analyzed the associations between MeDi and outcomes with linear regression models controlling for several covariates. In addition, we applied hypothesis-driven mediation and moderation analysis. Results Higher MeDi adherence related to larger mediotemporal gray matter volume (p < 0.05 family-wise error corrected), better memory (beta +/- SE = 0.03 +/- 0.02; p = 0.038), and less amyloid (A beta(42/40) ratio, beta +/- SE = 0.003 +/- 0.001; p = 0.008) and pTau181 (beta +/- SE = -1.96 +/- 0.68; p = 0.004) pathology. Mediotemporal volume mediated the association between MeDi and memory (40% indirect mediation). Finally, MeDi favorably moderated the associations among A beta(42/40) ratio, pTau181, and mediotemporal atrophy. Results were consistent correcting for APOE-epsilon 4 status. Conclusion Our findings corroborate the view of MeDi as a protective factor against memory decline and mediotemporal atrophy. They suggest that these associations might be explained by a decrease of amyloidosis and tau pathology. Longitudinal and dietary intervention studies should further examine this conjecture and its treatment implications

Novelty-Related fMRI Responses of Precuneus and Medial Temporal Regions in Individuals at Risk for Alzheimer Disease

Background and Objectives We assessed whether novelty-related fMRI activity in medial temporal lobe regions and the precuneus follows an inverted U-shaped pattern across the clinical spectrum of increased Alzheimer disease (AD) risk as previously suggested. Specifically, we tested for potentially increased activity in individuals with a higher AD risk due to subjective cognitive decline (SCD) or mild cognitive impairment (MCI). We further tested whether activity differences related to diagnostic groups were accounted for by CSF markers of AD or brain atrophy. Methods We studied 499 participants aged 60-88 years from the German Center for Neurodegenerative Diseases Longitudinal Cognitive Impairment and Dementia Study (DELCODE) who underwent task-fMRI. Participants included 163 cognitively normal (healthy control, HC) individuals, 222 SCD, 82 MCI, and 32 patients with clinical diagnosis of mild AD. CSF levels of beta-amyloid 42/40 ratio and phosphorylated-tau181 were available from 232 participants. We used region-based analyses to assess novelty-related activity (novel > highly familiar scenes) in entorhinal cortex, hippocampus, and precuneus as well as whole-brain voxel-wise analyses. First, general linear models tested differences in fMRI activity between participant groups. Complementary regression models tested quadratic relationships between memory impairment and activity. Second, relationships of activity with AD CSF biomarkers and brain volume were analyzed. Analyses were controlled for age, sex, study site, and education. Results In the precuneus, we observed an inverted U-shaped pattern of novelty-related activity across groups, with higher activity in SCD and MCI compared with HC, but not in patients with AD who showed relatively lower activity than MCI. This nonlinear pattern was confirmed by a quadratic relationship between memory impairment and precuneus activity. Precuneus activity was not related to AD biomarkers or brain volume. In contrast to the precuneus, hippocampal activity was reduced in AD dementia compared with all other groups and related to AD biomarkers. Discussion Novelty-related activity in the precuneus follows a nonlinear pattern across the clinical spectrum of increased AD risk. Although the underlying mechanism remains unclear, increased precuneus activity might represent an early signature of memory impairment. Our results highlight the nonlinearity of activity alterations that should be considered in clinical trials using functional outcome measures or targeting hyperactivity