An agile development cycle of an online memory program for healthy older adults

Online interventions for older adults should be tailored to their unique needs to increase the efficacy of and adherence to the intervention. The agile development cycle is a dynamic model to solicit and incorporate feedback from older adults during the design process. We combined this approach with the framework of Harvard University’s clinical and translational phases that provide a clear structure for evaluating new health programs before they are offered in the community. We based our online memory program on the empirically validated in-person Memory and Aging Program. The aim of the present study was to combine the agile development cycle with the clinical and translational phases framework to develop and pilot an online memory program tailored to the unique needs of older adults. Study 1 involved piloting individual program modules on site and integrating participant feedback into the program’s design to optimize usability. Study 2 involved two sequential pilots of the program accessed remotely to evaluate preliminary clinical outcomes and obtain feedback for iterative modifications. Plans for further validation and limitations are discussed. The successful application of the agile development cycle implemented in this series of studies can be adapted by others seeking to offer online content for targeted end users. Les interventions en ligne pour les personnes âgées doivent être adaptées à leurs besoins spécifiques afin d’augmenter leur efficacité et l’adhésion des utilisateurs. Le cycle de développement agile est un modèle dynamique permettant de solliciter et d’intégrer les commentaires des personnes âgées au cours du processus de conception. Nous avons combiné cette approche avec le Cadre des phases cliniques et translationnelles de l’université Harvard qui fournit une structure claire pour évaluer les nouveaux programmes de santé avant qu’ils ne soient proposés dans la communauté. Nous avons élaboré notre programme en ligne sur la mémoire à partir du programme sur la mémoire et le vieillissement qui se donnait en présentiel, et qui avait été validé empiriquement. L’objectif de l’étude était d’associer le cycle de développement agile avec le Cadre des phases cliniques et translationnelles pour concevoir et tester un programme pilote en ligne sur la mémoire qui est adapté aux besoins uniques des personnes âgées. L’étude no 1 a permis de tester dans une phase pilote les modules individuels du programme avec des participants présents sur place, et à intégrer leurs commentaires lors du développement du programme afin d’en optimiser la convivialité. L’étude no 2 a consisté en deux pilotes séquentiels du programme accessibles à distance dans lesquels les résultats cliniques préliminaires ont été évalués et des commentaires ont été collectés pour guider les modifications itératives. Les plans pour une validation ultérieure et les limites des études sont discutés. L’application réussie du cycle de développement agile mis en œuvre dans cette série d’études pourra être adaptée par d’autres équipes souhaitant proposer un contenu en ligne à des groupes d’utilisateurs finaux plus spécifiques

Development and evaluation of a self-administered on-line test of memory and attention for middle-aged and older adults

There is a need for rapid and reliable Internet-based screening tools for cognitive assessment in middle-aged and older adults. We report the psychometric properties of an on-line tool designed to screen for cognitive deficits that require further investigation. The tool is composed of measures of memory and executive attention processes known to be sensitive to brain changes associated with aging and with cognitive disorders that become more prevalent with age. These measures included spatial working memory, Stroop interference, face-name associative recognition, and number-letter alternation. Normative data were collected from 361 healthy adults age 50 to 79 who scored in the normal range on a standardized measure of general cognitive ability. Participants took the 20-minute on-line test on their home computers, and a subset of 288 participants repeated the test one week later. Analyses of the individual tasks indicated adequate internal consistency, construct validity, test-retest reliability, and alternate version reliability. As expected, scores were correlated with age. The four tasks loaded on the same principle component. Demographically-corrected z-scores from the individual tasks were combined to create an overall score, which showed good reliability and classification consistency. These results indicate the tool may be useful for identifying middle-aged and older adults with lower than expected scores who may benefit from clinical evaluation of their cognition by a health care professional

Sex differences and Modifiable Dementia Risk Factors Synergistically Influence Memory over the Adult Lifespan

INTRODUCTION: More women than men develop Alzheimer’s disease, yet women show less age-related episodic memory decline, a contradiction that may be accounted for by modifiable risk factors for dementia. METHODS: Associations between sex, modifiable dementia risk factors, and cognition were measured in a cross-sectional online sample (n = 21,840, ages 18-89). RESULTS: Across four tests of associative memory and executive functions, only a Face-Name Association task revealed sex differences in age-related decline. Men had worse associative memory than women (the equivalent of four years of aging). Each additional risk factor had the equivalent of three and a half years of aging. Men had greater age-related decline in associative memory than women among those with no to one risk factors, but multiple risk factors eliminated the female advantage. DISCUSSION: Because the relationship between dementia risk factors and age-related memory decline differs for men and women, sex-specific dementia prevention approaches are warranted

When I'm 64: Age-related variability in over 40,000 online cognitive test takers

Modellling of age-related change in memory and attention, using a 5 year online dataset (115, 973 test completions) collected with the Cogniciti Brain Health Assessmen

The adverse effect of modifiable dementia risk factors on cognition amplify across the adult lifespan

Background: Modifiable lifestyle behaviours can reduce dementia risk by 40%, but their prevalence and association with cognition throughout the adult lifespan is less well understood. Methods: Associations between eight modifiable risk factors for dementia (low education, hypertension, hearing loss, traumatic brain injury, alcohol or substance abuse, diabetes, smoking, and depression) and cognition were examined in an online sample (N = 22,117, aged 18-89). Findings: Older adults (ages 66-89) had more risk factors than middle-aged (ages 45-65) and younger adults (ages 18-44). Polynomial regression revealed each additional risk factor was associated with a drop in cognitive performance (equivalent to three years of aging), with a larger association as age increased. People with no risk factors in their forties to seventies showed similar cognitive performance to people ten or twenty years younger with many risk factors. Interpretation: Modifiable dementia risk factors may be more important than age in predicting cognitive performance

Interindividual and intraindividual variability in amnestic mild cognitive impairment (aMCI) measured with an online cognitive assessment

Investigating interindividual variability (diversity) and intraindividual variability across tasks (dispersion) in amnestic mild cognitive impairment (aMCI) using online tests of memory and attention (the Cogniciti Brain Health Assessment, BHA). The study uses an existing dataset (Paterson et al., in review)