@Article{info:doi/10.2196/20298, author="Hu, Mingyue and Shu, Xinhui and Yu, Gang and Wu, Xinyin and V{\"a}lim{\"a}ki, Maritta and Feng, Hui", title="A Risk Prediction Model Based on Machine Learning for Cognitive Impairment Among Chinese Community-Dwelling Elderly People With Normal Cognition: Development and Validation Study", journal="J Med Internet Res", year="2021", month="Feb", day="24", volume="23", number="2", pages="e20298", keywords="prediction model", keywords="cognitive impairment", keywords="machine learning", keywords="nomogram", abstract="Background: Identifying cognitive impairment early enough could support timely intervention that may hinder or delay the trajectory of cognitive impairment, thus increasing the chances for successful cognitive aging. Objective: We aimed to build a prediction model based on machine learning for cognitive impairment among Chinese community-dwelling elderly people with normal cognition. Methods: A prospective cohort of 6718 older people from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) register, followed between 2008 and 2011, was used to develop and validate the prediction model. Participants were included if they were aged 60 years or above, were community-dwelling elderly people, and had a cognitive Mini-Mental State Examination (MMSE) score ?18. They were excluded if they were diagnosed with a severe disease (eg, cancer and dementia) or were living in institutions. Cognitive impairment was identified using the Chinese version of the MMSE. Several machine learning algorithms (random forest, XGBoost, na{\"i}ve Bayes, and logistic regression) were used to assess the 3-year risk of developing cognitive impairment. Optimal cutoffs and adjusted parameters were explored in validation data, and the model was further evaluated in test data. A nomogram was established to vividly present the prediction model. Results: The mean age of the participants was 80.4 years (SD 10.3 years), and 50.85\% (3416/6718) were female. During a 3-year follow-up, 991 (14.8\%) participants were identified with cognitive impairment. Among 45 features, the following four features were finally selected to develop the model: age, instrumental activities of daily living, marital status, and baseline cognitive function. The concordance index of the model constructed by logistic regression was 0.814 (95\% CI 0.781-0.846). Older people with normal cognitive functioning having a nomogram score of less than 170 were considered to have a low 3-year risk of cognitive impairment, and those with a score of 170 or greater were considered to have a high 3-year risk of cognitive impairment. Conclusions: This simple and feasible cognitive impairment prediction model could identify community-dwelling elderly people at the greatest 3-year risk for cognitive impairment, which could help community nurses in the early identification of dementia. ", doi="10.2196/20298", url="https://www.jmir.org/2021/2/e20298", url="http://www.ncbi.nlm.nih.gov/pubmed/33625369" } @Article{info:doi/10.2196/20177, author="Kim, Jeongsim and Shin, EunJi and Han, KyungHwa and Park, Soowon and Youn, Hae Jung and Jin, Guixiang and Lee, Jun-Young", title="Efficacy of Smart Speaker--Based Metamemory Training in Older Adults: Case-Control Cohort Study", journal="J Med Internet Res", year="2021", month="Feb", day="16", volume="23", number="2", pages="e20177", keywords="smart speaker", keywords="cognitive training", keywords="cognitive decline", abstract="Background: Metamemory training (MMT) is a useful training strategy for improving cognitive functioning in the older adult population. Despite the advantages, there are limitations imposed by location and time constraints. Objective: This study aimed to develop a smart speaker--based MMT program and evaluate the efficacy of the program in older adults without cognitive impairment. Methods: This study used a case-control cohort design. The smart speaker--based MMT program comprised 3 training sessions per day, 5 days a week, for 8 weeks. Each training session took approximately 15 minutes. This program was implemented using smart speakers, not human trainers. All participants completed the Mini-Mental State Examination, Subjective Memory Complaints Questionnaire, Verbal Learning Test, Digit Span Test, fluency tests, and a short-form version of the Geriatric Depression Scale before and after training. Results: A total of 60 subjects (29 in the MMT group and 31 in the control group) participated in the study. The training group showed significant increases in the delayed free recall, digit span forward, digit span backward, and fluency test scores compared with the control group. Conclusions: This study confirmed the efficacy of smart speaker--based MMT in older adults. Home-based smart speaker--based MMT is not limited with respect to location or constrained by space and may help older adults with subjective cognitive decline without requiring intervention by human professionals. ", doi="10.2196/20177", url="http://www.jmir.org/2021/2/e20177/", url="http://www.ncbi.nlm.nih.gov/pubmed/33591276" } @Article{info:doi/10.2196/14953, author="Kajiwara, Kohei and Kako, Jun and Noto, Hiroko and Oosono, Yasufumi and Kobayashi, Masamitsu", title="The Potential for the Internet and Telehealth in Caregiver Support. Comment on ``Using Technology to Facilitate Fidelity Assessments: The Tele-STAR Caregiver Intervention''", journal="J Med Internet Res", year="2021", month="Feb", day="16", volume="23", number="2", pages="e14953", keywords="dementia", keywords="caregiver", keywords="technology", doi="10.2196/14953", url="https://www.jmir.org/2021/2/e14953", url="http://www.ncbi.nlm.nih.gov/pubmed/33591281" } @Article{info:doi/10.2196/25340, author="Koh, Qi Wei and Ang, Hui Faith Xin and Casey, Dympna", title="Impacts of Low-cost Robotic Pets for Older Adults and People With Dementia: Scoping Review", journal="JMIR Rehabil Assist Technol", year="2021", month="Feb", day="12", volume="8", number="1", pages="e25340", keywords="social robot", keywords="assistive technology", keywords="robotic animals", keywords="pet robots", keywords="older adults", keywords="dementia", keywords="low-cost robot", keywords="psychosocial intervention", keywords="intervention", keywords="robot", keywords="review", abstract="Background: Older adults and people with dementia are particularly vulnerable to social isolation. Social robots, including robotic pets, are promising technological interventions that can benefit the psychosocial health of older adults and people with dementia. However, issues such as high costs can lead to a lack of equal access and concerns about infection control. Although there are previous reviews on the use of robotic pets for older adults and people with dementia, none have included or had a focus on low-cost and familiarly and realistically designed pet robots. Objective: The aim of this review is to synthesize evidence on the delivery and impact of low-cost, familiarly and realistically designed interactive robotic pets for older adults and people with dementia. Methods: The Arksey and O'Malley framework was used to guide this review. First, the research question was identified. Second, searches were conducted on five electronic databases and Google Scholar. Studies were selected using a two-phase screening process, where two reviewers independently screened and extracted data using a standardized data extraction form. Finally, the results were discussed, categorized, and presented narratively. Results: A total of 9 studies were included in the review. Positive impacts related to several psychosocial domains, including mood and affect, communication and social interaction, companionship, and other well-being outcomes. Issues and concerns associated with its use included misperceptions of the robotic pets as a live animal, ethical issues of attachment, negative reactions by users, and other pragmatic concerns such as hygiene and cost. Conclusions: Overall, the findings resonate with previous studies that investigated the effectiveness of other social robots, demonstrating the promise of these low-cost robotic pets in addressing the psychosocial needs of older adults and people with dementia. The affordability of these robotic pets appeared to influence the practicalities of real-world use, such as intervention delivery and infection control, which are especially relevant in light of COVID-19. Moving forward, studies should also consider comparing the effects of these low-cost robots with other robotic pets. ", doi="10.2196/25340", url="http://rehab.jmir.org/2021/1/e25340/", url="http://www.ncbi.nlm.nih.gov/pubmed/33497349" } @Article{info:doi/10.2196/24965, author="Ramirez, Magaly and Duran, C. Miriana and Pabiniak, J. Chester and Hansen, E. Kelly and Kelley, Ann and Ralston, D. James and McCurry, M. Susan and Teri, Linda and Penfold, B. Robert", title="Family Caregiver Needs and Preferences for Virtual Training to Manage Behavioral and Psychological Symptoms of Dementia: Interview Study", journal="JMIR Aging", year="2021", month="Feb", day="10", volume="4", number="1", pages="e24965", keywords="dementia", keywords="Alzheimer disease", keywords="behavioral symptoms", keywords="caregivers", keywords="internet-based intervention", keywords="education", keywords="behavior", keywords="symptom", keywords="psychology", keywords="qualitative", keywords="caregiver", keywords="intervention", keywords="training", keywords="virtual care", keywords="digital health", abstract="Background: Behavioral and psychological symptoms of dementia (BPSD) are associated with increased stress, burden, and depression among family caregivers of people with dementia. STAR-Caregivers Virtual Training and Follow-up (STAR-VTF) is adapted from an evidence-based, in-person program that trains family caregivers to manage BPSD. We used a human-centered design approach to obtain feedback from family caregivers about STAR-VTF. The program will be evaluated using a pragmatic randomized trial. Objective: The objective of the study was to understand the needs of family caregivers for improving BPSD management and the extent to which caregivers perceived that STAR-VTF could address those needs. Methods: Between July and September 2019, we conducted 15 semistructured interviews with family caregivers of people with dementia who receive care at Kaiser Permanente Washington in the Seattle metropolitan area. We identified participants from electronic health records, primarily based on a prescription for antipsychotic medication for the person with dementia (a proxy for caregivers dealing with BPSD). We showed caregivers low-fidelity prototypes of STAR-VTF online self-directed materials and verbally described potential design elements. We obtained caregiver feedback on these elements, focusing on their needs and preferences and perceived barriers to using STAR-VTF. We used a hybrid approach of inductive and deductive coding and aggregated codes to develop themes. Results: The idea of a virtual training program for learning to manage BPSD appealed to caregivers. They said health care providers did not provide adequate education in the early disease stages about the personality and behavior symptoms that can affect people with dementia. Caregivers found it unexpected and frustrating when the person with dementia began experiencing BPSD, symptoms they felt unprepared to manage. Accordingly, caregivers expressed a strong desire for the health care organization to offer programs such as STAR-VTF much sooner. Caregivers had already put considerable effort into problem solving challenging behaviors. They anticipated deriving less value from STAR-VTF at that point. Nonetheless, many were interested in the virtual aspect of the training due to the convenience of receiving help from home and the perception that help from a virtual program would be timelier than traditional service modalities (eg, face to face). Given caregivers' limited time, they suggested dividing the STAR-VTF content into chunks to review as time permitted. Caregivers were interested in having a STAR-VTF provider for additional support in managing challenging behaviors. Caregivers reported a preference for having the same coach for the program duration. Conclusions: Caregivers we interviewed would likely accept a virtual training program such as STAR-VTF to obtain information about BPSD and receive help managing it. Family caregivers anticipated deriving more value if STAR-VTF was offered earlier in the disease course. ", doi="10.2196/24965", url="http://aging.jmir.org/2021/1/e24965/", url="http://www.ncbi.nlm.nih.gov/pubmed/33565984" } @Article{info:doi/10.2196/21629, author="Christie, Liane Hannah and Boots, Maria Lizzy Mitzy and Tange, Johannes Huibert and Verhey, Josef Frans Rochus and de Vugt, Elizabeth Marjolein", title="Implementations of Evidence-Based eHealth Interventions for Caregivers of People With Dementia in Municipality Contexts (Myinlife and Partner in Balance): Evaluation Study", journal="JMIR Aging", year="2021", month="Feb", day="5", volume="4", number="1", pages="e21629", keywords="eHealth", keywords="mHealth", keywords="implementation science", keywords="dementia", keywords="caregiving", keywords="municipality", abstract="Background: Very few evidence-based eHealth interventions for caregivers of people with dementia are implemented into practice. Municipalities are one promising context in which to implement these interventions due to their available policy and innovation incentives regarding (dementia) caregiving and prevention. In this study, two evidence-based eHealth interventions for caregivers of people with dementia (Partner in Balance and Myinlife) were implemented in 8 municipalities in the Euregion Meuse-Rhine. Partner in Balance is a blended care, 8-week, self-management intervention intervention designed to aid caregivers of people with dementia in adapting to their new roles that is delivered through coaches in participating health care organizations who are trained to use it to offer online support to their clients. Myinlife is an eHealth/mHealth intervention integrated into the Dutch Alzheimer's Association website and available from the App Store or Google Play, designed to help caregivers of people with dementia use their social network to better organize care and share positive (caregiving) experiences. Objective: This study's objectives were to evaluate the success of the implementation of Myinlife and Partner in Balance and investigate determinants of their successful implementation in the municipality context. Methods: This study collected eHealth use data, Partner in Balance coach evaluation questionnaires, and information on implementation determinants. This was done by conducting interviews with the municipality officials based on the measurement instrument for determinants of implementation (MIDI). These data from multiple sources and perspectives were integrated and analyzed to form a total picture of the determinants (barriers and facilitators to implementation in the municipality context). Results: The municipality implementation of Partner in Balance and Myinlife showed varying levels of success. In the end, 3 municipalities planned to continue the implementation of Partner in Balance, while none planned to continue the implementation of Myinlife. The 2 Partner in Balance municipalities that did not consider the implementation to be successful viewed the implementation as an external project. For Myinlife, it was clear that more face-to-face contact was needed to engage the implementing municipality and target groups. Successful implementations were linked to implementer self-efficacy and sense of ownership, which seemed to be absent in unsuccessful implementations. Conclusions: The experiences of implementing these interventions suggested that this implementation context was feasible regarding the required budget and infrastructure. The need to foster sense of ownership and self-efficacy in implementers will be integrated into future implementation protocols as part of standard implementation materials for municipalities and organizations implementing Myinlife and Partner in Balance. ", doi="10.2196/21629", url="http://aging.jmir.org/2021/1/e21629/", url="http://www.ncbi.nlm.nih.gov/pubmed/33544085" } @Article{info:doi/10.2196/26254, author="Bacsu, Juanita-Dawne and O'Connell, E. Megan and Cammer, Allison and Azizi, Mahsa and Grewal, Karl and Poole, Lisa and Green, Shoshana and Sivananthan, Saskia and Spiteri, J. Raymond", title="Using Twitter to Understand the COVID-19 Experiences of People With Dementia: Infodemiology Study", journal="J Med Internet Res", year="2021", month="Feb", day="3", volume="23", number="2", pages="e26254", keywords="Twitter", keywords="social media", keywords="dementia", keywords="COVID-19", keywords="health policy", keywords="experience", keywords="support", keywords="disorder", keywords="theme", keywords="collaborate", keywords="quality of life", abstract="Background: The COVID-19 pandemic is affecting people with dementia in numerous ways. Nevertheless, there is a paucity of research on the COVID-19 impact on people with dementia and their care partners. Objective: Using Twitter, the purpose of this study is to understand the experiences of COVID-19 for people with dementia and their care partners. Methods: We collected tweets on COVID-19 and dementia using the GetOldTweets application in Python from February 15 to September 7, 2020. Thematic analysis was used to analyze the tweets. Results: From the 5063 tweets analyzed with line-by-line coding, we identified 4 main themes including (1) separation and loss; (2) COVID-19 confusion, despair, and abandonment; (3) stress and exhaustion exacerbation; and (4) unpaid sacrifices by formal care providers. Conclusions: There is an imminent need for governments to rethink using a one-size-fits-all response to COVID-19 policy and use a collaborative approach to support people with dementia. Collaboration and more evidence-informed research are essential to reducing COVID-19 mortality and improving the quality of life for people with dementia and their care partners. ", doi="10.2196/26254", url="https://www.jmir.org/2021/2/e26254", url="http://www.ncbi.nlm.nih.gov/pubmed/33468449" } @Article{info:doi/10.2196/22406, author="Appel, Lora and Kisonas, Erika and Appel, Eva and Klein, Jennifer and Bartlett, Deanna and Rosenberg, Jarred and Smith, NC Christopher", title="Administering Virtual Reality Therapy to Manage Behavioral and Psychological Symptoms in Patients With Dementia Admitted to an Acute Care Hospital: Results of a Pilot Study", journal="JMIR Form Res", year="2021", month="Feb", day="3", volume="5", number="2", pages="e22406", keywords="virtual reality", keywords="wearable electronic devices", keywords="sensory art therapies", keywords="hospitalization", keywords="hospitals, community", keywords="hospitals, general", keywords="aged", keywords="humans", keywords="dementia", keywords="behavioral symptoms", keywords="nature", keywords="mobile phone", abstract="Background: As virtual reality (VR) technologies become increasingly accessible and affordable, clinicians are eager to try VR therapy as a novel means to manage behavioral and psychological symptoms of dementia, which are exacerbated during acute care hospitalization, with the goal of reducing the use of antipsychotics, sedatives, and physical restraints associated with negative adverse effects, increased length of stay, and caregiver burden. To date, no evaluations of immersive VR therapy have been reported for patients with dementia in acute care hospitals. Objective: This study aimed to determine the feasibility (acceptance, comfort, and safety) of using immersive VR therapy for people living with dementia (mild, moderate, and advanced) during acute care hospitalization and explore its potential to manage behavioral and psychological symptoms of dementia. Methods: A prospective, longitudinal pilot study was conducted at a community teaching hospital in Toronto. The study was nonrandomized and unblinded. A total of 10 patients aged >65 years (mean 86.5, SD 5.7) diagnosed with dementia participated in one or more research coordinator--facilitated sessions of viewing immersive 360{\textdegree} VR footage of nature scenes displayed on a Samsung Gear VR head-mounted display. This mixed-methods study included review of patient charts, standardized observations during the intervention, and pre- and postintervention semistructured interviews about the VR experience. Results: All recruited participants (N=10) completed the study. Of the 10 participants, 7 (70\%) displayed enjoyment or relaxation during the VR session, which averaged 6 minutes per view, and 1 (10\%) experienced dizziness. No interference between the VR equipment and hearing aids or medical devices was reported. Conclusions: It is feasible to expose older people with dementia of various degrees admitted to an acute care hospital to immersive VR therapy. VR therapy was found to be acceptable to and comfortable by most participants. This pilot study provides the basis for conducting the first randomized controlled trial to evaluate the impact of VR therapy on managing behavioral and psychological symptoms of dementia in acute care hospitals. ", doi="10.2196/22406", url="https://formative.jmir.org/2021/2/e22406", url="http://www.ncbi.nlm.nih.gov/pubmed/33533720" } @Article{info:doi/10.2196/23384, author="Cyr, Andr{\'e}e-Ann and Romero, Kristoffer and Galin-Corini, Laura", title="Web-Based Cognitive Testing of Older Adults in Person Versus at Home: Within-Subjects Comparison Study", journal="JMIR Aging", year="2021", month="Feb", day="1", volume="4", number="1", pages="e23384", keywords="web-based testing", keywords="aging", keywords="cognition", keywords="neuropsychology", keywords="mobile phone", abstract="Background: Web-based research allows cognitive psychologists to collect high-quality data from a diverse pool of participants with fewer resources. However, web-based testing presents unique challenges for researchers and clinicians working with aging populations. Older adults may be less familiar with computer usage than their younger peers, leading to differences in performance when completing web-based tasks in their home versus in the laboratory under the supervision of an experimenter. Objective: This study aimed to use a within-subjects design to compare the performance of healthy older adults on computerized cognitive tasks completed at home and in the laboratory. Familiarity and attitudes surrounding computer use were also examined. Methods: In total, 32 community-dwelling healthy adults aged above 65 years completed computerized versions of the word-color Stroop task, paired associates learning, and verbal and matrix reasoning in 2 testing environments: at home (unsupervised) and in the laboratory (supervised). The paper-and-pencil neuropsychological versions of these tasks were also administered, along with questionnaires examining computer attitudes and familiarity. The order of testing environments was counterbalanced across participants. Results: Analyses of variance conducted on scores from the computerized cognitive tasks revealed no significant effect of the testing environment and no correlation with computer familiarity or attitudes. These null effects were confirmed with follow-up Bayesian analyses. Moreover, performance on the computerized tasks correlated positively with performance on their paper-and-pencil equivalents. Conclusions: Our findings show comparable performance on computerized cognitive tasks in at-home and laboratory testing environments. These findings have implications for researchers and clinicians wishing to harness web-based testing to collect meaningful data from older adult populations. ", doi="10.2196/23384", url="http://aging.jmir.org/2021/1/e23384/", url="http://www.ncbi.nlm.nih.gov/pubmed/33522972" } @Article{info:doi/10.2196/18482, author="Gamito, Pedro and Oliveira, Jorge and Matias, Marcelo and Cunha, Elsa and Brito, Rodrigo and Lopes, Ferreira Paulo and Deus, Alberto", title="Virtual Reality Cognitive Training Among Individuals With Alcohol Use Disorder Undergoing Residential Treatment: Pilot Randomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Jan", day="29", volume="23", number="1", pages="e18482", keywords="alcohol use disorder", keywords="cognitive training", keywords="virtual reality", abstract="Background: Alcohol use disorder (AUD) has been associated with diverse physical and mental morbidities. Among the main consequences of chronic and excessive alcohol use are cognitive and executive deficits. Some of these deficits may be reversed in specific cognitive and executive domains with behavioral approaches consisting of cognitive training. The advent of computer-based interventions may leverage these improvements, but randomized controlled trials (RCTs) of digital interactive-based interventions are still scarce. Objective: The aim of this study is to explore whether a cognitive training approach using VR exercises based on activities of daily living is feasible for improving the cognitive function of patients with AUD undergoing residential treatment, as well as to estimate the effect size for this intervention to power future definitive RCTs. Methods: This study consisted of a two-arm pilot RCT with a sample of 36 individuals recovering from AUD in a therapeutic community; experimental group participants received a therapist-guided, VR-based cognitive training intervention combined with treatment as usual, and control group participants received treatment as usual without cognitive training. A comprehensive neuropsychological battery of tests was used both at pre- and postassessments, including measurement of global cognition, executive functions, attention, visual memory, and cognitive flexibility. Results: In order to control for potential effects of global cognition and executive functions at baseline, these domains were controlled for in the statistical analysis for each individual outcome. Results indicate intervention effects on attention in two out of five outcomes and on cognitive flexibility in two out of six outcomes, with effect sizes in significant comparisons being larger for attention than for cognitive flexibility. Patient retention in cognitive training was high, in line with previous studies. Conclusions: Overall, the data suggest that VR-based cognitive training results in specific contributions to improving attention ability and cognitive flexibility of patients recovering from AUD. Trial Registration: ClinicalTrials.gov NCT04505345; https://clinicaltrials.gov/show/NCT04505345 ", doi="10.2196/18482", url="http://www.jmir.org/2021/1/e18482/", url="http://www.ncbi.nlm.nih.gov/pubmed/33512329" } @Article{info:doi/10.2196/14781, author="Stanyon, Miriam and Streater, Amy and Coleston-Shields, Maria Donna and Yates, Jennifer and Challis, David and Dening, Tom and Hoe, Juanita and Lloyd-Evans, Brynmor and Mitchell, Shirley and Moniz-Cook, Esme and Poland, Fiona and Prothero, David and Orrell, Martin", title="Development of an Evidence-Based Best Practice Model for Teams Managing Crisis in Dementia: Protocol for a Qualitative Study", journal="JMIR Res Protoc", year="2021", month="Jan", day="27", volume="10", number="1", pages="e14781", keywords="dementia", keywords="caregivers", keywords="crisis", keywords="mental health", keywords="home management", abstract="Background: Teams working in the community to manage crisis in dementia currently exist, but with widely varying models of practice, it is difficult to determine the effectiveness of such teams. Objective: The aim of this study is to develop a ``best practice model'' for dementia services managing crisis, as well as a set of resources to help teams implement this model to measure and improve practice delivery. These will be the best practice tool and toolkit to be utilized by teams to improve the effectiveness of crisis teams working with older people with dementia and their caregivers. This paper describes the protocol for a prospective study using qualitative methods to establish an understanding of the current practice to develop a ``best practice model.'' Methods: Participants (people with dementia, caregivers, staff members, and stakeholders) from a variety of geographical areas, with a broad experience of crisis and noncrisis work, will be purposively selected to participate in qualitative approaches including interviews, focus groups, a consensus workshop, and development and field testing of both the best practice tool and toolkit. Results: Data were collected between October 2016 and August 2018. Thematic analysis will be utilized to establish the current working of teams managing crisis in dementia in order to draw together elements of the best practice. Conclusions: This is the first study to systematically explore the requirements needed to fulfill effective and appropriate home management for people with dementia and their caregivers at the time of mental health crisis, as delivered by teams managing crisis in dementia. This systematic approach to development will support greater acceptability and validity of the best practice tool and toolkit and lay the foundation for a large scale trial with teams managing crisis in dementia across England to investigate the effects on practice and impact on service provision, as well as the associated experiences of people with dementia and their caregivers. International Registered Report Identifier (IRRID): RR1-10.2196/14781 ", doi="10.2196/14781", url="http://www.researchprotocols.org/2021/1/e14781/", url="http://www.ncbi.nlm.nih.gov/pubmed/33502333" } @Article{info:doi/10.2196/19244, author="Sturge, Jodi and Meijering, Louise and Jones, Allyson C. and Garvelink, Mirjam and Caron, Danielle and Nordin, Susanna and Elf, Marie and L{\'e}gar{\'e}, France", title="Technology to Improve Autonomy and Inform Housing Decisions for Older Adults With Memory Problems Who Live at Home in Canada, Sweden, and the Netherlands: Protocol for a Multipronged Mixed Methods Study", journal="JMIR Res Protoc", year="2021", month="Jan", day="21", volume="10", number="1", pages="e19244", keywords="aging in place", keywords="co-design", keywords="cross-country comparison", keywords="electronic decision support intervention", keywords="housing decisions", keywords="memory problems", keywords="mixed methods", keywords="mobility patterns", keywords="shared decision making", keywords="technology", abstract="Background: Understanding the mobility patterns and experiences of older adults with memory problems living at home has the potential to improve autonomy and inform shared decision making (SDM) about their housing options. Objective: We aim to (1) assess the mobility patterns and experiences of older adults with memory problems, (2) co-design an electronic decision support intervention (e-DSI) that integrates users' mobility patterns and experiences, (3) explore their intention to use an e-DSI to support autonomy at home, and (4) inform future SDM processes about housing options. Methods: Informed by the Good Reporting of A Mixed Methods Study (GRAMMS) reporting guidelines, we will conduct a 3-year, multipronged mixed methods study in Canada, Sweden, and the Netherlands. For Phase 1, we will recruit a convenience sample of 20 older adults living at home with memory problems from clinical and community settings in each country, for a total of 60 participants. We will ask participants to record their mobility patterns outside their home for 14 days using a GPS tracker and a travel diary; in addition, we will conduct a walking interview and a final debrief interview after 14 days. For Phase 2, referring to results from the first phase, we will conduct one user-centered co-design process per country with older adults with memory issues, caregivers, health care professionals, and information technology representatives informed by the Double Diamond method. We will ask participants how personalized information about mobility patterns and experiences could be added to an existing e-DSI and how this information could inform SDM about housing options. For Phase 3, using online web-based surveys, we will invite 210 older adults with memory problems and/or their caregivers, split equally across the three countries, to use the e-DSI and provide feedback on its strengths and limitations. Finally, in Phase 4, we will triangulate and compare data from all phases and countries to inform a stakeholder meeting where an action plan will be developed. Results: The study opened for recruitment in the Netherlands in November 2018 and in Canada and Sweden in December 2019. Data collection will be completed by April 2021. Conclusions: This project will explore how e-DSIs can integrate the mobility patterns and mobility experiences of older adults with memory problems in three countries, improve older adults' autonomy, and, ultimately, inform SDM about housing options. Trial Registration: ClinicalTrials.gov NCT04267484; https://clinicaltrials.gov/ct2/show/NCT04267484 International Registered Report Identifier (IRRID): DERR1-10.2196/19244 ", doi="10.2196/19244", url="http://www.researchprotocols.org/2021/1/e19244/", url="http://www.ncbi.nlm.nih.gov/pubmed/33475512" } @Article{info:doi/10.2196/22831, author="Grigorovich, Alisa and Kulandaivelu, Yalinie and Newman, Kristine and Bianchi, Andria and Khan, S. Shehroz and Iaboni, Andrea and McMurray, Josephine", title="Factors Affecting the Implementation, Use, and Adoption of Real-Time Location System Technology for Persons Living With Cognitive Disabilities in Long-term Care Homes: Systematic Review", journal="J Med Internet Res", year="2021", month="Jan", day="20", volume="23", number="1", pages="e22831", keywords="assistive technology", keywords="real-time location system", keywords="long-term care", keywords="implementation science", keywords="dementia", keywords="Alzheimer disease", keywords="ambulatory monitoring", keywords="wearable technology", keywords="qualitative research", abstract="Background: As the aging population continues to grow, the number of adults living with dementia or other cognitive disabilities in residential long-term care homes is expected to increase. Technologies such as real-time locating systems (RTLS) are being investigated for their potential to improve the health and safety of residents and the quality of care and efficiency of long-term care facilities. Objective: The aim of this study is to identify factors that affect the implementation, adoption, and use of RTLS for use with persons living with dementia or other cognitive disabilities in long-term care homes. Methods: We conducted a systematic review of the peer-reviewed English language literature indexed in MEDLINE, Embase, PsycINFO, and CINAHL from inception up to and including May 5, 2020. Search strategies included keywords and subject headings related to cognitive disability, residential long-term care settings, and RTLS. Study characteristics, methodologies, and data were extracted and analyzed using constant comparative techniques. Results: A total of 12 publications were included in the review. Most studies were conducted in the Netherlands (7/12, 58\%) and used a descriptive qualitative study design. We identified 3 themes from our analysis of the studies: barriers to implementation, enablers of implementation, and agency and context. Barriers to implementation included lack of motivation for engagement; technology ecosystem and infrastructure challenges; and myths, stories, and shared understanding. Enablers of implementation included understanding local workflows, policies, and technologies; usability and user-centered design; communication with providers; and establishing policies, frameworks, governance, and evaluation. Agency and context were examined from the perspective of residents, family members, care providers, and the long-term care organizations. Conclusions: There is a striking lack of evidence to justify the use of RTLS to improve the lives of residents and care providers in long-term care settings. More research related to RTLS use with cognitively impaired residents is required; this research should include longitudinal evaluation of end-to-end implementations that are developed using scientific theory and rigorous analysis of the functionality, efficiency, and effectiveness of these systems. Future research is required on the ethics of monitoring residents using RTLS and its impact on the privacy of residents and health care workers. ", doi="10.2196/22831", url="http://www.jmir.org/2021/1/e22831/", url="http://www.ncbi.nlm.nih.gov/pubmed/33470949" } @Article{info:doi/10.2196/25307, author="Palmdorf, Sarah and Stark, Lea Anna and Nadolny, Stephan and Elia{\ss}, Gerrit and Karlheim, Christoph and Kreisel, H. Stefan and Gruschka, Tristan and Trompetter, Eva and Dockweiler, Christoph", title="Technology-Assisted Home Care for People With Dementia and Their Relatives: Scoping Review", journal="JMIR Aging", year="2021", month="Jan", day="20", volume="4", number="1", pages="e25307", keywords="dementia", keywords="home care", keywords="assistive technologies", keywords="scoping review", abstract="Background: Assistive technologies for people with dementia and their relatives have the potential to ensure, improve, and facilitate home care and thereby enhance the health of the people caring or being cared for. The number and diversity of technologies and research have continuously increased over the past few decades. As a result, the research field has become complex. Objective: The goal of this scoping review was to provide an overview of the research on technology-assisted home care for people with dementia and their relatives in order to guide further research and technology development. Methods: A scoping review was conducted following a published framework and by searching 4 databases (MEDLINE, CINAHL, PsycInfo, and CENTRAL) for studies published between 2013 and 2018. We included qualitative and quantitative studies in English or German focusing on technologies that support people with dementia or their informal carers in the home care setting. Studies that targeted exclusively people with mild cognitive impairment, delirium, or health professionals were excluded as well as studies that solely consisted of assessments without implication for the people with dementia or their relatives and prototype developments. We mapped the research field regarding study design, study aim, setting, sample size, technology type, and technology aim, and we report relative and absolute frequencies. Results: From an initial 5328 records, we included 175 studies. We identified a variety of technology types including computers, telephones, smartphones, televisions, gaming consoles, monitoring devices, ambient assisted living, and robots. Assistive technologies were most commonly used by people with dementia (77/175, 44.0\%), followed by relatives (68/175, 38.9\%), and both target groups (30/175, 17.1\%). Their most frequent goals were to enable or improve care, provide therapy, or positively influence symptoms of people with dementia (eg, disorientation). The greatest proportions of studies were case studies and case series (72/175, 41.1\%) and randomized controlled trials (44/175, 25.1\%). The majority of studies reported small sample sizes of between 1 and 50 participants (122/175, 69.7\%). Furthermore, most of the studies analyzed the effectiveness (85/233, 36.5\%) of the technology, while others targeted feasibility or usability or were explorative. Conclusions: This review demonstrated the variety of technologies that support people with dementia and their relatives in the home care setting. Whereas this diversity provides the opportunity for needs-oriented technical solutions that fit individual care arrangements, it complicates the choice of the right technology. Therefore, research on the users' informational needs is required. Moreover, there is a need for larger studies on the technologies' effectiveness that could contribute to a higher acceptance and thus to a transition of technologies from research into the daily lives of people with dementia and their relatives. ", doi="10.2196/25307", url="http://aging.jmir.org/2021/1/e25307/", url="http://www.ncbi.nlm.nih.gov/pubmed/33470935" } @Article{info:doi/10.2196/22463, author="Ahmed, Mona and Mar{\'i}n, Mayca and Bou{\c{c}}a-Machado, Raquel and How, Daniella and Judica, Elda and Tropea, Peppino and Bentlage, Ellen and Brach, Michael", title="Investigating Users' and Other Stakeholders' Needs in the Development of a Personalized Integrated Care Platform (PROCare4Life) for Older People with Dementia or Parkinson Disease: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2021", month="Jan", day="12", volume="10", number="1", pages="e22463", keywords="dementia", keywords="older adults", keywords="neurodegenerative diseases", keywords="integrated care", keywords="health care technologies", keywords="user-centered design", abstract="Background: Dementias---including Alzheimer disease---and Parkinson disease profoundly impact the quality of life of older population members and their families. PROCare4Life (Personalized Integrated Care Promoting Quality of Life for Older Adults) is a European project that recognizes the benefit of technology-based integrated care models in improving the care coordination and the quality of life of these target groups. This project proposes an integrated, scalable, and interactive care platform targeting older people suffering from neurodegenerative diseases, their caregivers, and socio-health professionals. PROCare4Life adopts a user-centered design approach from the early stage and throughout platform development and implementation, during which the platform is designed and adapted to the needs and requirements of all the involved users. Objective: This paper presents the study protocol for investigating users' needs and requirements regarding the design of the proposed PROCare4Life platform. Methods: A mixed qualitative and quantitative study design is utilized, including online surveys, interviews, and workshops. The study aimed to recruit approximately 200 participants, including patients diagnosed with dementia or Parkinson disease, caregivers, socio-health professionals, and other stakeholders, from five different European countries: Germany, Italy, Portugal, Romania, and Spain. Results: The study took place between April and September 2020. Recruitment is now closed, and all the data have been collected and analyzed in order to be used in shaping the large-scale pilot phase of the PROCare4Life project. Results of the study are expected to be published in spring 2021. Conclusions: This paper charts the protocol for a user-centered design approach at the early stage of the PROCare4Life project in order to shape and influence an integrated health platform suitable for its intended target group and purpose. International Registered Report Identifier (IRRID): DERR1-10.2196/22463 ", doi="10.2196/22463", url="https://www.researchprotocols.org/2021/1/e22463", url="http://www.ncbi.nlm.nih.gov/pubmed/33433394" } @Article{info:doi/10.2196/25144, author="Moussavi, Zahra and Rutherford, Grant and Lithgow, Brian and Millikin, Colleen and Modirrousta, Mandana and Mansouri, Behzad and Wang, Xikui and Omelan, Craig and Fellows, Lesley and Fitzgerald, Paul and Koski, Lisa", title="Repeated Transcranial Magnetic Stimulation for Improving Cognition in Patients With Alzheimer Disease: Protocol for a Randomized, Double-Blind, Placebo-Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Jan", day="8", volume="10", number="1", pages="e25144", keywords="repetitive transcranial magnetic stimulation", keywords="Alzheimer disease", keywords="double blind", keywords="treatment", keywords="placebo controlled", keywords="randomized", abstract="Background: Alzheimer disease has no known cure. As existing pharmacologic interventions only modestly slow cognitive decline, there is a need for new treatments. Recent trials of repetitive transcranial magnetic stimulation (rTMS) have reported encouraging results for improving or stabilizing cognition in patients diagnosed with Alzheimer dementia. However, owing to small samples and lack of a well-controlled double-blind design, the results to date are inconclusive. This paper presents the protocol for a large placebo-controlled double-blind study designed with sufficient statistical rigor to measure the efficacy of rTMS treatment in patients with Alzheimer dementia. Objective: The objectives are to (1) recruit and enroll up to 200 eligible participants, (2) estimate the difference in treatment effects between active treatment and sham treatment, (3) estimate the difference in treatment effects between two doses of rTMS applications, (4) estimate the duration of treatment effects among responders to active rTMS treatment, and (5) estimate the effect of dementia severity on treatment outcomes among patients receiving active rTMS treatment. Methods: We have designed our study to be a double-blind, randomized, placebo-controlled clinical trial investigating the short- and long-term (up to 6 months) benefits of active rTMS treatment at two doses (10 sessions over 2 weeks and 20 sessions over 4 weeks) compared with sham rTMS treatment. The study will include patients aged ?55 years who are diagnosed with Alzheimer disease at an early to moderate stage and have no history of seizures and no major depression. The primary outcome measure is the change in the Alzheimer Disease Assessment Scale-Cognitive Subscale score from pretreatment to posttreatment. Secondary outcomes are changes in performance on tests of frontal lobe functioning (Stroop test and verbal fluency), changes in neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire), and changes in activities of daily living (Alzheimer Disease Co-operative Study-Activities of Daily Living Inventory). Tolerability of the intervention will be assessed using a modification of the Treatment Satisfaction Questionnaire for Medication. We assess participants at baseline and 3, 5, 8, 16, and 24 weeks after the intervention. Results: As of November 1, 2020, we have screened 523 individuals, out of which 133 were eligible and have been enrolled. Out of the 133 individuals, 104 have completed the study. Moreover, as of November 1, 2020, there has been no serious adverse event. We anticipate that rTMS will considerably improve cognitive function, with effects lasting up to 3 months. Moreover, we expect rTMS to be a well-tolerated treatment with no serious side effect. Conclusions: This protocol design will allow to address both the rTMS active treatment dose and its short- and long-term effects compared with sham treatment in large samples. Trial Registration: ClinicalTrials.gov NCT02908815; https://clinicaltrials.gov/ct2/show/NCT02908815 International Registered Report Identifier (IRRID): DERR1-10.2196/25144 ", doi="10.2196/25144", url="http://www.researchprotocols.org/2021/1/e25144/", url="http://www.ncbi.nlm.nih.gov/pubmed/33416500" } @Article{info:doi/10.2196/20225, author="Rivera-Rodriguez, Claudia and Cheung, Gary and Cullum, Sarah", title="Using Big Data to Estimate Dementia Prevalence in New Zealand: Protocol for an Observational Study", journal="JMIR Res Protoc", year="2021", month="Jan", day="6", volume="10", number="1", pages="e20225", keywords="routinely collected data", keywords="repeated measures", keywords="dementia", keywords="Alzheimer disease", keywords="modeling", keywords="complex sampling \emspace", abstract="Background: Dementia describes a cluster of symptoms that includes memory loss; difficulties with thinking, problem solving, or language; and functional impairment. Dementia can be caused by a number of neurodegenerative diseases, such as Alzheimer disease and cerebrovascular disease. Currently in New Zealand, most of the systematically collected and detailed information on dementia is obtained through a suite of International Residential Assessment Instrument (interRAI) assessments, including the home care, contact assessment, and long-term care facility versions. These versions of interRAI are standardized comprehensive geriatric assessments. Patients are referred to have an interRAI assessment by the Needs Assessment and Service Coordination (NASC) services after a series of screening processes. Previous estimates of the prevalence and costs of dementia in New Zealand have been based on international studies with different populations and health and social care systems. This new local knowledge will have implications for estimating the demographic distribution and socioeconomic impact of dementia in New Zealand. Objective: This study investigates the prevalence of dementia, risk factors for dementia, and drivers of the informal cost of dementia among people registered in the NASC database in New Zealand. Methods: This study aims to analyze secondary data routinely collected by the NASC and interRAI (home care and contact assessment versions) databases between July 1, 2014, and July 1, 2019, in New Zealand. The databases will be linked to produce an integrated data set, which will be used to (1) investigate the sociodemographic and clinical risk factors associated with dementia and other neurological conditions, (2) estimate the prevalence of dementia using weighting methods for complex samples, and (3) identify the cost of informal care per client (in number of hours of care provided by unpaid carers) and the drivers of such costs. We will use design-based survey methods for the estimation of prevalence and generalized estimating equations for regression models and correlated and longitudinal data. Results: The results will provide much needed statistics regarding dementia prevalence and risk factors and the cost of informal care for people living with dementia in New Zealand. Potential health inequities for different ethnic groups will be highlighted, which can then be used by decision makers to inform the development of policy and practice. Conclusions: As of November 2020, there were no dementia prevalence studies or studies on informal care costs of dementia using national data from New Zealand. All existing studies have used data from other populations with substantially different demographic distributions. This study will give insight into the actual prevalence, risk factors, and informal care costs of dementia for the population with support needs in New Zealand. It will provide valuable information to improve health outcomes and better inform policy and planning. International Registered Report Identifier (IRRID): DERR1-10.2196/20225 ", doi="10.2196/20225", url="https://www.researchprotocols.org/2021/1/e20225", url="http://www.ncbi.nlm.nih.gov/pubmed/33404510" } @Article{info:doi/10.2196/25351, author="Mace, A. Ryan and Doorley, D. James and Popok, J. Paula and Vranceanu, Ana-Maria", title="Live Video Adaptations to a Mind-Body Activity Program for Chronic Pain and Cognitive Decline: Protocol for the Virtual Active Brains Study", journal="JMIR Res Protoc", year="2021", month="Jan", day="4", volume="10", number="1", pages="e25351", keywords="chronic pain", keywords="cognitive decline", keywords="physical activity", keywords="mind-body therapies", keywords="aged", keywords="telemedicine", keywords="mobile phone", abstract="Background: Chronic pain (CP) and cognitive decline (CD) are costly, challenging to treat, prevalent among older adults, and worsen each other over time. We are iteratively developing Active Brains-Fitbit (AB-F), a live video program for older adults with CP and CD that teaches mind-body skills and gradual increases in step count. AB-F has demonstrated feasibility; acceptability; and signs of improvement in emotional, physical, and cognitive functions when delivered in person to older adults. Objective: We are conducting a feasibility randomized controlled trial (RCT) of AB-F versus a time- and dose-matched educational control (health enhancement program [HEP]) in older adults with CP and CD. Here, we describe virtual adaptions to our study protocol, manualized treatments, evaluation plan, and study design in response to feedback from former participants and COVID-19. We will evaluate the feasibility benchmarks and the potential of AB-F to improve physical, emotional, and cognitive functions. Methods: This is a single-blind pilot RCT. Participants are randomized to AB-F or HEP. Patients are recruited through pain clinic referrals, institutional registries, and flyers. Interested participants are screened for eligibility via telephone and provide electronic informed consent. After randomization, participants are mailed all study documents, including their treatment manual, an ActiGraph accelerometer, and a Fitbit (separate envelope for AB-F only). Both conditions are manualized and delivered over 8 weekly sessions via Zoom. Participants complete self-report and performance-based (6-min walk test and Montreal Cognitive Assessment) outcome measures via Zoom at baseline and post intervention. Primary outcomes are a priori set feasibility (recruitment, quantitative measures, and adherence), acceptability, credibility, expectancy, and satisfaction benchmarks. Secondary outcomes are physical, cognitive, and emotional functions as well as intervention targets (social function, pain intensity, pain-specific coping, and mindfulness). Results: The trial is ongoing. We have recruited 21 participants (10 AB-F and 11 HEP) across 2 rounds. Only 2 participants have withdrawn (1 before baseline and 1 before the first session). All 19 remaining participants have completed the baseline assessment. In the first round, attendance is high (11 out of 12 participants completed all 4 sessions so far), and AB-F participants are adherent to their Fitbit and step goals (5 out of 6 participants). Conclusions: Preliminary findings are promising for the feasibility of our completely virtual AB-F intervention. However, these findings need to be confirmed at the trial conclusion. This study will answer important questions about the feasibility of delivering a completely virtual mind-body activity program to older adults with comorbid CP and CD, which, to our knowledge, is unprecedented. Details on integrating multiple digital platforms for virtual assessments and intervention delivery will inform treatment development for older adults and those with comorbid CP and CD, which is crucial during the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04044183; https://clinicaltrials.gov/ct2/show/NCT04044183 International Registered Report Identifier (IRRID): DERR1-10.2196/25351 ", doi="10.2196/25351", url="https://www.researchprotocols.org/2021/1/e25351", url="http://www.ncbi.nlm.nih.gov/pubmed/33208301" } @Article{info:doi/10.2196/17332, author="Chan, C. Joyce Y. and Wong, Adrian and Yiu, Brian and Mok, Hazel and Lam, Patti and Kwan, Pauline and Chan, Amany and Mok, T. Vincent C. and Tsoi, F. Kelvin K. and Kwok, Y. Timothy C.", title="Electronic Cognitive Screen Technology for Screening Older Adults With Dementia and Mild Cognitive Impairment in a Community Setting: Development and Validation Study", journal="J Med Internet Res", year="2020", month="Dec", day="18", volume="22", number="12", pages="e17332", keywords="EC-Screen", keywords="cognitive screening", keywords="dementia", keywords="mild cognitive impairment", abstract="Background: A digital cognitive test can be a useful and quick tool for the screening of cognitive impairment. Previous studies have shown that the diagnostic performance of digital cognitive tests is comparable with that of conventional paper-and-pencil tests. However, the use of commercially available digital cognitive tests is not common in Hong Kong, which may be due to the high cost of the tests and the language barrier. Thus, we developed a brief and user-friendly digital cognitive test called the Electronic Cognitive Screen (EC-Screen) for the detection of mild cognitive impairment (MCI) and dementia of older adults. Objective: The aim of this study was to evaluate the performance of the EC-Screen for the detection of MCI and dementia in older adults. Methods: The EC-Screen is a brief digital cognitive test that has been adapted from the Rapid Cognitive Screen test. The EC-Screen uses a cloud-based platform and runs on a tablet. Participants with MCI, dementia, and cognitively healthy controls were recruited from research clinics and the community. The outcomes were the performance of the EC-Screen in distinguishing participants with MCI and dementia from controls, and in distinguishing participants with dementia from those with MCI and controls. The cohort was randomly split into derivation and validation cohorts based on the participants' disease group. In the derivation cohort, the regression-derived score of the EC-Screen was calculated using binomial logistic regression. Two predictive models were produced. The first model was used to distinguish participants with MCI and dementia from controls, and the second model was used to distinguish participants with dementia from those with MCI and controls. Receiver operating characteristic curves were constructed and the areas under the curves (AUCs) were calculated. The performances of the two predictive models were tested using the validation cohorts. The relationship between the EC-Screen and paper-and-pencil Montreal Cognitive Assessment-Hong Kong version (HK-MoCA) was evaluated by the Pearson correlation coefficient. Results: A total of 126 controls, 54 participants with MCI, and 63 participants with dementia were included in the study. In differentiating participants with MCI and dementia from controls, the AUC of the EC-Screen in the derivation and validation cohorts was 0.87 and 0.84, respectively. The optimal sensitivity and specificity in the derivation cohorts were 0.81 and 0.80, respectively. In differentiating participants with dementia from those with MCI and controls, the AUC of the derivation and validation cohorts was 0.90 and 0.88, respectively. The optimal sensitivity and specificity in the derivation cohort were 0.83 and 0.83, respectively. There was a significant correlation between the EC-Screen and HK-MoCA (r=--0.67, P<.001). Conclusions: The EC-Screen is suggested to be a promising tool for the detection of MCI and dementia. This test can be self-administered or assisted by a nonprofessional staff or family member. Therefore, the EC-Screen can be a useful tool for case finding in primary health care and community settings. ", doi="10.2196/17332", url="http://www.jmir.org/2020/12/e17332/", url="http://www.ncbi.nlm.nih.gov/pubmed/33337341" } @Article{info:doi/10.2196/23904, author="Levinson, J. Anthony and Bousfield, John and Douglas, William and Ayers, Stephanie and Sztramko, Richard", title="A Novel Educational Prescription Web-Based Application to Support Education for Caregivers of People Living With Dementia: Development and Usability Study With Clinicians", journal="JMIR Hum Factors", year="2020", month="Dec", day="4", volume="7", number="4", pages="e23904", keywords="dementia", keywords="caregiver", keywords="education prescription", keywords="online education", keywords="internet", keywords="eHealth", keywords="knowledge translation", keywords="implementation science", keywords="scale and spread", abstract="Background: It is estimated that 564,000 Canadians are currently living with dementia and there are approximately 486,000 to 1.1 million informal family/friend caregivers. Family/friend caregivers often receive little to no education or training about dementia but are expected to provide ongoing support for a complex condition. Web-based family/friend caregiver interventions may be helpful, but little is known about how best to implement them. Objective: The objectives of this study were to 1) design and develop a novel education prescription application to help scale and spread web-based dementia education to family/friend caregivers, 2) conduct user testing, and 3) conduct a larger-scale field trial. Methods: A novel education prescription web-based application was designed and developed. Initial user testing used task completion and the ``think aloud'' technique with a small sample of representative clinicians who work with people living with dementia and family/friend caregivers. Following iterative incorporation of feedback, a larger field trial was conducted with a convenience sample of clinicians. Account invitations were sent to 55 clinicians and, following a 2-month trial period, surveys were administered to participants including the System Usability Scale and the Net Promoter Score. Results: During the initial user testing phase, participants (N=7) from representative disciplines easily completed associated tasks, and had very positive feedback with respect to the usability of the application. The System Usability Scale score during this phase was 91.4. Suggestions from feedback were incorporated into the application. During the larger field trial phase, participants (total N=55; activated account n=17; did not activate account n=38) were given access to the iGeriCare education prescription application. During this period, 2 participants created educational prescriptions; a total of 3 educational prescriptions were sent. Survey completers who did not activate their account (n=5) identified that their lack of use was due to time constraints, competing priorities, or forgetting to use the application. Survey completers who activated their account (n=5) identified their lower use was due to lack of time, lack of eligible family/friend caregivers during trial period, and competing priorities due to the COVID-19 pandemic. The System Usability Scale score during this phase was 78.75, and the Net Promoter Score was 50. Conclusions: Study findings indicate a generally positive response for the usability of a web-based application for clinicians to prescribe dementia education to family/friend caregivers. The dissonance between the promising data and widespread enthusiasm for the design and purpose of the education prescription application found in the initial user testing phase and subsequent lack of significant adoption in the field trial represents both an important lesson for other novel health technologies and a potential area for further investigation. Further research is required to better understand factors associated with implementation of this type of intervention and impact on dissemination of education to family/friend caregivers. ", doi="10.2196/23904", url="http://humanfactors.jmir.org/2020/4/e23904/", url="http://www.ncbi.nlm.nih.gov/pubmed/33275103" } @Article{info:doi/10.2196/17531, author="Rai, Kaur Harleen and Cavalcanti Barroso, Aline and Yates, Lauren and Schneider, Justine and Orrell, Martin", title="Involvement of People With Dementia in the Development of Technology-Based Interventions: Narrative Synthesis Review and Best Practice Guidelines", journal="J Med Internet Res", year="2020", month="Dec", day="3", volume="22", number="12", pages="e17531", keywords="dementia", keywords="technology", keywords="co-production", keywords="participation", keywords="development", abstract="Background: Technology can be helpful in supporting people with dementia in their daily lives. However, people with dementia are often not fully involved in the development process of new technology. This lack of involvement of people with dementia in developing technology-based interventions can lead to the implementation of faulty and less suitable technology. Objective: This systematic review aims to evaluate current approaches and create best practice guidelines for involving people with dementia in developing technology-based interventions. Methods: A systematic search was conducted in January 2019 in the following databases: EMBASE (Excerpta Medica database), PsycINFO, MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulated Index to Nursing and Allied Health Literature), and Web of Science. The search strategy included search terms in 3 categories: dementia, technology, and involvement in development. Narrative synthesis wove the evidence together in a structured approach. Results: A total of 21 studies met the inclusion criteria. Most studies involved people with dementia in a single phase, such as development (n=10), feasibility and piloting (n=7), or evaluation (n=1). Only 3 studies described involvement in multiple phases. Frequently used methods for assessing involvement included focus groups, interviews, observations, and user tests. Conclusions: Most studies concluded that it was both necessary and feasible to involve people with dementia, which can be optimized by having the right prerequisites in place, ensuring that technology meets standards of reliability and stability, and providing a positive research experience for participants. Best practice guidelines for the involvement of people with dementia in developing technology-based interventions are described. ", doi="10.2196/17531", url="https://www.jmir.org/2020/12/e17531", url="http://www.ncbi.nlm.nih.gov/pubmed/33270034" } @Article{info:doi/10.2196/20430, author="Boujut, Arnaud and Mellah, Samira and Lussier, Maxime and Maltezos, Samantha and Verty, Valeyry Lynn and Bherer, Louis and Belleville, Sylvie", title="Assessing the Effect of Training on the Cognition and Brain of Older Adults: Protocol for a Three-Arm Randomized Double-Blind Controlled Trial (ACTOP)", journal="JMIR Res Protoc", year="2020", month="Nov", day="24", volume="9", number="11", pages="e20430", keywords="cognitive training", keywords="working memory", keywords="brain plasticity", keywords="aging", keywords="cognitive reserve", abstract="Background: To prevent age-related cognitive impairment, many intervention programs offer exercises targeting different central cognitive processes. However, the effects of different process-based training programs are rarely compared within equivalent experimental designs. Objective: Using a randomized double-blind controlled trial, this project aims to examine and compare the impact of 2 process-based interventions, inhibition and updating, on the cognition and brain of older adults. Methods: A total of 90 healthy older adults were randomly assigned to 1 of 3 training conditions: (1) inhibition (Stroop-like exercises), (2) updating (N-back-type exercises), and (3) control active (quiz game exercise). Training was provided in 12 half-hour sessions over 4 weeks. First, the performance gain observed will be measured on the trained tasks. We will then determine the extent of transfer of gain on (1) untrained tasks that rely on the same cognitive process, (2) complex working memory (WM) measurements hypothesized to involve 1 of the 2 trained processes, and (3) virtual reality tasks that were designed to mimic real-life situations that require WM. We will assess whether training increases cortical volume given that the volume of the cortex is determined by cortical area and thickness in regions known to be involved in WM or changes task-related brain activation patterns measured with functional magnetic resonance imaging. Dose effects will be examined by measuring outcomes at different time points during training. We will also determine whether individual characteristics moderate the effect of training on cognitive and cerebral outcomes. Finally, we will evaluate whether training reduces the age-related deficit on transfer and brain outcomes, by comparing study participants to a group of 30 younger adults. Results: The project was funded in January 2017; enrollment began in October 2017 and data collection was completed in April 2019. Data analysis has begun in June 2020 and the first results should be published by the end of 2020 or early 2021. Conclusions: The results of this study will help understand the relative efficacy of 2 attentional control interventions on the cognition and the brain of older adults, as well as the moderating role of individual characteristics on training efficiency and transfer. Trial Registration: ClinicalTrials.gov NCT03532113; https://clinicaltrials.gov/ct2/show/NCT03532113 International Registered Report Identifier (IRRID): DERR1-10.2196/20430 ", doi="10.2196/20430", url="http://www.researchprotocols.org/2020/11/e20430/", url="http://www.ncbi.nlm.nih.gov/pubmed/33231556" } @Article{info:doi/10.2196/17105, author="Rai, Kaur Harleen and Schneider, Justine and Orrell, Martin", title="An Individual Cognitive Stimulation Therapy App for People With Dementia: Development and Usability Study of Thinkability", journal="JMIR Aging", year="2020", month="Nov", day="16", volume="3", number="2", pages="e17105", keywords="dementia", keywords="cognitive stimulation therapy", keywords="eHealth", keywords="development", abstract="Background: There is a lack of technological resources for the mental stimulation and communication of people with dementia, which can be helpful in improving cognition and quality of life. Paper-based individual cognitive stimulation therapy (iCST) for people with dementia has the potential to be adapted to a touchscreen format. This can improve accessibility and provide mental stimulation using interactive features. There is a need for a rigorous and systematic approach toward development, leading to improved suitability and implementation of the intervention, so that more people can benefit from its use. Objective: This study aims to develop and investigate the usability of Thinkability, an iCST app that can be used by people with dementia and carers on touchscreen tablets. Methods: The Medical Research Council framework for evaluating complex interventions and the Centre for eHealth Research roadmap served as frameworks for the stages of intervention and technology development. The development of the iCST app itself adopted an agile approach with elements from action research. Hence, it was developed in 3 successive sprints and was evaluated by relevant stakeholders at each sprint. Sprint 1 included 2 patient and public involvement (PPI) consultation meetings, sprint 2 included 1 PPI consultation meeting, and 4 focus groups and 10 individual interviews were organized in sprint 3. A feasibility trial is currently underway. Results: The findings from each sprint were used to inform the development. Sprint 1 helped to identify the relevant evidence base and explored the attitudes of people with dementia and carers toward a potential iCST app. In sprint 2, an initial prototype was evaluated in a small PPI consultation meeting. In sprint 3, feedback was gathered through a qualitative study on the quality and perceived effectiveness of the iCST app. It was well received by people with dementia and carers. A need for more updated and personalized content was highlighted. Conclusions: This study proves that an agile approach toward technology development involving all relevant stakeholders is effective in creating suitable technology. Adding to our previous knowledge of noncomputerized cognitive stimulation therapy, the release of the iCST app will make this psychosocial intervention accessible to more users worldwide. ", doi="10.2196/17105", url="http://aging.jmir.org/2020/2/e17105/", url="http://www.ncbi.nlm.nih.gov/pubmed/33196451" } @Article{info:doi/10.2196/17720, author="Jurkeviciute, Monika and van Velsen, Lex and Eriksson, Henrik and Lifvergren, Svante and Trimarchi, Davide Pietro and Andin, Ulla and Svensson, Johan", title="Identifying the Value of an eHealth Intervention Aimed at Cognitive Impairments: Observational Study in Different Contexts and Service Models", journal="J Med Internet Res", year="2020", month="Oct", day="8", volume="22", number="10", pages="e17720", keywords="eHealth value", keywords="evaluation of value", keywords="eHealth intervention", keywords="cognitive impairment", keywords="role of context", keywords="cost benefit", abstract="Background: Value is one of the central concepts in health care, but it is vague within the field of summative eHealth evaluations. Moreover, the role of context in explaining the value is underexplored, and there is no explicit framework guiding the evaluation of the value of eHealth interventions. Hence, different studies conceptualize and operationalize value in different ways, ranging from measuring outcomes such as clinical efficacy or behavior change of patients or professionals to measuring the perceptions of various stakeholders or in economic terms. Objective: The objective of our study is to identify contextual factors that determine similarities and differences in the value of an eHealth intervention between two contexts. We also aim to reflect on and contribute to the discussion about the specification, assessment, and relativity of the ``value'' concept in the evaluation of eHealth interventions. Methods: The study concerned a 6-month eHealth intervention targeted at elderly patients (n=107) diagnosed with cognitive impairment in Italy and Sweden. The intervention introduced a case manager role and an eHealth platform to provide remote monitoring and coaching services to the patients. A model for evaluating the value of eHealth interventions was designed as monetary and nonmonetary benefits and sacrifices, based on the value conceptualizations in eHealth and marketing literature. The data was collected using the Mini--Mental State Examination (MMSE), the clock drawing test, and the 5-level EQ-5D (EQ-5D-5L). Semistructured interviews were conducted with patients and health care professionals. Monetary data was collected from the health care and technology providers. Results: The value of an eHealth intervention applied to similar types of populations but differed in different contexts. In Sweden, patients improved cognitive performance (MMSE mean 0.85, SD 1.62, P<.001), reduced anxiety (EQ-5D-5L mean 0.16, SD 0.54, P=.046), perceived their health better (EQ-5D-5L VAS scale mean 2.6, SD 9.7, P=.035), and both patients and health care professionals were satisfied with the care. However, the Swedish service model demonstrated an increased cost, higher workload for health care professionals, and the intervention was not cost-efficient. In Italy, the patients were satisfied with the care received, and the health care professionals felt empowered and had an acceptable workload. Moreover, the intervention was cost-effective. However, clinical efficacy and quality of life improvements have not been observed. We identified 6 factors that influence the value of eHealth intervention in a particular context: (1) service delivery design of the intervention (process of delivery), (2) organizational setup of the intervention (ie, organizational structure and professionals involved), (3) cost of different treatments, (4) hourly rates of staff for delivering the intervention, (5) lifestyle habits of the population (eg, how physically active they were in their daily life and if they were living alone or with family), and (6) local preferences on the quality of patient care. Conclusions: Value in the assessments of eHealth interventions need to be considered beyond economic terms, perceptions, or behavior changes. To obtain a holistic view of the value created, it needs to be operationalized into monetary and nonmonetary outcomes, categorizing these into benefits and sacrifices. ", doi="10.2196/17720", url="http://www.jmir.org/2020/10/e17720/", url="http://www.ncbi.nlm.nih.gov/pubmed/33064089" } @Article{info:doi/10.2196/19852, author="Bartels, Laureen Sara and van Knippenberg, M. Rosalia J. and Malinowsky, Camilla and Verhey, J. Frans R. and de Vugt, E. Marjolein", title="Smartphone-Based Experience Sampling in People With Mild Cognitive Impairment: Feasibility and Usability Study", journal="JMIR Aging", year="2020", month="Oct", day="16", volume="3", number="2", pages="e19852", keywords="experience sampling method", keywords="mild cognitive impairment", keywords="cognition", keywords="feasibility", keywords="smartphones", abstract="Background: Daily functioning of people with cognitive disorders such as mild cognitive impairment (MCI) is usually depicted by retrospective questionnaires, which can be memory-biased and neglect fluctuations over time or contexts. Objective: This study examines the feasibility and usability of applying the experience sampling method (ESM) in people with MCI to provide a detailed and dynamic picture of behavioral, emotional, and cognitive patterns in everyday life. Methods: For 6 consecutive days, 21 people with MCI used an ESM app on their smartphones. At 8 semi-random timepoints per day, participants filled in momentary questionnaires on mood, activities, social context, and subjective cognitive complaints. Feasibility was determined through self-reports and observable human-technology interactions. Usability was demonstrated on an individual and group level. Results: Of the 21 participants, 3 dropped out due to forgetting to carry their smartphones or forgetting the study instructions. In the remaining 18 individuals, the compliance rate was high, at 78.7\%. Participants reported that momentary questions reflected their daily experiences well. Of the 18 participants, 13 (72\%) experienced the increase in awareness of their own memory functions as pleasant or neutral. Conclusions: Support was found for the general feasibility of smartphone-based experience sampling in people with MCI. However, many older adults with MCI are currently not in possession of smartphones, and study adherence seems challenging for a minority of individuals. Momentary data can increase the insights into daily patterns and may guide the person-tailored development of self-management strategies in clinical settings. ", doi="10.2196/19852", url="http://aging.jmir.org/2020/2/e19852/", url="http://www.ncbi.nlm.nih.gov/pubmed/33064084" } @Article{info:doi/10.2196/18971, author="Broome, Elizabeth Emma and Coleston-Shields, Maria Donna and Dening, Tom and Moniz-Cook, Esme and Poland, Fiona and Stanyon, Miriam and Orrell, Martin", title="AQUEDUCT Intervention for Crisis Team Quality and Effectiveness in Dementia: Protocol for a Feasibility Study", journal="JMIR Res Protoc", year="2020", month="Oct", day="13", volume="9", number="10", pages="e18971", keywords="dementia", keywords="crisis", keywords="mental health", keywords="community services", keywords="feasibility study", abstract="Background: Specialist community teams often support people with dementia who experience crisis. These teams may vary in composition and models of practice, which presents challenges when evaluating their effectiveness. A best practice model for dementia crisis services could be used by teams to improve the quality and effectiveness of the care they deliver. Objective: The aim of this study is to examine the feasibility of conducting a large-scale randomized controlled trial comparing the AQUEDUCT (Achieving Quality and Effectiveness in Dementia Using Crisis Teams) Resource Kit intervention to treatment as usual. Methods: This is a multisite feasibility study in preparation for a future randomized controlled trial. Up to 54 people with dementia (and their carers) and 40 practitioners will be recruited from 4 geographically widespread teams managing crisis in dementia. Quantitative outcomes will be recorded at baseline and at discharge. This study will also involve a nested health economic substudy and qualitative research to examine participant experiences of the intervention and acceptability of research procedures. Results: Ethical approval for this study was granted in July 2019. Participant recruitment began in September 2019, and as of September 2020, all data collection has been completed. Results of this study will establish the acceptability of the intervention, recruitment rates, and will assess the feasibility and appropriateness of the outcome measures in preparation for a large-scale randomized controlled trial. Conclusions: There is a need to evaluate the effectiveness of crisis intervention teams for older people with dementia. This is the first study to test the feasibility of an evidence-based best practice model for teams managing crisis in dementia. The results of this study will assist in the planning and delivery of a large-scale randomized controlled trial. International Registered Report Identifier (IRRID): DERR1-10.2196/18971 ", doi="10.2196/18971", url="http://www.researchprotocols.org/2020/10/e18971/", url="http://www.ncbi.nlm.nih.gov/pubmed/33048059" } @Article{info:doi/10.2196/18455, author="Amaefule, O. Chimezie and L{\"u}dtke, Stefan and Kirste, Thomas and Teipel, J. Stefan", title="Effect of Spatial Disorientation in a Virtual Environment on Gait and Vital Features in Patients with Dementia: Pilot Single-Blind Randomized Control Trial", journal="JMIR Serious Games", year="2020", month="Oct", day="8", volume="8", number="4", pages="e18455", keywords="spatial disorientation", keywords="activity recognition", keywords="wayfinding", keywords="wearable sensors", keywords="dementia", keywords="virtual reality", keywords="older adults", abstract="Background: Orientation deficits are among the most devastating consequences of early dementia. Digital navigation devices could overcome these deficits if adaptable to the user's needs (ie, provide situation-aware, proactive navigation assistance). To fulfill this task, systems need to automatically detect spatial disorientation from sensors in real time. Ideally, this would require field studies consisting of real-world navigation. However, such field studies can be challenging and are not guaranteed to cover sufficient instances of disorientation due to the large variability of real-world settings and a lack of control over the environment. Objective: Extending a foregoing field study, we aim to evaluate the feasibility of using a sophisticated virtual reality (VR) setup, which allows a more controlled observation of disorientation states and accompanying behavioral and physiological parameters in cognitively healthy older people and people with dementia. Methods: In this feasibility study, we described the experimental design and pilot outcomes of an ongoing study aimed at investigating the effect of disorientation on gait and selected physiological features in a virtual laboratory. We transferred a real-world navigation task to a treadmill-based virtual system for gait analysis. Disorientation was induced by deliberately manipulating landmarks in the VR projection. Associated responses in motion behavior and physiological parameters were recorded by sensors. Primary outcomes were variations in motion and physiological parameters, frequency of disorientation, and questionnaire-derived usability estimates (immersion and perceived control of the gait system) for our population of interest. At this time, the included participants were 9 cognitively healthy older participants [5/9 women, 4/9 men; mean age 70 years, SD 4.40; Mini--Mental State Examination (MMSE) mean 29, SD 0.70) and 4 participants with dementia (2/4 women, 2/4 men; mean age 78 years, SD 2.30 years; MMSE mean 20.50, SD 7.54). Recruitment is ongoing, with the aim of including 30 cognitively healthy older participants and 20 participants with dementia. Results: All 13 participants completed the experiment. Patients' route was adapted by shortening it relative to the original route. Average instances of disorientation were 21.40, 36.50, and 37.50 for the cognitively healthy older control, cognitively healthy older experimental participants, and participants with dementia, respectively. Questionnaire outcomes indicated that participants experienced adequate usability and immersion; 4.30 for presence, 3.73 for involvement, and 3.85 for realism of 7 possible points, indicating a good overall ability to cope with the experiment. Variations were also observed in motion and physiological parameters during instances of disorientation. Conclusions: This study presents the first feasibility outcomes of a study investigating the viability of using a sophisticated VR setup, based on an earlier real-world navigation study, to study spatial disorientation among cognitively healthy older people and people with dementia. Preliminary outcomes give confidence to the notion that our setup can be used to assess motion and physiological markers of disorientation, even in people with cognitive decline. Trial Registration: ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT04134806 ", doi="10.2196/18455", url="https://games.jmir.org/2020/4/e18455", url="http://www.ncbi.nlm.nih.gov/pubmed/33030436" } @Article{info:doi/10.2196/21264, author="Levinson, J. Anthony and Ayers, Stephanie and Butler, Lianna and Papaioannou, Alexandra and Marr, Sharon and Sztramko, Richard", title="Barriers and Facilitators to Implementing Web-Based Dementia Caregiver Education From the Clinician's Perspective: Qualitative Study", journal="JMIR Aging", year="2020", month="Oct", day="2", volume="3", number="2", pages="e21264", keywords="dementia", keywords="caregiver", keywords="online education", keywords="implementation science", keywords="internet", keywords="eHealth", abstract="Background: Internet-based dementia caregiver interventions have been shown to be effective for a range of caregiver outcomes; however, little is known about how to best implement them. We developed iGeriCare, an evidence-based, multimedia, web-based educational resource for family caregivers of people living with dementia. Objective: This study aims to obtain feedback and opinions from experts and clinicians involved in dementia care and caregiver education about 1 iGeriCare and 2 barriers and facilitators to implementing a web-based caregiver program. Methods: We carried out semistructured interviews with individuals who had a role in dementia care and/or caregiver education in several key stakeholder settings in Southern Ontario, Canada. We queried participants' perceptions of iGeriCare, caregiver education, the implementation process, and their experience with facilitators and barriers. Transcripts were coded and analyzed using a grounded theory approach. The themes that emerged were organized using the Consolidated Framework for Implementation Research. Results: A total of 12 participants from a range of disciplines described their perceptions of iGeriCare and identified barriers and facilitators to the implementation of the intervention. The intervention was generally perceived as a high-quality resource for caregiver education and support, with many stakeholders highlighting the relative advantage of a web-based format. The intervention was seen to meet dementia caregiver needs, partially because of its flexibility, accessibility, and compatibility within existing clinical workflows. In addition, the intervention helps to overcome time constraints for both caregivers and clinicians. Conclusions: Study findings indicate a generally positive response to the use of internet-based interventions for dementia caregiver education. Results suggest that iGeriCare may be a useful clinical resource to complement traditional face-to-face and print material--based caregiver education. More comprehensive studies are required to identify the effectiveness and longevity of web-based caregiver education interventions and to better understand barriers and facilitators with regard to the implementation of technology-enhanced caregiver educational interventions in various health care settings. ", doi="10.2196/21264", url="http://aging.jmir.org/2020/2/e21264/", url="http://www.ncbi.nlm.nih.gov/pubmed/33006563" } @Article{info:doi/10.2196/19880, author="Frost, Emily and Porat, Talya and Malhotra, Paresh and Picinali, Lorenzo", title="A Novel Auditory-Cognitive Training App for Delaying or Preventing the Onset of Dementia: Participatory Design With Stakeholders", journal="JMIR Hum Factors", year="2020", month="Sep", day="30", volume="7", number="3", pages="e19880", keywords="cognitive decline", keywords="mobile phone", keywords="hearing loss", abstract="Background: Multiple gaming apps exist under the dementia umbrella for skills such as navigation; however, an app to specifically investigate the role of hearing loss in the process of cognitive decline is yet to be designed. There is a demonstrable gap in the utilization of games to further the knowledge of the potential relationship between hearing loss and dementia. Objective: This study aims to identify the needs, facilitators, and barriers in designing a novel auditory-cognitive training gaming app. Methods: A participatory design approach was used to engage key stakeholders across audiology and cognitive disorder specialties. Two rounds, including paired semistructured interviews and focus groups, were completed and thematically analyzed. Results: A total of 18 stakeholders participated, and 6 themes were identified to inform the next stage of app development. These included congruence with hobbies, life getting in the way, motivational challenge, accessibility, addictive competition, and realism. Conclusions: The findings can now be implemented in the development of the app. The app will be evaluated against outcome measures of speech listening in noise, cognitive and attentional tasks, quality of life, and usability. ", doi="10.2196/19880", url="http://humanfactors.jmir.org/2020/3/e19880/", url="http://www.ncbi.nlm.nih.gov/pubmed/32996884" } @Article{info:doi/10.2196/21881, author="Wilson, Rozanne and Small, Jeff", title="Care Staff Perspectives on Using Mobile Technology to Support Communication in Long-Term Care: Mixed Methods Study", journal="JMIR Nursing", year="2020", month="Sep", day="29", volume="3", number="1", pages="e21881", keywords="mobile apps", keywords="mobile phone", keywords="caregivers", keywords="dementia", keywords="communication", keywords="patient care", abstract="Background: Long-term care (LTC) homes provide 24-hour care for people living with complex care needs. LTC staff assist older adults living with chronic conditions such as Alzheimer disease, related dementias, and stroke, which can cause communication disorders. In addition to the complex cognitive challenges that can impact communication, further difficulties can arise from cultural-language differences between care staff and residents. Breakdowns in caregiver-resident communication can negatively impact the delivery of person-centered care. Recent advances in mobile technology, specifically mobile devices (tablets and smartphones) and their software apps, offer innovative solutions for supporting everyday communication between care staff and residents. To date, little is known about the care staff's perspectives on the different ways that mobile technology could be used to support communication with residents. Objective: This study aims to identify care staff's perspectives on the different ways of using devices and apps to support everyday communication with adults living in LTC homes and the priority care areas for using mobile technology to support communication with residents. Methods: This descriptive study employed concept mapping methods to explore care staff's perspectives about ways of using mobile technology with residents and to identify the usefulness, practicality, and probable uses of mobile technology to support communication in priority care areas. Concept mapping is an integrated mixed methods approach (qualitative and quantitative) that uses a structured process to identify priority areas for planning and evaluation. In total, 13 care staff from a single LTC home participated in this study. Concept mapping includes 2 main data collection phases: (1) statement generations through brainstorming and (2) statement structuring through sorting and rating. Brainstorming took place in person in a group session, whereas sorting and rating occurred individually after the brainstorming session. Concept mapping data were analyzed using multidimensional scaling and cluster analysis to generate numerous interpretable data maps and displays. Results: Participants generated 67 unique statements during the brainstorming session. Following the sorting and rating of the statements, a concept map analysis was performed. In total, 5 clusters were identified: (1) connect, (2) care management, (3) facilitate, (4) caregiving, and (5) overcoming barriers. Although all 5 clusters were rated as useful, with a mean score of 4.1 to 4.5 (Likert: 1-5), the care staff rated cluster 2 (care management) as highest on usefulness, practicality, and probable use of mobile technology to support communication in LTC. Conclusions: This study provided insight into the viewpoints of care staff regarding the different ways mobile technology could be used to support caregiver-resident communication in LTC. Our findings suggest that care management, facilitating communication, and overcoming barriers are 3 priority target areas for implementing mobile health interventions to promote person-centered care and resident-centered care. ", doi="10.2196/21881", url="https://nursing.jmir.org/2020/1/e21881/" } @Article{info:doi/10.2196/19431, author="Anstey, J. Kaarin and Cherbuin, Nicolas and Kim, Sarang and McMaster, Mitchell and D'Este, Catherine and Lautenschlager, Nicola and Rebok, George and McRae, Ian and Torres, J. Susan and Cox, L. Kay and Pond, Dimity Constance", title="An Internet-Based Intervention Augmented With a Diet and Physical Activity Consultation to Decrease the Risk of Dementia in At-Risk Adults in a Primary Care Setting: Pragmatic Randomized Controlled Trial", journal="J Med Internet Res", year="2020", month="Sep", day="24", volume="22", number="9", pages="e19431", keywords="risk reduction behavior", keywords="dementia prevention \& control", keywords="primary prevention", keywords="pragmatic clinical trial", keywords="prevention", keywords="primary care", abstract="Background: There is a need to develop interventions to reduce the risk of dementia in the community by addressing lifestyle factors and chronic diseases over the adult life course. Objective: This study aims to evaluate a multidomain dementia risk reduction intervention, Body Brain Life in General Practice (BBL-GP), targeting at-risk adults in primary care. Methods: A pragmatic, parallel, three-arm randomized trial involving 125 adults aged 18 years or older (86/125, 68.8\% female) with a BMI of ?25 kg/m2 or a chronic health condition recruited from general practices was conducted. The arms included (1) BBL-GP, a web-based intervention augmented with an in-person diet and physical activity consultation; (2) a single clinician--led group, Lifestyle Modification Program (LMP); and (3) a web-based control. The primary outcome was the Australian National University Alzheimer Disease Risk Index Short Form (ANU-ADRI-SF). Results: Baseline assessments were conducted on 128 participants. A total of 125 participants were randomized to 3 groups (BBL-GP=42, LMP=41, and control=42). At immediate, week 18, week 36, and week 62 follow-ups, the completion rates were 43\% (18/42), 57\% (24/42), 48\% (20/42), and 48\% (20/42), respectively, for the BBL-GP group; 71\% (29/41), 68\% (28/41), 68\% (28/41), and 51\% (21/41), respectively, for the LMP group; and 62\% (26/42), 69\% (29/42), 60\% (25/42), and 60\% (25/42), respectively, for the control group. The primary outcome of the ANU-ADRI-SF score was lower for the BBL-GP group than the control group at all follow-ups. These comparisons were all significant at the 5\% level for estimates adjusted for baseline differences (immediate: difference in means ?3.86, 95\% CI ?6.81 to ?0.90, P=.01; week 18: difference in means ?4.05, 95\% CI ?6.81 to ?1.28, P<.001; week 36: difference in means ?4.99, 95\% CI ?8.04 to ?1.94, P<.001; and week 62: difference in means ?4.62, 95\% CI ?7.62 to ?1.62, P<.001). Conclusions: A web-based multidomain dementia risk reduction program augmented with allied health consultations administered within the general practice context can reduce dementia risk exposure for at least 15 months. This study was limited by a small sample size, and replication on a larger sample with longer follow-up will strengthen the results. Trial Registration: Australian clinical trials registration number (ACTRN): 12616000868482; https://anzctr.org.au/ACTRN12616000868482.aspx. ", doi="10.2196/19431", url="http://www.jmir.org/2020/9/e19431/", url="http://www.ncbi.nlm.nih.gov/pubmed/32969833" } @Article{info:doi/10.2196/19579, author="Campbell, M. Laura and Paolillo, W. Emily and Heaton, Anne and Tang, Bin and Depp, A. Colin and Granholm, Eric and Heaton, K. Robert and Swendsen, Joel and Moore, J. David and Moore, C. Raeanne", title="Daily Activities Related to Mobile Cognitive Performance in Middle-Aged and Older Adults: An Ecological Momentary Cognitive Assessment Study", journal="JMIR Mhealth Uhealth", year="2020", month="Sep", day="24", volume="8", number="9", pages="e19579", keywords="ecological momentary assessment", keywords="daily functioning", keywords="telemedicine", keywords="digital health", keywords="neuropsychological test", keywords="cognition", keywords="HIV", keywords="aging", keywords="mobile phone", abstract="Background: Daily activities have been associated with neurocognitive performance. However, much of this research has used in-person neuropsychological testing that requires participants to travel to a laboratory or clinic, which may not always be feasible and does not allow for the examination of real-time relationships between cognition and behavior. Thus, there is a need to understand the real-time relationship between activities in the real world and neurocognitive functioning to improve tracking of symptoms or disease states and aid in the early identification of neurocognitive deficits among at-risk individuals. Objective: We used a smartphone-based ecological momentary cognitive assessment (EMCA) platform to examine real-time relationships between daily activities and neurocognitive performance (executive functioning and verbal learning) in the everyday environment of middle-aged and older adults with and without HIV. Methods: A total of 103 adults aged 50-74 years (67 persons with HIV; mean age 59 years, SD 6.4) were recruited from the University of California, San Diego HIV Neurobehavioral Research Program and the San Diego community. Participants completed our EMCA protocol for 14 days. Participants reported their current daily activities 4 times per day; following 2 of the 4 daily ecological momentary assessment (EMA) surveys, participants were administered the mobile Color-Word Interference Test (mCWIT) and mobile Verbal Learning Test (mVLT), each once per day. Activities were categorized into cognitively stimulating activities, passive leisure activities, and instrumental activities of daily living (IADLs). We used multilevel modeling to examine the same-survey and lagged within-person and between-person effects of each activity type on mobile cognitive performance. Results: On average, participants completed 91\% of the EMA surveys, 85\% of the mCWIT trials, and 80\% of the mVLT trials, and they reported engaging in cognitively stimulating activities on 17\% of surveys, passive leisure activities on 33\% of surveys, and IADLs on 20\% of surveys. Adherence and activity percentages did not differ by HIV status. Within-persons, engagement in cognitively stimulating activities was associated with better mCWIT performance ($\beta$=?1.12; P=.007), whereas engagement in passive leisure activities was associated with worse mCWIT performance ($\beta$=.94; P=.005). There were no lagged associations. At the aggregate between-person level, a greater percentage of time spent in cognitively stimulating activities was associated with better mean mVLT performance ($\beta$=.07; P=.02), whereas a greater percentage of time spent in passive leisure activities was associated with worse mean mVLT performance ($\beta$=?.07; P=.01). IADLs were not associated with mCWIT or mVLT performance. Conclusions: Smartphones present unique opportunities for assessing neurocognitive performance and behavior in middle-aged and older adults' own environment. Measurement of cognition and daily functioning outside of clinical settings may generate novel insights on the dynamic association of daily behaviors and neurocognitive performance and may add new dimensions to understanding the complexity of human behavior. ", doi="10.2196/19579", url="http://mhealth.jmir.org/2020/9/e19579/", url="http://www.ncbi.nlm.nih.gov/pubmed/32969829" } @Article{info:doi/10.2196/18234, author="Middleton, M. Rod and Pearson, R. Owen and Ingram, Gillian and Craig, M. Elaine and Rodgers, J. William and Downing-Wood, Hannah and Hill, Joseph and Tuite-Dalton, Katherine and Roberts, Christopher and Watson, Lynne and Ford, V. David and Nicholas, Richard and ", title="A Rapid Electronic Cognitive Assessment Measure for Multiple Sclerosis: Validation of Cognitive Reaction, an Electronic Version of the Symbol Digit Modalities Test", journal="J Med Internet Res", year="2020", month="Sep", day="23", volume="22", number="9", pages="e18234", keywords="cognition", keywords="multiple sclerosis", keywords="eHealth", keywords="electronic assessment", keywords="patient reported outcomes", keywords="neurology", abstract="Background: Incorporating cognitive testing into routine clinical practice is a challenge in multiple sclerosis (MS), given the wide spectrum of both cognitive and physical impairments people can have and the time that testing requires. Shortened paper and verbal assessments predominate but still are not used routinely. Computer-based tests are becoming more widespread; however, changes in how a paper test is implemented can impact what exactly is being assessed in an individual. The Symbol Digit Modalities Test (SDMT) is one validated test that forms part of the cognitive batteries used in MS and has some computer-based versions. We developed a tablet-based SDMT variant that has the potential to be ultimately deployed to patients' own devices. Objective: This paper aims to develop, validate, and deploy a computer-based SDMT variant, the Cognition Reaction (CoRe) test, that can reliably replicate the characteristics of the paper-based SDMT. Methods: We carried out analysis using Pearson and intraclass correlations, as well as a Bland-Altman comparison, to examine consistency between the SDMT and CoRe tests and for test-retest reliability. The SDMT and CoRe tests were evaluated for sensitivity to disability levels and age. A novel metric in CoRe was found: question answering velocity could be calculated. This was evaluated in relation to disability levels and age for people with MS and compared with a group of healthy control volunteers. Results: SDMT and CoRe test scores were highly correlated and consistent with 1-month retest values. Lower scores were seen in patients with higher age and some effect was seen with increasing disability. There was no learning effect evident. Question answering velocity demonstrated a small increase in speed over the 90-second duration of the test in people with MS and healthy controls. Conclusions: This study validates a computer-based alternative to the SDMT that can be used in clinics and beyond. It enables accurate recording of elements of cognition relevant in MS but offers additional metrics that may offer further value to clinicians and people with MS. ", doi="10.2196/18234", url="http://www.jmir.org/2020/9/e18234/", url="http://www.ncbi.nlm.nih.gov/pubmed/32965240" } @Article{info:doi/10.2196/19897, author="Li, Juan and Maharjan, Bikesh and Xie, Bo and Tao, Cui", title="A Personalized Voice-Based Diet Assistant for Caregivers of Alzheimer Disease and Related Dementias: System Development and Validation", journal="J Med Internet Res", year="2020", month="Sep", day="21", volume="22", number="9", pages="e19897", keywords="Alzheimer disease", keywords="dementia", keywords="diet", keywords="knowledge", keywords="ontology", keywords="voice assistant", abstract="Background: The world's aging population is increasing, with an expected increase in the prevalence of Alzheimer disease and related dementias (ADRD). Proper nutrition and good eating behavior show promise for preventing and slowing the progression of ADRD and consequently improving patients with ADRD's health status and quality of life. Most ADRD care is provided by informal caregivers, so assisting caregivers to manage patients with ADRD's diet is important. Objective: This study aims to design, develop, and test an artificial intelligence--powered voice assistant to help informal caregivers manage the daily diet of patients with ADRD and learn food and nutrition-related knowledge. Methods: The voice assistant is being implemented in several steps: construction of a comprehensive knowledge base with ontologies that define ADRD diet care and user profiles, and is extended with external knowledge graphs; management of conversation between users and the voice assistant; personalized ADRD diet services provided through a semantics-based knowledge graph search and reasoning engine; and system evaluation in use cases with additional qualitative evaluations. Results: A prototype voice assistant was evaluated in the lab using various use cases. Preliminary qualitative test results demonstrate reasonable rates of dialogue success and recommendation correctness. Conclusions: The voice assistant provides a natural, interactive interface for users, and it does not require the user to have a technical background, which may facilitate senior caregivers' use in their daily care tasks. This study suggests the feasibility of using the intelligent voice assistant to help caregivers manage patients with ADRD's diet. ", doi="10.2196/19897", url="http://www.jmir.org/2020/9/e19897/", url="http://www.ncbi.nlm.nih.gov/pubmed/32955452" } @Article{info:doi/10.2196/17963, author="Lunardini, Francesca and Luperto, Matteo and Romeo, Marta and Basilico, Nicola and Daniele, Katia and Azzolino, Domenico and Damanti, Sarah and Abbate, Carlo and Mari, Daniela and Cesari, Matteo and Borghese, Alberto Nunzio and Ferrante, Simona", title="Supervised Digital Neuropsychological Tests for Cognitive Decline in Older Adults: Usability and Clinical Validity Study", journal="JMIR Mhealth Uhealth", year="2020", month="Sep", day="21", volume="8", number="9", pages="e17963", keywords="aging", keywords="Bells Test", keywords="computerized testing", keywords="dementia", keywords="early diagnosis", keywords="eHealth", keywords="mild cognitive impairment", keywords="neuropsychological assessment", keywords="Trail Making Test", abstract="Background: Dementia is a major and growing health problem, and early diagnosis is key to its management. Objective: With the ultimate goal of providing a monitoring tool that could be used to support the screening for cognitive decline, this study aims to develop a supervised, digitized version of 2 neuropsychological tests: Trail Making Test and Bells Test. The system consists of a web app that implements a tablet-based version of the tests and consists of an innovative vocal assistant that acts as the virtual supervisor for the execution of the test. A replay functionality is added to allow inspection of the user's performance after test completion. Methods: To deploy the system in a nonsupervised environment, extensive functional testing of the platform was conducted, together with a validation of the tablet-based tests. Such validation had the two-fold aim of evaluating system usability and acceptance and investigating the concurrent validity of computerized assessment compared with the corresponding paper-and-pencil counterparts. Results: The results obtained from 83 older adults showed high system acceptance, despite the patients' low familiarity with technology. The system software was successfully validated. A concurrent validation of the system reported good ability of the digitized tests to retain the same predictive power of the corresponding paper-based tests. Conclusions: Altogether, the positive results pave the way for the deployment of the system to a nonsupervised environment, thus representing a potential efficacious and ecological solution to support clinicians in the identification of early signs of cognitive decline. ", doi="10.2196/17963", url="http://mhealth.jmir.org/2020/9/e17963/", url="http://www.ncbi.nlm.nih.gov/pubmed/32955442" } @Article{info:doi/10.2196/18209, author="Dove, Erica and Wang, Rosalie and Zabjek, Karl and Astell, Arlene", title="Impacts of Motion-Based Technology on Balance, Movement Confidence, and Cognitive Function Among People With Dementia or Mild Cognitive Impairment: Protocol for a Quasi-Experimental Pre- and Posttest Study", journal="JMIR Res Protoc", year="2020", month="Sep", day="18", volume="9", number="9", pages="e18209", keywords="motion-based technology", keywords="dementia", keywords="mild cognitive impairment", keywords="cognitive dysfunction", keywords="postural balance", keywords="movement confidence", keywords="cognition", keywords="exercise movement techniques", abstract="Background: While exercise can benefit the health and well-being of people with dementia or mild cognitive impairment, many exercise programs offered to this population are passive, unengaging, and inaccessible, resulting in poor adherence. Motion-based technologies are increasingly being explored to encourage exercise participation among people with dementia or mild cognitive impairment. However, the impacts of using motion-based technologies with people with dementia or mild cognitive impairment on variables including balance, movement confidence, and cognitive function have yet to be determined. Objective: The purpose of this study is to examine the impacts of a group motion-based technology intervention on balance, movement confidence, and cognitive function among people with dementia or mild cognitive impairment. Methods: In this quasi-experimental pre- and posttest design, we will recruit 24 people with dementia or mild cognitive impairment from 4 adult day programs and invite them to play Xbox Kinect bowling in a group setting, twice weekly for 10 weeks. We will require participants to speak and understand English, be without visual impairment, and be able to stand and walk. At pretest, participants will complete the Mini-Balance Evaluation Systems Test (Mini-BESTest) and the Montreal Cognitive Assessment (MoCA). We will video record participants during weeks 1, 5, and 10 of the intervention to capture behavioral indicators of movement confidence (eg, fluency of motion) through coding. At posttest, the Mini-BESTest and MoCA will be repeated. We will analyze quantitative data collected through the Mini-BESTest and the MoCA using an intent-to-treat analysis, with study site and number of intervention sessions attended as covariates. To analyze the videos, we will extract count and percentage data from the coded recordings. Results: This study will address the question of whether a group motion-based technology intervention, delivered in an adult day program context, has the potential to impact balance, movement confidence, and cognitive function among people with dementia or mild cognitive impairment. The project was funded in 2019 and enrollment was completed on February 28, 2020. Data analysis is underway and the first results are expected to be submitted for publication in 2021. Conclusions: This study will assess the feasibility and potential benefits of using motion-based technology to deliver exercise interventions to people with dementia or mild cognitive impairment. This work can also be used as the basis for developing specific software and future exercise programs using motion-based technology for people with dementia or mild cognitive impairment, as well as understanding some of the conditions in which these programs can be delivered. International Registered Report Identifier (IRRID): DERR1-10.2196/18209 ", doi="10.2196/18209", url="http://www.researchprotocols.org/2020/9/e18209/", url="http://www.ncbi.nlm.nih.gov/pubmed/32945780" } @Article{info:doi/10.2196/20995, author="Rankin, Debbie and Black, Michaela and Flanagan, Bronac and Hughes, F. Catherine and Moore, Adrian and Hoey, Leane and Wallace, Jonathan and Gill, Chris and Carlin, Paul and Molloy, M. Anne and Cunningham, Conal and McNulty, Helene", title="Identifying Key Predictors of Cognitive Dysfunction in Older People Using Supervised Machine Learning Techniques: Observational Study", journal="JMIR Med Inform", year="2020", month="Sep", day="16", volume="8", number="9", pages="e20995", keywords="classification", keywords="supervised machine learning", keywords="cognition", keywords="diet", keywords="aging", keywords="geriatric assessment", abstract="Background: Machine learning techniques, specifically classification algorithms, may be effective to help understand key health, nutritional, and environmental factors associated with cognitive function in aging populations. Objective: This study aims to use classification techniques to identify the key patient predictors that are considered most important in the classification of poorer cognitive performance, which is an early risk factor for dementia. Methods: Data were used from the Trinity-Ulster and Department of Agriculture study, which included detailed information on sociodemographic, clinical, biochemical, nutritional, and lifestyle factors in 5186 older adults recruited from the Republic of Ireland and Northern Ireland, a proportion of whom (987/5186, 19.03\%) were followed up 5-7 years later for reassessment. Cognitive function at both time points was assessed using a battery of tests, including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), with a score <70 classed as poorer cognitive performance. This study trained 3 classifiers---decision trees, Na{\"i}ve Bayes, and random forests---to classify the RBANS score and to identify key health, nutritional, and environmental predictors of cognitive performance and cognitive decline over the follow-up period. It assessed their performance, taking note of the variables that were deemed important for the optimized classifiers for their computational diagnostics. Results: In the classification of a low RBANS score (<70), our models performed well (F1 score range 0.73-0.93), all highlighting the individual's score from the Timed Up and Go (TUG) test, the age at which the participant stopped education, and whether or not the participant's family reported memory concerns to be of key importance. The classification models performed well in classifying a greater rate of decline in the RBANS score (F1 score range 0.66-0.85), also indicating the TUG score to be of key importance, followed by blood indicators: plasma homocysteine, vitamin B6 biomarker (plasma pyridoxal-5-phosphate), and glycated hemoglobin. Conclusions: The results suggest that it may be possible for a health care professional to make an initial evaluation, with a high level of confidence, of the potential for cognitive dysfunction using only a few short, noninvasive questions, thus providing a quick, efficient, and noninvasive way to help them decide whether or not a patient requires a full cognitive evaluation. This approach has the potential benefits of making time and cost savings for health service providers and avoiding stress created through unnecessary cognitive assessments in low-risk patients. ", doi="10.2196/20995", url="http://medinform.jmir.org/2020/9/e20995/", url="http://www.ncbi.nlm.nih.gov/pubmed/32936084" } @Article{info:doi/10.2196/19133, author="Ferrario, Andrea and Demiray, Burcu and Yordanova, Kristina and Luo, Minxia and Martin, Mike", title="Social Reminiscence in Older Adults' Everyday Conversations: Automated Detection Using Natural Language Processing and Machine Learning", journal="J Med Internet Res", year="2020", month="Sep", day="15", volume="22", number="9", pages="e19133", keywords="aging", keywords="dementia", keywords="reminiscence", keywords="real-life conversations", keywords="electronically activated recorder (EAR)", keywords="natural language processing", keywords="machine learning", keywords="imbalanced learning", abstract="Background: Reminiscence is the act of thinking or talking about personal experiences that occurred in the past. It is a central task of old age that is essential for healthy aging, and it serves multiple functions, such as decision-making and introspection, transmitting life lessons, and bonding with others. The study of social reminiscence behavior in everyday life can be used to generate data and detect reminiscence from general conversations. Objective: The aims of this original paper are to (1) preprocess coded transcripts of conversations in German of older adults with natural language processing (NLP), and (2) implement and evaluate learning strategies using different NLP features and machine learning algorithms to detect reminiscence in a corpus of transcripts. Methods: The methods in this study comprise (1) collecting and coding of transcripts of older adults' conversations in German, (2) preprocessing transcripts to generate NLP features (bag-of-words models, part-of-speech tags, pretrained German word embeddings), and (3) training machine learning models to detect reminiscence using random forests, support vector machines, and adaptive and extreme gradient boosting algorithms. The data set comprises 2214 transcripts, including 109 transcripts with reminiscence. Due to class imbalance in the data, we introduced three learning strategies: (1) class-weighted learning, (2) a meta-classifier consisting of a voting ensemble, and (3) data augmentation with the Synthetic Minority Oversampling Technique (SMOTE) algorithm. For each learning strategy, we performed cross-validation on a random sample of the training data set of transcripts. We computed the area under the curve (AUC), the average precision (AP), precision, recall, as well as F1 score and specificity measures on the test data, for all combinations of NLP features, algorithms, and learning strategies. Results: Class-weighted support vector machines on bag-of-words features outperformed all other classifiers (AUC=0.91, AP=0.56, precision=0.5, recall=0.45, F1=0.48, specificity=0.98), followed by support vector machines on SMOTE-augmented data and word embeddings features (AUC=0.89, AP=0.54, precision=0.35, recall=0.59, F1=0.44, specificity=0.94). For the meta-classifier strategy, adaptive and extreme gradient boosting algorithms trained on word embeddings and bag-of-words outperformed all other classifiers and NLP features; however, the performance of the meta-classifier learning strategy was lower compared to other strategies, with highly imbalanced precision-recall trade-offs. Conclusions: This study provides evidence of the applicability of NLP and machine learning pipelines for the automated detection of reminiscence in older adults' everyday conversations in German. The methods and findings of this study could be relevant for designing unobtrusive computer systems for the real-time detection of social reminiscence in the everyday life of older adults and classifying their functions. With further improvements, these systems could be deployed in health interventions aimed at improving older adults' well-being by promoting self-reflection and suggesting coping strategies to be used in the case of dysfunctional reminiscence cases, which can undermine physical and mental health. ", doi="10.2196/19133", url="http://www.jmir.org/2020/9/e19133/", url="http://www.ncbi.nlm.nih.gov/pubmed/32866108" } @Article{info:doi/10.2196/19468, author="Leng, Minmin and Zhao, Yajie and Xiao, Hongmei and Li, Ce and Wang, Zhiwen", title="Internet-Based Supportive Interventions for Family Caregivers of People With Dementia: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2020", month="Sep", day="9", volume="22", number="9", pages="e19468", keywords="family caregivers", keywords="dementia", keywords="supportive interventions", keywords="internet", keywords="systematic review", abstract="Background: Caring for people with dementia is perceived as one of the most stressful and difficult forms of caring. Family caregivers always experience high levels of psychological burden and physical strain, so effective and practical support is essential. Internet-based supportive interventions can provide convenient and efficient support and education to potentially reduce the physical and psychological burden associated with providing care. Objective: This review aimed to (1) assess the efficacy of internet-based supportive interventions in ameliorating health outcomes for family caregivers of people with dementia, and (2) evaluate the potential effects of internet-based supportive intervention access by caregivers on their care recipients. Methods: An electronic literature search of the PubMed, EMBASE, Web of Science, CINAHL, Cochrane Library, and PsycINFO databases was conducted up to January 2020. Two reviewers (ML and YZ) worked independently to identify randomized controlled trials (RCTs) that met the inclusion criteria and independently extracted data. The quality of the included RCTs was evaluated using the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Standardized mean differences (SMDs) with 95\% CIs were applied to calculate the pooled effect sizes. Results: In total, 17 RCTs met the eligibility criteria and were included in this systematic review. The meta-analysis showed that internet-based supportive interventions significantly ameliorated depressive symptoms (SMD=--0.21; 95\% CI --0.31 to --0.10; P<.001), perceived stress (SMD=--0.40; 95\% CI --0.55 to --0.24; P<.001), anxiety (SMD=--0.33; 95\% CI --0.51 to --0.16; P<.001), and self-efficacy (SMD=0.19; 95\% CI 0.05-0.33; P=.007) in dementia caregivers. No significant improvements were found in caregiver burden, coping competence, caregiver reactions to behavioral symptoms, or quality of life. Six studies assessed the unintended effects of internet-based supportive intervention access by caregivers on their care recipients. The results showed that internet-based supportive interventions had potential benefits on the quality of life and neuropsychiatric symptoms in care recipients. Conclusions: Internet-based supportive interventions are generally effective at ameliorating depressive symptoms, perceived stress, anxiety, and self-efficacy in dementia caregivers and have potential benefits on care recipients. Future studies are encouraged to adopt personalized internet-based supportive interventions to improve the health of family caregivers and their care recipients. Trial Registration: PROSPERO CRD42020162434; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=162434 ", doi="10.2196/19468", url="http://www.jmir.org/2020/9/e19468/", url="http://www.ncbi.nlm.nih.gov/pubmed/32902388" } @Article{info:doi/10.2196/19870, author="Shen, Xiao and Wang, Guanjin and Kwan, Yiu-Cho Rick and Choi, Kup-Sze", title="Using Dual Neural Network Architecture to Detect the Risk of Dementia With Community Health Data: Algorithm Development and Validation Study", journal="JMIR Med Inform", year="2020", month="Aug", day="31", volume="8", number="8", pages="e19870", keywords="cognitive screening", keywords="dementia risk", keywords="dual neural network", keywords="predictive models", keywords="primary care", abstract="Background: Recent studies have revealed lifestyle behavioral risk factors that can be modified to reduce the risk of dementia. As modification of lifestyle takes time, early identification of people with high dementia risk is important for timely intervention and support. As cognitive impairment is a diagnostic criterion of dementia, cognitive assessment tools are used in primary care to screen for clinically unevaluated cases. Among them, Mini-Mental State Examination (MMSE) is a very common instrument. However, MMSE is a questionnaire that is administered when symptoms of memory decline have occurred. Early administration at the asymptomatic stage and repeated measurements would lead to a practice effect that degrades the effectiveness of MMSE when it is used at later stages. Objective: The aim of this study was to exploit machine learning techniques to assist health care professionals in detecting high-risk individuals by predicting the results of MMSE using elderly health data collected from community-based primary care services. Methods: A health data set of 2299 samples was adopted in the study. The input data were divided into two groups of different characteristics (ie, client profile data and health assessment data). The predictive output was the result of two-class classification of the normal and high-risk cases that were defined based on MMSE. A dual neural network (DNN) model was proposed to obtain the latent representations of the two groups of input data separately, which were then concatenated for the two-class classification. Mean and k-nearest neighbor were used separately to tackle missing data, whereas a cost-sensitive learning (CSL) algorithm was proposed to deal with class imbalance. The performance of the DNN was evaluated by comparing it with that of conventional machine learning methods. Results: A total of 16 predictive models were built using the elderly health data set. Among them, the proposed DNN with CSL outperformed in the detection of high-risk cases. The area under the receiver operating characteristic curve, average precision, sensitivity, and specificity reached 0.84, 0.88, 0.73, and 0.80, respectively. Conclusions: The proposed method has the potential to serve as a tool to screen for elderly people with cognitive impairment and predict high-risk cases of dementia at the asymptomatic stage, providing health care professionals with early signals that can prompt suggestions for a follow-up or a detailed diagnosis. ", doi="10.2196/19870", url="https://medinform.jmir.org/2020/8/e19870", url="http://www.ncbi.nlm.nih.gov/pubmed/32865498" } @Article{info:doi/10.2196/19495, author="Petersen, Ding Jindong and Larsen, Ladekj{\ae}r Eva and la Cour, Karen and von B{\"u}low, Cecilie and Skouboe, Malene and Christensen, Reffstrup Jeanette and Waldorff, Boch Frans", title="Motion-Based Technology for People With Dementia Training at Home: Three-Phase Pilot Study Assessing Feasibility and Efficacy", journal="JMIR Ment Health", year="2020", month="Aug", day="26", volume="7", number="8", pages="e19495", keywords="dementia", keywords="motion-based technology", keywords="virtual reality", keywords="telerehabilitation", keywords="physical training", keywords="physical and mental function", abstract="Background: Persons with dementia tend to be vulnerable to mobility challenges and hence face a greater risk of fall and subsequent fractures, morbidity, and mortality. Motion-based technologies (MBTs), also called sensor-based technologies or virtual reality, have the potential for assisting physical exercise and training as a part of a disease management and rehabilitation program, but little is known about its' use for people with dementia. Objective: The purpose of this pilot study was to investigate the feasibility and efficacy of MBT physical training at home for people with dementia. Methods: A 3-phase pilot study: (1) baseline start-up, (2) 15 weeks of group training at a local care center twice a week, and (3) 12 weeks of group training reduced to once a week, supplemented with individual MBT training twice a week at home. A total of 26 people with dementia from a municipality in Southern Denmark were eligible and agreed to participate in this study. Three withdrew from the study, leaving 23 participants for the final analysis. Feasibility was measured by the percentage of participants who trained with MBT at home, and their completion rate of total scheduled MBT sessions. Efficacy was evaluated by physical function, measured by Sit-to-Stand (STS), Timed-Up-and-Go (TUG), 6-minute Walk Test (6MW), and 10-meter Dual-task Walking Test (10MDW); cognitive function was measured by Mini-Mental State Examination (MMSE) and Neuropsychiatric Inventory-Questionnaire (NPI-Q); and European Quality of Life 5 dimensions questionnaire (EQOL5) was used for measuring quality of life. Descriptive statistics were applied accordingly. Wilcoxon signed-rank and rank-sum tests were applied to explore significant differences within and between the groups. Results: As much as 12 of 23 participants (52\%) used the supplemental MBT training at home. Among them, 6 (50\%) completed 75\% or more scheduled sessions, 3 completed 25\% or less, and 3 completed between 25\% and 75\% of scheduled sessions. For physical and cognitive function tests, supplementing with MBT training at home showed a tendency of overall stabilization of scores among the group of participants who actively trained with MBT; especially, the 10MDW test even showed a significant improvement from 9.2 to 7.1 seconds (P=.03). We found no positive effect on EQOL5 tests. Conclusions: More than half of the study population with dementia used MBT training at home, and among them, half had an overall high adherence to the home training activity. Physical function tended to remain stable or even improved among high-adherence MBT individuals. We conclude that MBT training at home may be feasible for some individuals with dementia. Further research is warranted. ", doi="10.2196/19495", url="http://mental.jmir.org/2020/8/e19495/", url="http://www.ncbi.nlm.nih.gov/pubmed/32845243" } @Article{info:doi/10.2196/18189, author="Xie, Bo and Tao, Cui and Li, Juan and Hilsabeck, C. Robin and Aguirre, Alyssa", title="Artificial Intelligence for Caregivers of Persons With Alzheimer's Disease and Related Dementias: Systematic Literature Review", journal="JMIR Med Inform", year="2020", month="Aug", day="20", volume="8", number="8", pages="e18189", keywords="Alzheimer disease", keywords="dementia", keywords="caregiving", keywords="technology", keywords="artificial intelligence", abstract="Background: Artificial intelligence (AI) has great potential for improving the care of persons with Alzheimer's disease and related dementias (ADRD) and the quality of life of their family caregivers. To date, however, systematic review of the literature on the impact of AI on ADRD management has been lacking. Objective: This paper aims to (1) identify and examine literature on AI that provides information to facilitate ADRD management by caregivers of individuals diagnosed with ADRD and (2) identify gaps in the literature that suggest future directions for research. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for conducting systematic literature reviews, during August and September 2019, we performed 3 rounds of selection. First, we searched predetermined keywords in PubMed, Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, PsycINFO, IEEE Xplore Digital Library, and the ACM Digital Library. This step generated 113 nonduplicate results. Next, we screened the titles and abstracts of the 113 papers according to inclusion and exclusion criteria, after which 52 papers were excluded and 61 remained. Finally, we screened the full text of the remaining papers to ensure that they met the inclusion or exclusion criteria; 31 papers were excluded, leaving a final sample of 30 papers for analysis. Results: Of the 30 papers, 20 reported studies that focused on using AI to assist in activities of daily living. A limited number of specific daily activities were targeted. The studies' aims suggested three major purposes: (1) to test the feasibility, usability, or perceptions of prototype AI technology; (2) to generate preliminary data on the technology's performance (primarily accuracy in detecting target events, such as falls); and (3) to understand user needs and preferences for the design and functionality of to-be-developed technology. The majority of the studies were qualitative, with interviews, focus groups, and observation being their most common methods. Cross-sectional surveys were also common, but with small convenience samples. Sample sizes ranged from 6 to 106, with the vast majority on the low end. The majority of the studies were descriptive, exploratory, and lacking theoretical guidance. Many studies reported positive outcomes in favor of their AI technology's feasibility and satisfaction; some studies reported mixed results on these measures. Performance of the technology varied widely across tasks. Conclusions: These findings call for more systematic designs and evaluations of the feasibility and efficacy of AI-based interventions for caregivers of people with ADRD. These gaps in the research would be best addressed through interdisciplinary collaboration, incorporating complementary expertise from the health sciences and computer science/engineering--related fields. ", doi="10.2196/18189", url="http://medinform.jmir.org/2020/8/e18189/", url="http://www.ncbi.nlm.nih.gov/pubmed/32663146" } @Article{info:doi/10.2196/17406, author="Bogza, Laura-Mihaela and Patry-Lebeau, Cassandra and Farmanova, Elina and Witteman, O. Holly and Elliott, Jacobi and Stolee, Paul and Hudon, Carol and Giguere, C. Anik M.", title="User-Centered Design and Evaluation of a Web-Based Decision Aid for Older Adults Living With Mild Cognitive Impairment and Their Health Care Providers: Mixed Methods Study", journal="J Med Internet Res", year="2020", month="Aug", day="19", volume="22", number="8", pages="e17406", keywords="decision aid", keywords="mild cognitive impairment", keywords="elderly", keywords="decision support technique", keywords="aging", abstract="Background: Mild cognitive impairment (MCI) is often considered a transitional state between normal and pathologic (eg, dementia) cognitive aging. Although its prognosis varies largely, the diagnosis carries the risk of causing uncertainty and overtreatment of older adults with MCI who may never progress to dementia. Decision aids help people become better informed and more involved in decision making by providing evidence-based information about options and possible outcomes and by assisting them in clarifying their personal values in relation to the decision to be made. Objective: This study aimed to incorporate features that best support values clarification and adjust the level of detail of a web-based decision aid for individuals with MCI. Methods: We conducted a rapid review to identify options to maintain or improve cognitive functions in individuals with MCI. The evidence was structured into a novel web-based decision aid designed in collaboration with digital specialists and graphic designers. Qualitative and user-centered evaluations were used to draw on users' knowledge, clarify values, and inform potential adoption in routine clinical practice. We invited clinicians, older adults with MCI, and their caregivers to evaluate the decision aid in 6 consecutive rounds, with new participants in each round. Quantitative data were collected using the Values Clarity and Informed subscales of the Decisional Conflict Scale, the System Usability Scale, the Ottawa Acceptability questionnaire, and a 5-point satisfaction rating scale. We verified their comprehension using a teach-back method and recorded usability issues. We recorded the audio and computer screen during the session. An inductive thematic qualitative analysis approach was used to identify and describe the issues that arose. After each round, an expert panel met to prioritize and find solutions to mitigate the issues. An integrated analysis was conducted to confirm our choices. Results: A total of 7 clinicians (social workers, nurses, family physicians, psychologists) and 12 older (?60 years) community-dwelling individuals with MCI, half of them women, with education levels going from none to university diploma, were recruited and completed testing. The thematic analysis revealed 3 major issues. First, the user should be guided through the decision-making process by tailoring the presentation of options to users' priorities using the values clarification exercise. Second, its content should be simple, but not simplistic, notably by using information layering, plain language, and pictograms. Third, the interface should be intuitive and user friendly, utilize pop-up windows and information tips, avoid drop-down menus, and limit the need to scroll down. The quantitative assessments corroborated the qualitative findings. Conclusions: This project resulted in a promising web-based decision aid that can support decision making for MCI intervention, based on the personal values and preferences of the users. Further ongoing research will allow its implementation to be tested in clinical settings. ", doi="10.2196/17406", url="https://www.jmir.org/2020/8/e17406", url="http://www.ncbi.nlm.nih.gov/pubmed/32442151" } @Article{info:doi/10.2196/18136, author="Kim, Woon Ko and Lee, Yun Sung and Choi, Jongdoo and Chin, Juhee and Lee, Hwa Byung and Na, L. Duk and Choi, Hyun Jee", title="A Comprehensive Evaluation of the Process of Copying a Complex Figure in Early- and Late-Onset Alzheimer Disease: A Quantitative Analysis of Digital Pen Data", journal="J Med Internet Res", year="2020", month="Aug", day="12", volume="22", number="8", pages="e18136", keywords="alzheimer disease", keywords="Rey-Osterrieth Complex Figure", keywords="digital biomarkers", keywords="copying process", abstract="Background: The Rey-Osterrieth Complex Figure Test (RCFT) is a neuropsychological test that is widely used to assess visual memory and visuoconstructional deficits in patients with cognitive impairment, including Alzheimer disease (AD). Patients with AD have an increased tendency for exhibiting extraordinary behaviors in the RCFT for selecting the drawing area, organizing the figure, and deciding the order of images, among other activities. However, the conventional scoring system based on pen and paper has a limited ability to reflect these detailed behaviors. Objective: This study aims to establish a scoring system that addresses not only the spatial arrangement of the finished drawing but also the drawing process of patients with AD by using digital pen data. Methods: A digital pen and tablet were used to copy complex figures. The stroke patterns and kinetics of normal controls (NCs) and patients with early-onset AD (EOAD) and late-onset AD (LOAD) were analyzed by comparing the pen tip trajectory, spatial arrangement, and similarity of the finished drawings. Results: Patients with AD copied the figure in a more fragmented way with a longer pause than NCs (EOAD: P=.045; LOAD: P=.01). Patients with AD showed an increased tendency to draw the figures closer toward the target image in comparison with the NCs (EOAD: P=.005; LOAD: P=.01) Patients with AD showed the lower accuracy than NCs (EOAD: P=.004; LOAD: P=.002). Patients with EOAD and LOAD showed similar but slightly different drawing behaviors, especially in space use and in the initial stage of drawing. Conclusions: The digitalized complex figure test evaluated copying performance quantitatively and further elucidated the patients' ongoing process during copying. We believe that this novel approach can be used as a digital biomarker of AD. In addition, the repeatability of the test will delineate the process of executive functions and constructional organization abilities with disease progression. ", doi="10.2196/18136", url="https://www.jmir.org/2020/8/e18136", url="http://www.ncbi.nlm.nih.gov/pubmed/32491988" } @Article{info:doi/10.2196/16089, author="Piano, Marianne and Nilforooshan, Ramin and Evans, Simon", title="Binocular Vision, Visual Function, and Pupil Dynamics in People Living With Dementia and Their Relation to the Rate of Cognitive Decline and Structural Changes Within the Brain: Protocol for an Observational Study", journal="JMIR Res Protoc", year="2020", month="Aug", day="10", volume="9", number="8", pages="e16089", keywords="binocular vision", keywords="dementia", keywords="magnetic resonance imaging", keywords="stereopsis", keywords="pupil", keywords="sleep", abstract="Background: Visual impairment is a common comorbidity in people living with dementia. Addressing sources of visual difficulties can have a significant impact on the quality of life for people living with dementia and their caregivers. Depth perception problems are purportedly common in dementia and also contribute to falls, visuomotor task difficulties, and poorer psychosocial well-being. However, depth perception and binocular vision are rarely assessed in dementia research. Sleep fragmentation is also common for people living with dementia, and binocular cooperation for depth perception can be affected by fatigue. Pupillary responses under cognitive load also have the potential to be a risk marker for cognitive decline in people living with dementia and can be combined with the above measures for a comprehensive evaluation of clinical visual changes in people living with dementia and their relation to changes in cognitive status, sleep quality, and cortical structure or function. Objective: This study aims to characterize the nature of clinical visual changes and altered task-evoked pupillary responses that may occur in people living with dementia and evaluate whether these responses relate to changes in cognitive status (standardized Mini Mental State Examination [MMSE] score), Pittsburgh sleep quality index, and cortical structure or function. Methods: This proposed exploratory observational study will enroll ?210 people with recently diagnosed dementia (within the last 24 months). The following parameters will be assessed on 3 occasions, 4 months apart (plus or minus 2 weeks): visual function (visual acuity and contrast sensitivity), binocular function (motor fusion and stereopsis), task-evoked pupillary responses (minimum and maximum pupil size, time to maximum dilation, and dilation velocity), cognitive status (MMSE score), and sleep quality (Pittsburgh Sleep Quality Index). A subset of patients (n=30) with Alzheimer disease will undergo structural and functional magnetic resonance imaging at first and third visits, completing a 10-day consensus sleep diary to monitor sleep quality, verified by sleep actimetry. Results: This research was funded in February 2018 and received National Health Service Research Ethics Committee approval in September 2018. The data collection period was from October 1, 2018, to November 30, 2019. A total of 24 participants were recruited for the study. The data analysis is complete, with results expected to be published before the end of 2020. Conclusions: Findings will demonstrate how often people with dementia experience binocular vision problems. If frequent, diagnosing and treating them could improve quality of life by reducing the risk of falls and fine visuomotor task impairment and by relieving psychosocial anxiety. This research will also demonstrate whether changes in depth perception, pupillary responses, and quality of vision relate to changes in memory or sleep quality and brain structure or function. If related, these quick and noninvasive eye tests help monitor dementia. This would help justify whether binocular vision and pupillary response testing should be included in dementia-friendly eye-testing guidelines. International Registered Report Identifier (IRRID): RR1-10.2196/16089 ", doi="10.2196/16089", url="https://www.researchprotocols.org/2020/8/e16089", url="http://www.ncbi.nlm.nih.gov/pubmed/32773379" } @Article{info:doi/10.2196/17565, author="Andrade Ferreira, Duarte Luis and Ferreira, Henrique and Cavaco, Sofia and Cameir{\~a}o, M{\'o}nica and i Badia, Berm{\'u}dez Sergi", title="User Experience of Interactive Technologies for People With Dementia: Comparative Observational Study", journal="JMIR Serious Games", year="2020", month="Aug", day="5", volume="8", number="3", pages="e17565", keywords="dementia", keywords="technology", keywords="interaction", keywords="psychomotor performance", keywords="equipment safety", keywords="costs and cost analysis", keywords="user-computer interface", abstract="Background: Serious games (SGs) are used as complementary approaches to stimulate patients with dementia. However, many of the SGs use out-of-the-shelf technologies that may not always be suitable for such populations, as they can lead to negative behaviors, such as anxiety, fatigue, and even cybersickness. Objective: This study aims to evaluate how patients with dementia interact and accept 5 out-of-the-shelf technologies while completing 10 virtual reality tasks. Methods: A total of 12 participants diagnosed with dementia (mean age 75.08 [SD 8.07] years, mean Mini-Mental State Examination score 17.33 [SD 5.79], and mean schooling 5.55 [SD 3.30]) at a health care center in Portugal were invited to participate in this study. A within-subject experimental design was used to allow all participants to interact with all technologies, such as HTC VIVE, head-mounted display (HMD), tablet, mouse, augmented reality (AR), leap motion (LM), and a combination of HMD with LM. Participants' performance was quantified through behavioral and verbal responses, which were captured through video recordings and written notes. Results: The findings of this study revealed that the user experience using technology was dependent on the patient profile; the patients had a better user experience when they use technologies with direct interaction configuration as opposed to indirect interaction configuration in terms of assistance required (P=.01) and comprehension (P=.01); the participants did not trigger any emotional responses when using any of the technologies; the participants' performance was task-dependent; the most cost-effective technology was the mouse, whereas the least cost-effective was AR; and all the technologies, except for one (HMD with LM), were not exposed to external hazards. Conclusions: Most participants were able to perform tasks using out-of-the-shelf technologies. However, there is no perfect technology, as they are not explicitly designed to address the needs and skills of people with dementia. Here, we propose a set of guidelines that aim to help health professionals and engineers maximize user experience when using such technologies for the population with dementia. ", doi="10.2196/17565", url="http://games.jmir.org/2020/3/e17565/", url="http://www.ncbi.nlm.nih.gov/pubmed/32755894" } @Article{info:doi/10.2196/16180, author="Minen, Tova Mia and Reichel, Frederica Julia and Pemmireddy, Pallavi and Loder, Elizabeth and Torous, John", title="Characteristics of Neuropsychiatric Mobile Health Trials: Cross-Sectional Analysis of Studies Registered on ClinicalTrials.gov", journal="JMIR Mhealth Uhealth", year="2020", month="Aug", day="4", volume="8", number="8", pages="e16180", keywords="smartphones", keywords="mobile phones", keywords="apps", keywords="mental health", keywords="regulation", keywords="stroke", keywords="migraine", keywords="major depressive disorder", keywords="Alzheimer disease", keywords="anxiety disorders", keywords="alcohol use disorders", keywords="opioid use disorders", keywords="epilepsy", keywords="schizophrenia", abstract="Background: The development of mobile health (mHealth) technologies is progressing at a faster pace than that of the science to evaluate their validity and efficacy. Under the International Committee of Journal Medical Editors (ICMJE) guidelines, clinical trials that prospectively assign people to interventions should be registered with a database before the initiation of the study. Objective: The aim of this study was to better understand the smartphone mHealth trials for high-burden neuropsychiatric conditions registered on ClinicalTrials.gov through November 2018, including the number, types, and characteristics of the studies being conducted; the frequency and timing of any outcome changes; and the reporting of results. Methods: We conducted a systematic search of ClinicalTrials.gov for the top 10 most disabling neuropsychiatric conditions and prespecified terms related to mHealth. According to the 2016 World Health Organization Global Burden of Disease Study, the top 10 most disabling neuropsychiatric conditions are (1) stroke, (2) migraine, (3) major depressive disorder, (4) Alzheimer disease and other dementias, (5) anxiety disorders, (6) alcohol use disorders, (7) opioid use disorders, (8) epilepsy, (9) schizophrenia, and (10) other mental and substance use disorders. There were no date, location, or status restrictions. Results: Our search identified 135 studies. A total of 28.9\% (39/135) of studies evaluated interventions for major depressive disorder, 14.1\% (19/135) of studies evaluated interventions for alcohol use disorders, 12.6\% (17/135) of studies evaluated interventions for stroke, 11.1\% (15/135) of studies evaluated interventions for schizophrenia, 8.1\% (11/135) of studies evaluated interventions for anxiety disorders, 8.1\% (11/135) of studies evaluated interventions for other mental and substance use disorders, 7.4\% (10/135) of studies evaluated interventions for opioid use disorders, 3.7\% (5/135) of studies evaluated interventions for Alzheimer disease or other dementias, 3.0\% (4/135) of studies evaluated interventions for epilepsy, and 3.0\% (4/135) of studies evaluated interventions for migraine. The studies were first registered in 2008; more than half of the studies were registered from 2016 to 2018. A total of 18.5\% (25/135) of trials had results reported in some publicly accessible location. Across all the studies, the mean estimated enrollment (reported by the study) was 1078, although the median was only 100. In addition, across all the studies, the actual reported enrollment was lower, with a mean of 249 and a median of 80. Only about a quarter of the studies (35/135, 25.9\%) were funded by the National Institutes of Health. Conclusions: Despite the increasing use of health-based technologies, this analysis of ClinicalTrials.gov suggests that only a few apps for high-burden neuropsychiatric conditions are being clinically evaluated in trials. ", doi="10.2196/16180", url="https://mhealth.jmir.org/2020/8/e16180", url="http://www.ncbi.nlm.nih.gov/pubmed/32749230" } @Article{info:doi/10.2196/18389, author="Bhardwaj, Niharika and Cecchetti, A. Alfred and Murughiyan, Usha and Neitch, Shirley", title="Analysis of Benzodiazepine Prescription Practices in Elderly Appalachians with Dementia via the Appalachian Informatics Platform: Longitudinal Study", journal="JMIR Med Inform", year="2020", month="Aug", day="4", volume="8", number="8", pages="e18389", keywords="dementia", keywords="Alzheimer disease", keywords="benzodiazepines", keywords="Appalachia", keywords="geriatrics", keywords="informatics platform", keywords="interactive visualization", keywords="eHealth", keywords="clinical data", abstract="Background: Caring for the growing dementia population with complex health care needs in West Virginia has been challenging due to its large, sizably rural-dwelling geriatric population and limited resource availability. Objective: This paper aims to illustrate the application of an informatics platform to drive dementia research and quality care through a preliminary study of benzodiazepine (BZD) prescription patterns and its effects on health care use by geriatric patients. Methods: The Maier Institute Data Mart, which contains clinical and billing data on patients aged 65 years and older (N=98,970) seen within our clinics and hospital, was created. Relevant variables were analyzed to identify BZD prescription patterns and calculate related charges and emergency department (ED) use. Results: Nearly one-third (4346/13,910, 31.24\%) of patients with dementia received at least one BZD prescription, 20\% more than those without dementia. More women than men received at least one BZD prescription. On average, patients with dementia and at least one BZD prescription sustained higher charges and visited the ED more often than those without one. Conclusions: The Appalachian Informatics Platform has the potential to enhance dementia care and research through a deeper understanding of dementia, data enrichment, risk identification, and care gap analysis. ", doi="10.2196/18389", url="https://medinform.jmir.org/2020/8/e18389", url="http://www.ncbi.nlm.nih.gov/pubmed/32749226" } @Article{info:doi/10.2196/16928, author="Lai, Rhoda and Tensil, Maria and Kurz, Alexander and Lautenschlager, T. Nicola and Diehl-Schmid, Janine", title="Perceived Need and Acceptability of an App to Support Activities of Daily Living in People With Cognitive Impairment and Their Carers: Pilot Survey Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="31", volume="8", number="7", pages="e16928", keywords="Aged", keywords="dementia", keywords="memory disorders", keywords="carers", keywords="mobile apps", abstract="Background: Modern technologies, including smartphone apps, have the potential to assist people with cognitive impairment with activities of daily living, allowing them to maintain their independence and reduce carer burden. However, such tools have seen a slow rate of uptake in this population, and data on the acceptability of assistive technologies in this population are limited. Objective: This pilot study included older adults with cognitive impairment and their carers, and explored the perceived needs for and acceptability of an app that was designed to be a simple assistive tool for activities of daily living. In particular, this study aimed to assess the acceptability of common app functions such as communication, reminder, navigation, and emergency tools in this population, and to compare patients' and carers' responses to them. Methods: A total of 24 German participants with mild cognitive impairment or dementia and their family carers separately completed two short questionnaires. The first questionnaire asked the participants with cognitive impairment and their carers to self-rate the patients' cognitive impairment levels and affinity to technology. Following a demonstration of the app, participants rated the usability and acceptability of the app and its functions in a second questionnaire. Results: Participants rated themselves as much less cognitively impaired than their carers did (P=.01), and insight into the level of support they received was low. The majority of the participants (19/24, 79\%) and their carers (20/24, 83\%) had low affinity to technology, and even after the demonstration, 63\% (15/24) of the participants had low interest in using the app. A breakdown of acceptability responses by app function revealed that participants were more amenable to the reminder function, the emergency feature, and a wearable form of the app. Features that centered around carers monitoring participants' movements were reported to be less acceptable to participants. Conclusions: This study highlights the importance of focusing on acceptability and the consumer's perceptions in the development of assistive technology for older adults with cognitive impairment. Participants showed an aversion to functions they perceived as eroding their independence, while functions that more closely aligned with independence and autonomy were perceived as more acceptable. ", doi="10.2196/16928", url="http://mhealth.jmir.org/2020/7/e16928/", url="http://www.ncbi.nlm.nih.gov/pubmed/32735223" } @Article{info:doi/10.2196/16596, author="Kwan, YC Rick and Lee, Deborah and Lee, H. Paul and Tse, Mimi and Cheung, SK Daphne and Thiamwong, Ladda and Choi, Kup-Sze", title="Effects of an mHealth Brisk Walking Intervention on Increasing Physical Activity in Older People With Cognitive Frailty: Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="31", volume="8", number="7", pages="e16596", keywords="cognitive frailty", keywords="brisk walking", keywords="smartphone", keywords="moderate-to-vigorous physical activity", keywords="older people", abstract="Background: Cognitive frailty is the coexistence of physical frailty and cognitive impairment and is an at-risk state for many adverse health outcomes. Moderate-to-vigorous physical activity (MVPA) is protective against the progression of cognitive frailty. Physical inactivity is common in older people, and brisk walking is a feasible form of physical activity that can enhance their MVPA. Mobile health (mHealth) employing persuasive technology has been successful in increasing the levels of physical activity in older people. However, its feasibility and effects on older people with cognitive frailty are unclear. Objective: We aimed to identify the issues related to the feasibility of an mHealth intervention and the trial (ie, recruitment, retention, participation, and compliance) and to examine the effects of the intervention on cognitive function, physical frailty, walking time, and MVPA. Methods: An open-label, parallel design, randomized controlled trial (RCT) was employed. The eligibility criteria for the participants were age ?60 years, having cognitive frailty, and having physical inactivity. In the intervention group, participants received both conventional behavior change intervention and mHealth (ie, smartphone-assisted program using Samsung Health and WhatsApp) interventions. In the control group, participants received conventional behavior change intervention only. The outcomes included cognitive function, frailty, walking time, and MVPA. Permuted block randomization in 1:1 ratio was used. The feasibility issue was described in terms of participant recruitment, retention, participation, and compliance. Wilcoxon signed-rank test was used to test the within-group effects in both groups separately. Results: We recruited 99 participants; 33 eligible participants were randomized into either the intervention group (n=16) or the control (n=17) group. The median age was 71.0 years (IQR 9.0) and the majority of them were females (28/33, 85\%). The recruitment rate was 33\% (33/99), the participant retention rate was 91\% (30/33), and the attendance rate of all the face-to-face sessions was 100\% (33/33). The majority of the smartphone messages were read by the participants within 30 minutes (91/216, 42.1\%). ActiGraph (58/66 days, 88\%) and smartphone (54/56 days, 97\%) wearing compliances were good. After the interventions, cognitive function improvement was significant in both the intervention (P=.003) and the control (P=.009) groups. The increase in frailty reduction (P=.005), walking time (P=.03), step count (P=.02), brisk walking time (P=.009), peak cadence (P=.003), and MVPA time (P=.02) were significant only in the intervention group. Conclusions: Our mHealth intervention is feasible for implementation in older people with cognitive impairment and is effective at enhancing compliance with the brisk walking training program delivered by the conventional behavior change interventions. We provide preliminary evidence that this mHealth intervention can increase MVPA time to an extent sufficient to yield clinical benefits (ie, reduction in cognitive frailty). A full-powered and assessor-blinded RCT should be employed in the future to warrant these effects. Trial Registration: HKU Clinical Trials Registry HKUCTR-2283; http://www.hkuctr.com/Study/Show/31df4708944944bd99e730d839db4756 ", doi="10.2196/16596", url="https://mhealth.jmir.org/2020/7/e16596", url="http://www.ncbi.nlm.nih.gov/pubmed/32735218" } @Article{info:doi/10.2196/14637, author="Odejimi, Opeyemi and Tadros, George and Sabry, Noha", title="Prevalence of Mental Disorders, Cognitive Impairment, and Dementia Among Older Adults in Egypt: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2020", month="Jul", day="24", volume="9", number="7", pages="e14637", keywords="mental disorders", keywords="cognitive impairment", keywords="dementia", keywords="older adults", keywords="Egypt", keywords="prevalence", keywords="socio-demographic factors", keywords="systematic review", keywords="protocol", abstract="Background: In Egypt, the population of older adults is rapidly growing. The last census in 2017 indicated that older adults numbered 94.8 million, which is a 2.56\% increase from the 2006 census. There is growing evidence that the older population is at greater risk for some forms of mental disorders such as depression, dementia, and many more. Objective: This study aims to review the current evidence regarding the prevalence of mental disorders among older adults in Egypt. This will be achieved by estimating the current prevalence of mental disorders and identifying any sociodemographic correlations with mental disorders. Methods: An electronic search of 5 key databases (MEDLINE, PsycINFO, EMBASE, AMED, and PubMed) from their date of inception was conducted. In addition, scans of reference lists and searches of key journals, citations, and relevant internet resources were conducted. Studies were included if they were published in English, point prevalence studies, conducted with older Egyptians aged ?60 years, and conducted using a validated diagnostic tool to ascertain mental disorders. Studies that did not meet any of these criteria were excluded. Results: This systematic review started in November 2018. The literature search of the 5 databases revealed 343 papers. After screening titles and abstracts, scanning citations and reference lists, and searching internet sources, a total of 38 full-text articles were accessed, of which 16 studies met the eligibility criteria and were included. We are currently in the process of data extraction and synthesis. Conclusions: This research will help bring the scale of mental disorders among older adults in Egypt to the forefront. This may help ensure evidence-based initiatives are established and that priority is given to resource allocation for geriatric mental health in Egypt. Trial Registration: PROSPERO International Prospective Register of Systematic Review CRD42018114831; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=114831 International Registered Report Identifier (IRRID): DERR1-10.2196/14637 ", doi="10.2196/14637", url="http://www.researchprotocols.org/2020/7/e14637/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706699" } @Article{info:doi/10.2196/15600, author="Guisado-Fernandez, Estefania and Blake, Catherine and Mackey, Laura and Silva, Alexandra Paula and Power, Dermot and O'Shea, Diarmuid and Caulfield, Brian", title="A Smart Health Platform for Measuring Health and Well-Being Improvement in People With Dementia and Their Informal Caregivers: Usability Study", journal="JMIR Aging", year="2020", month="Jul", day="23", volume="3", number="2", pages="e15600", keywords="Connected Health", keywords="dementia", keywords="informal caregiver", keywords="home care", keywords="home monitoring", abstract="Background: Dementia is a neurodegenerative chronic condition characterized by a progressive decline in a person's memory, thinking, learning skills, and the ability to perform activities of daily living. Previous research has indicated that there are many types of technology interventions available in the literature that have shown promising results in improving disease progression, disease management, and the well-being of people with dementia (PwD) and their informal caregiver, thus facilitating dementia care and living. Technology-driven home care interventions, such as Connected Health (CH), could offer a convenient and low-cost alternative to traditional home care, providing an informal caregiver with the support they may need at home while caring for a PwD, improving their physical and mental well-being. Objective: This study aimed (1) to create a multidimensional profile for evaluating the well-being progression of the PwD--informal caregiver dyad for a year during their use of a CH platform, designed for monitoring PwD and supporting their informal caregivers at home, and (2) to conduct a long-term follow-up using the proposed well-being profile at different time-interval evaluations. Methods: The PwD--informal caregiver well-being profile was created based on the World Health Organization International Classification of Functioning considering the following outcomes: functional status, cognitive status, and quality of life for the PwD and mental well-being, sleeping quality, and burden for the informal caregiver. Over a year, comprehensive assessments of these outcomes were conducted every 3 months to evaluate the well-being of PwD--informal caregivers, using international and standardized validated questionnaires. Participants' demographic information was analyzed using descriptive statistics and presented as means and SDs. A nonparametric Friedman test was used to analyze the outcome changes and the progression in the PwD-caregiver dyads and to determine if those changes were statistically significant. Results: There were no significant changes in the well-being of PwD or their caregivers over the year of follow-up, with the majority of the PwD-caregiver dyads remaining stable. The only instances in which significant changes were observed were the functional status in the PwD and sleep quality in their caregivers. In each of these measures, post hoc pairwise comparisons did not indicate that the changes observed were related to the deployment of the CH platform. Conclusions: The follow-up of this population of PwD and their informal caregivers has shown that disease progression and physical and mental well-being do not change significantly during the time, being a slow and gradual process. The well-being profile created to analyze the potential impact of the CH platform on the PwD--informal caregiver dyad well-being, once validated, could be used as a future tool to conduct the same analyses with other CH technologies for this population. International Registered Report Identifier (IRRID): RR2-10.2196/13280 ", doi="10.2196/15600", url="http://aging.jmir.org/2020/2/e15600/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706650" } @Article{info:doi/10.2196/17851, author="Du, Yan and Paiva, Kristi and Cebula, Adrian and Kim, Seon and Lopez, Katrina and Li, Chengdong and White, Carole and Myneni, Sahiti and Seshadri, Sudha and Wang, Jing", title="Diabetes-Related Topics in an Online Forum for Caregivers of Individuals Living With Alzheimer Disease and Related Dementias: Qualitative Inquiry", journal="J Med Internet Res", year="2020", month="Jul", day="6", volume="22", number="7", pages="e17851", keywords="diabetes", keywords="Alzheimer disease", keywords="dementia", keywords="caregivers", abstract="Background: Diabetes and Alzheimer disease and related dementias (ADRD) are the seventh and sixth leading causes of death in the United States, respectively, and they coexist in many older adults. Caring for a loved one with both ADRD and diabetes is challenging and burdensome. Objective: This study aims to explore diabetes-related topics in the Alzheimer's Association ALZConnected caregiver forum by family caregivers of persons living with ADRD. Methods: User posts on the Alzheimer's Association ALZConnected caregiver forum were extracted. A total of 528 posts related to diabetes were included in the analysis. Of the users who generated the 528 posts, approximately 96.1\% (275/286) were relatives of the care recipient with ADRD (eg, child, grandchild, spouse, sibling, or unspecified relative). Two researchers analyzed the data independently using thematic analysis. Any divergence was discussed among the research team, and an agreement was reached with a senior researcher's input as deemed necessary. Results: Thematic analysis revealed 7 key themes. The results showed that comorbidities of ADRD were common topics of discussions among family caregivers. Diabetes management in ADRD challenged family caregivers. Family caregivers might neglect their own health care because of the caring burden, and they reported poor health outcomes and reduced quality of life. The online forum provided a platform for family caregivers to seek support in their attempts to learn more about how to manage the ADRD of their care recipients and seek support for managing their own lives as caregivers. Conclusions: The ALZConnected forum provided a platform for caregivers to seek informational and emotional support for caring for persons living with ADRD and diabetes. The overwhelming burdens with these two health conditions were apparent for both caregivers and care recipients based on discussions from the online forum. Studies are urgently needed to provide practical guidelines and interventions for diabetes management in individuals with diabetes and ADRD. Future studies to explore delivering diabetes management interventions through online communities in caregivers and their care recipients with ADRD and diabetes are warranted. ", doi="10.2196/17851", url="http://www.jmir.org/2020/7/e17851/", url="http://www.ncbi.nlm.nih.gov/pubmed/32628119" } @Article{info:doi/10.2196/17120, author="Potts, Courtney and Bond, Raymond and Ryan, Assumpta and Mulvenna, Maurice and McCauley, Claire and Laird, Elizabeth and Goode, Deborah", title="Ecological Momentary Assessment Within a Digital Health Intervention for Reminiscence in Persons With Dementia and Caregivers: User Engagement Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="6", volume="8", number="7", pages="e17120", keywords="ecological momentary assessment", keywords="EMA", keywords="app", keywords="behaviour analytics", keywords="event logging", keywords="dementia", keywords="carers", keywords="reminiscence", keywords="reminiscing", keywords="mHealth", abstract="Background: User-interaction event logs provide rich and large data sets that can provide valuable insights into how people engage with technology. Approaches such as ecological momentary assessment (EMA) can be used to gather accurate real-time data in an individual's natural environment by asking questions at any given instant. Objective: The purpose of this study was to evaluate user engagement and responses to EMA questions using InspireD, an app used for reminiscence by persons with dementia and their caregivers. Research findings can be used to inform EMA use within digital health interventions. Methods: A feasibility trial was conducted in which participants (n=56) used the InspireD app over a 12-week period. Participants were a mean age of 73 (SD 13) and were either persons with dementia (n=28) or their caregivers (n=28). Questions, which they could either answer or choose to dismiss, were presented to participants at various instants after reminiscence with personal or generic photos, videos, and music. Presentation and dismissal rates for questions were compared by hour of the day and by trial week to investigate user engagement. Results: Overall engagement was high, with 69.1\% of questions answered when presented. Questions that were presented in the evening had the lowest dismissal rate; the dismissal rate for questions presented at 9 PM was significantly lower than the dismissal rate for questions presented at 11 AM (9 PM: 10\%; 11 AM: 50\%; $\chi$21=21.4, P<.001). Questions asked following reminiscence with personal media, especially those asked after personal photos, were less likely to be answered compared to those asked after other media. In contrast, questions asked after the user had listened to generic media, in particular those asked after generic music, were much more likely to be answered. Conclusions: The main limitation of our study was the lack of generalizability of results to a larger population given the quasi-experimental design and older demographic where half of participants were persons with dementia; however, this study shows that older people are willing to participate and engage in EMA. Based on this study, we propose a series of recommendations for app design to increase user engagement with EMA. These include presenting questions no more than once per day, after 8 PM in the evening, and only if the user is not trying to complete a task within the app. ", doi="10.2196/17120", url="https://mhealth.jmir.org/2020/7/e17120", url="http://www.ncbi.nlm.nih.gov/pubmed/32420890" } @Article{info:doi/10.2196/16841, author="Zhao, Yinan and Feng, Hui and Wu, Xinyin and Du, Yan and Yang, Xiufen and Hu, Mingyue and Ning, Hongting and Liao, Lulu and Chen, Huijing and Zhao, Yishan", title="Effectiveness of Exergaming in Improving Cognitive and Physical Function in People With Mild Cognitive Impairment or Dementia: Systematic Review", journal="JMIR Serious Games", year="2020", month="Jun", day="30", volume="8", number="2", pages="e16841", keywords="mild cognitive impairment", keywords="dementia", keywords="exergaming", keywords="physical", keywords="cognitive", abstract="Background: Individuals with mild cognitive impairment and dementia have impaired physical and cognitive functions, leading to a reduced quality of life compared with those without such impairment. Exergaming, which is defined as a combination of exercise and gaming, is an innovative, fun, and relatively safe way to exercise in a virtual reality or gaming environment. Therefore, exergaming may help people living with mild cognitive impairment or dementia to overcome obstacles that they may experience regarding regular exercise and activities. Objective: The aim of this systematic review was to review studies on exergaming interventions administered to elderly individuals with mild cognitive impairment and dementia, and to summarize the results related to physical and cognitive functions such as balance, gait, executive function, and episodic memory. Methods: We searched Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, PsycINFO, Amed, and Nursing Database for articles published from the inception of the respective databases to January 2019. We included all clinical trials of exergaming interventions in individuals with mild cognitive impairment and dementia for review. The risk of bias was independently evaluated by two reviewers using the Cochrane Collaboration and Risk of Bias in Non-randomized Studies of Interventions tools. Results: Ten studies involving 702 participants were included for review. There was consistent evidence from 7 studies with a low risk of bias showing statistically significant effects of exergaming on cognitive functioning in people with mild cognitive impairment and dementia. With respect to physical function, 3 of 5 full-scale studies found positive results, and the intensity of most games was classified as moderate. Conclusions: Overall, exergaming is an innovative tool for improving physical and cognitive function in people with mild cognitive impairment or dementia, although there is high heterogeneity among studies in terms of the duration, frequency, and gaming platform used. The quality of the included articles was moderate to high. More high-quality studies with more accurate outcome indicators are needed for further exploration and validation of the benefits of exergaming for this population. ", doi="10.2196/16841", url="http://games.jmir.org/2020/2/e16841/", url="http://www.ncbi.nlm.nih.gov/pubmed/32602841" } @Article{info:doi/10.2196/17632, author="Saredakis, Dimitrios and Keage, AD Hannah and Corlis, Megan and Loetscher, Tobias", title="Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study", journal="J Med Internet Res", year="2020", month="Jun", day="26", volume="22", number="6", pages="e17632", keywords="reminiscence", keywords="head-mounted display", keywords="apathy", keywords="cognitive aging", keywords="dementia", keywords="residential facilities", keywords="virtual reality", abstract="Background: Apathy is a common symptom in neurological disorders, including dementia, and is associated with a faster rate of cognitive decline, reduced quality of life, and high caregiver burden. There is a lack of effective pharmacological treatments for apathy, and nonpharmacological interventions are a preferred first-line approach to treatment. Virtual reality (VR) using head-mounted displays (HMDs) is being successfully used in exposure- and distraction-based therapies; however, there is limited research on using HMDs for symptoms of neurological disorders. Objective: This feasibility study aimed to assess whether VR using HMDs could be used to deliver tailored reminiscence therapy and examine the willingness to participate, response rates to measures, time taken to create tailored content, and technical problems. In addition, this study aimed to explore the immediate effects between verbal fluency and apathy after exposure to VR. Methods: A mixed methods study was conducted in a sample of older adults residing in aged care, and 17 participants were recruited. Apathy was measured using the Apathy Evaluation Scale (AES), and verbal fluency was used as a proxy measure of improvements in apathy and debriefing interviews to assess feedback from participants. Side effects that can occur from using HMDs were also measured. Results: We recruited participants from a high socioeconomic status setting with a high education level, and the participation rate was 85\% (17/20); most responses to measures were positive. Access to a wide range of freely available content and the absence of technical difficulties made the delivery of a VR reminiscence intervention highly feasible. Participants had improved semantic scores (t14=?3.27; P=.006) but not phonemic fluency scores (t14=0.55; P=.59) immediately after the intervention. Those with higher levels of apathy demonstrated the greatest cognitive improvements after a VR reminiscence experience, which was indicated by a strong positive relationship between the AES and semantic verbal fluency change scores postminus pre-VR (r=0.719; 95\% CI 0.327 to 0.900; P=.003). All participants enjoyed the experience despite 35\% (6/17) of participants experiencing temporary side effects. Conclusions: This study provides initial evidence that it is feasible to use VR with HMDs for therapy to treat symptoms of apathy in older adults in residential aged care. However, there is a need to closely monitor the side effects of HMD use in older adults. Further research is needed using an active control group to compare the use of VR with traditional forms of reminiscence therapy. ", doi="10.2196/17632", url="http://www.jmir.org/2020/6/e17632/", url="http://www.ncbi.nlm.nih.gov/pubmed/32469314" } @Article{info:doi/10.2196/17769, author="Peterson, M. Colleen and Mikal, P. Jude and McCarron, R. Hayley and Finlay, M. Jessica and Mitchell, L. Lauren and Gaugler, E. Joseph", title="The Feasibility and Utility of a Personal Health Record for Persons With Dementia and Their Family Caregivers for Web-Based Care Coordination: Mixed Methods Study", journal="JMIR Aging", year="2020", month="Jun", day="26", volume="3", number="1", pages="e17769", keywords="Alzheimer disease", keywords="technology", keywords="disease management", keywords="personal health record", keywords="family caregiving", keywords="informal caregiving", keywords="caregiver burnout", keywords="web-based intervention", keywords="assistive technology", abstract="Background: Managing the complex and long-term care needs of persons living with Alzheimer disease and related dementias (ADRD) can adversely impact the health of informal caregivers and their care recipients. Web-based personal health records (PHRs) are one way to potentially alleviate a caregiver's burden by simplifying ADRD health care management Objective: This study aimed to evaluate Personal Health Record for Persons with Dementia and Their Family Caregivers (PHR-ADRD), a free web-based information exchange tool, using a multiphase mixed methods approach. Methods: Dementia caregivers (N=34) were surveyed for their well-being and perceptions of PHR-ADRD feasibility and utility at 6 and 12 months using close- and open-ended questions as well as a semistructured interview (n=8). Exploratory analyses compared participants' characteristics as well as PHR-ADRD use and experiences based on overall favorability status. Results: Feasibility and utility scores decreased over time, but a subset of participants indicated that the system was helpful. Quantitative comparisons could not explain why some participants indicated favorable, neutral, or unfavorable views of the system overall or had not engaged with PHR-ADRD. Qualitative findings suggested that technology literacy and primary care provider buy-in were barriers. Both qualitative and qualitative findings indicated that time constraints to learn and use the system affected most participants. Conclusions: Development and dissemination of PHRs for family caregivers of persons with ADRD should aim to make systems user-friendly for persons with limited time and technological literacy. Establishing health care provider buy-in may be essential to the future success of any PHR system. ", doi="10.2196/17769", url="http://aging.jmir.org/2020/1/e17769/", url="http://www.ncbi.nlm.nih.gov/pubmed/32589158" } @Article{info:doi/10.2196/18624, author="Christie, Liane Hannah and Boots, Maria Lizzy Mitzy and Peetoom, Kirsten and Tange, Johannes Huibert and Verhey, Josef Frans Rochus and de Vugt, Elizabeth Marjolein", title="Developing a Plan for the Sustainable Implementation of an Electronic Health Intervention (Partner in Balance) to Support Caregivers of People With Dementia: Case Study", journal="JMIR Aging", year="2020", month="Jun", day="25", volume="3", number="1", pages="e18624", keywords="dementia", keywords="caregiving", keywords="eHealth", keywords="implementation", keywords="business modeling", abstract="Background: Given the increasing use of digital interventions in health care, understanding how best to implement them is crucial. However, evidence on how to implement new academically developed interventions in complex health care environments is lacking. This case study offers an example of how to develop a theory-based implementation plan for Partner in Balance, an electronic health (eHealth) intervention to support the caregivers of people with dementia. Objective: The specific objectives of this study were to (1) formulate evidence-based implementation strategies, (2) develop a sustainable business model, and (3) integrate these elements into an implementation plan. Methods: This case study concerns Partner in Balance, a blended care intervention to support the caregivers of people with dementia, which is effective in improving caregiver self-efficacy, quality of life, and experienced control. The large-scale implementation of Partner in Balance took place in local dementia case-management services, local care homes, dementia support groups, and municipalities. Experiences from real-life pilots (n=22) and qualitative interviews with national stakeholders (n=14) were used to establish an implementation plan consisting of implementation strategies and a business model. Results: The main finding was the need for a business model to facilitate decision-making from potential client organizations, who need reliable pricing information before they can commit to training coaches and implementing the intervention. Additionally, knowledge of the organizational context and a wider health care system are essential to ensure that the intervention meets the needs of its target users. Based on these findings, the research team formulated implementation strategies targeted at the engagement of organizations and staff, dissemination of the intervention, and facilitation of long-term project management in the future. Conclusions: This study offers a theory-based example of implementing an evidence-based eHealth intervention in dementia health care. The findings help fill the knowledge gap on the eHealth implementation context for evidence-based eHealth interventions after the trial phase, and they can be used to inform individuals working to develop and sustainably implement eHealth. ", doi="10.2196/18624", url="http://aging.jmir.org/2020/1/e18624/", url="http://www.ncbi.nlm.nih.gov/pubmed/32584261" } @Article{info:doi/10.2196/16371, author="Seelye, Adriana and Leese, Isabelle Mira and Dorociak, Katherine and Bouranis, Nicole and Mattek, Nora and Sharma, Nicole and Beattie, Zachary and Riley, Thomas and Lee, Jonathan and Cosgrove, Kevin and Fleming, Nicole and Klinger, Jessica and Ferguson, John and Lamberty, John Greg and Kaye, Jeffrey", title="Feasibility of In-Home Sensor Monitoring to Detect Mild Cognitive Impairment in Aging Military Veterans: Prospective Observational Study", journal="JMIR Form Res", year="2020", month="Jun", day="8", volume="4", number="6", pages="e16371", keywords="aging", keywords="mild cognitive impairment", keywords="activities of daily living", keywords="technology", abstract="Background: Aging military veterans are an important and growing population who are at an elevated risk for developing mild cognitive impairment (MCI) and Alzheimer dementia, which emerge insidiously and progress gradually. Traditional clinic-based assessments are administered infrequently, making these visits less ideal to capture the earliest signals of cognitive and daily functioning decline in older adults. Objective: This study aimed to evaluate the feasibility of a novel ecologically valid assessment approach that integrates passive in-home and mobile technologies to assess instrumental activities of daily living (IADLs) that are not well captured by clinic-based assessment methods in an aging military veteran sample. Methods: Participants included 30 community-dwelling military veterans, classified as healthy controls (mean age 72.8, SD 4.9 years; n=15) or MCI (mean age 74.3, SD 6.0 years; n=15) using the Clinical Dementia Rating Scale. Participants were in relatively good health (mean modified Cumulative Illness Rating Scale score 23.1, SD 2.9) without evidence of depression (mean Geriatrics Depression Scale score 1.3, SD 1.6) or anxiety (mean generalized anxiety disorder questionnaire 1.3, SD 1.3) on self-report measures. Participants were clinically assessed at baseline and 12 months later with health and daily function questionnaires and neuropsychological testing. Daily computer use, medication taking, and physical activity and sleep data were collected via passive computer monitoring software, an instrumented pillbox, and a fitness tracker watch in participants' environments for 12 months between clinical study visits. Results: Enrollment began in October 2018 and continued until the study groups were filled in January 2019. A total of 201 people called to participate following public posting and focused mailings. Most common exclusionary criteria included nonveteran status 11.4\% (23/201), living too far from the study site 9.4\% (19/201), and having exclusionary health concerns 17.9\% (36/201). Five people have withdrawn from the study: 2 with unanticipated health conditions, 2 living in a vacation home for more than half of the year, and 1 who saw no direct benefit from the research study. At baseline, MCI participants had lower Montreal Cognitive Assessment (P<.001) and higher Functional Activities Questionnaire (P=.04) scores than healthy controls. Over seven months, research personnel visited participants' homes a total of 73 times for technology maintenance. Technology maintenance visits were more prevalent for MCI participants (P=.04) than healthy controls. Conclusions: Installation and longitudinal deployment of a passive in-home IADL monitoring platform with an older adult military veteran sample was feasible. Knowledge gained from this pilot study will be used to help develop acceptable and effective home-based assessment tools that can be used to passively monitor cognition and daily functioning in older adult samples. ", doi="10.2196/16371", url="https://formative.jmir.org/2020/6/e16371", url="http://www.ncbi.nlm.nih.gov/pubmed/32310138" } @Article{info:doi/10.2196/17819, author="Hane, A. Christopher and Nori, S. Vijay and Crown, H. William and Sanghavi, M. Darshak and Bleicher, Paul", title="Predicting Onset of Dementia Using Clinical Notes and Machine Learning: Case-Control Study", journal="JMIR Med Inform", year="2020", month="Jun", day="3", volume="8", number="6", pages="e17819", keywords="Alzheimer disease", keywords="dementia", keywords="health information systems", keywords="machine learning", keywords="natural language processing", keywords="health information interoperability", abstract="Background: Clinical trials need efficient tools to assist in recruiting patients at risk of Alzheimer disease and related dementias (ADRD). Early detection can also assist patients with financial planning for long-term care. Clinical notes are an important, underutilized source of information in machine learning models because of the cost of collection and complexity of analysis. Objective: This study aimed to investigate the use of deidentified clinical notes from multiple hospital systems collected over 10 years to augment retrospective machine learning models of the risk of developing ADRD. Methods: We used 2 years of data to predict the future outcome of ADRD onset. Clinical notes are provided in a deidentified format with specific terms and sentiments. Terms in clinical notes are embedded into a 100-dimensional vector space to identify clusters of related terms and abbreviations that differ across hospital systems and individual clinicians. Results: When using clinical notes, the area under the curve (AUC) improved from 0.85 to 0.94, and positive predictive value (PPV) increased from 45.07\% (25,245/56,018) to 68.32\% (14,153/20,717) in the model at disease onset. Models with clinical notes improved in both AUC and PPV in years 3-6 when notes' volume was largest; results are mixed in years 7 and 8 with the smallest cohorts. Conclusions: Although clinical notes helped in the short term, the presence of ADRD symptomatic terms years earlier than onset adds evidence to other studies that clinicians undercode diagnoses of ADRD. De-identified clinical notes increase the accuracy of risk models. Clinical notes collected across multiple hospital systems via natural language processing can be merged using postprocessing techniques to aid model accuracy. ", doi="10.2196/17819", url="https://medinform.jmir.org/2020/6/e17819", url="http://www.ncbi.nlm.nih.gov/pubmed/32490841" } @Article{info:doi/10.2196/16772, author="Chan, SY Windy and Leung, YM Angela", title="Facebook as a Novel Tool for Continuous Professional Education on Dementia: Pilot Randomized Controlled Trial", journal="J Med Internet Res", year="2020", month="Jun", day="2", volume="22", number="6", pages="e16772", keywords="dementia", keywords="Facebook", keywords="social network sites", keywords="continuous professional education", abstract="Background: Social network sites (SNSs) are widely exploited in health education and communication by the general public, including patients with various conditions. Nevertheless, there is an absence of evidence evaluating SNSs in connecting health professionals for professional purposes. Objective: This pilot randomized controlled trial was designed to evaluate the feasibility of an intervention aiming to investigate the effects of a continuous professional education program utilizing Facebook to obtain knowledge on dementia and care for patients with dementia. Methods: Eighty health professionals from Hong Kong were recruited for participation in the study and randomized at a 1:1 ratio by a block randomization method to the intervention group (n=40) and control group (n=40). The intervention was an 8-week educational program developed to deliver updated knowledge on dementia care from a multidisciplinary perspective, either by Facebook (intervention group) or by email (control group) from October 2018 to January 2019. The primary outcomes were the effects of the intervention, measured by differences in the means of changes in pre- and postintervention scores of knowledge assessments from the 25-item Dementia Knowledge Assessment Scale (DKAS) and formative evaluation of 20 multiple choice questions. Other outcome measurements included participant compliance, participant engagement in Facebook, satisfaction, and self-perceived uses of Facebook for continuing professional education programs. Results: Significantly more intervention group participants (n=35) completed the study than the control group (n=25) (P<.001). The overall retention rate was 75\% (60/80). The mean of changes in scores in the intervention group were significant in all assessments (P<.001). A significant difference in the mean of changes in scores between the two groups was identified in the DKAS subscale Communication and Behavior (95\% CI 0.4-3.3, P=.02). There was no significant difference in the total DKAS scores, scores of other DKAS subscales, and multiple choice questions. Participant compliance was significantly higher in the intervention group than in the control group (P<.001). The mean numbers of participants accessing the learning materials were 31.5 (SD 3.9) and 17.6 (SD 5.2) in the intervention and control group, respectively. Polls attracted the highest level of participant engagement, followed by videos. Intervention group participants scored significantly higher in favoring the use of Facebook for the continuing education program (P=.03). Overall, participants were satisfied with the interventions (mean score 4 of a total of 5, SD 0.6). Conclusions: The significantly higher retention rate, together with the high levels of participant compliance and engagement, demonstrate that Facebook is a promising tool for professional education. Education delivered through Facebook was significantly more effective at improving participants' knowledge of how people with dementia communicate and behave. Participants demonstrated positive attitudes toward utilizing Facebook for professional learning. These findings provide evidence for the feasibility of using Facebook as an intervention delivery tool in a manner that can be rolled out into practical settings. ", doi="10.2196/16772", url="https://www.jmir.org/2020/6/e16772", url="http://www.ncbi.nlm.nih.gov/pubmed/32484441" } @Article{info:doi/10.2196/17253, author="Guzman-Parra, Jose and Barnestein-Fonseca, Pilar and Guerrero-Perti{\~n}ez, Gloria and Anderberg, Peter and Jimenez-Fernandez, Luis and Valero-Moreno, Esperanza and Goodman-Casanova, Marian Jessica and Cuesta-Vargas, Antonio and Garolera, Maite and Quintana, Maria and Garc{\'i}a-Betances, I. Rebeca and Lemmens, Evi and Sanmartin Berglund, Johan and Mayoral-Cleries, Fermin", title="Attitudes and Use of Information and Communication Technologies in Older Adults With Mild Cognitive Impairment or Early Stages of Dementia and Their Caregivers: Cross-Sectional Study", journal="J Med Internet Res", year="2020", month="Jun", day="1", volume="22", number="6", pages="e17253", keywords="aging", keywords="mild cognitive impairment", keywords="dementia eHealth", keywords="information and communication technology", keywords="technophilia", abstract="Background: Information and communication technologies are promising tools to increase the quality of life of people with dementia or mild cognitive impairment and that of their caregivers. However, there are barriers to their use associated with sociodemographic factors and negative attitudes, as well as inadequate knowledge about technologies. Objective: The aim of this study was to analyze technophilia (attitudes toward new technologies) and the use of smartphones and tablets along with associated factors in people with dementia/mild cognitive impairment and their caregivers. Methods: Data from the first visit of the Support Monitoring and Reminder for Mild Dementia (SMART4MD) randomized multicenter clinical trial were used for this analysis. Data were obtained from two European countries, Spain and Sweden, and from three centers: Consorci Sanitari de Terrassa (Catalonia, Spain), Servicio Andaluz de Salud (Andalusia, Spain), and the Blekinge Institute of Technology (Sweden). Participants with a score between 20 and 28 in the Mini Mental State Examination, with memory problems (for more than 6 months), and who were over the age of 55 years were included in the study, along with their caregivers. The bivariate Chi square and Mann-Whitney tests, and multivariate linear and logistic regression models were used for statistical analysis. Results: A total of 1086 dyads were included (N=2172). Overall, 299 (27.53\%) of people with dementia/mild cognitive impairment had a diagnosis of dementia. In addition, 588 (54.14\%) of people with dementia/mild cognitive impairment reported using a smartphone almost every day, and 106 (9.76\%) used specific apps or software to support their memory. Among the caregivers, 839 (77.26\%) used smartphones and tablets almost every day, and 181 (16.67\%) used specific apps or software to support their memory. The people with dementia/mild cognitive impairment showed a lower level of technophilia in comparison to that of their caregivers after adjusting for confounders (B=0.074, P=.02) with differences in technology enthusiasm (B=0.360, P<.001), but not in technology anxiety (B=--0.042, P=.37). Technophilia was associated with lower age (B=--0.009, P=.004), male gender (B=--0.160, P<.001), higher education level (P=.01), living arrangement (living with children vs single; B=--2.538, P=.01), country of residence (Sweden vs Spain; B=0.256, P<.001), lower depression (B=--0.046, P<.001), and better health status (B=0.004, P<.001) in people with dementia/mild cognitive impairment. Among caregivers, technophilia was associated with comparable sociodemographic factors (except for living arrangement), along with a lower caregiver burden (B=--0.005, P=.04) and better quality of life (B=0.348, P<.001). Conclusions: Technophilia was associated with a better quality of life and sociodemographic variables in people with dementia/mild cognitive impairment and caregivers, suggesting potential barriers for technological interventions. People with dementia/mild cognitive impairment frequently use smartphones and tablets, but the use of specific apps or software to support memory is limited. Interventions using these technologies are needed to overcome barriers in this population related to sociodemographic characteristics and the lack of enthusiasm for new technologies. Trial Registration: ClinicalTrials.gov NCT03325699; https://clinicaltrials.gov/ct2/show/NCT03325699 ", doi="10.2196/17253", url="https://www.jmir.org/2020/6/e17253", url="http://www.ncbi.nlm.nih.gov/pubmed/32442136" } @Article{info:doi/10.2196/19434, author="Goodman-Casanova, Marian Jessica and Dura-Perez, Elena and Guzman-Parra, Jose and Cuesta-Vargas, Antonio and Mayoral-Cleries, Fermin", title="Telehealth Home Support During COVID-19 Confinement for Community-Dwelling Older Adults With Mild Cognitive Impairment or Mild Dementia: Survey Study", journal="J Med Internet Res", year="2020", month="May", day="22", volume="22", number="5", pages="e19434", keywords="telehealth", keywords="confinement", keywords="coronavirus", keywords="COVID-19", keywords="well-being", keywords="emergency response", keywords="public health", keywords="mental health", keywords="physical health", keywords="elderly", keywords="older adults", keywords="cognitive impairment", keywords="dementia", abstract="Background: The public health emergency of coronavirus disease (COVID-19) is rapidly evolving worldwide; some countries, including Spain, have implemented restrictive measures. Populations that are vulnerable to this outbreak and its physical and mental health effects include community-dwelling older adults with mild cognitive impairment or mild dementia. Telehealth is a potential tool to deliver health care and decrease exposure risk. Objective: The aims of this study were to explore the impact of confinement on the health and well-being of community-dwelling older adults with mild cognitive impairment or mild dementia, to provide television-based and telephone-based health and social support, and to study the effects of a television-based assistive integrated technology, TV-AssistDem (TeleVision-based ASSistive Integrated Service to supporT European adults living with mild DEMentia or mild cognitive impairment). Methods: A telephone-based survey was administered in Spain to 93 participants in the TV-AssistDem clinical trial from March 25 to April 6, 2020. Results: Of the respondents, 60/93 (65\%) were women. The mean age was 73.34 (SD 6.07), and 69/93 (74\%) lived accompanied. Lockdown measures forced 17/93 respondents (18\%) to change their living arrangements. Health status was found to be optimal in 89/93 respondents (96\%), with no COVID-19 symptoms. Grocery and pharmacy outings were performed by family members of 68/93 participants (73\%); 57 (61\%) reported overall well-being, and 65 (70\%) maintained their sleep quality. However, participants living alone reported greater negative feelings and more sleeping problems. Regarding leisure activities, 53/93 respondents (57\%) took walks, 32 (35\%) played memory games, 55 (60\%) watched television, and 91 (98\%) telephoned relatives. 58/93 (64\%) respondents reported accessing moderate or too much COVID-19 information, 89 (97\%) received it from television, and 56 (62\%) stated that their understanding of the information was extreme. 39/93 (39\%) respondents had contacted health and social services, while 29 (31\%) requested information regarding these services during the telephone call. There were no significant differences in health and well-being between the intervention and control groups. Respondents with TV-AssistDem performed more memory exercises (24/93, 52\% vs 8/93, 17.4\%; P<.001) than control respondents. Conclusions: Our findings suggest that during COVID-19 confinement, the physical and mental health and well-being was optimal for the majority of our vulnerable population. However, those living alone reported greater negative psychological effects and sleeping problems. Measures adopted to address the negative experiences of confinement included keeping informed about the situation, accessing health and social services, having a support network that prevents risk of exposure to COVID-19 and guarantees food and medical supplies, a daily routine with maintained sleeping habits and leisure activities, staying physically and mentally active with cognitive stimulation exercises, and ensuring social connectedness using technology. Television sets were preferred technological devices to access COVID-19 information, watch television as a recreational activity, and perform memory exercises as an intellectual activity. Television-based telehealth support using TV-AssistDem demonstrated potential for cognitive stimulation. Trial Registration: ClinicalTrials.gov NCT03653234; https://clinicaltrials.gov/ct2/show/NCT03653234 ", doi="10.2196/19434", url="http://www.jmir.org/2020/5/e19434/", url="http://www.ncbi.nlm.nih.gov/pubmed/32401215" } @Article{info:doi/10.2196/17255, author="Christie, Liane Hannah and Schichel, Philomela Mignon Chlo{\"e} and Tange, Johannes Huibert and Veenstra, Yvonne Marja and Verhey, Josef Frans Rochus and de Vugt, Elizabeth Marjolein", title="Perspectives From Municipality Officials on the Adoption, Dissemination, and Implementation of Electronic Health Interventions to Support Caregivers of People With Dementia: Inductive Thematic Analysis", journal="JMIR Aging", year="2020", month="May", day="13", volume="3", number="1", pages="e17255", keywords="dementia", keywords="caregiver", keywords="internet", keywords="eHealth", keywords="implementation, senior friendly communities", abstract="Background: Very few evidence-based electronic health (eHealth) interventions for caregivers of people with dementia are implemented into practice. As part of a cross-border collaboration focusing on dementia and depression in older people, two eHealth interventions for caregivers of people with dementia (``Myinlife'' and ``Partner in Balance'') were adopted by nine municipalities in the Euregion Meuse-Rhine. Objective: This study aimed to (1) identify determinants for the implementation of eHealth interventions for caregivers of people with dementia in a municipality context and (2) formulate implementation strategies for these interventions. Methods: Eight municipality officials were interviewed using open-ended, semistructured interviews about their background, thoughts on the implementation of the intervention, recommended strategies, and thoughts on eHealth in general. One additional municipality discontinued the implementation project and submitted answers to the interview questions via email. The interviews were transcribed and independently analyzed using inductive thematic analysis. Results: The interviews provided information on the perspectives of municipality officials on implementing eHealth for caregivers of people with dementia in their local communities. Key findings from the inductive thematic analysis included the importance of face-to-face interviews in developing tailor-made implementation plans, the need for regular meetings, the enthusiasm of municipality officials to implement these interventions, the need for long-term sustainability planning through collecting data on the required resources and benefits, and the effect of name brand recognition in adoption. Conclusions: The findings contribute toward filling the previously identified gap in the literature on the implementation context of eHealth interventions for caregivers of people with dementia. Municipality officials' views indicated which implementation determinants they expected would influence the adoption, dissemination, and future implementation of eHealth interventions for caregivers of people with dementia in a municipal context. These insights were applied to tailored implementation strategies to facilitate the future implementation of interventions such as Myinlife and Partner in Balance. ", doi="10.2196/17255", url="http://aging.jmir.org/2020/1/e17255/", url="http://www.ncbi.nlm.nih.gov/pubmed/32401217" } @Article{info:doi/10.2196/14617, author="Tsolaki, C. Anthoula and Tsolaki, Magda and Pandria, Niki and Lazarou, Eftychia and Gkatzima, Olymbia and Zilidou, Vasiliki and Karagianni, Maria and Iakovidou-Kritsi, Zafiroula and Kimiskidis, K. Vasilios and Bamidis, D. Panagiotis", title="Web-Based Intervention Effects on Mild Cognitive Impairment Based on Apolipoprotein E Genotype: Quasi-Experimental Study", journal="J Med Internet Res", year="2020", month="May", day="7", volume="22", number="5", pages="e14617", keywords="mild cognitive impairment", keywords="APOE $\epsilon$4", keywords="computerized training", keywords="exergaming", keywords="Alzheimer disease", abstract="Background: Apolipoprotein E (APOE) $\epsilon$4 allele is a major genetic risk factor for Alzheimer disease and mild cognitive impairment (MCI). Computer-based training programs can improve cognitive performance in elderly populations. However, the effects of computer-based interventions on MCI APOE $\epsilon$4 carriers have never been studied before. Objective: The effects of different web-based interventions and the APOE isoform-specific differences in training outcomes are investigated. Methods: Using a quasi-experimental study design, 202 participants with MCI aged 60 years and older took part in three different intervention programs (physical and cognitive [Long-Lasting Memories, or LLM], cognitive [Active Control, or AC], or physical intervention [Physical Training Control, or PTC]) via an innovative information and communication technologies exergaming platform. Participants in each interventional group were subdivided into APOE $\epsilon$4 carriers and non--APOE $\epsilon$4 carriers. All participants underwent an extensive neuropsychological evaluation before and after the training, blood tests, and brain imaging. Results: All interventions resulted in multiple statistically significant cognitive benefits after the intervention. Verbal learning (California Verbal Learning Test: immediate recall test score---LLM: P=.04; AC: P<.001), working memory (digit span forward and backward test scores---AC: P=.03; PTC: P=.02 and P=.006, respectively), and long-term memory (California Verbal Learning Test: delayed recall test score---LLM: P=.02; AC: P=.002; and PTC: P=.02) were improved. There was no statistically significant difference among the intervention effects. APOE $\epsilon$4 presence moderates intervention effects as the LLM intervention improved only their task-switching processing speed (Trail Making Test, Part B: P=.03) and the PTC intervention improved only the working memory (digit span backward: P=.03). No significant performance alteration was noted for the APOE $\epsilon$4+ cognitive AC training group. Conclusions: None of the applied interventions could be identified as the optimal one; it is suggested, however, that combined cognitive and physical training and physical training via exergaming may be more effective for the high-risk MCI $\Alpha$POE $\epsilon$4+ subgroup. ", doi="10.2196/14617", url="https://www.jmir.org/2020/5/e14617", url="http://www.ncbi.nlm.nih.gov/pubmed/32379048" } @Article{info:doi/10.2196/16854, author="Rawtaer, Iris and Mahendran, Rathi and Kua, Heok Ee and Tan, Pink Hwee and Tan, Xian Hwee and Lee, Tih-Shih and Ng, Pin Tze", title="Early Detection of Mild Cognitive Impairment With In-Home Sensors to Monitor Behavior Patterns in Community-Dwelling Senior Citizens in Singapore: Cross-Sectional Feasibility Study", journal="J Med Internet Res", year="2020", month="May", day="5", volume="22", number="5", pages="e16854", keywords="dementia", keywords="neurocognitive disorder", keywords="pattern recognition, automated/methods", keywords="internet of things", keywords="early diagnosis", abstract="Background: Dementia is a global epidemic and incurs substantial burden on the affected families and the health care system. A window of opportunity for intervention is the predementia stage known as mild cognitive impairment (MCI). Individuals often present to services late in the course of their disease and more needs to be done for early detection; sensor technology is a potential method for detection. Objective: The aim of this cross-sectional study was to establish the feasibility and acceptability of utilizing sensors in the homes of senior citizens to detect changes in behaviors unobtrusively. Methods: We recruited 59 community-dwelling seniors (aged >65 years who live alone) with and without MCI and observed them over the course of 2 months. The frequency of forgetfulness was monitored by tagging personal items and tracking missed doses of medication. Activities such as step count, time spent away from home, television use, sleep duration, and quality were tracked with passive infrared motion sensors, smart plugs, bed sensors, and a wearable activity band. Measures of cognition, depression, sleep, and social connectedness were also administered. Results: Of the 49 participants who completed the study, 28 had MCI and 21 had healthy cognition (HC). Frequencies of various sensor-derived behavior metrics were computed and compared between MCI and HC groups. MCI participants were less active than their HC counterparts and had more sleep interruptions per night. MCI participants had forgotten their medications more times per month compared with HC participants. The sensor system was acceptable to over 80\% (40/49) of study participants, with many requesting for permanent installation of the system. Conclusions: We demonstrated that it was both feasible and acceptable to set up these sensors in the community and unobtrusively collect data. Further studies evaluating such digital biomarkers in the homes in the community are needed to improve the ecological validity of sensor technology. We need to refine the system to yield more clinically impactful information. ", doi="10.2196/16854", url="https://www.jmir.org/2020/5/e16854", url="http://www.ncbi.nlm.nih.gov/pubmed/32369031" } @Article{info:doi/10.2196/15376, author="Ding, Huitong and An, Ning and Au, Rhoda and Devine, Sherral and Auerbach, H. Sanford and Massaro, Joseph and Joshi, Prajakta and Liu, Xue and Liu, Yulin and Mahon, Elizabeth and Ang, FA Ting and Lin, Honghuang", title="Exploring the Hierarchical Influence of Cognitive Functions for Alzheimer Disease: The Framingham Heart Study", journal="J Med Internet Res", year="2020", month="Apr", day="23", volume="22", number="4", pages="e15376", keywords="Alzheimer disease", keywords="neuropsychological test", keywords="stratification", keywords="Bayesian network", keywords="clustering", abstract="Background: Although some neuropsychological (NP) tests are considered more central for the diagnosis of Alzheimer disease (AD), there is a lack of understanding about the interaction between different cognitive tests. Objective: This study aimed to demonstrate a global view of hierarchical probabilistic dependencies between NP tests and the likelihood of cognitive impairment to assist physicians in recognizing AD precursors. Methods: Our study included 2091 participants from the Framingham Heart Study. These participants had undergone a variety of NP tests, including Wechsler Memory Scale, Wechsler Adult Intelligence Scale, and Boston Naming Test. Heterogeneous cognitive Bayesian networks were developed to understand the relationship between NP tests and the cognitive status. The performance of probabilistic inference was evaluated by the 10-fold cross validation. Results: A total of 4512 NP tests were used to build the Bayesian network for the dementia diagnosis. The network demonstrated conditional dependency between different cognitive functions that precede the development of dementia. The prediction model reached an accuracy of 82.24\%, with sensitivity of 63.98\% and specificity of 92.74\%. This probabilistic diagnostic system can also be applied to participants that exhibit more heterogeneous profiles or with missing responses for some NP tests. Conclusions: We developed a probabilistic dependency network for AD diagnosis from 11 NP tests. Our study revealed important psychological functional segregations and precursor evidence of AD development and heterogeneity. ", doi="10.2196/15376", url="http://www.jmir.org/2020/4/e15376/", url="http://www.ncbi.nlm.nih.gov/pubmed/32324139" } @Article{info:doi/10.2196/17108, author="Zahid, Mahnoor and Gallant, L. Natasha and Hadjistavropoulos, Thomas and Stroulia, Eleni", title="Behavioral Pain Assessment Implementation in Long-Term Care Using a Tablet App: Case Series and Quasi-Experimental Design", journal="JMIR Mhealth Uhealth", year="2020", month="Apr", day="22", volume="8", number="4", pages="e17108", keywords="pain measurement", keywords="long-term care", keywords="nursing", keywords="technology Alzheimer disease", keywords="mHealth", abstract="Background: Pain is often underassessed and undertreated among long-term care (LTC) residents living with dementia. When used regularly, the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC) scales have been shown to have beneficial effects on pain assessment and management practices and stress and burnout levels in frontline staff in LTC facilities. Such scales, however, are not utilized as often as recommended, which is likely to be related to additional record-keeping and tracking over time involved with their paper-and-pencil administration. Objective: Using implementation science principles, we assessed the introduction of the PACSLAC-II scale by comparing two methods of administration---a newly developed tablet app version and the original paper-and-pencil version---with respect to the frequency of pain assessment and facility staff feedback. Methods: Using a case series approach, we tracked pain-related quality indicators at baseline, implementation, and follow-up periods. A quasi-experimental design was used to evaluate the effect of the method of administration (ie, paper-and-pencil only [n=18], tablet only [n=12], paper-and-pencil followed by tablet app [n=31], and tablet app followed by paper-and-pencil [n=31]) on pain assessment frequency and frontline staff stress and burnout levels. Finally, semistructured interviews were conducted with frontline staff to obtain perspectives on each method of administration. Results: The implementation effort resulted in a great increase in pain assessment frequency across 7 independent LTC units, although these increases were not maintained during the follow-up period. Frontline staff reported lower levels of workload in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P<.001) and tablet app followed by paper-and-pencil (P<.001) conditions. Frontline staff also reported lower levels of workload in the tablet-only condition than those in the paper-and-pencil only condition (P=.05). Similarly, lower levels of emotional exhaustion were reported by frontline staff in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P=.002) and tablet app followed by paper-and-pencil (P=.002) conditions. Finally, frontline staff reported higher levels of depersonalization in the paper-and-pencil only condition than those in the tablet app only (P=.008), paper-and-pencil followed by tablet app (P<.001), and tablet app followed by paper-and-pencil (P<.001) conditions. Furthermore, narrative data from individual interviews with frontline staff revealed a preference for the tablet app over the paper-and-pencil method of administration. Conclusions: This study provides support for the use of either the tablet app or the paper-and-pencil version of the PACSLAC-II to improve pain-related quality indicators, but a reported preference for and lower levels of stress and burnout with the use of the tablet app method of administration suggests that the use of the tablet app may have more advantages compared with the paper-and-pencil method of administration. ", doi="10.2196/17108", url="http://mhealth.jmir.org/2020/4/e17108/", url="http://www.ncbi.nlm.nih.gov/pubmed/32319955" } @Article{info:doi/10.2196/18179, author="Shu, Sara and Woo, P. Benjamin K.", title="The Roles of YouTube and WhatsApp in Dementia Education for the Older Chinese American Population: Longitudinal Analysis", journal="JMIR Aging", year="2020", month="Apr", day="13", volume="3", number="1", pages="e18179", keywords="dementia", keywords="mental health", keywords="social media", keywords="geriatrics", keywords="health promotion", keywords="health education", abstract="Background: Dementia remains a stigmatized topic in the Chinese community. Objective: This study aims to analyze and compare the usage of dementia educational YouTube videos and the modalities of video sharing over a 6-year period. Methods: Dementia educational videos were uploaded to YouTube. Data was collected over a 6-year period. Results from the first 3 years were compared to those from the second 3 years using descriptive statistics and chi-square analysis. Results: Over 6 years, the dementia educational videos generated a total watch time of 269,388 minutes, 37,690 views, and an average view duration of 7.1 minutes. Comparing the first and second 3-year periods of video performance data, there was a longer watch time (59,262 vs 210,126 minutes), more total views (9387 vs 28,303 views), and a longer average view duration (6.3 vs 7.4 minutes). Furthermore, WhatsApp has become a leading external traffic source and top sharing service, accounting for 43.5\% (929/2137) and 67.0\% (677/1011), respectively. Conclusions: Over 6 years, YouTube has become an increasingly popular tool to deliver culturally sensitive dementia education to Chinese Americans. WhatsApp continues to be the preferred method of sharing dementia education and has become a top external traffic source to dementia educational videos. Taken together, these social media platforms are promising means of reducing the disparity in dementia knowledge in linguistically and culturally isolated populations. ", doi="10.2196/18179", url="http://aging.jmir.org/2020/1/e18179/", url="http://www.ncbi.nlm.nih.gov/pubmed/32281940" } @Article{info:doi/10.2196/16142, author="Lancaster, Claire and Koychev, Ivan and Blane, Jasmine and Chinner, Amy and Wolters, Leona and Hinds, Chris", title="Evaluating the Feasibility of Frequent Cognitive Assessment Using the Mezurio Smartphone App: Observational and Interview Study in Adults With Elevated Dementia Risk", journal="JMIR Mhealth Uhealth", year="2020", month="Apr", day="2", volume="8", number="4", pages="e16142", keywords="technology assessment", keywords="cognition", keywords="smartphone", keywords="mhealth", keywords="mobile phone", keywords="Alzheimer disease", keywords="early diagnosis", keywords="feasibility study", keywords="ecological momentary assessment", abstract="Background: By enabling frequent, sensitive, and economic remote assessment, smartphones will facilitate the detection of early cognitive decline at scale. Previous studies have sustained participant engagement with remote cognitive assessment over a week; extending this to a period of 1 month clearly provides a greater opportunity for measurement. However, as study durations are increased, the need to understand how participant burden and scientific value might be optimally balanced also increases. Objective: This study explored the little but often approach to assessment employed by the Mezurio app when prompting participants to interact every day for over a month. Specifically, this study aimed to understand whether this extended duration of remote study is feasible, and which factors promote sustained participant engagement over such periods. Methods: A total of 35 adults (aged 40-59 years) with no diagnosis of cognitive impairment were prompted to interact with the Mezurio smartphone app platform for up to 36 days, completing short, daily episodic memory tasks in addition to optional executive function and language tests. A subset (n=20) of participants completed semistructured interviews focused on their experience of using the app. Results: Participants complied with 80\% of the daily learning tasks scheduled for subsequent tests of episodic memory, with 88\% of participants still actively engaged by the final task. A thematic analysis of the participants' experiences highlighted schedule flexibility, a clear user interface, and performance feedback as important considerations for engagement with remote digital assessment. Conclusions: Despite the extended study duration, participants demonstrated high compliance with the schedule of daily learning tasks and were extremely positive about their experiences. Long durations of remote digital interaction are therefore definitely feasible but only when careful attention is paid to the design of the users' experience. ", doi="10.2196/16142", url="https://mhealth.jmir.org/2020/4/e16142", url="http://www.ncbi.nlm.nih.gov/pubmed/32238339" } @Article{info:doi/10.2196/17167, author="Robert, Philippe and Manera, Valeria and Derreumaux, Alexandre and Ferrandez Y Montesino, Marion and Leone, Elsa and Fabre, Roxane and Bourgeois, Jeremy", title="Efficacy of a Web App for Cognitive Training (MeMo) Regarding Cognitive and Behavioral Performance in People With Neurocognitive Disorders: Randomized Controlled Trial", journal="J Med Internet Res", year="2020", month="Mar", day="11", volume="22", number="3", pages="e17167", keywords="neurocognitive disorders", keywords="Alzheimer disease", keywords="cognition", keywords="motivation", keywords="apathy", keywords="intervention", abstract="Background: Cognitive and behavioral symptoms are the clinical hallmarks of neurocognitive disorders. Cognitive training may be offered to reduce the risks of cognitive decline and dementia and to reduce behavioral symptoms, such as apathy. Information and communication technology approaches, including serious games, can be useful in improving the playful aspect of computerized cognitive training and providing motivating solutions in elderly patients. Objective: The objective of this study was to assess the effectiveness of employing the MeMo (Memory Motivation) Web app with regard to cognitive and behavioral symptoms in patients with neurocognitive disorders. Methods: MeMo is a Web app that can be used on any Web browser (computer or tablet). The training activities proposed in MeMo are divided into the following two parts: memory and mental flexibility/attention. The study included 46 individuals (mean age 79.4 years) with a diagnosis of neurocognitive disorders at the Institut Claude Pompidou Memory Center in Nice. This randomized controlled study compared the evolution of cognition and behavior between patients not using MeMo (control group) and patients using MeMo (MeMo group) for 12 weeks (four sessions per week). Patients underwent memory and attention tests, as well as an apathy assessment at baseline, week 12 (end of the training period), and week 24 (12 weeks after the end of the training sessions). In addition, to assess the impact of high and low game uses, the MeMo group was divided into patients who used MeMo according to the instructions (about once every 2 days; active MeMo group) and those who used it less (nonactive MeMo group). Results: When comparing cognitive and behavioral scores among baseline, week 12, and week 24, mixed model analysis for each cognitive and behavioral score indicated no significant interaction between testing time and group. On comparing the active MeMo group (n=9) and nonactive MeMo group (n=13), there were significant differences in two attention tests (Trial Making Test A [P=.045] and correct Digit Symbol Substitution Test items [P=.045]) and in the Apathy Inventory (AI) (P=.02). Mixed analysis (time: baseline, week 12, and week 24 {\texttimes} number of active days) indicated only one significant interaction for the AI score (P=.01), with a significant increase in apathy in the nonactive MeMo group. Conclusions: This study indicates that the cognitive and behavioral efficacies of MeMo, a Web-based training app, can be observed only with regular use of the app. Improvements were observed in attention and motivation. Trial Registration: ClinicalTrials.gov NCT04142801; https://clinicaltrials.gov/ct2/show/NCT04142801 ", doi="10.2196/17167", url="https://www.jmir.org/2020/3/e17167", url="http://www.ncbi.nlm.nih.gov/pubmed/32159519" } @Article{info:doi/10.2196/13001, author="Huis in het Veld, G. Judith and Willemse, M. Bernadette and van Asch, FM Iris and Groot Zwaaftink, BM Rob and Verkade, Paul-Jeroen and Twisk, WR Jos and Verkaik, Renate and Blom, M. Marco and van Meijel, Berno and Francke, L. Anneke", title="Online Self-Management Support for Family Caregivers Dealing With Behavior Changes in Relatives With Dementia (Part 2): Randomized Controlled Trial", journal="J Med Internet Res", year="2020", month="Feb", day="25", volume="22", number="2", pages="e13001", keywords="dementia", keywords="family caregivers", keywords="self-management", keywords="support", keywords="intervention", abstract="Background: Online contacts with a health professional have the potential to support family caregivers of people with dementia. Objective: The goal of the research was to study the effects of an online self-management support intervention in helping family caregivers deal with behavior changes of a relative with dementia. The intervention---involving among others personal email contacts with a dementia nurse---was compared with online interventions without these email contacts. Methods: A randomized controlled trial was conducted with 81 family caregivers of people with dementia who live at home. Participants were randomly assigned to a (1) major self-management support intervention consisting of personal email contacts with a specialist dementia nurse, online videos, and e-bulletins; (2) medium intervention consisting only of online videos and e-bulletins; or (3) minor intervention consisting of only the e-bulletins. The primary outcome was family caregivers' self-efficacy in dealing with behavior changes of the relative with dementia. Secondary outcomes were family caregivers' reports of behavior problems in the people with dementia and the quality of the relationship between the family caregiver and the person with dementia. Measurements were performed at the baseline and at 6 (T1) and 12 weeks (T2) after the baseline. A mixed-model analysis was conducted to compare the outcomes of the 3 intervention arms. Results: Family caregivers participating in the major intervention involving email contacts showed no statistically significant differences in self-efficacy after the intervention compared with the minor intervention involving only e-bulletins (difference --0.02, P=.99). In the adjusted analysis, the medium intervention (involving videos and e-bulletins) showed a negative trend over time (difference --4.21, P=.09) and at T1 (difference --4.71, P=.07) compared with the minor intervention involving only e-bulletins. No statistical differences were found between the intervention arms in terms of the reported behavior problems and the quality of the relationship between the family caregiver and the person with dementia. Conclusions: The expectation that an online self-management support intervention involving email contacts would lead to positive effects and be more effective than online interventions without personal email contacts was not borne out. One explanation might be related to the fact that not all family caregivers who were assigned to that intervention actually made use of the opportunity for personal email contact. The online videos were also not always viewed. To obtain more definite conclusions, future research involving extra efforts to reach higher use rates is required. Trial Registration: Netherlands Trial Registry NTR6237; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6237 (Archived by WebCite at http://www.webcitation.org/6v0S4fxTC) International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8365 ", doi="10.2196/13001", url="http://www.jmir.org/2020/2/e13001/", url="http://www.ncbi.nlm.nih.gov/pubmed/32130142" } @Article{info:doi/10.2196/14583, author="Della Mea, Vincenzo and Popescu, Horia Mihai and Gonano, Dario and Petaros, Toma? and Emili, Ivo and Fattori, Grazia Maria", title="A Communication Infrastructure for the Health and Social Care Internet of Things: Proof-of-Concept Study", journal="JMIR Med Inform", year="2020", month="Feb", day="25", volume="8", number="2", pages="e14583", keywords="health services for the aged", keywords="remote sensing technology", keywords="sensors and actuators", keywords="embedded systems", keywords="Internet of Things", keywords="LoRaWAN", abstract="Background: Increasing life expectancy and reducing birth rates indicate that the world population is becoming older, with many challenges related to quality of life for old and fragile people, as well as their informal caregivers. In the last few years, novel information and communication technology techniques generally known as the Internet of Things (IoT) have been developed, and they are centered around the provision of computation and communication capabilities to objects. The IoT may provide older people with devices that enable their functional independence in daily life by either extending their own capacity or facilitating the efforts of their caregivers. LoRa is a proprietary wireless transmission protocol optimized for long-range, low-power, low--data-rate applications. LoRaWAN is an open stack built upon LoRa. Objective: This paper describes an infrastructure designed and experimentally developed to support IoT deployment in a health care setup, and the management of patients with Alzheimer's disease and dementia has been chosen for a proof-of-concept study. The peculiarity of the proposed approach is that it is based on the LoRaWAN protocol stack, which exploits unlicensed frequencies and allows for the use of very low-power radio devices, making it a rational choice for IoT communication. Methods: A complete LoRaWAN-based infrastructure was designed, with features partly decided in agreement with caregivers, including outdoor patient tracking to control wandering; fall recognition; and capability of collecting data for further clinical studies. Further features suggested by caregivers were night motion surveillance and indoor tracking for large residential structures. Implementation involved a prototype node with tracking and fall recognition capabilities, a middle layer based on an existing network server, and a Web application for overall management of patients and caregivers. Tests were performed to investigate indoor and outdoor capabilities in a real-world setting and study the applicability of LoRaWAN in health and social care scenarios. Results: Three experiments were carried out. One aimed to test the technical functionality of the infrastructure, another assessed indoor features, and the last assessed outdoor features. The only critical issue was fall recognition, because a slip was not always easy to recognize. Conclusions: The project allowed the identification of some advantages and restrictions of the LoRaWAN technology when applied to the health and social care sectors. Free installation allows the development of services that reach ranges comparable to those available with cellular telephony, but without running costs like telephony fees. However, there are technological limitations, which restrict the scenarios in which LoRaWAN is applicable, although there is room for many applications. We believe that setting up low-weight infrastructure and carefully determining whether applications can be concretely implemented within LoRaWAN limits might help in optimizing community care activities while not adding much burden and cost in information technology management. ", doi="10.2196/14583", url="http://medinform.jmir.org/2020/2/e14583/", url="http://www.ncbi.nlm.nih.gov/pubmed/32130158" } @Article{info:doi/10.2196/14927, author="Sch{\"u}ssler, Sandra and Zuschnegg, Julia and Paletta, Lucas and Fellner, Maria and Lodron, Gerald and Steiner, Josef and Pansy-Resch, Sandra and Lammer, Lara and Prodromou, Dimitrios and Brunsch, Sebastian and Holter, Magdalena and Carnevale, Lorenzo and Russegger, Silvia", title="The Effects of a Humanoid Socially Assistive Robot Versus Tablet Training on Psychosocial and Physical Outcomes of Persons With Dementia: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2020", month="Feb", day="5", volume="9", number="2", pages="e14927", keywords="dementia", keywords="socially assistive robot", keywords="home care", keywords="caregiver", keywords="dementia trainers", keywords="motivation", keywords="physical training", keywords="cognitive training", keywords="care burden", keywords="humanoid robot", abstract="Background: New technologies, like socially assistive robots (SARs), may have the potential to support caregivers at home. Still, the evidence for people with dementia in home care is unclear because a lot of studies are performed in a laboratory or institutional setting, and mainly use robots in prototype stages. Objective: This study aims to explore the effects of the refined, commercially-available, humanoid SAR Pepper combined with a tablet PC--based dementia training program (Coach Pepper) versus an exclusively tablet PC--based dementia training program on psychosocial and physical outcomes of people with dementia living at home, including caregivers and dementia trainers. We hypothesize that Coach Pepper has a more positive effect on the primary outcome motivation (stable or decreased apathy) of people with dementia. Methods: A mixed methods study will be performed, including a randomized controlled, parallel, 2-arm study with a complementary qualitative part. This sample includes 40 PWD living at home and 40 relatives, each complemented with five professional caregivers and dementia trainers. The intervention group will receive Coach Pepper (a SAR connected with a tablet PC--based dementia training program), and the control group will receive exclusively tablet PC--based training without the SAR. The duration of the intervention will be three weeks per household. Data will be collected at baseline and during and after the intervention by standardized questionnaires, sensor data of the robot, and tablet PC, as well as semistructured interviews, focus groups, and observation. Results: To date, no results are available for this study protocol. The study intervention started in May 2019 and will end in Spring 2020. Conclusions: The intervention of this study can be seen as a nonpharmacological intervention, including cognitive and physical training by a robot. This study will help to further refine SAR for the specific needs of people with dementia living at home. International Registered Report Identifier (IRRID): DERR1-10.2196/14927 ", doi="10.2196/14927", url="https://www.researchprotocols.org/2020/2/e14927" } @Article{info:doi/10.2196/15290, author="Guo, Yuqi and Yang, Fan and Hu, Fei and Li, Wei and Ruggiano, Nicole and Lee, Yun Hee", title="Existing Mobile Phone Apps for Self-Care Management of People With Alzheimer Disease and Related Dementias: Systematic Analysis", journal="JMIR Aging", year="2020", month="Jan", day="24", volume="3", number="1", pages="e15290", keywords="alzheimer disease", keywords="dementia", keywords="self-care", keywords="mobile phone apps", abstract="Background: Alzheimer disease and related dementias (AD/RD) are progressive neurocognitive disorders that currently affect approximately 50 million people worldwide. Mobile phone apps have been well-integrated into daily lives and can be used to deliver and promote health care. There is an increase in the use of technology to provide care and support to AD/RD patients and their families. Objective: This study aimed to review apps designed for AD/RD patients and analyze the benefits of, and challenges to, such technological solutions. Methods: A systematic approach was applied to review the availability, content, features, and quality of mobile phone apps to support self-care among AD/RD patients. Results: The initial search for this review was conducted in January 2019, and the screening and analysis of the included apps were completed in May 2019. A total of 14 apps were included from an initial search of 245 apps. The top 3 features were alert (9/14, 64\%), self-care tips (6/14, 42\%), and social networking capacity (5/14, 35\%). On average, the readability of the apps was a tenth-grade reading level (SD 3.06). The overall quality was 3.71 out of 5 (SD 1.37). Conclusions: Our findings suggest that currently available apps for AD/RD patients may not meet complex needs and may be challenging to use, given the possible impaired communication ability associated with AD/RD. Therefore, high-quality apps need to be developed and rigorously evaluated for feasibility and efficacy. ", doi="10.2196/15290", url="http://aging.jmir.org/2020/1/e15290/", url="http://www.ncbi.nlm.nih.gov/pubmed/32012045" } @Article{info:doi/10.2196/16808, author="Moehead, Anne and DeSouza, Kathryn and Walsh, Karen and Pit, W. Sabrina", title="A Web-Based Dementia Education Program and its Application to an Australian Web-Based Dementia Care Competency and Training Network: Integrative Systematic Review", journal="J Med Internet Res", year="2020", month="Jan", day="22", volume="22", number="1", pages="e16808", keywords="education", keywords="workforce", keywords="online learning", keywords="Web-based learning", keywords="distance education", keywords="dementia", keywords="nursing", keywords="facilitated learning", keywords="competency", keywords="training", keywords="network", keywords="capability", keywords="skills", keywords="person-centered", abstract="Background: Dementia education that meets quality and safety standards is paramount to ensure a highly skilled dementia care workforce. Web-based education provides a flexible and cost-effective medium. To be successful, Web-based education must contain features that promote learning and support knowledge translation into practice. The Dementia Care Competency and Training Network (DCC\&TN) has developed an innovative Web-based program that promotes improvement of the attitudes, knowledge, skills, behavior, and practice of clinicians, regardless of their work setting, in order to improve the quality of life for people living with dementia. Objective: This review aims to (1) determine the key features that are associated with an effective and functional Web-based education program---an effective and functional Web-based program is defined as one that measures results, is accessible, is user friendly, and translates into clinical practice---and (2) determine how these features correlate with the DCC\&TN. Methods: Six electronic databases---Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), AusHealth, Nursing@Ovid, and Google Scholar---were searched for articles published between 2009 and 2018 using the following keywords: Education, Distance, Continuing, Learning, Online, Web-Based, Internet, Dementia, Program Evaluation, Validation Studies, Outcome and Process Assessment Healthcare, Nursing, Assisted Instruction, and Facilitated. The Critical Appraisal Skills Programme (CASP) and Kirkpatrick's model for the evaluation of training were used to ensure quality and rigor of the analysis. Results: A total of 46 studies met the inclusion criteria. In total, 14 key features were associated with an effective Web-based learning environment, which enabled the environment to be as follows: self-directed, individualized, interactive, multimodal, flexible, accessible, consistent, cost-effective, measurable with respect to participant satisfaction, equitable, facilitated, nurturing of critical thinking and reflection, supportive of creating a learning community, and translated into practice. These features were further categorized into five subgroups: applicability, attractiveness, functionality, learner interaction, and implementation into practice. Literature frequently cites Kirkpatrick's four-level model of evaluation and application in the review of education and training; however, few studies appeared to integrate all four levels of Kirkpatrick's model. Features were then correlated against the DCC\&TN, with an encouraging connection found between these features and their inclusion within the content and structure of the DCC\&TN. Conclusions: A total of 14 key features were identified that support an effective and functional Web-based learning environment. Few studies incorporated Kirkpatrick's salient elements of the model---reaction, learning, behavior, and results---in their evaluation and clinical application. It could, therefore, be considered prudent to include Kirkpatrick's levels of training evaluation within studies of dementia training. There were few studies that evaluated Web-based dementia education programs, with even fewer reporting evidence that Web-based training could increase staff confidence, knowledge, skills, and attitudes toward people with dementia and be sustainable over time. The DCC\&TN appeared to contain the majority of key features and is one of the few programs inclusive of hospital, community, and residential care settings. The 14 key features can potentially enhance and complement future development of online training programs for health sciences education and beyond. The DCC\&TN model could potentially be used as a template for future developers and evaluators of Web-based dementia training. ", doi="10.2196/16808", url="http://www.jmir.org/2020/1/e16808/", url="http://www.ncbi.nlm.nih.gov/pubmed/32012077" } @Article{info:doi/10.2196/16790, author="Yamada, Yasunori and Shinkawa, Kaoru and Shimmei, Keita", title="Atypical Repetition in Daily Conversation on Different Days for Detecting Alzheimer Disease: Evaluation of Phone-Call Data From a Regular Monitoring Service", journal="JMIR Ment Health", year="2020", month="Jan", day="14", volume="7", number="1", pages="e16790", keywords="dementia", keywords="Alzheimer disease", keywords="speech analysis", keywords="screening", keywords="monitoring", keywords="behavioral marker", keywords="daily conversation", abstract="Background: Identifying signs of Alzheimer disease (AD) through longitudinal and passive monitoring techniques has become increasingly important. Previous studies have succeeded in quantifying language dysfunctions and identifying AD from speech data collected during neuropsychological tests. However, whether and how we can quantify language dysfunction in daily conversation remains unexplored. Objective: The objective of this study was to explore the linguistic features that can be used for differentiating AD patients from daily conversations. Methods: We analyzed daily conversational data of seniors with and without AD obtained from longitudinal follow-up in a regular monitoring service (from n=15 individuals including 2 AD patients at an average follow-up period of 16.1 months; 1032 conversational data items obtained during phone calls and approximately 221 person-hours). In addition to the standard linguistic features used in previous studies on connected speech data during neuropsychological tests, we extracted novel features related to atypical repetition of words and topics reported by previous observational and descriptive studies as one of the prominent characteristics in everyday conversations of AD patients. Results: When we compared the discriminative power of AD, we found that atypical repetition in two conversations on different days outperformed other linguistic features used in previous studies on speech data during neuropsychological tests. It was also a better indicator than atypical repetition in single conversations as well as that in two conversations separated by a specific number of conversations. Conclusions: Our results show how linguistic features related to atypical repetition across days could be used for detecting AD from daily conversations in a passive manner by taking advantage of longitudinal data. ", doi="10.2196/16790", url="http://mental.jmir.org/2020/1/e16790/" } @Article{info:doi/10.2196/12504, author="Efthymiou, Areti and Middleton, Nicos and Charalambous, Andreas and Papastavrou, Evridiki", title="Adapting the eHealth Literacy Scale for Carers of People With Chronic Diseases (eHeals-Carer) in a Sample of Greek and Cypriot Carers of People With Dementia: Reliability and Validation Study", journal="J Med Internet Res", year="2019", month="Nov", day="28", volume="21", number="11", pages="e12504", keywords="eHealth", keywords="literacy", keywords="scales", keywords="carers", keywords="technology", keywords="chronic disease", abstract="Background: As the population ages, many more people will be in need of long-term care. According to a recent report by Alzheimer's Disease International and the Karolinska Institute, 84\% of people with dementia are cared for at home and 16\% in nursing homes. Several Web-based interventions have been developed to assist the work of carers at home. Measuring the levels of electronic health (eHealth) literacy is of top priority to facilitate inclusion of this population and develop training programs to enhance eHealth literacy skills. Objective: This study aimed to adapt the eHealth Literacy Scale (eHeals) for carers of people with dementia, who speak Greek as their native language and live in Greece and Cyprus, and to test the reliability and validity of the scale for carers. Methods: The content validity of the eHealth Literacy Scale for Carers of People With Chronic Diseases (eHeals-Carer) was assessed with an expert panel (N=10). A descriptive study with face-to-face interviews among 101 primary carers of people with dementia was conducted. In addition to the eHeals-Carer to assess their perceived eHealth literacy, participants responded to a brief questionnaire regarding characteristics of internet use and provided sociodemographic data. The internal consistency of the tool and the construct validity via an exploratory factor analysis (EFA) were explored. Results: The Mean Item-Level Content Validity Index (CVI) and Scale-Level CVI Average was 0.93. The participants were mostly women (75.2\%, 76/101), aged less than 60 years (67.3\%, 68/101) with secondary education. The internal consistency was estimated at a Cronbach alpha of .83. Two factors were extracted from the EFA: information seeking questions 1 to 5 (factor 1) and evaluation questions 6 to 8 (factor 2). Conclusions: eHeals-Carer is the first perceived eHealth literacy tool adapted for carers of people with dementia. The use of Web-based services available for carers could help them and improve the health care system in the long term. In Greece and Cyprus, there is a lack of services, and improving the digital skills of carers could provide them with the means to support themselves at home and improve care provision. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8080 ", doi="10.2196/12504", url="http://www.jmir.org/2019/11/e12504/", url="http://www.ncbi.nlm.nih.gov/pubmed/31778120" } @Article{info:doi/10.2196/15122, author="Koo, Mi Bon and Vizer, M. Lisa", title="Examining Mobile Technologies to Support Older Adults With Dementia Through the Lens of Personhood and Human Needs: Scoping Review", journal="JMIR Mhealth Uhealth", year="2019", month="Nov", day="11", volume="7", number="11", pages="e15122", keywords="dementia", keywords="Alzheimer disease", keywords="mobile health", keywords="consumer health informatics", keywords="personhood", keywords="systematic review", keywords="smartphone", keywords="mobile phone", keywords="tablet computers", abstract="Background: With the world's rapidly growing older adult population, there is an increase in the number of people living with dementia. This growth leads to a strain on their caregivers and our health care system and to an increased attention on mitigating strain by using mobile technology to sustain the independence of people with dementia. However, less attention is given to whether these technologies meet the stated and unstated needs of people with dementia. Objective: The aim of this study was to provide an overview of the current research on mobile technologies for people with dementia, considering the current research through the lens of personhood and human needs, and to identify any gaps that represent research opportunities. Methods: We performed a systematic search in Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science, PsycINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), and the Cochrane Central Register of Controlled Trials (CENTRAL) in October 2018. We screened 5560 articles and identified 24 that met our inclusion and exclusion criteria. We then performed thematic analysis to organize the articles by the types of support mobile technologies provide and mapped those types of support to human needs to identify the gaps in support. Results: Articles described research on mobile technologies that support people with dementia to (1) perform daily activities, (2) maintain social interaction, (3) aid memory, (4) engage in leisure activities, (5) track location, and (6) monitor health. At least one type of support mapped to each human need, with most supporting lower-level needs such as physiological and safety needs. Little attention seems to be paid to personhood. Conclusions: Mobile technologies that support daily activities, relationships, memory, leisure activities, health, and safety can partially compensate for decreased function owing to dementia, but the human needs of people with dementia are often not adequately considered. Most technologies support basic physiological and safety needs, whereas many pay little attention to higher-level needs such as self-esteem and agency. Important research opportunities include using person-centered methods to develop technology to meet higher-level needs and to preserve personhood by incorporating human and psychological needs of people with dementia along with ethical considerations. ", doi="10.2196/15122", url="https://mhealth.jmir.org/2019/11/e15122", url="http://www.ncbi.nlm.nih.gov/pubmed/31710305" } @Article{info:doi/10.2196/15733, author="Glenn, Jordan and Madero, Nicole Erica and Gray, Michelle and Fuseya, Nami and Ikeda, Mari and Kawamura, Tomoo and Arita, Yoshiko and Bott, Thomas Nick", title="Engagement With a Digital Platform for Multimodal Cognitive Assessment and Multidomain Intervention in a Japanese Population: Pilot, Quasi-Experimental, Longitudinal Study", journal="JMIR Mhealth Uhealth", year="2019", month="Oct", day="25", volume="7", number="10", pages="e15733", keywords="cognitive decline", keywords="Alzheimer disease", keywords="lifestyle risk reduction", keywords="digital health", keywords="FINGER", keywords="neurocognitive tests", keywords="cognition", keywords="dementia", abstract="Background: As the global prevalence of dementia continues to rise, multidomain lifestyle interventions that address modifiable risk factors associated with pathological cognitive decline are increasing. Although some digital options have been developed to increase the reach and scalability of these programs, because of cultural differences, the efficacy of the programs in one population cannot easily be generalized to populations in other countries. Objective: This investigation aimed to examine the usability and engagement of a digitally delivered multidomain cognitive lifestyle intervention developed in the United States for a Japanese population. Methods: This feasibility investigation utilized a quasi-experimental, single-arm, nonrandomized, longitudinal design where participants engaged in the behavioral intervention on a smartphone. Of the 559 participants that initially enrolled (age: mean 51 years, SD 7.5 years; 51.7\% female [289/559]), 242 completed the final testing trial. Participants enrolled in a multidomain lifestyle program that consisted of (1) psychoeducational material, (2) physical activity tracker, (3) nutrition tracker, (4) audio-based meditations, and (5) health coaching. Engagement with the program was assessed through the total number of app sessions and the use of the exercise, diet, and meditation tracking features within the app. The total number of minutes exercised was collected through subjective user inputs, and nutrition was quantified by the Mediterranean-DASH Intervention for Neurodegenerative Delay diet adherence score. Results: Significant relationships existed between overall nutrition score and frequency of nutrition tracking (r=0.18), frequency of physical activity tracking (r=0.19), and the total number of minutes exercised (r=0.22). Total minutes exercised was significantly correlated with total app sessions (r=0.57), frequency of physical activity tracking (r=0.85), frequency of nutrition tracking (r=0.64), number of times participants meditated (r=0.46), and total lessons read (r=0.36). The number of completed lessons was significantly related to frequency of physical activity tracking (r=0.40), frequency of nutrition tracking (r=0.43), the total number of times participants meditated (r=0.35), and total minutes exercised (r=0.33). Dividing the cohort into two groups based on lesson completion (<10 lessons completed vs ?10 lessons completed), significant differences were observed between the total minutes exercised, frequency of physical activity tracking, frequency of nutrition tracking, and total number of times participants meditated (all P values <.01). Conclusions: Overall, this cross-cultural feasibility study in Japanese users demonstrated that the various engagement metrics were significantly correlated, and greater engagement was related to improved nutrition scores and increased time exercising. In addition, the relationships between lesson completion and other engagement metrics suggest that there may be value in exploring mechanisms that enhance lesson completion. Future research should examine the program in randomized control trials to more rigorously evaluate program efficacy. ", doi="10.2196/15733", url="http://mhealth.jmir.org/2019/10/e15733/", url="http://www.ncbi.nlm.nih.gov/pubmed/31654567" } @Article{info:doi/10.2196/12346, author="Thorpe, Julia and Forchhammer, Hysse Birgitte and Maier, M. Anja", title="Adapting Mobile and Wearable Technology to Provide Support and Monitoring in Rehabilitation for Dementia: Feasibility Case Series", journal="JMIR Form Res", year="2019", month="Oct", day="17", volume="3", number="4", pages="e12346", keywords="dementia", keywords="cognitive rehabilitation", keywords="mobility", keywords="activity", keywords="mHealth", keywords="uHealth", keywords="pervasive health care", keywords="P4 health care", keywords="health care design", abstract="Background: Mobile and wearable devices are increasingly being used to support our everyday lives and track our behavior. Since daily support and behavior tracking are two core components of cognitive rehabilitation, such personal devices could be employed in rehabilitation approaches aimed at improving independence and engagement among people with dementia. Objective: The aim of this work was to investigate the feasibility of using smartphones and smartwatches to augment rehabilitation by providing adaptable, personalized support and objective, continuous measures of mobility and activity behavior. Methods: A feasibility study comprising 6 in-depth case studies was carried out among people with early-stage dementia and their caregivers. Participants used a smartphone and smartwatch for 8 weeks for personalized support and followed goals for quality of life. Data were collected from device sensors and logs, mobile self-reports, assessments, weekly phone calls, and interviews. This data were analyzed to evaluate the utility of sensor data generated by devices used by people with dementia in an everyday life context; this was done to compare objective measures with subjective reports of mobility and activity and to examine technology acceptance focusing on usefulness and health efficacy. Results: Adequate sensor data was generated to reveal behavioral patterns, even for minimal device use. Objective mobility and activity measures reflecting fluctuations in participants' self-reported behavior, especially when combined, may be advantageous in revealing gradual trends and could provide detailed insights regarding goal attainment ratings. Personalized support benefited all participants to varying degrees by addressing functional, memory, safety, and psychosocial needs. A total of 4 of 6 (67\%) participants felt motivated to be active by tracking their step count. One participant described a highly positive impact on mobility, anxiety, mood, and caregiver burden, mainly as a result of navigation support and location-tracking tools. Conclusions: Smartphones and wearables could provide beneficial and pervasive support and monitoring for rehabilitation among people with dementia. These results substantiate the need for further investigation on a larger scale, especially considering the inevitable presence of mobile and wearable technology in our everyday lives for years to come. ", doi="10.2196/12346", url="http://formative.jmir.org/2019/4/e12346/", url="http://www.ncbi.nlm.nih.gov/pubmed/31625951" } @Article{info:doi/10.2196/14106, author="Pinto-Bruno, C. {\'A}ngel and Pot, Margriet Anne and Kleiboer, Annet and Droes, Rose-Marie and van Straten, Annemieke", title="An Online Minimally Guided Intervention to Support Family and Other Unpaid Carers of People With Dementia: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2019", month="Oct", day="10", volume="8", number="10", pages="e14106", keywords="informal carers", keywords="dementia", keywords="ICT intervention", keywords="online", keywords="perceived stress", abstract="Background: About three-quarters of people with dementia live in their own homes, with help from family members and/or other unpaid carers, such as friends or neighbors. Often, unpaid carers themselves experience negative consequences, such as stress, burden, and symptoms of depression or anxiety. Research has shown that these consequences can be alleviated by psychosocial and psychological interventions. Moreover, there are indications that those interventions can be effective when offered online. Objective: This paper describes the protocol of a randomized controlled trial (RCT) that will take place in the Netherlands to evaluate the effectiveness of iSupport, a minimally guided, internet-based intervention to improve carers' mental health and coping resources. Methods: A superiority two-arm RCT comparing the effects of the online support program with a waiting list control condition will be carried out in the Netherlands. The iSupport intervention was developed by the World Health Organization and is based on cognitive behavioral therapy principles. It has five main themes divided into 23 lessons. Carers can pick and choose which lessons they want to complete. We aim to recruit 200 unpaid carers. The experimental group (n=100) will be provided with access to the intervention for 3 months following randomization; those in the waiting list control group (n=100) will be granted access to the intervention after 3 months. Assessments will be conducted at baseline (T0), 3 months after baseline (post intervention, T1), and 6 months after baseline (follow-up, T2). The primary outcome is perceived stress, measured by the Perceived Stress Scale. Secondary outcomes are symptoms of depression and anxiety, caregiver burden, sense of competence, self-efficacy, mastery, and carers' attitudes toward dementia and their person-centered approach (ie, to what extent carers tailor the provided care to the interest, needs, and history of the person with dementia). Results: Recruitment for the trial started in January 2019. As of July 2019, we have enrolled 120 participants. Data collection is expected to be completed by March 2020. Once all the data have been collected, we will conduct the data analyses between April and May 2020. We aim to publish our results in a manuscript by June 2020. Conclusions: Online interventions have shown promising results in improving the mental health of carers of people with dementia. Additionally, online interventions may overcome accessibility barriers. If successful, this intervention will have important potential for implementation as a public health intervention, since costs and support by trained staff are minimal. Trial Registration: Netherlands Trial Register (NTL) NL6417; https://www.trialregister.nl/trial/6417 International Registered Report Identifier (IRRID): DERR1-10.2196/14106 ", doi="10.2196/14106", url="http://www.researchprotocols.org/2019/10/e14106/", url="http://www.ncbi.nlm.nih.gov/pubmed/31603433" } @Article{info:doi/10.2196/14096, author="Goodall, Gemma and Ciobanu, Ileana and Taraldsen, Kristin and S{\o}rgaard, Jon and Marin, Andreea and Draghici, Rozeta and Zamfir, Mihai-Viorel and Berteanu, Mihai and Maetzler, Walter and Serrano, Artur J.", title="The Use of Virtual and Immersive Technology in Creating Personalized Multisensory Spaces for People Living With Dementia (SENSE-GARDEN): Protocol for a Multisite Before-After Trial", journal="JMIR Res Protoc", year="2019", month="Aug", day="19", volume="8", number="9", pages="e14096", keywords="dementia", keywords="emotions", keywords="technology", keywords="multimedia", keywords="eHealth", abstract="Background: The number of people living with dementia is rapidly increasing. With dementia's impact on memory, communication, and self-identity, it is important to identify ways of meeting individual needs of diagnosed individuals and their caregivers. This study will test a new intervention, SENSE-GARDEN, that integrates autobiographical music, films, pictures, and scents with innovative technology to create an immersive environment tailored specifically for the individual. Objective: The SENSE-GARDEN study is an Active Assisted Living Program--funded multicenter project. The primary objective of the study is to assess whether a personalized, innovative technology-based intervention can improve the well-being of older adults living with moderate to severe dementia. The study will also assess whether the intervention can improve coping and reduce burden in caregivers. Methods: A controlled before-after study design will be used. There will be 3 sites in 3 trial countries: Belgium, Norway, and Portugal. A total of 55 people with dementia (PWDs) will be recruited. All eligible participants for the study will be randomized into the intervention or control group. For the first three months of the study, all participants will receive the SENSE-GARDEN intervention. For the final month of the study, the intervention group will continue visits to the SENSE-GARDEN, and the control group will discontinue visits. A mixed-methods approach will be used, including the use of standardized outcome measures, quantitative physiological data, and qualitative interview data. Results: The trials commenced recruitment in August 2019, and all data are expected to be collected by the end of May 2020. A user-centered design process is underway, with results from the first phase of user interviews indicating that people with mild cognitive impairment, family caregivers, and professional caregivers consider the SENSE-GARDEN to be a potentially valuable tool in providing numerous benefits to dementia care. Feasibility testing of the SENSE-GARDEN has been completed and results are expected to be published in October 2019. Conclusions: Findings from the SENSE-GARDEN trials will provide insights into the use of technology for personalizing interventions to the PWD. This will have potential implications on not only dementia research, but it may also have influences on care practice. International Registered Report Identifier (IRRID): DERR1-10.2196/14096 ", doi="10.2196/14096", url="https://www.researchprotocols.org/2019/9/e14096", url="http://www.ncbi.nlm.nih.gov/pubmed/31538942" } @Article{info:doi/10.2196/13887, author="Ijaz, Kiran and Ahmadpour, Naseem and Naismith, L. Sharon and Calvo, A. Rafael", title="An Immersive Virtual Reality Platform for Assessing Spatial Navigation Memory in Predementia Screening: Feasibility and Usability Study", journal="JMIR Ment Health", year="2019", month="Sep", day="03", volume="6", number="9", pages="e13887", keywords="virtual reality", keywords="healthy aging", keywords="memory", keywords="cognition", keywords="dementia", abstract="Background: Traditional methods for assessing memory are expensive and have high administrative costs. Memory assessment is important for establishing cognitive impairment in cases such as detecting dementia in older adults. Virtual reality (VR) technology can assist in establishing better quality outcome in such crucial screening by supporting the well-being of individuals and offering them an engaging, cognitively challenging task that is not stressful. However, unmet user needs can compromise the validity of the outcome. Therefore, screening technology for older adults must address their specific design and usability requirements. Objective: This study aimed to design and evaluate the feasibility of an immersive VR platform to assess spatial navigation memory in older adults and establish its compatibility by comparing the outcome to a standard screening platform on a personal computer (PC). Methods: VR-CogAssess is a platform integrating an Oculus Rift head-mounted display and immersive photorealistic imagery. In a pilot study with healthy older adults (N=42; mean age 73.22 years, SD 9.26), a landmark recall test was conducted, and assessment on the VR-CogAssess was compared against a standard PC (SPC) setup. Results: Results showed that participants in VR were significantly more engaged (P=.003), achieved higher landmark recall scores (P=.004), made less navigational mistakes (P=.04), and reported a higher level of presence (P=.002) than those in SPC setup. In addition, participants in VR indicated no significantly higher stress than SPC setup (P=.87). Conclusions: The study findings suggest immersive VR is feasible and compatible with SPC counterpart for spatial navigation memory assessment. The study provides a set of design guidelines for creating similar platforms in the future. ", doi="10.2196/13887", url="https://mental.jmir.org/2019/9/e13887/", url="http://www.ncbi.nlm.nih.gov/pubmed/31482851" } @Article{info:doi/10.2196/14530, author="Gilson, Aaron and Dodds, Debby and Kaur, Arveen and Potteiger, Michael and Ford II, H. James", title="Using Computer Tablets to Improve Moods for Older Adults With Dementia and Interactions With Their Caregivers: Pilot Intervention Study", journal="JMIR Form Res", year="2019", month="Sep", day="03", volume="3", number="3", pages="e14530", keywords="mood change", keywords="caregiver interactions", keywords="older adults", keywords="Alzheimer disease", keywords="dementia", keywords="computer tablets", keywords="person-centered care", abstract="Background: Persons living with dementia represent a significant and growing segment of the older adult (aged 65 years and older) population. They are often challenged expressively and may experience difficulties with sharing their feelings or moods. Availability of, and easy access to, tablets facilitates the use of information and communication technologies (ICTs) as a delivery mechanism for nonpharmacological interventions, especially for persons living with dementia. Evidence of the impact of ICTs in different community settings on mood with older adults and the impact of engagement on their caregivers is needed to promote broader adoption and sustainment of these technologies in the United States. Objective: This study aimed to determine the extent of the effects of tablets on positive mood change and examine the effects of study variables on care recipients' mood changes and caregivers' daily interactions. Methods: The tablet intervention was developed and evaluated in five programs. The primary outcome was caregivers' assessment of care recipients' mood (n=1089) before and after a tablet engagement session using an eight-point mood visual analog scale. Session influence on caregivers' daily activities was captured for a subsample of participants (n=542). Frequency distributions were computed for each study variables. Chi-square tests of association were calculated to determine the association of the variables on mood changes for all care recipients, as well as those being treated in skilled nursing facilities and in-home, and then for those that affected caregivers' daily activities. Results: The study sample comprised 1089 care recipient and caregiver engagement sessions. Cumulatively, 50.78\% (553/1089) of care recipients showed a transition from negative to positive moods, whereas another 41.78\% (455/1089) maintained an already-positive mood after the caregiver engagement session. Chi-square analyses demonstrated that positive mood changes resulted from using music ($\chi$210=72.9; P<.001), using YouTube as the sole app ($\chi$212=64.5; P<.001), using multiple engagement strategies ($\chi$22=42.8; P<.001), and when cared for in a skilled nursing facility ($\chi$24=236.8; P<.001) across the entire care recipient sample. In addition, although many features of the engagement session positively influenced the caregivers' day, the largest effect was observed when care recipients' mood was considered to have improved following the session ($\chi$24=234.7; P<.001). Conclusions: The study is one of the first in the United States to explore the impact of ICTs, in particular managed tablets and Web-based video services that can be used on a tablet through an app, on improving mood in persons living with dementia, and enhancing caregivers' perceptions about their care recipient interactions. Importantly, these pilot data substantiate ICTs as part of a personalized engagement approach, as beneficial alternatives to pharmaceutical interventions for mood enhancement. However, a more comprehensive study that explores the ICT's impact on additional clinical outcomes is needed to confirm these preliminary findings. ", doi="10.2196/14530", url="http://formative.jmir.org/2019/3/e14530/", url="http://www.ncbi.nlm.nih.gov/pubmed/31482847" } @Article{info:doi/10.2196/12785, author="Piau, Antoine and Wild, Katherine and Mattek, Nora and Kaye, Jeffrey", title="Current State of Digital Biomarker Technologies for Real-Life, Home-Based Monitoring of Cognitive Function for Mild Cognitive Impairment to Mild Alzheimer Disease and Implications for Clinical Care: Systematic Review", journal="J Med Internet Res", year="2019", month="Aug", day="30", volume="21", number="8", pages="e12785", keywords="technology", keywords="Alzheimer disease", keywords="cognition disorders", keywords="dementia", keywords="older adults", keywords="digital biomarkers", keywords="digital phenotyping", keywords="digital health", abstract="Background: Among areas that have challenged the progress of dementia care has been the assessment of change in symptoms over time. Digital biomarkers are defined as objective, quantifiable, physiological, and behavioral data that are collected and measured by means of digital devices, such as embedded environmental sensors or wearables. Digital biomarkers provide an alternative assessment approach, as they allow objective, ecologically valid, and long-term follow-up with continuous assessment. Despite the promise of a multitude of sensors and devices that can be applied, there are no agreed-upon standards for digital biomarkers, nor are there comprehensive evidence-based results for which digital biomarkers may be demonstrated to be most effective. Objective: In this review, we seek to answer the following questions: (1) What is the evidence for real-life, home-based use of technologies for early detection and follow-up of mild cognitive impairment (MCI) or dementia? And (2) What transformation might clinicians expect in their everyday practices? Methods: A systematic search was conducted in PubMed, Cochrane, and Scopus databases for papers published from inception to July 2018. We searched for studies examining the implementation of digital biomarker technologies for mild cognitive impairment or mild Alzheimer disease follow-up and detection in nonclinic, home-based settings. All studies that included the following were examined: community-dwelling older adults (aged 65 years or older); cognitively healthy participants or those presenting with cognitive decline, from subjective cognitive complaints to early Alzheimer disease; a focus on home-based evaluation for noninterventional follow-up; and remote diagnosis of cognitive deterioration. Results: An initial sample of 4811 English-language papers were retrieved. After screening and review, 26 studies were eligible for inclusion in the review. These studies ranged from 12 to 279 participants and lasted between 3 days to 3.6 years. Most common reasons for exclusion were as follows: inappropriate setting (eg, hospital setting), intervention (eg, drugs and rehabilitation), or population (eg, psychiatry and Parkinson disease). We summarized these studies into four groups, accounting for overlap and based on the proposed technological solutions, to extract relevant data: (1) data from dedicated embedded or passive sensors, (2) data from dedicated wearable sensors, (3) data from dedicated or purposive technological solutions (eg, games or surveys), and (4) data derived from use of nondedicated technological solutions (eg, computer mouse movements). Conclusions: Few publications dealt with home-based, real-life evaluations. Most technologies were far removed from everyday life experiences and were not mature enough for use under nonoptimal or uncontrolled conditions. Evidence available from embedded passive sensors represents the most relatively mature research area, suggesting that some of these solutions could be proposed to larger populations in the coming decade. The clinical and research communities would benefit from increasing attention to these technologies going forward. ", doi="10.2196/12785", url="http://www.jmir.org/2019/8/e12785/", url="http://www.ncbi.nlm.nih.gov/pubmed/31471958" } @Article{info:doi/10.2196/13139, author="Kim, Jung Woo and Sung, Min Ji and Sung, David and Chae, Myeong-Hun and An, Kyoon Suk and Namkoong, Kee and Lee, Eun and Chang, Hyuk-Jae", title="Cox Proportional Hazard Regression Versus a Deep Learning Algorithm in the Prediction of Dementia: An Analysis Based on Periodic Health Examination", journal="JMIR Med Inform", year="2019", month="Aug", day="30", volume="7", number="3", pages="e13139", keywords="dementia", keywords="deep learning", keywords="proportional hazards models", abstract="Background: With the increase in the world's aging population, there is a growing need to prevent and predict dementia among the general population. The availability of national time-series health examination data in South Korea provides an opportunity to use deep learning algorithm, an artificial intelligence technology, to expedite the analysis of mass and sequential data. Objective: This study aimed to compare the discriminative accuracy between a time-series deep learning algorithm and conventional statistical methods to predict all-cause dementia and Alzheimer dementia using periodic health examination data. Methods: Diagnostic codes in medical claims data from a South Korean national health examination cohort were used to identify individuals who developed dementia or Alzheimer dementia over a 10-year period. As a result, 479,845 and 465,081 individuals, who were aged 40 to 79 years and without all-cause dementia and Alzheimer dementia, respectively, were identified at baseline. The performance of the following 3 models was compared with predictions of which individuals would develop either type of dementia: Cox proportional hazards model using only baseline data (HR-B), Cox proportional hazards model using repeated measurements (HR-R), and deep learning model using repeated measurements (DL-R). Results: The discrimination indices (95\% CI) for the HR-B, HR-R, and DL-R models to predict all-cause dementia were 0.84 (0.83-0.85), 0.87 (0.86-0.88), and 0.90 (0.90-0.90), respectively, and those to predict Alzheimer dementia were 0.87 (0.86-0.88), 0.90 (0.88-0.91), and 0.91 (0.91-0.91), respectively. The DL-R model showed the best performance, followed by the HR-R model, in predicting both types of dementia. The DL-R model was superior to the HR-R model in all validation groups tested. Conclusions: A deep learning algorithm using time-series data can be an accurate and cost-effective method to predict dementia. A combination of deep learning and proportional hazards models might help to enhance prevention strategies for dementia. ", doi="10.2196/13139", url="http://medinform.jmir.org/2019/3/e13139/", url="http://www.ncbi.nlm.nih.gov/pubmed/31471957" } @Article{info:doi/10.2196/13280, author="Guisado-Fernandez, Estefania and Caulfield, Brian and Silva, Alexandra Paula and Mackey, Laura and Singleton, David and Leahy, Daniel and Dossot, S{\'e}bastien and Power, Dermot and O'Shea, Diarmuid and Blake, Catherine", title="Development of a Caregivers' Support Platform (Connected Health Sustaining Home Stay in Dementia): Protocol for a Longitudinal Observational Mixed Methods Study", journal="JMIR Res Protoc", year="2019", month="Aug", day="28", volume="8", number="8", pages="13280", keywords="connected health", keywords="dementia", keywords="caregivers", keywords="home care", keywords="home monitoring", abstract="Background: Dementia disease is a chronic condition that leads a person with dementia (PwD) into a state of progressive deterioration and a greater dependence in performing their activities of daily living (ADL). It is believed nowadays that PwDs and their informal caregivers can have a better life when provided with the appropriate services and support. Connected Health (CH) is a new technology-enabled model of chronic care delivery where the stakeholders are connected through a health portal, ensuring continuity and efficient flow of information. CH has demonstrated promising results regarding supporting informal home care and Aging in Place, and it has been increasingly considered by researchers and health care providers as a method for dementia home care management. Objective: This study aims to describe the development and implementation protocol of a CH platform system to support informal caregivers of PwDs at home. Methods: This is a longitudinal observational mixed methods study where quantitative and qualitative data will be combined for determining the utility of the CH platform for dementia home care. Dyads, consisting of a PwD and their informal caregiver living in the community, will be divided into 2 groups: the intervention group, which will receive the CH technology package at home, and the usual care group, which will not have any CH technology at all. Dyads will be followed up for 12 months during which they will continue with their traditional care plan, but in addition, the intervention group will receive the CH package for their use at home during 6 months (months 3 to 9 of the yearly follow-up). Further comprehensive assessments related to the caregiver's and PwD's emotional and physical well-being will be performed at the initial assessment and at 3, 6, 9, and 12 months using international and standardized validated questionnaires and semistructured individual interviews. Results: This 3-year funded study (2016-2019) is currently in its implementation phase and is expected to finish by December 2019. We believe that CH can potentially change the PwD current care model, facilitating a proactive and preventive model, utilizing self-management--based strategies, and enhancing caregivers' involvement in the management of health care at home for PwDs. Conclusions: We foresee that our CH platform will provide knowledge and promote autonomy for the caregivers, which may empower them into greater control of the care for PwDs, and with it, improve the quality of life and well-being for the person they are caring for and for themselves through a physical and cognitive decline predictive model. We also believe that facilitating information sharing between all the PwDs' care stakeholders may enable a stronger relationship between them, facilitate a more coordinated care plan, and increase the feelings of empowerment in the informal caregivers. International Registered Report Identifier (IRRID): DERR1-10.2196/13280 ", doi="10.2196/13280", url="http://www.researchprotocols.org/2019/8/e13280/", url="http://www.ncbi.nlm.nih.gov/pubmed/31464187" } @Article{info:doi/10.2196/11340, author="Wiegers, Agnes Therese and Hendriks, Michelle and Malanda, Uri{\"e}ll and de Boer, Dolf", title="Users' Experiences With Web-Based Health Care Information: Qualitative Study About Diabetes and Dementia Information Presented on a Governmental Website", journal="J Med Internet Res", year="2019", month="Jul", day="08", volume="21", number="7", pages="e11340", keywords="patients", keywords="qualitative research", keywords="choice behavior", abstract="Background: Information on health and health care is abundant on the internet. To make informed choices, patients need reliable and easy-to-understand information about quality and availability of care providers and treatment options. However, the reliability of such Web-based information is difficult to assess. Objective: This study aimed to test Web-based information about diabetes and dementia and specifically a new presentation format of care routes to see if people are able to understand and use the information. Methods: Overall, 38 cognitive interviews were held; 20 people viewed the information about diabetes and 18 viewed the dementia information. Participants were asked what they would want to know about either diabetes or dementia, what choices they would want to make concerning their preferred care provider and treatment, and what information they would like to find to make these choices. They were then asked to view the relevant pages and comment on them. The interview was focused on general information about the condition, the care route, and the quality information for choosing a hospital. The interviews were transcribed verbatim and then systematically coded and ordered into themes. Results: The themes that were developed for both Web pages during the analysis were information needs, findability, usability, comprehension and readability, recognizability, care route, quality information, and usefulness. Information needs were found to be very diverse and dependent on the personal situation and condition of the participant. Several participants were unable to find specific items because they were not where they expected them to be. Most participants were positive about the layout, font, and color scheme of the test pages. However, options of clicking through to another website and indications where information can be expanded and collapsed could be made clearer. Participants generally found the information easy to understand but felt a need for a more detailed explanation of the medical terms. Recognition of the information played an important role: participants assessed whether the information they found matched their experiences. The term care route meant little to most of the participants, but the layout of the care route itself was found to be clear. Not many respondents spontaneously went to the quality information, and a number of participants had difficulty understanding it. Overall, the participants thought the information on the website was useful and helpful. Conclusions: The cognitive interviews gave numerous insights into how Web-based information is processed and understood. The care route offers a clear overview of the various stages as the condition progresses, but the name care route is not clear to everyone. We gained insight into differences between subgroups of people in terms of information needs, comprehension, and use of the information because the diversity within the group of participants was lower than expected. ", doi="10.2196/11340", url="https://www.jmir.org/2019/7/e11340/", url="http://www.ncbi.nlm.nih.gov/pubmed/31287066" } @Article{info:doi/10.2196/13417, author="van Maurik, S. Ingrid and Visser, NC Leonie and Pel-Littel, E. Ruth and van Buchem, M. Marieke and Zwan, D. Marissa and Kunneman, Marleen and Pelkmans, Wiesje and Bouwman, H. Femke and Minkman, Mirella and Schoonenboom, Niki and Scheltens, Philip and Smets, MA Ellen and van der Flier, M. Wiesje", title="Development and Usability of ADappt: Web-Based Tool to Support Clinicians, Patients, and Caregivers in the Diagnosis of Mild Cognitive Impairment and Alzheimer Disease", journal="JMIR Form Res", year="2019", month="Jul", day="08", volume="3", number="3", pages="e13417", keywords="Alzheimer's disease", keywords="biomarkers", keywords="decision aids", keywords="mild cognitive impairment", keywords="precision medicine", keywords="risk", keywords="shared decision making", abstract="Background: As a result of advances in diagnostic testing in the field of Alzheimer disease (AD), patients are diagnosed in earlier stages of the disease, for example, in the stage of mild cognitive impairment (MCI). This poses novel challenges for a clinician during the diagnostic workup with regard to diagnostic testing itself, namely, which tests are to be performed, but also on how to engage patients in this decision and how to communicate test results. As a result, tools to support decision making and improve risk communication could be valuable for clinicians and patients. Objective: The aim of this study was to present the design, development, and testing of a Web-based tool for clinicians in a memory clinic setting and to ascertain whether this tool can (1) facilitate the interpretation of biomarker results in individual patients with MCI regarding their risk of progression to dementia, (2) support clinicians in communicating biomarker test results and risks to MCI patients and their caregivers, and (3) support clinicians in a process of shared decision making regarding the diagnostic workup of AD. Methods: A multiphase mixed-methods approach was used. Phase 1 consisted of a qualitative needs assessment among professionals, patients, and caregivers; phase 2, consisted of an iterative process of development and the design of the tool (ADappt); and phase 3 consisted of a quantitative and qualitative assessment of usability and acceptability of ADappt. Across these phases, co-creation was realized via a user-centered qualitative approach with clinicians, patients, and caregivers. Results: In phase 1, clinicians indicated the need for risk calculation tools and visual aids to communicate test results to patients. Patients and caregivers expressed their needs for more specific information on their risk for developing AD and related consequences. In phase 2, we developed the content and graphical design of ADappt encompassing 3 modules: a risk calculation tool, a risk communication tool including a summary sheet for patients and caregivers, and a conversation starter to support shared decision making regarding the diagnostic workup. In phase 3, ADappt was considered to be clear and user-friendly. Conclusions: Clinicians in a memory clinic setting can use ADappt, a Web-based tool, developed using multiphase design and co-creation, for support that includes an individually tailored interpretation of biomarker test results, communication of test results and risks to patients and their caregivers, and shared decision making on diagnostic testing. ", doi="10.2196/13417", url="https://formative.jmir.org/2019/3/e13417/", url="http://www.ncbi.nlm.nih.gov/pubmed/31287061" } @Article{info:doi/10.2196/13360, author="Rockwood, Kenneth and Sanon Aigbogun, Myrlene and Stanley, Justin and Wong, Helen and Dunn, Taylor and Chapman, T. Ch{\`e}re A. and Howlett, E. Susan and Miguelez, Maia and McGarrigle, Lisa and Baker, A. Ross", title="The Symptoms Targeted for Monitoring in a Web-Based Tracking Tool by Caregivers of People With Dementia and Agitation: Cross-Sectional Study", journal="J Med Internet Res", year="2019", month="Jun", day="28", volume="21", number="6", pages="e13360", keywords="Alzheimer disease", keywords="dementia", keywords="agitation", keywords="neuropsychiatric symptoms", keywords="internet", keywords="caregiver", abstract="Background: In people with dementia, neuropsychiatric symptoms (NPSs), especially agitation, are associated with worse quality of life and caregiver burden. As NPSs may vary with illness severity, knowledge of how people with dementia and their caregivers describe and rate the importance of agitation symptoms can improve the understanding of the clinical meaningfulness of the manifestations of agitation. The internet provides new opportunities to better understand patient experiences, as patients and caregivers increasingly look to Web-based platforms as a means of managing symptoms. Objective: The aim of this study was to examine Web-based reports from a dementia symptom website to better understand the symptoms of agitation and explore how they are being targeted for monitoring by caregivers of people with dementia. Methods: The Dementia Guide website hosts a Web-based database used by caregivers (97\%) and people with dementia (3\%). From its 61 dementia symptoms, users can select relevant symptoms that they deem important to monitor or track the effects of treatment. We employed a staging algorithm to determine if individuals had mild cognitive impairment (MCI) or mild, moderate, or severe dementia. Agitation was defined using terms consistent with the International Psychogeriatrics Association's provisional consensus definition. We compared the proportion of people with NPSs and agitation across stages of dementia severity and studied how many agitation-defining descriptors were selected, and how often they occurred, by stage. Results: As of March 2017, 4121 people had used the tracking tool, of whom 2577 provided sufficient data to allow disease severity staging. NPSs were tracked by 2127/2577 (82.54\%) and agitation by 1898/2577 (73.65\%). The proportion in whom agitation was tracked increased with increasing cognitive impairment: 68.5\% (491/717) in people with MCI, and 72.50\% (754/1040), 73.3\% (378/516), and 90.5\% (275/304) in mild, moderate, and severe dementia, respectively ($\chi$23=54.9; P<.001). The number of NPS and agitation descriptors selected also increased with severity (median number of NPSs=1, 2, 2, and 3 for MCI, mild, moderate, and severe dementia, respectively, Kruskal-Wallis H Test H3=250.47; P<.001; median number of agitation descriptors=1, 2, 3, and 4, H3=146.11; P<.001). Conclusions: NPSs and agitation are common targets for tracking over the course of dementia and appear more frequently with increasing disease severity. These common and distressing symptoms represent clinically meaningful targets in treating people with dementia. ", doi="10.2196/13360", url="https://www.jmir.org/2019/6/e13360/", url="http://www.ncbi.nlm.nih.gov/pubmed/31254339" } @Article{info:doi/10.2196/13711, author="Anderberg, Peter and Barnestein-Fonseca, Pilar and Guzman-Parra, Jose and Garolera, Maite and Quintana, Mar{\'i}a and Mayoral-Cleries, Fermin and Lemmens, Evi and Sanmartin Berglund, Johan", title="The Effects of the Digital Platform Support Monitoring and Reminder Technology for Mild Dementia (SMART4MD) for People With Mild Cognitive Impairment and Their Informal Carers: Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2019", month="Jun", day="21", volume="8", number="6", pages="e13711", keywords="dementia", keywords="mild cognitive impairment", keywords="tablet", keywords="app", keywords="carer", keywords="eHealth", keywords="mHealth", abstract="Background: Many countries are witnessing a trend of growth in the number and proportion of older adults within the total population. In Europe, population aging has had and will continue to have major social and economic consequences. This is a fundamentally positive development where the added life span is of great benefit for both the individual and the society. Yet, the risk for the individual to contract noncommunicable diseases and disability increases with age. This may adversely affect the individual's ability to live his or her life in the way that is desired. Cognitive conditions constitute a group of chronic diseases that predominantly affects older people. Recent technology advancements can help support the day-to-day living activities at home for people with cognitive impairments. Objective: A digital platform (Support Monitoring and Reminder for Mild Dementia; SMART4MD) is created to improve or maintain the quality of life for people with mild cognitive impairment (PwMCI) and their carers. The platform will provide reminders, information, and memory support in everyday life, with the purpose of giving structure and lowering stress. In the trial, we will include participants with a diagnosed neurocognitive disorder as well as persons with an undiagnosed subjective memory problem and cognitive impairment, that is, 20 to 28 points on the Mini-Mental State Examination. Methods: A pragmatic, multicenter RCT is being conducted in Spain, Sweden, and Belgium. The targets for recruitment are 1200 dyads---split into an intervention group and a control group that are in usual care. Intervention group participants will be provided with a data-enabled computer tablet with the SMART4MD app. Its core functionalities, intended to be used daily at home, are based on reminders, cognitive supporting activities, and sharing health information. Results: Inclusion of participants started in December 2017, and recruitment is expected to end in February 2019. Furthermore, there will be 3 follow-up visits at 6, 12, and 18 months after the baseline visit. Conclusions: This RCT is expected to offer benefits at several levels including in-depth knowledge of the possibilities of introducing a holistic multilayered information and communication technology solution for this group. SMART4MD has been developed in a process involving the structured participation of PwMCI, their informal carers, and clinicians. The adoption of SMART4MD faces the challenge of this age group's relative unfamiliarity with digital devices and services. However, this challenge can also be an opportunity for developing a digital device tailored to a group at risk of digital exclusion. This research responds to the wider call for the development of digital devices which are accessible and affordable to older people and this full scale RCT can hopefully serve as a model for further studies in this field. Trial Registration: ClinicalTrials.gov NCT03325699; https://clinicaltrials.gov/ct2/show/NCT03325699 International Registered Report Identifier (IRRID): DERR1-10.2196/13711 ", doi="10.2196/13711", url="http://www.researchprotocols.org/2019/6/e13711/", url="http://www.ncbi.nlm.nih.gov/pubmed/31228177" } @Article{info:doi/10.2196/13378, author="McCarron, R. Hayley and Zmora, Rachel and Gaugler, E. Joseph", title="A Web-Based Mobile App With a Smartwatch to Support Social Engagement in Persons With Memory Loss: Pilot Randomized Controlled Trial", journal="JMIR Aging", year="2019", month="Jun", day="18", volume="2", number="1", pages="e13378", keywords="Alzheimer disease", keywords="dementia", keywords="social support", keywords="quality of life", keywords="well-being", keywords="technology", keywords="social engagement", keywords="facial recognition", keywords="smartwatch", abstract="Background: It is estimated that the number of individuals living with dementia worldwide will increase from 50 million in 2017 to 152 million by 2050. Assistive technology has been recognized as a promising tool to improve the lives of persons living with memory loss and their caregivers. The use of assistive technology in dementia care is expanding, although it is most often intended to manage care and promote safety. There is a lack of assistive technology designed to aid persons with memory loss in participating in meaningful activities. The Social Support Aid (SSA) is a mobile phone-based app that employs facial recognition software. It was designed to assist persons with memory loss remember the names and relationships of the people they interact with to promote social engagement. Objective: This study uses a pilot randomized controlled trial (RCT) design to evaluate the SSA. The objectives were to ascertain (1) the feasibility and utility of the SSA, (2) whether the outcomes of SSA use suggest potential benefits for persons living with memory loss and their care partners, and (3) how study design components could inform subsequent RCTs. Methods: Persons with memory loss were randomized to the SSA (n=20) or the usual care control group (n=28). Quantitative data were collected at three timepoints (baseline, 3 months, and 6 months). Participants in the intervention group participated in qualitative interviews following completion of their 6-month survey. Results: Participant eligibility, willingness to be randomized, and retention were not barriers to conducting a full-scale RCT; however, recruitment strategies should be addressed before doing so. Feasibility and utility scores indicated that participants felt neutral about the technology. Use of the SSA was not significantly associated with changes in quality of social interactions or quality of life measures over the 6 months of follow-up (P>.05). The qualitative analysis revealed three themes that described how and why the SSA worked or not: (1) outcomes, (2) reasons why it was or was not useful, and (3) recommendations. Conclusions: There is a need to develop effective assistive technology that improves the quality of life of persons with memory loss. Assistive technology that allows persons living with memory loss to maintain some level of autonomy should be a priority for future research. This study suggests reasons why the SSA facial recognition software did not appear to improve the quality of social interaction and quality of life of people with memory loss. Results also provide recommendations for future assistive technology development and evaluation. Trial Registration: ClinicalTrials.gov NCT03645694; https://clinicaltrials.gov/ct2/show/NCT03645694 (Archived by WebCite at http://www.webcitation.org/78dcVZIqq) ", doi="10.2196/13378", url="http://aging.jmir.org/2019/1/e13378/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518270" } @Article{info:doi/10.2196/12013, author="Thorpe, Rosemary Julia and Forchhammer, Hysse Birgitte and Maier, M. Anja", title="Development of a Sensor-Based Behavioral Monitoring Solution to Support Dementia Care", journal="JMIR Mhealth Uhealth", year="2019", month="May", day="30", volume="7", number="6", pages="e12013", keywords="ambulatory monitoring", keywords="patient-centered care", keywords="physical activity", keywords="dementia", keywords="wearable electronics devices", keywords="activity trackers", keywords="mHealth", keywords="human behavior", keywords="system design", abstract="Background: Mobile and wearable technology presents exciting opportunities for monitoring behavior using widely available sensor data. This could support clinical research and practice aimed at improving quality of life among the growing number of people with dementia. However, it requires suitable tools for measuring behavior in a natural real-life setting that can be easily implemented by others. Objective: The objectives of this study were to develop and test a set of algorithms for measuring mobility and activity and to describe a technical setup for collecting the sensor data that these algorithms require using off-the-shelf devices. Methods: A mobility measurement module was developed to extract travel trajectories and home location from raw GPS (global positioning system) data and to use this information to calculate a set of spatial, temporal, and count-based mobility metrics. Activity measurement comprises activity bout extraction from recognized activity data and daily step counts. Location, activity, and step count data were collected using smartwatches and mobile phones, relying on open-source resources as far as possible for accessing data from device sensors. The behavioral monitoring solution was evaluated among 5 healthy subjects who simultaneously logged their movements for 1 week. Results: The evaluation showed that the behavioral monitoring solution successfully measures travel trajectories and mobility metrics from location data and extracts multimodal activity bouts during travel between locations. While step count could be used to indicate overall daily activity level, a concern was raised regarding device validity for step count measurement, which was substantially higher from the smartwatches than the mobile phones. Conclusions: This study contributes to clinical research and practice by providing a comprehensive behavioral monitoring solution for use in a real-life setting that can be replicated for a range of applications where knowledge about individual mobility and activity is relevant. ", doi="10.2196/12013", url="https://mhealth.jmir.org/2019/6/e12013/", url="http://www.ncbi.nlm.nih.gov/pubmed/31199304" } @Article{info:doi/10.2196/14110, author="Alvarez-Mon, Angel Miguel and Llavero-Valero, Mar{\'i}a and S{\'a}nchez-Bayona, Rodrigo and Pereira-Sanchez, Victor and Vallejo-Valdivielso, Maria and Monserrat, Jorge and Lahera, Guillermo and Asunsolo del Barco, Angel and Alvarez-Mon, Melchor", title="Areas of Interest and Stigmatic Attitudes of the General Public in Five Relevant Medical Conditions: Thematic and Quantitative Analysis Using Twitter", journal="J Med Internet Res", year="2019", month="May", day="28", volume="21", number="5", pages="e14110", keywords="social stigma", keywords="social media", keywords="psychosis", keywords="breast cancer", keywords="HIV", keywords="dementia", keywords="public opinion", keywords="diabetes", abstract="Background: Twitter is an?indicator of real-world?performance, thus, is an appropriate arena to assess the social consideration and attitudes toward psychosis. Objective: The aim of this study was to perform a mixed-methods study of the content and key metrics of tweets referring to psychosis in comparison with tweets referring to control diseases (breast cancer, diabetes, Alzheimer, and human immunodeficiency virus). Methods: Each tweet's content was rated as nonmedical (NM: testimonies, health care products, solidarity or awareness and misuse) or medical (M: included a reference to the illness's diagnosis, treatment, prognosis, or prevention). NM tweets were classified as positive or pejorative. We assessed the appropriateness of the medical content. The number of retweets generated and the potential reach and impact of the hashtags analyzed was also investigated. Results: We analyzed a total of 15,443 tweets: 8055 classified as NM and 7287 as M. Psychosis-related tweets (PRT) had a significantly higher frequency of misuse 33.3\% (212/636) vs 1.15\% (853/7419; P<.001) and pejorative content 36.2\% (231/636) vs 11.33\% (840/7419; P<.001). The medical content of the PRT showed the highest scientific appropriateness 100\% (391/391) vs 93.66\% (6030/6439; P<.001) and had a higher frequency of content about disease prevention. The potential reach and impact of the tweets related to psychosis were low, but they had a high retweet-to-tweet ratio. Conclusions: We show a reduced number and a different pattern of contents in tweets about psychosis compared with control diseases. PRT showed a predominance of nonmedical content with increased frequencies of misuse and pejorative tone. However, the medical content of PRT showed high scientific appropriateness aimed toward prevention. ", doi="10.2196/14110", url="http://www.jmir.org/2019/5/e14110/", url="http://www.ncbi.nlm.nih.gov/pubmed/31140438" } @Article{info:doi/10.2196/13302, author="Madden, Michael Kenneth and Feldman, Boris", title="Weekly, Seasonal, and Geographic Patterns in Health Contemplations About Sundown Syndrome: An Ecological Correlational Study", journal="JMIR Aging", year="2019", month="May", day="28", volume="2", number="1", pages="e13302", keywords="sundown syndrome", keywords="geriatric medicine", keywords="dementia", keywords="circadian rhythms", keywords="infodemiology", keywords="infoveillance", keywords="internet", abstract="Background: Sundown syndrome (ie, agitation later in the day) is common in older adults with dementia. The underlying etiology for these behaviors is unclear. Possibilities include increased caregiver fatigue at the end of the day and disruption of circadian rhythms by both age and neurodegenerative illness. Objective: This study sought to examine circumseptan (weekly) patterns in search volumes related to sundown syndrome, in order to determine if such searches peaked at the end of the weekend, a time when caregiver supports are least available. We also sought to examine both seasonal differences and associations of state-by-state search activity with both state latitude and yearly sun exposure. Methods: Daily Internet search query data was obtained from Google Trends (2005-2017 inclusive). Circumseptan patterns were determined by wavelet analysis, and seasonality was determined by the difference in search volumes between winter (December, January, and February) and summer (June, July, and August) months. Geographic associations between percent sunny days and latitude were done on a state-by-state basis. Results: ``Sundowning'' searches showed a significant increase at the end of the weekend with activity being 10.9\% (SD 4.0) higher on Sunday as compared to the rest of the week. Search activity showed a seasonal pattern with search activity significantly highest in the winter months (36.6 [SD 0.6] vs 13.7 [SD 0.2], P<.001). State-by-state variations in ``sundowning'' searches showed a significant negative association with increasing mean daily sunlight (R2=.16, $\beta$=-.429 [SD .149], P=.006) and showed a positive association with increasing latitude (R2=.38, $\beta$=.648 [SD .122], P<.001). Conclusions: Interest in ``sundowning'' is highest after a weekend, which is a time when external caregiver support is reduced. Searches related to sundown syndrome also were highest in winter, in states with less sun, and in states at more northerly latitudes, supporting disrupted circadian rhythms as another contributing factor to these behaviors. ", doi="10.2196/13302", url="http://aging.jmir.org/2019/1/e13302/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518264" } @Article{info:doi/10.2196/13333, author="Martens, Kris and Takano, Keisuke and Barry, J. Tom and Goedleven, Jolien and Van den Meutter, Louise and Raes, Filip", title="Remediating Reduced Autobiographical Memory in Healthy Older Adults With Computerized Memory Specificity Training (c-MeST): An Observational Before-After Study", journal="J Med Internet Res", year="2019", month="May", day="14", volume="21", number="5", pages="e13333", keywords="memory specificity training", keywords="autobiographical memory", keywords="cognitive aging", keywords="online", keywords="depression", keywords="memory", keywords="telemedicine", keywords="rumination, cognitive", abstract="Background: The ability to retrieve specific autobiographical memories decreases with cognitive aging. This decline is clinically relevant due to its association with impairments in problem solving, daily functioning, and depression. A therapist-delivered group training protocol, Memory Specificity Training (MeST), has been shown to enhance the retrieval of specific memories while ameliorating the impairments and negative outcomes associated with reduced specificity. The therapist-delivered nature of this intervention means it is relatively expensive to deliver and difficult for people with mobility impairments, such as older people, to receive. Objective: The objective of this study was to test if a novel, Web-based computerized version of a group training protocol called Memory Specificity Training, has the potential to increase autobiographical memory specificity and impact associated secondary psychological processes. Methods: A total of 21 participants (13 female; mean age 67.05, SD 6.55) who experienced a deficit in retrieving specific autobiographical memory were trained with c-MeST. We assessed memory specificity at preintervention and postintervention, as well as secondary processes such as depressive symptoms, rumination, and problem-solving skills. Results: Memory specificity increased significantly after participants completed c-MeST (r=.57). Session-to-session scores indicated that autobiographical memory specificity improved most from the online baseline assessment to the first Web-based session. Symptoms or secondary processes such as problem-solving skills did not change significantly. Conclusions: A Web-based automated individual version of MeST is a feasible, low-cost intervention for reduced memory specificity in healthy older adults. Future studies should clarify the preventive impact of c-MeST in other at-risk sample populations with longer follow-up times. ", doi="10.2196/13333", url="https://www.jmir.org/2019/5/e13333/", url="http://www.ncbi.nlm.nih.gov/pubmed/31094362" } @Article{info:doi/10.2196/13415, author="Zhao, Yinan and Feng, Hui and Hu, Mingyue and Hu, Hengyu and Li, Hui and Ning, Hongting and Chen, Huijing and Liao, Lulu and Peng, Linlin", title="Web-Based Interventions to Improve Mental Health in Home Caregivers of People With Dementia: Meta-Analysis", journal="J Med Internet Res", year="2019", month="May", day="6", volume="21", number="5", pages="e13415", keywords="internet", keywords="education", keywords="mental health", keywords="caregivers", keywords="dementia", abstract="Background: Dementia is a major cause of disability and dependency in older adults worldwide. It is often accompanied by general psychological distress, such as depression and anxiety symptoms, among caregivers of people with dementia (PwD). The physical and mental health of the caregiver is a prerequisite and a promise to help PwD continue to live as long and as well as possible. Web-based interventions can provide convenient and efficient support and an education tool to potentially reduce the negative outcomes associated with providing care. Objective: The aim of this study was to examine the effect of internet-based interventions on the mental health outcomes of family caregivers of PwD and to explore which components of the Web-based interventions play an important role. Methods: A comprehensive literature search was conducted in PubMed, Excerpta Medica dataBASE, PsycINFO, Cochrane Database, and the Cumulative Index to Nursing and Allied Health Literature using relevant terms such as Web-based and caregiver as keywords, covering all studies published before June 2018. A total of 2 reviewers independently reviewed all published abstracts, according to established inclusion and exclusion criteria. We extracted information about the participants, interventions, and results and reviewed article quality in terms of the randomized trial methods, using the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Results: A total of 815 caregivers participated in 6 studies, with 4 of the studies using depression as an outcome. The analysis found that depression scores dropped an average of 0.23 (95\% CI ?0.38 to ?0.07; P<.01) after Web-based interventions. In 2 studies of caregivers who were experiencing anxiety symptoms, the average score for anxiety dropped by 0.32 points (95\% CI ?0.50 to ?0.14; P<.01). However, in terms of coping, pain, and stress, the Web-based interventions showed a poor effect. On the whole, the addition of professional psychological support on the basis of education can improve caregivers' mental health. Conclusions: Internet-based interventions were generally effective at reducing anxiety and depression in dementia caregivers, although negative results were found in some studies. As for burden and stress, further research is required. ", doi="10.2196/13415", url="http://www.jmir.org/2019/5/e13415/", url="http://www.ncbi.nlm.nih.gov/pubmed/31066680" } @Article{info:doi/10.2196/12192, author="Guisado-Fern{\'a}ndez, Estefan{\'i}a and Giunti, Guido and Mackey, M. Laura and Blake, Catherine and Caulfield, Michael Brian", title="Factors Influencing the Adoption of Smart Health Technologies for People With Dementia and Their Informal Caregivers: Scoping Review and Design Framework", journal="JMIR Aging", year="2019", month="Apr", day="30", volume="2", number="1", pages="e12192", keywords="dementia", keywords="informal caregiver", keywords="smart health technologies", keywords="user-centered design", keywords="technology adoption", abstract="Background: Smart Health technologies (s-Health technologies) are being developed to support people with dementia (PwD) and their informal caregivers at home, to improve care and reduce the levels of burden and stress they experience. However, although s-Health technologies have the potential to facilitate this, the factors influencing a successful implementation in this population are still unknown. Objective: The aim of this study was to review existing literature to explore the factors influencing PwD and their informal caregivers' adoption of s-Health technologies for home care. Methods: Following the Arksey and O'Malley methodology, this study is a scoping review providing a narrative description of the scientific literature on factors influencing s-Health technology adoption for PwD and their informal caregivers. A search was conducted using PubMed, the Cochrane library, the IEEE library, and Scopus. Publications screening was conducted by 2 researchers based on inclusion criteria, and full-text analysis was then conducted by 1 researcher. The included articles were thematically analyzed by 2 researchers to gain an insight into factors influencing adoption that PwD and their informal caregivers have to encounter when using s-Health technologies. Relevant information was identified and coded. Codes were later discussed between the researchers for developing and modifying them and for achieving a consensus, and the researchers organized the codes into broader themes. Results: Emerging themes were built in a way that said something specific and meaningful about the research question, creating a list of factors influencing the adoption of s-Health technologies for PwD and their informal caregivers, including attitudinal aspects, ethical issues, technology-related challenges, condition-related challenges, and identified gaps. A design framework was created as a guide for future research and innovation in the area of s-Health technologies for PwD and their informal caregivers: DemDesCon for s-Health Technologies. DemDesCon for s-Health Technologies addresses 4 domains to consider for the design and development of s-Health technologies for this population: cognitive decline domain, physical decline domain, social domain, and development domain. Conclusions: Although s-Health technologies have been used in health care scenarios, more work is needed for them to fully achieve their potential for use in dementia care. Researchers, businesses, and public governments need to collaborate to design and implement effective technology solutions for PwD and their informal caregivers, but the lack of clear design guidelines seems to be slowing the process. We believe that the DemDesCon framework will provide them with the guidance and assistance needed for creating meaningful devices for PwD home care and informal caregivers, filling a much-needed space in the present knowledge gap. ", doi="10.2196/12192", url="http://aging.jmir.org/2019/1/e12192/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518262" } @Article{info:doi/10.2196/12870, author="Hanna-Pladdy, Brenda and Gullapalli, Rao and Chen, Hegang", title="Functional Magnetic Resonance Imaging Biomarkers Predicting Cognitive Progression in Parkinson Disease: Protocol for a Prospective Longitudinal Cohort Study", journal="JMIR Res Protoc", year="2019", month="Apr", day="29", volume="8", number="4", pages="e12870", keywords="Parkinson disease", keywords="cognition", keywords="disease progression", keywords="dementia", keywords="mild cognitive impairment", keywords="biomarkers", keywords="functional neuroimaging", abstract="Background: Cardinal features of Parkinson disease (PD) are motor symptoms, but nonmotor features such as mild cognitive impairment (MCI) are common early in the disease process. MCI can progress and convert to dementia in advanced stages, creating significant disability and reduced quality of life. The primary pathological substrate for cognitive decline in PD is unclear, and there are no reliable biomarkers predicting the risk of conversion to dementia. A subgroup of PD patients with visual hallucinations may display more rapid conversion to dementia, suggesting that regional markers of visuoperceptual dysfunction may be sensitive to pathologic density in posterior cortical regions. Objective: The purpose of this project is to characterize PD-MCI and evaluate the utility of genetic and neuroimaging biomarkers in predicting cognitive outcomes with a prospective longitudinal study. We will evaluate whether accelerated cognitive progression may be reflected in biomarkers of early posterior cortical changes reflective of $\alpha$-synuclein deposition. Methods: We will evaluate a cohort of early-stage PD patients with the following methods to predict cognitive progression: (1) serial neuropsychological evaluations including detailed visuoperceptual functioning across 4 years; (2) genetic analysis of SNCA ($\alpha$-synuclein), MAPT (microtubule-associated tau), and APOE (apolipoprotein E); (3) an event-related functional magnetic resonance imaging paradigm of object recognition memory; and (4) anatomical and regional brain activation changes (resting-state functional magnetic resonance imaging) across 4 years. Results: The project received funding from the National Institutes of Health in August 2017, and data collection began in February 2018. Enrollment is ongoing, and subjects will be evaluated annually for 4 years extended across a 5-year project including data analysis and image processing. Conclusions: Cognitive, genetic, and structural and functional magnetic resonance imaging will characterize neural network changes predictive of cognitive progression in PD across 4 years. Identification of biomarkers with sensitivity for early prediction and estimation of risk for conversion to dementia in PD will pave the way for effective intervention with neuroprotective therapies during the critical stage when treatment can have the greatest impact. International Registered Report Identifier (IRRID): DERR1-10.2196/12870 ", doi="10.2196/12870", url="http://www.researchprotocols.org/2019/4/e12870/", url="http://www.ncbi.nlm.nih.gov/pubmed/31033450" } @Article{info:doi/10.2196/12104, author="Wesselman, MP Linda and Hooghiemstra, M. Astrid and Schoonmade, J. Linda and de Wit, CJ Marjolein and van der Flier, M. Wiesje and Sikkes, AM Sietske", title="Web-Based Multidomain Lifestyle Programs for Brain Health: Comprehensive Overview and Meta-Analysis", journal="JMIR Ment Health", year="2019", month="Apr", day="09", volume="6", number="4", pages="e12104", keywords="meta-analysis", keywords="telemedicine", keywords="internet", keywords="lifestyle", keywords="healthy aging", keywords="cognition", keywords="dementia", keywords="health promotion", keywords="primary prevention", abstract="Background: The number of people living with dementia is increasing worldwide, mainly because of aging of the population. To date, there is no pharmaceutical intervention to delay or treat cognitive decline or dementia. As an estimated one-third of dementia cases might be attributable to modifiable lifestyle factors (such as cognitive and physical activity), multidomain lifestyle interventions are a promising way to maintain or improve brain health. Offering programs online would enable large-scale implementation. An overview of multidomain Web-based lifestyle programs for brain health would facilitate comparison and improvement of such programs to develop effective and sustainable interventions. Objective: This study aimed to (1) provide a comprehensive overview of Web-based multidomain lifestyle programs aimed at optimizing brain health in healthy adult populations and (2) describe the programs and targeted lifestyle factors, availability, and evaluation of adherence and user experience. In addition, a meta-analysis was performed to evaluate the effectiveness of these programs. Methods: Electronic databases (PubMed, EMBASE, and PsycINFO) were searched for Web-based lifestyle programs that were included when the program (1) aimed to optimize brain health, (2) focused on multiple lifestyle factors, (3) was completely Web-based (website, Web application or mobile app), (4) consisted of multiple sessions, and (5) focused on a healthy adult population. Program characteristics (target population, duration, frequency, tailoring, platform, and availability) and results of program evaluations (effectiveness, user evaluations, and adherence) were extracted and compared. Studies using a controlled design were included in a random-effects meta-analysis on the effectiveness on brain health outcomes. Study quality was assessed using the physiotherapy evidence database (PEDro) scale. Results: The electronic searches yielded 44 documents describing 14 Web-based lifestyle programs; physical and cognitive activities were targeted in all programs. Four programs (4/14, 29\%) were publicly available and free of charge, whereas others were restricted to research settings (5/14, 36\%), available after payment (1/14, 7\%), or not available at all (2/14, 14\%). User evaluations were reported for 8 (57\%) of the 14 programs. Reported dropout of the intervention groups ranged from 2\% to 52\%. Overall, 3 studies evaluated the effectiveness of a program using a controlled design and were included in the meta-analysis (moderate-to-high quality). Pooled results showed a significant small-to-medium effect of the Web-based multidomain lifestyle interventions on outcome measures for brain health (global cognition score, subjective cognitive score, and lifestyle risk score; standard mean difference=0.45; 95\% CI 0.12-0.78), with a high degree heterogeneity across studies (I2=75\%; P=.02). Conclusions: In total, 14 Web-based multidomain lifestyle programs aimed at optimizing brain health were found. The programs showed heterogeneity in both characteristics and effectiveness evaluation. Despite this heterogeneity, this meta-analysis suggests that Web-based lifestyle programs can positively influence brain health outcomes and have the potential to contribute to the prevention of dementia. ", doi="10.2196/12104", url="http://mental.jmir.org/2019/4/e12104/", url="http://www.ncbi.nlm.nih.gov/pubmed/30964438" } @Article{info:doi/10.2196/12850, author="Sikder, Taher Abu and Yang, Cheng Francis and Schafer, Rhiana and Dowling, A. Glenna and Traeger, Lara and Jain, Ananda Felipe", title="Mentalizing Imagery Therapy Mobile App to Enhance the Mood of Family Dementia Caregivers: Feasibility and Limited Efficacy Testing", journal="JMIR Aging", year="2019", month="Mar", day="21", volume="2", number="1", pages="e12850", keywords="family caregivers", keywords="mindfulness", keywords="depression", keywords="mobile apps", keywords="psychotherapy", abstract="Background: Family caregivers of patients with Alzheimer disease and related dementias (AD and ADRD) often experience high stress and are at high risk for depression. Technologically delivered therapy is attractive for AD and ADRD caregivers because of the time demands associated with in-person participation. Objective: We aimed to study the feasibility and conduct limited efficacy testing of a mobile app intervention delivering mentalizing imagery therapy (MIT) for family caregivers. Methods: A 4-week trial of the MIT app for family AD and ADRD caregivers was conducted to assess the feasibility of use and investigate changes in depression symptoms, mood, and caregiving experience. Semistructured interviews were conducted to characterize participants' perceived feasibility and benefits. Results: A total of 17 of the 21 (80\%) consented participants (mean age 67 years, range 54-79) utilized the app at least once and were further analyzed. Average usage of audio recordings was on 14 (SD 10) days out of 28 possible and comprised 29 (SD 28) individual sessions. There were improvements in depression with a large effect size for those who used the app at least moderately (P=.008), increases in positive mood postintervention (P<.05), and acute increases in mood following daily guided imagery practice (Stretching and Breathing, P<.001; Eye in the Center, P<.001; Nesting Doll, P=.002; Situation Solver, P=.003; and Life Globe, P=.006). Semistructured interviews revealed perceived benefits such as greater ability to remain ``centered'' despite caregiving challenges and positive reframing of the caregiver experience. Conclusions: App delivery of MIT is feasible for family AD and ADRD caregivers, including aging seniors. Results showed moderate to high usage of the app for a majority of users. Limited efficacy testing provides justification for studying the MIT app for AD and ADRD caregivers to improve mood and reduce depression in larger, controlled trials. ", doi="10.2196/12850", url="http://aging.jmir.org/2019/1/e12850/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518275" } @Article{info:doi/10.2196/12615, author="Groppell, Samantha and Soto-Ruiz, M. Karina and Flores, Benjamin and Dawkins, William and Smith, Isabella and Eagleman, M. David and Katz, Yael", title="A Rapid, Mobile Neurocognitive Screening Test to Aid in Identifying Cognitive Impairment and Dementia (BrainCheck): Cohort Study", journal="JMIR Aging", year="2019", month="Mar", day="21", volume="2", number="1", pages="e12615", keywords="dementia", keywords="neurocognitive tests", keywords="neurocognitive computerized assessment tools (NCAT)", keywords="mild cognitive impairment (MCI)", keywords="BrainCheck", keywords="digital testing", keywords="Alzheimer's disease", keywords="electronic neurocognitive tools", keywords="computerized cognitive assessment", keywords="digital cognitive assessment", abstract="Background: The US population over the age of 65 is expected to double by the year 2050. Concordantly, the incidence of dementia is projected to increase. The subclinical stage of dementia begins years before signs and symptoms appear. Early detection of cognitive impairment and/or cognitive decline may allow for interventions to slow its progression. Furthermore, early detection may allow for implementation of care plans that may affect the quality of life of those affected and their caregivers. Objective: We sought to determine the accuracy and validity of BrainCheck Memory as a diagnostic aid for age-related cognitive impairment, as compared against physician diagnosis and other commonly used neurocognitive screening tests, including the Saint Louis University Mental Status (SLUMS) exam, the Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). Methods: We tested 583 volunteers over the age of 49 from various community centers and living facilities in Houston, Texas. The volunteers were divided into five cohorts: a normative population and four comparison groups for the SLUMS exam, the MMSE, the MoCA, and physician diagnosis. Each comparison group completed their respective assessment and BrainCheck Memory. Results: A total of 398 subjects were included in the normative population. A total of 84 participants were in the SLUMS exam cohort, 51 in the MMSE cohort, 35 in the MoCA cohort, and 18 in the physician cohort. BrainCheck Memory assessments were significantly correlated to the SLUMS exam, with coefficients ranging from .5 to .7. Correlation coefficients for the MMSE and BrainCheck and the MoCA and BrainCheck were also significant. Of the 18 subjects evaluated by a physician, 9 (50\%) were healthy, 6 (33\%) were moderately impaired, and 3 (17\%) were severely impaired. A significant difference was found between the severely and moderately impaired subjects and the healthy subjects (P=.02). We derived a BrainCheck Memory composite score that showed stronger correlations with the standard assessments as compared to the individual BrainCheck assessments. Receiver operating characteristic (ROC) curve analysis of this composite score found a sensitivity of 81\% and a specificity of 94\%. Conclusions: BrainCheck Memory provides a sensitive and specific metric for age-related cognitive impairment in older adults, with the advantages of a mobile, digital, and easy-to-use test. Trial Registration: ClinicalTrials.gov NCT03608722; https://clinicaltrials.gov/ct2/show/NCT03608722 (Archived by WebCite at http://www.webcitation.org/76JLoYUGf) ", doi="10.2196/12615", url="http://aging.jmir.org/2019/1/e12615/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518280" } @Article{info:doi/10.2196/11599, author="Ford II, H. James and Dodds, Debby and Hyland, Julie and Potteiger, Michael", title="Evaluating the Impact of Music \& Memory's Personalized Music and Tablet Engagement Program in Wisconsin Assisted Living Communities: Pilot Study", journal="JMIR Aging", year="2019", month="Mar", day="14", volume="2", number="1", pages="e11599", keywords="Music \& Memory", keywords="assisted living facilities", keywords="quality of life", keywords="agitation", keywords="medication adherance", keywords="iPod", keywords="iPad", keywords="implementation science", keywords="patient participation", abstract="Background: Individuals with Alzheimer disease or related dementia represent a significant and growing segment of the older adult (aged 65 years and above) population. In addition to physical health concerns, including comorbid medical conditions, these individuals often exhibit behavioral and psychological symptoms of dementia (BPSD). The presence of BPSD in long-term care residential facilities can disrupt resident's care and impact staff. Nonpharmacological interventions such as personalized music and tablet engagement maintain cognitive function, improve quality of life (QOL), and mitigate BPSD for older adults with dementia. Evidence of the impact of such interventions in assisted living communities (ALCs) is needed for widespread adoption and sustainment of these technologies. Objective: The aim of this study was to assess the impact of Music \& Memory's personalized music and tablet engagement (PMATE) program on QOL, agitation, and medication use for residents living in 6 Wisconsin ALCs. Methods: The data collected were on the utilization of iPods and iPads by the residents. Residents' outcomes were assessed using the Pittsburgh Agitation Scale, the Quality of Life in Late Stage Dementia scale, and self-reported medication use. A mixed-methods approach was utilized to examine the impact of the PMATE program on these outcomes. Descriptive statistics were calculated. A paired t test explored changes in residents' QOL. A 1-way analysis of variance was utilized to examine changes in resident's agitation and QOL based on the resident's utilization of the PMATE program. Qualitative interviews were conducted with the individuals responsible for PMATE implementation in the ALC. Residents excluded from the analysis were those who passed away, were discharged, or refused to participate. Results: A total of 5 apps, based on average times used by residents, were identified. In all, 4 of the 5 apps were rated as being useful to promote residents' engagement. PMATE utilization was not associated with changes in the residents' agitation levels or antipsychotic medication use over time. Over a 3-month period, the change in residents' QOL was significant (P=.047), and the differences across ALCs were also significant (F25=3.76, P=.02). High utilizers of the PMATE program (>2500 min over 3 months) showed greater improvements in QOL as compared with low utilizers (a change of ?5.90 points vs an increase of 0.43 points). The difference was significant (P=.03). Similar significant findings were found between the high- and midutilizers. Conclusions: The study is one of the first to explore the impact of Music \& Memory's PMATE program on residents living in ALCs. Findings suggest that higher utilization over time improves residents' QOL. However, a more comprehensive study with improved data collection efforts across multiple ALCs is needed to confirm these preliminary findings. ", doi="10.2196/11599", url="http://aging.jmir.org/2019/1/e11599/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518259" } @Article{info:doi/10.2196/13135, author="Walton, Campbell Courtney and Lampit, Amit and Boulamatsis, Christos and Hallock, Harry and Barr, Polly and Ginige, Anupama Jeewani and Brodaty, Henry and Chau, Tiffany and Heffernan, Megan and Sachdev, Singh Perminder and Fiatarone Singh, A. Maria and Valenzuela, Michael", title="Design and Development of the Brain Training System for the Digital ``Maintain Your Brain'' Dementia Prevention Trial", journal="JMIR Aging", year="2019", month="Feb", day="27", volume="2", number="1", pages="e13135", keywords="computerized cognitive training", keywords="dementia", keywords="clinical trial design", keywords="older adults", abstract="Background: Dementia is the leading cause of disability worldwide, and interventions aimed at reducing the prevalence and burden of the disease are urgently needed. Maintain Your Brain (MYB) is a randomized controlled trial of a multimodal digital health intervention targeting modifiable dementia risk factors to combat cognitive decline and potentially prevent dementia. In addition to behavioral modules targeting mood, nutrition, and physical exercise, a new Brain Training System (BTS) will deliver computerized cognitive training (CCT) throughout the trial to provide systematic, challenging, and personally adaptive cognitive activity. Objective: This paper aimed to describe the design and development of BTS. Methods: BTS has been designed with a central focus on the end user. Raw training content is provided by our partner NeuroNation and delivered in several innovative ways. A baseline cognitive profile directs selection and sequencing of exercises within and between sessions and is updated during the 10-week 30-session module. Online trainers are available to provide supervision at different levels of engagement, including face-to-face share-screen coaching, a key implementation resource that is triaged by a ``red flag'' system for automatic tracking of user adherence and engagement, or through user-initiated help requests. Individualized and comparative feedback is provided to aid motivation and, for the first time, establish a social support network for the user based on their real-world circle of friends and family. Results: The MYB pilot was performed from November 2017 to March 2018. We are currently analyzing data from this pilot trial (n=100), which will make up a separate research paper. The main trial was launched in June 2018. Process and implementation data from the first training module (September to November 2018) are expected to be reported in 2019 and final trial outcomes are anticipated in 2022. Conclusions: The BTS implemented in MYB is focused on maximizing adherence and engagement with CCT over the short and long term in the setting of a fully digital trial, which, if successful, could be delivered economically at scale. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000851268; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=370631\&isReview=true ", doi="10.2196/13135", url="http://aging.jmir.org/2019/1/e13135/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518277" } @Article{info:doi/10.2196/10952, author="van den Kieboom, CP Robin and Bongers, MB Inge and Mark, E. Ruth and Snaphaan, JAE Liselore", title="User-Driven Living Lab for Assistive Technology to Support People With Dementia Living at Home: Protocol for Developing Co-Creation--Based Innovations", journal="JMIR Res Protoc", year="2019", month="Jan", day="28", volume="8", number="1", pages="e10952", keywords="dementia", keywords="family caregivers", keywords="longitudinal studies", keywords="technology", abstract="Background: Owing to no cure for dementia currently, there is an urgent need to look for alternative ways to support these people and their informal caregivers. Carefully designed interventions can answer the unmet needs of both people with dementia and their informal caregivers in the community. However, existing products, systems, and services are often too complex or unsuitable. Objective: This study aims to identify, longitudinally, the changing needs (as dementia progresses) of people with dementia living at home and their informal caregivers. By developing co-creation-based innovations, these changing needs will hopefully be met. Methods: A user-driven Living Lab design is used to structurally explore the needs over time of people with dementia (and their informal caregivers) living in the community in the North Brabant region of the Netherlands. In addition, co-creation-based innovations will be developed, tested, and evaluated by these people and their caregivers at home. All participants will complete complaints-oriented questionnaires at 3 time-points---at the baseline, 1 year, and 2 years after they start participating. Home interviews are scheduled to explore if and how these complaints translate into participants' specific needs or wishes. Focus groups meet on a monthly basis to further identify the needs of people with dementia and their informal caregivers and provide feedback to the stakeholders. In the context field, participants have an opportunity to actually test the products at home and provide feedback. Quantitative outcome measurements include neuropsychiatric symptoms, cognitive decline, independence in activities of daily living, safety, and caregiver burden. Qualitative outcome measurements include feedback to the stakeholders regarding the needs of people with dementia and their informal caregivers and how these needs change over time, as well as user experiences about the specific innovations. Results: Participant recruitment will start in September 2018 and is ongoing. The first results of data analyses are expected in the spring of 2019. Conclusions: The overall aim of Innovate Dementia 2.0 is to facilitate person-centered innovations developed for people with dementia and their informal caregivers at all stages as dementia progresses. This should lead to newly designed concepts and innovations, which are better able to answer the needs of people with dementia and their caregivers in the community. International Registered Report Identifier (IRRID): DERR1-10.2196/10952 ", doi="10.2196/10952", url="http://www.researchprotocols.org/2019/1/e10952/", url="http://www.ncbi.nlm.nih.gov/pubmed/30688653" } @Article{info:doi/10.2196/11682, author="Xie, Bo and Champion, Dimmitt Jane and Kwak, Jung and Fleischmann, R. Kenneth", title="Mobile Health, Information Preferences, and Surrogate Decision-Making Preferences of Family Caregivers of People With Dementia in Rural Hispanic Communities: Cross-Sectional Questionnaire Study", journal="J Med Internet Res", year="2018", month="Dec", day="10", volume="20", number="12", pages="e11682", keywords="mHealth", keywords="dementia", keywords="caregivers", keywords="rural communities", abstract="Background: Mobile health (mHealth) technology holds promise for promoting health education and reducing health disparities and inequalities in underserved populations. However, little research has been done to develop mHealth interventions for family caregivers of people with dementia, particularly those in rural Hispanic communities, who often serve as surrogate decision makers for their relatives with dementia. Objective: As part of a larger project to develop and test a novel, affordable, and easy-to-use mHealth intervention to deliver individually tailored materials in rural Hispanic communities, in this pilot study, we aimed to examine (1) characteristics of people with dementia and their family caregivers in rural Hispanic communities, (2) caregivers' preferences for types and amounts of health information and participation in surrogate decision making, and (3) caregivers' mobile device usage and their desire for receiving information via mobile devices. Methods: This was a cross-sectional survey. A convenience sample of 50 caregivers of people with dementia was recruited from rural health care facilities in Southwest Texas during 3 weeks of April 2017 to May 2017 via word-of-mouth and flyers posted at the facilities. Results: More women than men were in the patient group ($\chi$21=17.2, P<.001) and in the caregiver group ($\chi$21=22.2, P<.001). More patients were on Medicare and Medicaid; more caregivers had private insurance (P<.001 in all cases). Overall, 42\% of patients did not have a power of attorney for their health care; 40\% did not have a living will or advance directive. Caregivers were interested in receiving all types of information and participating in all types of decisions, although on subscales for diagnosis, treatment, laboratory tests, self-care, and complementary and alternative medicine, their levels of interest for decision-making participation were significantly lower than those for receiving information. On the psychosocial subscale, caregivers' desire was greater for surrogate decision-making participation than for information. Caregivers did not differ in their interests in information and participation in decision making on the health care provider subscale. All but 1 caregiver (98\%) owned a mobile phone and 84\% had a smartphone. Two-thirds wanted to receive at least a little dementia-related information via a smartphone or tablet. The amount of dementia-related information caregivers wanted to receive via a mobile device was significantly greater for women than for men (U=84.50, P=.029). Caregivers who owned a tablet were more likely to want to receive dementia-related information via a mobile device than those who did not own a tablet (U=152.0, P=.006). Conclusions: Caregivers in rural Hispanic communities were interested in receiving a wide range of information as well as participating in making decisions for their relatives with dementia. There is much need for effective mHealth interventions that can provide information tailored to the needs and preferences of these caregivers. ", doi="10.2196/11682", url="https://www.jmir.org/2018/12/e11682/", url="http://www.ncbi.nlm.nih.gov/pubmed/30530450" } @Article{info:doi/10.2196/11542, author="Cheng, Yi-mei Tiffany and Liu, Lisa and Woo, KP Benjamin", title="Analyzing Twitter as a Platform for Alzheimer-Related Dementia Awareness: Thematic Analyses of Tweets", journal="JMIR Aging", year="2018", month="Dec", day="10", volume="1", number="2", pages="e11542", keywords="social media", keywords="Twitter", keywords="dementia", keywords="social support", abstract="Background: Dementia is a prevalent disorder among adults and often subjects an individual and his or her family. Social media websites may serve as a platform to raise awareness for dementia and allow researchers to explore health-related data. Objective: The objective of this study was to utilize Twitter, a social media website, to examine the content and location of tweets containing the keyword ``dementia'' to better understand the reasons why individuals discuss dementia. We adopted an approach that analyzed user location, user category, and tweet content subcategories to classify large publicly available datasets. Methods: A total of 398 tweets were collected using the Twitter search application programming interface with the keyword ``dementia,'' circulated between January and February 2018. Twitter users were categorized into 4 categories: general public, health care field, advocacy organization, and public broadcasting. Tweets posted by ``general public'' users were further subcategorized into 5 categories: mental health advocate, affected persons, stigmatization, marketing, and other. Placement into the categories was done through thematic analysis. Results: A total of 398 tweets were written by 359 different screen names from 28 different countries. The largest number of Twitter users were from the United States and the United Kingdom. Within the United States, the largest number of users were from California and Texas. The majority (281/398, 70.6\%) of Twitter users were categorized into the ``general public'' category. Content analysis of tweets from the ``general public'' category revealed stigmatization (113/281, 40.2\%) and mental health advocacy (102/281, 36.3\%) as the most common themes. Among tweets from California and Texas, California had more stigmatization tweets, while Texas had more mental health advocacy tweets. Conclusions: Themes from the content of tweets highlight the mixture of the political climate and the supportive network present on Twitter. The ability to use Twitter to combat stigma and raise awareness of mental health indicates the benefits that can potentially be facilitated via the platform, but negative stigmatizing tweets may interfere with the effectiveness of this social support. ", doi="10.2196/11542", url="http://aging.jmir.org/2018/2/e11542/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518232" } @Article{info:doi/10.2196/12274, author="Wozney, Lori and Freitas de Souza, M. Luciane and Kervin, Emily and Queluz, Francine and McGrath, J. Patrick and Keefe, Janice", title="Commercially Available Mobile Apps for Caregivers of People With Alzheimer Disease or Other Related Dementias: Systematic Search", journal="JMIR Aging", year="2018", month="Dec", day="07", volume="1", number="2", pages="e12274", keywords="alzheimer and other related dementias", keywords="apps", keywords="caregivers", keywords="eHealth", keywords="mobile phone", abstract="Background: More than 15 million Americans provide unpaid care for persons with Alzheimer disease or other related dementias (ADRD). While there is good evidence to suggest that caregivers benefit from psychosocial interventions, these have primarily been delivered via face-to-face individual or group format. Alternatively, offering electronic health (eHealth) interventions may assist caregivers in providing quality care while remaining in good health. Research to date has generated little knowledge about what app features support ADRD caregivers' behavioral changes and how developers might optimize features over the long term. Objective: There is an evident knowledge gap in the current landscape of commercially available apps, their integration of behavioral techniques, content focus, and compliance with usability recommendations. This paper systematically reviews and inventories the apps caregivers might typically be exposed to and determines the support integrated into the apps and their functionality for older adults. Methods: The search strategy was designed to mimic typical Web-based health information-seeking behavior for adults. Apps were included based on their explicit focus on ADRD caregiver knowledge and skill improvement. Two coders with expertise in behavioral interventions and eHealth pilot-tested the data extraction. One coder retained app characteristics and design features. Techniques used to promote change were determined, and 2 questions from the Mobile App Rating Scale were used to assess the app credibility and evidence base. Content topics were evaluated using a thematic framing technique, and each app was assessed using a usability heuristic checklist. Results: The search results generated 18 unique apps that met the inclusion criteria. Some apps were unavailable, and only 8 unique apps were reviewed. Of the 8, 7 (88\%) apps did not state which scientific orientation was followed to develop their content. None of the apps made clinical claims of improving caregivers' and care recipients' overall health. All apps relied on textual information to disseminate their contents. None of the apps was trialed and evidence based. Apps included on average 7 out of 10 behavioral change techniques, 5 out of 10 C.A.R.E. (Caregivers, Aspirations, Realities, and Expectations) features, and 10 out of 18 features on the usability heuristics checklist. Conclusions: Our findings suggest that caregivers are likely to discover apps that are not actually accessible and have low or no evidence base. Apps were found to be largely static, text-based informational resources, and few supported behaviors needed to maintain caregivers' health. While apps may be providing a high volume of information, caregivers must still navigate what resources they need with limited guidance. Finally, the commercial marketplace is addressing some of the major usability elements, but many design elements are not addressed. ", doi="10.2196/12274", url="http://aging.jmir.org/2018/2/e12274/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518255" } @Article{info:doi/10.2196/aging.9130, author="Cruickshank, Callum and MacIntyre, J. Donald", title="Digital Access in Working-Age and Older Adults and Their Caregivers Attending Psychiatry Outpatient Clinics: Quantitative Survey", journal="JMIR Aging", year="2018", month="Nov", day="22", volume="1", number="2", pages="e4", keywords="general psychiatry", keywords="internet access", keywords="memory assessment and treatment service", keywords="mobile phone", keywords="old age psychiatry", abstract="Background: It has been suggested that improving access to mental health services, supporting self-management, and increasing clinical productivity can be achieved through the delivery of technology-enabled care by personal mobile-based and internet-based services. There is little evidence available about whether working-age and older adults with mental health problems or their caregivers have access to these technologies or their confidence with these technologies. Objective: This study aimed to ascertain the prevalence and range of devices used to access the internet in patients and caregivers attending general and older adult psychiatry outpatient services and their confidence in using these technologies. Methods: We conducted an anonymous survey of 77 patients and caregivers from a general psychiatry and old age psychiatry clinic to determine rates of internet access and device ownership, and attitudes to technology-enabled care. Results: We found high levels of internet access and confidence in using the internet in working-age adults, their caregivers, and older adult caregivers but not in older adult patients. The smartphone usage predominated in working-age adults and their caregivers. Older adult caregivers were more likely to use desktop or laptop computers. In our sample, tablets were the least popular form factor. Conclusions: Access rates and uptake of internet-based services have the potential to be high in working-age adults and their caregivers but are likely to be markedly lower among older adult patients attending psychiatry clinics. Applications designed for tablets are likely to have low uptake. All groups identified appointment reminders as likely to be beneficial. ", doi="10.2196/aging.9130", url="http://aging.jmir.org/2018/2/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518247" } @Article{info:doi/10.2196/mental.9684, author="Laird, A. Elizabeth and Ryan, Assumpta and McCauley, Claire and Bond, B. Raymond and Mulvenna, D. Maurice and Curran, J. Kevin and Bunting, Brendan and Ferry, Finola and Gibson, Aideen", title="Using Mobile Technology to Provide Personalized Reminiscence for People Living With Dementia and Their Carers: Appraisal of Outcomes From a Quasi-Experimental Study", journal="JMIR Ment Health", year="2018", month="Sep", day="11", volume="5", number="3", pages="e57", keywords="dementia", keywords="evaluation", keywords="mobile apps", keywords="reminiscence", keywords="research", keywords="technology", keywords="mobile phone", abstract="Background: Dementia is an international research priority. Reminiscence is an intervention that prompts memories and has been widely used as a therapeutic approach for people living with dementia. We developed a novel iPad app to support home-based personalized reminiscence. It is crucial that technology-enabled reminiscence interventions are appraised. Objective: We sought to measure the effect of technology-enabled reminiscence on mutuality (defined as the level of ``closeness'' between an adult living with dementia and their carer), quality of carer and patient relationship, and subjective well-being. Methods: A 19-week personalized reminiscence intervention facilitated by a program of training and a bespoke iPad app was delivered to people living with dementia and their family carers at their own homes. Participants (N=60) were recruited in dyads from a cognitive rehabilitation team affiliated with a large UK health care organization. Each dyad comprised a person living with early to moderate dementia and his or her family carer. Outcome measurement data were collected at baseline, midpoint, and intervention closure. Results: Participants living with dementia attained statistically significant increases in mutuality, quality of carer and patient relationship, and subjective well-being (P<.001 for all 3) from baseline to endpoint. Carers attained nonsignificant increases in mutuality and quality of carer and patient relationship and a nonsignificant decrease in subjective well-being. Conclusions: Our results indicate that individual-specific reminiscence supported by an iPad app may be efficient in the context of early to moderate dementia. A robust randomized controlled trial of technology-enabled personalized reminiscence is warranted. ", doi="10.2196/mental.9684", url="http://mental.jmir.org/2018/3/e57/", url="http://www.ncbi.nlm.nih.gov/pubmed/30206053" } @Article{info:doi/10.2196/11368, author="Bott, Nicholas and Kumar, Shefali and Krebs, Caitlyn and Glenn, M. Jordan and Madero, N. Erica and Juusola, L. Jessie", title="A Remote Intervention to Prevent or Delay Cognitive Impairment in Older Adults: Design, Recruitment, and Baseline Characteristics of the Virtual Cognitive Health (VC Health) Study", journal="JMIR Res Protoc", year="2018", month="Aug", day="13", volume="7", number="8", pages="e11368", keywords="cognitive impairment", keywords="dementia", keywords="Alzheimer disease", keywords="lifestyle intervention", keywords="digital health", keywords="health coaching", keywords="cognitive dysfunction", keywords="risk reduction behavior", abstract="Background: A growing body of evidence supports the use of lifestyle interventions for preventing or delaying the onset of Alzheimer disease and other forms of dementia in at-risk individuals. The development of internet-delivered programs would increase the scalability and reach of these interventions, but requires validation to ensure similar effectiveness to brick-and-mortar options. Objective: We describe the study design, recruitment process, and baseline participant characteristics of the sample in the Virtual Cognitive Health (VC Health) study. Future analyses will assess the impact of the remotely delivered lifestyle intervention on (1) cognitive function, (2) depression and anxiety, and (3) various lifestyle behaviors, including diet, exercise, and sleep, in a cohort of older adults with subjective memory decline. Additional analyses will explore feasibility outcomes, as well as the participants' engagement patterns with the program. Methods: Older adults (aged 60-75 years) with subjective memory decline as measured by the Subjective Cognitive Decline 9-item (SCD-9) questionnaire, and who reported feeling worried about their memory decline, were eligible to participate in this single-arm pre-post study. All participants enrolled in the yearlong digital intervention, which consists of health coach-guided lifestyle change for improving diet, exercise, sleep, stress, and cognition. All components of this study were conducted remotely, including the collection of data and the administration of the intervention. We assessed participants at baseline, 12 weeks, 24 weeks, and 52 weeks with online surveys and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) test. We will conduct intention-to-treat analysis on all outcomes. Results: A total of 85 participants enrolled in the intervention and 82 are included in the study sample (3 participants withdrew). The study cohort of 82 participants comprises 61 (74\%) female, 72 (88\%) white, and 64 (78\%) overweight or obese participants, and 55 (67\%) have at least a college degree. The average baseline RBANS score was 95.9 (SD 11.1), which is within age-adjusted norms. The average SCD-9 score was 6.0 (SD 2.0), indicating minor subjective cognitive impairment at the beginning of the study. The average baseline Generalized Anxiety Disorder 7-item scale score was 6.2 (SD 4.5), and the average Patient Health Questionnaire 9-item score was 8.5 (SD 4.9), indicating mild levels of anxiety and depression at baseline. Conclusions: Internet-delivered lifestyle interventions are a scalable solution for the prevention or delay of Alzheimer disease. The results of this study will provide the first evidence for the effectiveness of a fully remote intervention and lay the groundwork for future investigations. Trial Registration: ClinicalTrials.gov NCT02969460; http://clinicaltrials.gov/ct2/show/NCT02969460 (Archived by WebCite at http://www.webcitation.org/71LkYAkSh) Registered Report Identifier: RR1-10.2196/11368 ", doi="10.2196/11368", url="http://www.researchprotocols.org/2018/8/e11368/", url="http://www.ncbi.nlm.nih.gov/pubmed/30104186" } @Article{info:doi/10.2196/resprot.9087, author="Lasrado, Reena and Bielsten, Ther{\'e}se and Hann, Mark and Davies, Linda and Schumm, James and Reilly, Siobhan and Swarbrick, Caroline and Keady, John and Hellstr{\"o}m, Ingrid", title="Designing and Implementing a Home-Based Couple Management Guide for Couples Where One Partner has Dementia (DemPower): Protocol for a Nonrandomized Feasibility Trial", journal="JMIR Res Protoc", year="2018", month="Aug", day="10", volume="7", number="8", pages="e171", keywords="dementia", keywords="couple management guide", keywords="dementia self-help", keywords="dementia intervention", abstract="Background: The increasing rate of dementia and high health and social care costs call for effective measures to improve public health and enhance the wellbeing of people living with dementia and their relational networks. Most postdiagnostic services focus on the condition and the person with dementia with limited attention to the caring spouse or partner. The key focus of the study is to develop a guide for couples where one partner has a diagnosis of dementia. This couple management guide is delivered in the form of an app, DemPower. Objective: This study aims to investigate the feasibility and acceptability of DemPower and to assess the criteria for a full-integrated clinical and economic randomized control trial. DemPower couple management app will be introduced to couples wherein one partner has dementia. Methods: The study will recruit 25 couples in the United Kingdom and 25 couples in Sweden. Couples will be given 3 months to engage with the app, and the amount of time taken to complete the guide (can be <3 or >3 months) will be reviewed. A set of outcome measures will be obtained at baseline and postintervention stages. Results: The proposed study is at the recruitment phase. The DemPower app is being introduced to couples from consultation groups at a pretrial phase for identifying any bugs and exploring if any navigation challenges exist. The feasibility testing will begin in April 2018. Conclusions: The study will determine how much support couples need to engage with DemPower and whether or not they make use of it in their everyday lives. If there is support for app use, a future study will assess whether it is superior to ``usual care.'' Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 10122979; http://www.isrctn.com/ISRCTN10122979 (Archived by WebCite at http://www.webcitation.org/70rB1iWYI) Registered Report Identifier: RR1-10.2196/9087 ", doi="10.2196/resprot.9087", url="http://www.researchprotocols.org/2018/8/e171/", url="http://www.ncbi.nlm.nih.gov/pubmed/30097423" } @Article{info:doi/10.2196/11143, author="Bott, Nicholas and Madero, N. Erica and Glenn, Jordan and Lange, Alexander and Anderson, John and Newton, Doug and Brennan, Adam and Buffalo, A. Elizabeth and Rentz, Dorene and Zola, Stuart", title="Device-Embedded Cameras for Eye Tracking--Based Cognitive Assessment: Validation With Paper-Pencil and Computerized Cognitive Composites", journal="J Med Internet Res", year="2018", month="Jul", day="24", volume="20", number="7", pages="e11143", keywords="eye tracking", keywords="visual paired comparison", keywords="preclinical Alzheimer's disease", keywords="neuropsychological testing", abstract="Background: As eye tracking-based assessment of cognition becomes more widely used in older adults, particularly those at risk for dementia, reliable and scalable methods to collect high-quality data are required. Eye tracking-based cognitive tests that utilize device-embedded cameras have the potential to reach large numbers of people as a screening tool for preclinical cognitive decline. However, to fully validate this approach, more empirical evidence about the comparability of eyetracking-based paradigms to existing cognitive batteries is needed. Objective: Using a population of clinically normal older adults, we examined the relationship between a 30-minute Visual Paired Comparison (VPC) recognition memory task and cognitive composite indices sensitive to a subtle decline in domains associated with Alzheimer disease. Additionally, the scoring accuracy between software used with a commercial grade eye tracking camera at 60 frames per second (FPS) and a manually scored procedure used with a laptop-embedded web camera (3 FPS) on the VPC task was compared, as well as the relationship between VPC task performance and domain-specific cognitive function. Methods: A group of 49 clinically normal older adults completed a 30-min VPC recognition memory task with simultaneous recording of eye movements by a commercial-grade eye-tracking camera and a laptop-embedded camera. Relationships between webcam VPC performance and the Preclinical Alzheimer Cognitive Composite (PACC) and National Institutes of Health Toolbox Cognitive Battery (NIHTB-CB) were examined. Inter-rater reliability for manually scored tests was analyzed using Krippendorff's kappa formula, and we used Spearman's Rho correlations to investigate the relationship between VPC performance scores with both cameras. We also examined the relationship between VPC performance with the device-embedded camera and domain-specific cognitive performance. Results: Modest relationships were seen between mean VPC novelty preference and the PACC (r=.39, P=.007) and NIHTB-CB (r=.35, P=.03) composite scores, and additional individual neurocognitive task scores including letter fluency (r=.33, P=.02), category fluency (r=.36, P=.01), and Trail Making Test A (--.40, P=.006). Robust relationships were observed between the 60 FPS eye tracker and 3 FPS webcam on both trial-level VPC novelty preference (r=.82, P<.001) and overall mean VPC novelty preference (r=.92 P<.001). Inter-rater agreement of manually scored web camera data was high (kappa=.84). Conclusions: In a sample of clinically normal older adults, performance on a 30-minute VPC task correlated modestly with computerized and paper-pencil based cognitive composites that serve as preclinical Alzheimer disease cognitive indices. The strength of these relationships did not differ between camera devices. We suggest that using a device-embedded camera is a reliable and valid way to assess performance on VPC tasks accurately and that these tasks correlate with existing cognitive composites. ", doi="10.2196/11143", url="http://www.jmir.org/2018/7/e11143/", url="http://www.ncbi.nlm.nih.gov/pubmed/30042093" } @Article{info:doi/10.2196/10017, author="Boots, MM Lizzy and de Vugt, E. Marjolein and Kempen, IJM Gertrudis and Verhey, RJ Frans", title="Effectiveness of a Blended Care Self-Management Program for Caregivers of People With Early-Stage Dementia (Partner in Balance): Randomized Controlled Trial", journal="J Med Internet Res", year="2018", month="Jul", day="13", volume="20", number="7", pages="e10017", keywords="internet", keywords="caregivers", keywords="technology", keywords="therapeutics", abstract="Background: The benefits of electronic health support for dementia caregivers are increasingly recognized. Reaching caregivers of people with early-stage dementia could prevent high levels of burden and psychological problems in the later stages. Objective: The current study evaluates the effectiveness of the blended care self-management program, Partner in Balance, compared to a control group. Methods: A single-blind randomized controlled trial with 81 family caregivers of community-dwelling people with mild dementia was conducted. Participants were randomly assigned to either the 8-week, blended care self-management Partner in Balance program (N=41) or a waiting-list control group (N=40) receiving usual care (low-frequent counseling). The program combines face-to-face coaching with tailored Web-based modules. Data were collected at baseline and after 8 weeks in writing by an independent research assistant who was blinded to the treatment. The primary proximal outcome was self-efficacy (Caregiver Self-Efficacy Scale) and the primary distal outcome was symptoms of depression (Center for Epidemiological Studies Depression Scale). Secondary outcomes included mastery (Pearlin Mastery Scale), quality of life (Investigation Choice Experiments for the Preferences of Older People), and psychological complaints (Hospital Anxiety and Depression Scale-Anxiety and Perceived Stress Scale). Results: A significant increase in favor of the intervention group was demonstrated for self-efficacy (care management, P=.002; service use P=.001), mastery (P=.001), and quality of life (P=.032). Effect sizes were medium for quality of life (d=0.58) and high for self-efficacy care management and service use (d=0.85 and d=0.93, respectively) and mastery (d=0.94). No significant differences between the groups were found on depressive symptoms, anxiety, and perceived stress. Conclusions: This study evaluated the first blended-care intervention for caregivers of people with early-stage dementia and demonstrated a significant improvement in self-efficacy, mastery, and quality of life after receiving the Partner in Balance intervention, compared to a waiting-list control group receiving care as usual. Contrary to our expectations, the intervention did not decrease symptoms of depression, anxiety, or perceived stress. However, the levels of psychological complaints were relatively low in the study sample. Future studies including long-term follow up could clarify if an increase in self-efficacy results in a decrease or prevention of increased stress and depression. To conclude, the program can provide accessible preventative care to future generations of caregivers of people with early-stage dementia. Trial Registration: Netherlands Trial Register NTR4748; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4748 (Archived by WebCite at http://www.webcitation.org/6vSb2t9Mg) ", doi="10.2196/10017", url="http://www.jmir.org/2018/7/e10017/", url="http://www.ncbi.nlm.nih.gov/pubmed/30006327" } @Article{info:doi/10.2196/10493, author="Cleret de Langavant, Laurent and Bayen, Eleonore and Yaffe, Kristine", title="Unsupervised Machine Learning to Identify High Likelihood of Dementia in Population-Based Surveys: Development and Validation Study", journal="J Med Internet Res", year="2018", month="Jul", day="09", volume="20", number="7", pages="e10493", keywords="dementia", keywords="cognition disorders", keywords="health surveys", keywords="electronic health records", keywords="diagnosis", keywords="unsupervised machine learning", keywords="cluster analysis", keywords="data mining", abstract="Background: Dementia is increasing in prevalence worldwide, yet frequently remains undiagnosed, especially in low- and middle-income countries. Population-based surveys represent an underinvestigated source to identify individuals at risk of dementia. Objective: The aim is to identify participants with high likelihood of dementia in population-based surveys without the need of the clinical diagnosis of dementia in a subsample. Methods: Unsupervised machine learning classification (hierarchical clustering on principal components) was developed in the Health and Retirement Study (HRS; 2002-2003, N=18,165 individuals) and validated in the Survey of Health, Ageing and Retirement in Europe (SHARE; 2010-2012, N=58,202 individuals). Results: Unsupervised machine learning classification identified three clusters in HRS: cluster 1 (n=12,231) without any functional or motor limitations, cluster 2 (N=4841) with walking/climbing limitations, and cluster 3 (N=1093) with both functional and walking/climbing limitations. Comparison of cluster 3 with previously published predicted probabilities of dementia in HRS showed that it identified high likelihood of dementia (probability of dementia >0.95; area under the curve [AUC]=0.91). Removing either cognitive or both cognitive and behavioral measures did not impede accurate classification (AUC=0.91 and AUC=0.90, respectively). Three clusters with similar profiles were identified in SHARE (cluster 1: n=40,223; cluster 2: n=15,644; cluster 3: n=2335). Survival rate of participants from cluster 3 reached 39.2\% (n=665 deceased) in HRS and 62.2\% (n=811 deceased) in SHARE after a 3.9-year follow-up. Surviving participants from cluster 3 in both cohorts worsened their functional and mobility performance over the same period. Conclusions: Unsupervised machine learning identifies high likelihood of dementia in population-based surveys, even without cognitive and behavioral measures and without the need of clinical diagnosis of dementia in a subsample of the population. This method could be used to tackle the global challenge of dementia. ", doi="10.2196/10493", url="http://www.jmir.org/2018/7/e10493/", url="http://www.ncbi.nlm.nih.gov/pubmed/29986849" } @Article{info:doi/10.2196/10484, author="Duggleby, Wendy and Ploeg, Jenny and McAiney, Carrie and Peacock, Shelley and Fisher, Kathryn and Ghosh, Sunita and Markle-Reid, Maureen and Swindle, Jennifer and Williams, Allison and Triscott, AC Jean and Forbes, Dorothy and Jovel Ruiz, Kathya", title="Web-Based Intervention for Family Carers of Persons with Dementia and Multiple Chronic Conditions (My Tools 4 Care): Pragmatic Randomized Controlled Trial", journal="J Med Internet Res", year="2018", month="Jun", day="29", volume="20", number="6", pages="e10484", keywords="carers", keywords="dementia", keywords="treatment", keywords="internet", abstract="Background: My Tools 4 Care (MT4C) is a Web-based intervention that was developed based on the transitions theory. It is an interactive, self-administered, and portable toolkit containing six main sections intended to support carers of community-living persons with Alzheimer's disease and related dementia and multiple chronic conditions through their transition experiences. Objective: The objective of our study was to evaluate the effectiveness of MT4C with respect to increasing hope, self-efficacy, and health-related quality of life in carers of community-living older persons with Alzheimer's disease and related dementia and multiple chronic conditions. Methods: A multisite, pragmatic, mixed methods, longitudinal, repeated-measures, randomized controlled trial was conducted between June 2015 and April 2017. Eligible participants were randomized into either treatment (MT4C) or educational control groups. Following baseline measures, carers in the treatment group received 3 months of password-protected access to MT4C. Trained research assistants collected data from participants via phone on hope (Herth Hope Index [HHI]), self-efficacy (General Self-Efficacy Scale), and health-related quality of life (Short Form-12 item [version 2] health survey; SF-12v2) at baseline, 1, 3, and 6 months. The use and cost of health and social services (Health and Social Services Utilization Inventory) among participants were measured at baseline, 3, and 6 months. Analysis of covariance was used to identify group differences at 3 months, and generalized estimating equations were used to identify group differences over time. Results: A total of 199 carers participated in this study, with 101 participants in the treatment group and 98 in the educational control group. Of all, 23\% (45/199) participants withdrew during the study for various reasons, including institutionalization or death of the person with dementia and lack of time from the carer. In the treatment group, 73\% (74/101) carers used MT4C at least once over the 3-month period. No significant differences in the primary outcome measure (mental component summary score from the SF-12v2) by group or time were noted at 3 months; however, significant differences were evident for HHI-factor 2 (P=.01), with higher hope scores in the treatment group than in the control group. General estimating equations showed no statistically significant group differences in terms of mental component summary score at all time points. Attrition and the fact that not all carers in the treatment group used MT4C may explain the absence of statistically significant results for the main outcome variable. Conclusions: Despite no significant differences between groups in terms of the primary outcome variable (mental component score), the significant differences in terms of one of the hope factors suggest that MT4C had a positive influence on the lives of participants. Trial Registration: ClinicalTrials.gov NCT02428387; https://clinicaltrials.gov/ct2/show/NCT02428387 (Archived by Webcite at http://www.webcitation.org/708oFCR8h). ", doi="10.2196/10484", url="http://www.jmir.org/2018/6/e10484/", url="http://www.ncbi.nlm.nih.gov/pubmed/29959111" } @Article{info:doi/10.2196/jmir.9548, author="Hopwood, Jenny and Walker, Nina and McDonagh, Lorraine and Rait, Greta and Walters, Kate and Iliffe, Stephen and Ross, Jamie and Davies, Nathan", title="Internet-Based Interventions Aimed at Supporting Family Caregivers of People With Dementia: Systematic Review", journal="J Med Internet Res", year="2018", month="Jun", day="12", volume="20", number="6", pages="e216", keywords="dementia", keywords="caregivers", keywords="internet", keywords="review", abstract="Background: Caring for someone with dementia is one of the most challenging caring roles. The need for support for family caregivers has been recognized for some time but is often still lacking. With an aging population, demand on health and social care services is growing, and the population is increasingly looking to the internet for information and support. Objective: In this review, we aimed to (1) identify the key components of existing internet-based interventions designed to support family caregivers of people with dementia, (2) develop an understanding of which components are most valued by caregivers, and (3) consider the evidence of effectiveness of internet-based interventions designed to support family caregivers of people with dementia. Methods: We conducted a systematic search of online databases in April 2018. We searched reference lists and tracked citations. All study designs were included. We adopted a narrative synthesis approach with thematic analysis and tabulation as tools. Results: We identified 2325 studies, of which we included 40. The interventions varied in the number and types of components, duration and dose, and outcomes used to measure effectiveness. The interventions focused on (1) contact with health or social care providers, (2) peer interaction, (3) provision of information, (4) decision support, and (5) psychological support. The overall quality of the studies was low, making interpretation and generalizability of the effectiveness findings difficult. However, most studies suggested that interventions may be beneficial to family caregiver well-being, including positive impacts on depression, anxiety, and burden. Particular benefit came from psychological support provided online, where several small randomized controlled trials suggested improvements in caregiver mental health. Provision of information online was most beneficial when tailored specifically for the individual and used as part of a multicomponent intervention. Peer support provided in online groups was appreciated by most participants and showed positive effects on stress. Finally, online contact with a professional was appreciated by caregivers, who valued easy access to personalized practical advice and emotional support, leading to a reduction in burden and strain. Conclusions: Although mixed, the results indicate a positive response for the use of internet-based interventions by caregivers. More high-quality studies are required to identify the effectiveness of internet interventions aimed at supporting family caregivers, with particular focus on meeting the needs of caregivers during the different stages of dementia. ", doi="10.2196/jmir.9548", url="http://www.jmir.org/2018/6/e216/", url="http://www.ncbi.nlm.nih.gov/pubmed/29895512" } @Article{info:doi/10.2196/jmir.9126, author="Rapoport, J. Mark and Zucchero Sarracini, Carla and Kiss, Alex and Lee, Linda and Byszewski, Anna and Seitz, P. Dallas and Vrkljan, Brenda and Molnar, Frank and Herrmann, Nathan and Tang-Wai, F. David and Frank, Christopher and Henry, Blair and Pimlott, Nicholas and Masellis, Mario and Naglie, Gary", title="Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial", journal="J Med Internet Res", year="2018", month="May", day="25", volume="20", number="5", pages="e194", keywords="dementia", keywords="mild cognitive impairment", keywords="automobile driving", keywords="decision support systems, clinical", abstract="Background: Physicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia and deciding when to report to transportation administrators. Care must be taken to balance the safety of patients and other road users with potential negative effects of issuing such reports. Objective: The aim of this study was to assess whether a computer-based Driving in Dementia Decision Tool (DD-DT) increased appropriate reporting of patients with mild dementia or mild cognitive impairment to transportation administrators. Methods: The study used a parallel-group cluster nonblinded randomized controlled trial design to test a multifaceted knowledge translation intervention. The intervention included a computer-based decision support system activated by the physician-user, which provides a recommendation about whether to report patients with mild dementia or mild cognitive impairment to transportation administrators, based on an algorithm derived from earlier work. The intervention also included a mailed educational package and Web-based specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were stratified by sex and randomized to either use the DD-DT or a control version of the tool that required identical data input as the intervention group, but instead generated a generic reminder about the reporting legislation in Ontario, Canada. The trial ran from September 9, 2014 to January 29, 2016, and the primary outcome was the number of reports made to the transportation administrators concordant with the algorithm. Results: A total of 69 participating physicians were randomized, and 36 of these used the DD-DT; 20 of the 35 randomized to the intervention group used DD-DT with 114 patients, and 16 of the 34 randomized to the control group used it with 103 patients. The proportion of all assessed patients reported to the transportation administrators concordant with recommendation did not differ between the intervention and the control groups (50\% vs 49\%; Z=?0.19, P=.85). Two variables predicted algorithm-based reporting---caregiver concern (odds ratio [OR]=5.8, 95\% CI 2.5-13.6, P<.001) and abnormal clock drawing (OR 6.1, 95\% CI 3.1-11.8, P<.001). Conclusions: On the basis of this quantitative analysis, in-office abnormal clock drawing and expressions of concern about driving from caregivers substantially influenced physicians to report patients with mild dementia or mild cognitive impairment to transportation administrators, but the DD-DT tool itself did not increase such reports among these expert physicians. Trial Registration: ClinicalTrials.gov NCT02036099; https://clinicaltrials.gov/ct2/show/NCT02036099 (Archived by WebCite at http://www.webcitation.org/6zGMF1ky8) ", doi="10.2196/jmir.9126", url="http://www.jmir.org/2018/5/e194/", url="http://www.ncbi.nlm.nih.gov/pubmed/29802093" } @Article{info:doi/10.2196/mental.8097, author="Carotenuto, Anna and Rea, Raffaele and Traini, Enea and Ricci, Giovanna and Fasanaro, Maria Angiola and Amenta, Francesco", title="Cognitive Assessment of Patients With Alzheimer's Disease by Telemedicine: Pilot Study", journal="JMIR Ment Health", year="2018", month="May", day="11", volume="5", number="2", pages="e31", keywords="dementia", keywords="telemedicine", keywords="videoconference", keywords="telepsychology", keywords="MMSE by videoconference", keywords="ADAS-cog by videoconference", abstract="Background: Approximately 46.8 million people are living with dementia worldwide and their number will grow in the next years. Any potential treatment should be administered as early as possible because it is important to provide an early cognitive assessment and to regularly monitor the mental function of patients. Information and communication technologies can be helpful to reach and follow patients without displacing them, but there may be doubts about the reliability of cognitive tests performed by telemedicine. Objective: The purpose of this study was to evaluate the reliability of the Mini Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-cog) tests administered in hospital by videoconference to patients with mild to moderate Alzheimer's disease. Methods: The tests were administered to 28 Alzheimer's disease outpatients (8 male, mean age 73.88, SD 7.45 years; 20 female mean age 76.00, SD 5.40 years) recruited and followed in the Alzheimer's Unit of the A Cardarelli National Hospital (Naples, Italy) at baseline and after 6, 12, 18, and 24 months of observation. Patients were evaluated first face-to-face by a psychologist and then, after 2 weeks, by another psychologist via videoconference in hospital. Results: This study showed no differences in the MMSE and ADAS-cog scores when the tests were administered face-to-face or by videoconference, except in patients with more pronounced cognitive deficits (MMSE<17), in which the assessment via videoconference overestimated the cognitive impairment (face to face, MMSE mean 13.9, SD 4.9 and ADAS-cog mean 9.0, SD 3.8; videoconference, MMSE mean 42.8, SD 12.5 and ADAS-cog mean 56.9, SD 5.5). Conclusions: We found that videoconferencing is a reliable approach to document cognitive stability or decline, and to measure treatment effects in patients with mild to moderate dementia. A more extended study is needed to confirm these results. ", doi="10.2196/mental.8097", url="http://mental.jmir.org/2018/2/e31/", url="http://www.ncbi.nlm.nih.gov/pubmed/29752254" } @Article{info:doi/10.2196/medinform.5587, author="Burleson, Winslow and Lozano, Cecil and Ravishankar, Vijay and Lee, Jisoo and Mahoney, Diane", title="An Assistive Technology System that Provides Personalized Dressing Support for People Living with Dementia: Capability Study", journal="JMIR Med Inform", year="2018", month="May", day="01", volume="6", number="2", pages="e21", keywords="Alzheimer disease", keywords="disorders, neurocognitive", keywords="image processing, computer-assisted", abstract="Background: Individuals living with advancing stages of dementia (persons with dementia, PWDs) or other cognitive disorders do not have the luxury of remembering how to perform basic day-to-day activities, which in turn makes them increasingly dependent on the assistance of caregivers. Dressing is one of the most common and stressful activities provided by caregivers because of its complexity and privacy challenges posed during the process. Objective: In preparation for in-home trials with PWDs, the aim of this study was to develop and evaluate a prototype intelligent system, the DRESS prototype, to assess its ability to provide automated assistance with dressing that can afford independence and privacy to individual PWDs and potentially provide additional freedom to their caregivers (family members and professionals). Methods: This laboratory study evaluated the DRESS prototype's capacity to detect dressing events. These events were engaged in by 11 healthy participants simulating common correct and incorrect dressing scenarios. The events ranged from donning a shirt and pants inside out or backwards to partial dressing---typical issues that challenge a PWD and their caregivers. Results: A set of expected detections for correct dressing was prepared via video analysis of all participants' dressing behaviors. In the initial phases of donning either shirts or pants, the DRESS prototype missed only 4 out of 388 expected detections. The prototype's ability to recognize other missing detections varied across conditions. There were also some unexpected detections such as detection of the inside of a shirt as it was being put on. Throughout the study, detection of dressing events was adversely affected by the relatively smaller effective size of the markers at greater distances. Although the DRESS prototype incorrectly identified 10 of 22 cases for shirts, the prototype preformed significantly better for pants, incorrectly identifying only 5 of 22 cases. Further analyses identified opportunities to improve the DRESS prototype's reliability, including increasing the size of markers, minimizing garment folding or occlusions, and optimal positioning of participants with respect to the DRESS prototype. Conclusions: This study demonstrates the ability to detect clothing orientation and position and infer current state of dressing using a combination of sensors, intelligent software, and barcode tracking. With improvements identified by this study, the DRESS prototype has the potential to provide a viable option to provide automated dressing support to assist PWDs in maintaining their independence and privacy, while potentially providing their caregivers with the much-needed respite. ", doi="10.2196/medinform.5587", url="http://medinform.jmir.org/2018/2/e21/", url="http://www.ncbi.nlm.nih.gov/pubmed/29716885" } @Article{info:doi/10.2196/aging.8475, author="Ploeg, Jenny and McAiney, Carrie and Duggleby, Wendy and Chambers, Tracey and Lam, Annie and Peacock, Shelley and Fisher, Kathryn and Forbes, Anne Dorothy and Ghosh, Sunita and Markle-Reid, Maureen and Triscott, Jean and Williams, Allison", title="A Web-Based Intervention to Help Caregivers of Older Adults With Dementia and Multiple Chronic Conditions: Qualitative Study", journal="JMIR Aging", year="2018", month="Apr", day="23", volume="1", number="1", pages="e2", keywords="Internet", keywords="Web-based interventions", keywords="qualitative research", keywords="caregivers", keywords="aged", keywords="dementia", keywords="multiple chronic conditions", abstract="Background: Caregivers (ie, family members and friends) play a vital role in the ongoing care and well-being of community-living older persons with Alzheimer disease and related dementia in combination with multiple chronic conditions. However, they often do so to the detriment of their own physical, mental, and emotional health. Caregivers often experience multiple challenges in their caregiving roles and responsibilities. Recent evidence suggests that Web-based interventions have the potential to support caregivers by decreasing caregiver stress and burden. However, we know little about how Web-based supports help caregivers. Objective: The objectives of this paper were to describe (1) how the use of a self-administered, psychosocial, supportive, Web-based Transition Toolkit, My Tools 4 Care (MT4C), designed by atmist, Edmonton, Alberta, Canada, helped caregivers of older adults with Alzheimer disease and related dementia and multiple chronic conditions; (2) which features of MT4C caregivers found most and least beneficial; and (3) what changes would they would recommend making to MT4C. Methods: This study was part of a larger multisite mixed-methods pragmatic randomized controlled trial. The qualitative portion of the study and the focus of this paper used a qualitative descriptive design. Data collectors conducted semistructured, open-ended, telephone interviews with study participants who were randomly allocated to use MT4C for 3 months. All interviews were audio-taped and ranged from 20 to 40 min. Interviews were conducted at 1 and 3 months following a baseline interview. Qualitative content analysis was used to analyze collected data. Results: Fifty-six caregivers from Alberta and Ontario, Canada, participated in either one or both of the follow-up interviews (89 interviews in total). Caregivers explained that using MT4C (1) encouraged reflection; (2) encouraged sharing of caregiving experiences; (3) provided a source of information and education; (4) provided affirmation; and for some participants (5) did not help. Caregivers also described features of MT4C that they found most and least beneficial and changes they would recommend making to MT4C. Conclusions: Study results indicate that a self-administered psychosocial supportive Web-based resource helps caregivers of community-dwelling older adults with Alzheimer disease and related dementia and multiple chronic conditions with their complex caregiving roles and responsibilities. The use of MT4C also helped caregivers in identifying supports for caring, caring for self, and planning for future caregiving roles and responsibilities. Caregivers shared important recommendations for future development of Web-based supports. ", doi="10.2196/aging.8475", url="http://aging.jmir.org/2018/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518230" } @Article{info:doi/10.2196/formative.9083, author="Zafeiridi, Paraskevi and Paulson, Kevin and Dunn, Rosie and Wolverson, Emma and White, Caroline and Thorpe, Adrian Jonathan and Antomarini, Marco and Cesaroni, Francesca and Scocchera, Francesca and Landrin-Dutot, Isabelle and Malherbe, La{\"e}titia and Lingiah, Hendi and B{\'e}rard, Marie and Giron{\`e}s, Xavier and Quintana, Maria and Cort{\'e}s, Ulises and Barru{\'e}, Cristian and Cort{\'e}s, Atia and Paliokas, Ioannis and Votis, Konstantinos and Tzovaras, Dimitrios", title="A Web-Based Platform for People With Memory Problems and Their Caregivers (CAREGIVERSPRO-MMD): Mixed-Methods Evaluation of Usability", journal="JMIR Formativ Res", year="2018", month="Mar", day="12", volume="2", number="1", pages="e4", keywords="dementia", keywords="technology", keywords="social support", keywords="caregivers", abstract="Background: The increasing number of people with dementia (PwD) drives research exploring Web-based support interventions to provide effective care for larger populations. In this concept, a Web-based platform (CAREGIVERSPRO-MMD, 620911) was designed to (1) improve the quality of life for PwD, (2) reduce caregiver burden, (3) reduce the financial costs for care, and (4) reduce administration time for health and social care professionals. Objective: The objective of this study was to evaluate the usability and usefulness of CAREGIVERSPRO-MMD platform for PwD or mild cognitive impairment (MCI), informal caregivers, and health and social care professionals with respect to a wider strategy followed by the project to enhance the user-centered approach. A secondary aim of the study was to collect recommendations to improve the platform before the future pilot study. Methods: A mixed methods design was employed for recruiting PwD or MCI (N=24), informal caregivers (N=24), and professionals (N=10). Participants were asked to rate their satisfaction, the perceived usefulness, and ease of use of each function of the platform. Qualitative questions about the improvement of the platform were asked when participants provided low scores for a function. Testing occurred at baseline and 1 week after participants used the platform. The dropout rate from baseline to the follow-up was approximately 10\% (6/58). Results: After 1 week of platform use, the system was useful for 90\% (20.75/23) of the caregivers and for 89\% (5.36/6) of the professionals. When users responded to more than 1 question per platform function, the mean of satisfied users per function was calculated. These user groups also provided positive evaluations for the ease of use (caregivers: 82\%, 18.75/23; professionals: 97\%, 5.82/6) and their satisfaction with the platform (caregivers: 79\%, 18.08/23; professionals: 73\%, 4.36/6). Ratings from PwD were lower than the other groups for usefulness (57\%, 13/23), ease of use (41\%, 9.4/23), and overall satisfaction (47\%, 11/23) with the platform (P<.05). Qualitative comments related to both improvements for functionality and the platform interface. Conclusions: Although caregivers and professionals were overall satisfied with the platform, further adaptations were recommended by PwD. This reiterates the importance of the involvement of end users in the development of Web-based interventions. Recommendations from users in this paper apply for the interface and functionality of a wider range of Web-based support interventions. ", doi="10.2196/formative.9083", url="http://formative.jmir.org/2018/1/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/30684403" } @Article{info:doi/10.2196/resprot.8744, author="Wallack, M. Elizabeth and Harris, Chelsea and Ploughman, Michelle and Butler, Roger", title="Telegerontology as a Novel Approach to Address Health and Safety by Supporting Community-Based Rural Dementia Care Triads: Randomized Controlled Trial Protocol", journal="JMIR Res Protoc", year="2018", month="Feb", day="22", volume="7", number="2", pages="e56", keywords="Aging", keywords="Remote Assessment", keywords="Monitoring", abstract="Background: Telegerontology is an approach using videoconferencing to connect an interdisciplinary team in a regional specialty center to patients in rural communities, which is becoming increasingly practical for addressing current limitations in rural community-based dementia care. Objective: Using the remotely-delivered expertise of the Telegerontology dementia care team, we aim to enhance the caregiver/patient/physician triad and thereby provide the necessary support for the person with dementia to ``age in place.'' Methods: This is a cluster randomized feasibility trial with four rural regions in the province of Newfoundland and Labrador, Canada (2 regions randomly assigned to ``intervention'' and 2 to ``control''). The study population includes 22 ``dementia triads'' that consist of a community-dwelling older Canadian with moderate to late dementia, their family caregivers, and their Primary Care Physician (PCP). Over the 6-month active study period, all participants will be provided an iPad. The intervention is intended as an adjunct to existing PCP care, consisting of weekly Skype-based videoconferencing calls with the Telegerontology physician, and other team members as needed (occupational therapist, physical therapist etc). Control participants receive usual community-based dementia care with their PCP. A baseline (pre-) assessment will be performed during a home visit with the study team. Post intervention, 6- and 12-month follow-up assessments will be collected remotely using specialized dementia monitoring applications and Skype calls. Primary outcomes include admission to long-term care, falls, emergency room visits, hospital stays, and caregiver burden. Results: Results will be available in March of 2018. Conclusions: Results from this study will demonstrate a novel approach to dementia care that has the potential to impact both rural PCPs, family caregivers, and people with dementia, as well as provide evidence for the utility of Telegerontology in models of eHealth-based care. ", doi="10.2196/resprot.8744", url="http://www.researchprotocols.org/2018/2/e56/", url="http://www.ncbi.nlm.nih.gov/pubmed/29472178" } @Article{info:doi/10.2196/jmir.7666, author="Boots, MM Lizzy and de Vugt, E. Marjolein and Smeets, MJ Claudia and Kempen, IJM Gertrudis and Verhey, RJ Frans", title="Implementation of the Blended Care Self-Management Program for Caregivers of People With Early-Stage Dementia (Partner in Balance): Process Evaluation of a Randomized Controlled Trial", journal="J Med Internet Res", year="2017", month="Dec", day="19", volume="19", number="12", pages="e423", keywords="internet", keywords="caregivers", keywords="technology", keywords="therapeutics", abstract="Background: Caring for a family member with dementia puts caregivers at risk of overburdening. Electronic health (eHealth) support for caregivers offers an opportunity for accessible tailored interventions. The blended care self-management program ``Partner in Balance'' (PiB) for early-stage dementia caregivers was executed in Dutch dementia care organizations. The program combines face-to-face coaching with tailored Web-based modules. Next to an evaluation of program effectiveness, an evaluation of sampling and intervention quality is essential for the generalizability and interpretation of results. Objective: The aim of this study was to describe the process evaluation from the perspective of both family caregivers (participants) and professionals delivering the intervention (coaches) to determine internal and external validity before the effect analysis and aid future implementation. Methods: Implementation, sampling, and intervention quality were evaluated with quantitative and qualitative data from logistical research data, coach questionnaires (n=13), and interviews with coaches (n=10) and participants (n=49). Goal attainment scaling was used to measure treatment-induced change. Analyses were performed with descriptive statistics and deductive content analysis. Results: The participation rate of eligible caregivers was 51.9\% (80/154). Recruitment barriers were lack of computer and lack of need for support. Young age and employment were considered recruitment facilitators. All coaches attended training and supervision in blended care self-management. Deviations from the structured protocol were reported on intervention time, structure, and feedback. Coaches described an intensified relationship with the caregiver post intervention. Caregivers appreciated the tailored content and positive feedback. The blended structure increased their openness. The discussion forum was appreciated less. Overall, personal goals were attained after the program (T>50). Implementation barriers included lack of financing, time, and deviating target population. Conclusions: Participants and coaches were satisfied with the intervention, but adapting the content to specific subgroups, for example, younger caregivers, was recommended. Implementation of the program requires more awareness of the benefits of blended care self-management programs and training in tailored self-management skills. Trial Registration: Dutch Trial Register (NTR): NTR4748; http://www.trialregister.nl (Archived by WebCite at http://www.webcitation.org/6vSb2t9Mg) ", doi="10.2196/jmir.7666", url="http://www.jmir.org/2017/12/e423/", url="http://www.ncbi.nlm.nih.gov/pubmed/29258980" } @Article{info:doi/10.2196/resprot.8365, author="Huis in het Veld, G. Judith and Willemse, M. Bernadette and van Asch, FM Iris and Groot Zwaaftink, BM Rob and Verkade, Paul-Jeroen and Veldhuijzen, J. Nienke and Verkaik, Renate and Blom, M. Marco and Francke, L. Anneke", title="Online Self-Management Support for Family Caregivers to Help Them Manage Behavior Changes in Their Relative With Dementia: Study Protocol for a Randomized Controlled Trial and a Process Evaluation", journal="JMIR Res Protoc", year="2017", month="Nov", day="28", volume="6", number="11", pages="e239", keywords="dementia", keywords="family caregivers", keywords="self-management", keywords="behavior problems", keywords="Internet", keywords="eHealth", keywords="RCT", keywords="process evaluation", abstract="Background: Online interventions are potentially effective ways to support family caregivers in the management of behavior changes in their relative with dementia. Objective: The objective of this paper is to present the design of a study evaluating and comparing 3 intervention arms for online self-management support. Methods: A randomized controlled trial (RCT) will be conducted with a total of 81 family caregivers of community-dwelling people with dementia in the Netherlands. Family caregivers will be randomly allocated to one of the following intervention arms: (1) a major self-management support intervention consisting of personal email contacts with a nurse specialized in dementia care, online videos, and electronic bulletins (e-bulletins); (2) a medium self-management support intervention consisting of only online videos and e-bulletins; and (3) a minor self-management support intervention with only e-bulletins. The primary outcome is the self-efficacy of the family caregiver. The secondary outcomes are the behavior problems of the person with dementia as reported by the family caregiver, and positive and negative aspects of the relationship. Background characteristics (eg, type of family relationship) will also be assessed. All data for the RCT will be collected via online questionnaires, administered before the intervention (T0), after 6 weeks (T1), and after 12 weeks (T2). Alongside the RCT, a process evaluation will be conducted, based on a number of evaluation questions and semi-open interviews with family caregivers. Results: Data collection will be completed in August 2017. Study results will be reported in early 2018. Conclusions: The study will shed more light on the effect of online self-management support interventions and insights will be gained into whether a major intervention, consisting of personal email contacts with specialized nurses, videos, and e-bulletins, has more effect than smaller online interventions. This is relevant in an age with increasing numbers of people with dementia, growing pressure on family caregivers, more and more people using the Internet, and increasing healthcare costs. Trial Registration: Nederlands Trial Registry (NTR): NTR6237; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6237 (Archived by WebCite at http://www.webcitation.org/6v0S4fxTC) ", doi="10.2196/resprot.8365", url="http://www.researchprotocols.org/2017/11/e239/", url="http://www.ncbi.nlm.nih.gov/pubmed/29183870" } @Article{info:doi/10.2196/resprot.8103, author="Smith, Glenn and Chandler, Melanie and Locke, EC Dona and Fields, Julie and Phatak, Vaishali and Crook, Julia and Hanna, Sherrie and Lunde, Angela and Morris, Miranda and Graff-Radford, Michelle and Hughes, A. Christine and Lepore, Susan and Cuc, Andrea and Caselli, Maria and Hurst, Duane and Wethe, Jennifer and Francone, Andrea and Eilertsen, Jeanne and Lucas, Pauline and Hoffman Snyder, Charlene and Kuang, LeeAnn and Becker, Marigrace and Dean, Pamela and Diehl, Nancy and Lofquist, Marvin and Vanderhook, Shirley and Myles, Diana and Cochran, Denise", title="Behavioral Interventions to Prevent or Delay Dementia: Protocol for a Randomized Comparative Effectiveness Study", journal="JMIR Res Protoc", year="2017", month="Nov", day="27", volume="6", number="11", pages="e223", keywords="cognition disorders", keywords="dementia", keywords="secondary prevention", keywords="behavioral research", abstract="Background: Currently, people at risk for dementia and their caregivers are confronted with confusing choices about what behavioral interventions are most effective. Objective: The objective of this study is to determine which empirically supported behavioral interventions most impact the outcomes highly valued by patients with mild cognitive impairment and their partners. Methods: This protocol describes a comparative effectiveness trial targeting 300 participants with mild cognitive impairment and their study partners. The trial is being conducted at the Mayo Clinic campuses in Arizona, Florida, Minnesota, and the University of Washington in Seattle. The study examines the contribution of five behavioral interventions (yoga, memory compensation training, computerized cognitive training, support groups, and wellness education) on primary outcomes of participant and partner quality of life and self-efficacy. In this unique 10-day multicomponent intervention, groups of couples were randomized to have one of the five interventions withheld while receiving the other four. Although the longitudinal follow-up is still under way, enrollment results are available and reported. Results: In total, 272 couples have been enrolled in the trial and follow-up visits continue. Outcomes will be assessed at the end-of-intervention and 6-, 12-, and 18-month follow-ups. We anticipate reporting on our primary and secondary outcomes across time points in the next 2 years. Conclusions: This paper describes the protocol for a randomized comparative effectiveness study of behavioral interventions to prevent or delay dementia. We describe of the rationale, design, power analysis, and analysis plan. Also because enrollment is complete and we are in follow-up phases of the study, we have included enrollment data from the trial. Trial Registration: ?ClinicalTrials.gov NCT02265757; http://clinicaltrials.gov/ctsshow/ NCT02265757 (Archived by WebCite at http://www.webcitation.org/6ueRfwSYv) ", doi="10.2196/resprot.8103", url="http://www.researchprotocols.org/2017/11/e223/", url="http://www.ncbi.nlm.nih.gov/pubmed/29180344" } @Article{info:doi/10.2196/jmir.8473, author="Lumsden, Jim and Skinner, Andy and Coyle, David and Lawrence, Natalia and Munafo, Marcus", title="Attrition from Web-Based Cognitive Testing: A Repeated Measures Comparison of Gamification Techniques", journal="J Med Internet Res", year="2017", month="Nov", day="22", volume="19", number="11", pages="e395", keywords="behavioral research/methods", keywords="games, experimental", keywords="computers", keywords="cognition", keywords="Internet", keywords="play and playthings/psychology", keywords="boredom", keywords="task performance and analysis", keywords="executive function", keywords="inhibition (psychology)", abstract="Background: The prospect of assessing cognition longitudinally and remotely is attractive to researchers, health practitioners, and pharmaceutical companies alike. However, such repeated testing regimes place a considerable burden on participants, and with cognitive tasks typically being regarded as effortful and unengaging, these studies may experience high levels of participant attrition. One potential solution is to gamify these tasks to make them more engaging: increasing participant willingness to take part and reducing attrition. However, such an approach must balance task validity with the introduction of entertaining gamelike elements. Objective: This study aims to investigate the effects of gamelike features on participant attrition using a between-subjects, longitudinal Web-based testing study. Methods: We used three variants of a common cognitive task, the Stop Signal Task (SST), with a single gamelike feature in each: one variant where points were rewarded for performing optimally; another where the task was given a graphical theme; and a third variant, which was a standard SST and served as a control condition. Participants completed four compulsory test sessions over 4 consecutive days before entering a 6-day voluntary testing period where they faced a daily decision to either drop out or continue taking part. Participants were paid for each session they completed. Results: A total of 482 participants signed up to take part in the study, with 265 completing the requisite four consecutive test sessions. No evidence of an effect of gamification on attrition was observed. A log-rank test showed no evidence of a difference in dropout rates between task variants ($\chi$22=3.0, P=.22), and a one-way analysis of variance of the mean number of sessions completed per participant in each variant also showed no evidence of a difference (F2,262=1.534, P=.21, partial $\eta$2=0.012). Conclusions: Our findings raise doubts about the ability of gamification to reduce attrition from longitudinal cognitive testing studies. ", doi="10.2196/jmir.8473", url="http://www.jmir.org/2017/11/e395/", url="http://www.ncbi.nlm.nih.gov/pubmed/29167090" } @Article{info:doi/10.2196/resprot.8118, author="Bravo, Gina and Rodrigue, Claudie and Th{\'e}riault, Vincent and Arcand, Marcel and Downie, Jocelyn and Dubois, Marie-France and Kaasalainen, Sharon and Hertogh, M. Cees and Pautex, Sophie and Van den Block, Lieve", title="Should Medical Assistance in Dying Be Extended to Incompetent Patients With Dementia? Research Protocol of a Survey Among Four Groups of Stakeholders From Quebec, Canada", journal="JMIR Res Protoc", year="2017", month="Nov", day="13", volume="6", number="11", pages="e208", keywords="euthanasia", keywords="dementia", keywords="decisional incapacity", keywords="advance directive", keywords="attitude", keywords="survey", keywords="Canada", abstract="Background: Alzheimer's disease and related disorders affect a growing number of people worldwide. Quality of life is generally good in the early stages of these diseases. However, many individuals fear living through the advanced stages. Such fears are triggering requests for medical assistance in dying (MAiD) by patients with dementia. Legislation was recently passed in Canada and the province of Quebec allowing MAiD at the explicit request of a patient who meets a set of eligibility criteria, including competence. Some commentators have argued that MAiD should be accessible to incompetent patients as well, provided appropriate safeguards are in place. Governments of both Quebec and Canada are currently considering whether MAiD should be accessible through written requests made in advance of loss of capacity. Objective: Aimed at informing the societal debate on this sensitive issue, this study will compare stakeholders' attitudes towards expanding MAiD to incompetent patients with dementia, the beliefs underlying stakeholders' attitudes on this issue, and the value they attach to proposed safeguards. This paper describes the study protocol. Methods: Data will be collected via a questionnaire mailed to random samples of community-dwelling seniors, relatives of persons with dementia, physicians, and nurses, all residing in Quebec (targeted sample size of 385 per group). Participants will be recruited through the provincial health insurance database, Alzheimer Societies, and professional associations. Attitudes towards MAiD for incompetent patients with dementia will be elicited through clinical vignettes featuring a patient with Alzheimer's disease for whom MAiD is considered towards the end of the disease trajectory. Vignettes specify the source of the request (from the patient through an advance request or from the patient's substitute decision-maker), manifestations of suffering, and how close the patient is to death. Arguments for or against MAiD are used to elicit the beliefs underlying respondents' attitudes. Results: The survey was launched in September 2016 and is still ongoing. At the time of submission, over 850 respondents have returned the questionnaire, mostly via mail. Conclusions: This study will be the first in Canada to directly compare views on MAiD for incompetent patients with dementia across key stakeholder groups. Our findings will contribute valuable data upon which to base further debate about whether MAiD should be accessible to incompetent patients with dementia, and if so, under what conditions. ", doi="10.2196/resprot.8118", url="http://www.researchprotocols.org/2017/11/e208/", url="http://www.ncbi.nlm.nih.gov/pubmed/29133281" } @Article{info:doi/10.2196/resprot.8080, author="Efthymiou, Areti and Middleton, Nicos and Charalambous, Andreas and Papastavrou, Evridiki", title="The Association of Health Literacy and Electronic Health Literacy With Self-Efficacy, Coping, and Caregiving Perceptions Among Carers of People With Dementia: Research Protocol for a Descriptive Correlational Study", journal="JMIR Res Protoc", year="2017", month="Nov", day="13", volume="6", number="11", pages="e221", keywords="health literacy", keywords="carers", keywords="dementia", keywords="ehealth", abstract="Background: In the last decade, electronic health (eHealth) literacy has attracted the attention of the scientific community, as it is associated with the self-management of patients with chronic diseases and the quality and cost of care. It is estimated that 80\% of people with chronic diseases are cared for at home by a family member, friend, or relative. Informal carers are susceptible to physical and mental health problems, as well as social and financial hardships. Nevertheless, there seems to be a research gap in terms of carers' needs, skills, and available resources in the age of new technologies, with the vital role of eHealth literacy of the carers remaining unexplored. Objective: The aim of this study was to investigate the level of eHealth literacy and health literacy of primary and secondary carers of people with dementia, to explore the association between health and eHealth literacy, as well as their association with the caregiving variables: self-efficacy, coping, and caring perceptions. Methods: A sample of 200 primary carers (the carer who supports the people with dementia in everyday living) and 200 secondary carers (family member, friend, or other person in the social network assisting the primary carer in their role) will be recruited from dementia day care centers and Alzheimer's associations in Greece and Cyprus. The study will be a cross-sectional correlational descriptive study. Tools to be used include the eHealth Literacy Scale adapted for carers to measure eHealth literacy, European Health Literacy Survey Questionnaire 16 (HLS-EU-Q16), Single Item Literacy Screener, Revised Scale for Caregiving Self-Efficacy, Carers of Older People in Europe?(COPE) index for caregiving perceptions, and COPE brief to measure selected coping strategies. Descriptive statistics will be reported, and correlations between different variables will be explored with parametric and nonparametric measures. Results: As a preliminary study, the HLS-EU-Q16 has been validated in 107 older people. The internal consistency of the scale as estimated using Cronbach alpha coefficient was .77, somewhat lower than other validation studies. Recruitment of pilot study participants started in May 2017. Conclusions: Carers' eHealth literacy is a new field. Whereas previous studies have focused on the role and impact of low eHealth literacy and health literacy among older adults, the eHealth literacy of carers, and in fact carers of people with dementia, has not been explored. We hypothesize an association between eHealth literacy and health literacy level with carers' perceptions about caregiving role, self-efficacy, and coping strategies. A possible moderator in these associations is the secondary carers' eHealth and health literacy level, which will also be explored. By confirming the above hypotheses, tailored eHealth literacy interventions for carers of people with dementia and their families will be developed as a direct outcome of this research. ", doi="10.2196/resprot.8080", url="http://www.researchprotocols.org/2017/11/e221/", url="http://www.ncbi.nlm.nih.gov/pubmed/29133284" } @Article{info:doi/10.2196/jmir.7981, author="LaMonica, M. Haley and English, Amelia and Hickie, B. Ian and Ip, Jerome and Ireland, Catriona and West, Stacey and Shaw, Tim and Mowszowski, Loren and Glozier, Nick and Duffy, Shantel and Gibson, A. Alice and Naismith, L. Sharon", title="Examining Internet and eHealth Practices and Preferences: Survey Study of Australian Older Adults With Subjective Memory Complaints, Mild Cognitive Impairment, or Dementia", journal="J Med Internet Res", year="2017", month="Oct", day="25", volume="19", number="10", pages="e358", keywords="eHealth", keywords="dementia", keywords="mild cognitive impairment", keywords="Internet", keywords="Alzheimer disease", abstract="Background: Interest in electronic health (eHealth) technologies to screen for and treat a variety of medical and mental health problems is growing exponentially. However, no studies to date have investigated the feasibility of using such e-tools for older adults with mild cognitive impairment (MCI) or dementia. Objective: The objective of this study was to describe patterns of Internet use, as well as interest in and preferences for eHealth technologies among older adults with varying degrees of cognitive impairment. Methods: A total of 221 participants (mean age=67.6 years) attending the Healthy Brain Ageing Clinic at the University of Sydney, a specialist mood and memory clinic for adults ?50 years of age, underwent comprehensive clinical and neuropsychological assessment and completed a 20-item self-report survey investigating current technology use and interest in eHealth technologies. Descriptive statistics and Fisher exact tests were used to characterize the findings, including variability in the results based on demographic and diagnostic factors, with diagnoses including subjective cognitive impairment (SCI), MCI, and dementia. Results: The sample comprised 27.6\% (61/221) SCI, 62.0\% (137/221) MCI, and 10.4\% (23/221) dementia (mean Mini-Mental State Examination=28.2). The majority of participants reported using mobile phones (201/220, 91.4\%) and computers (167/194, 86.1\%) routinely, with most respondents having access to the Internet at home (204/220, 92.6\%). Variability was evident in the use of computers, mobile phones, and health-related websites in relation to sociodemographic factors, with younger, employed respondents with higher levels of education being more likely to utilize these technologies. Whereas most respondents used email (196/217, 90.3\%), the use of social media websites was relatively uncommon. The eHealth intervention of most interest to the broader sample was memory strategy training, with 82.7\% (172/208) of participants reporting they would utilize this form of intervention. Preferences for other eHealth interventions varied in relation to educational level, with university-educated participants expressing greater interest in interventions related to mood (P=.01), socialization (P=.02), memory (P=.01), and computer-based exercises (P=.046). eHealth preferences also varied in association, with diagnosis for interventions targeting sleep (P=.01), nutrition (P=.004), vascular risk factors (P=.03), and memory (P=.02). Conclusions: Technology use is pervasive among older adults with cognitive impairment, though variability was noted in relation to age, education, vocational status, and diagnosis. There is also significant interest in Web-based interventions targeting cognition and memory, as well as other risk factors for cognitive decline, highlighting the urgent need for the development, implementation, and study of eHealth technologies tailored specifically to older adults, including those with MCI and early dementia. Strategies to promote eHealth use among older adults who are retired or have lower levels of education will also need to be considered. ", doi="10.2196/jmir.7981", url="http://www.jmir.org/2017/10/e358/", url="http://www.ncbi.nlm.nih.gov/pubmed/29070481" } @Article{info:doi/10.2196/jmir.8095, author="Bayen, Eleonore and Jacquemot, Julien and Netscher, George and Agrawal, Pulkit and Tabb Noyce, Lynn and Bayen, Alexandre", title="Reduction in Fall Rate in Dementia Managed Care Through Video Incident Review: Pilot Study", journal="J Med Internet Res", year="2017", month="Oct", day="17", volume="19", number="10", pages="e339", keywords="video monitoring", keywords="video review", keywords="mobile app", keywords="deep learning", keywords="fall", keywords="Alzheimer disease", keywords="dementia", abstract="Background: Falls of individuals with dementia are frequent, dangerous, and costly. Early detection and access to the history of a fall is crucial for efficient care and secondary prevention in cognitively impaired individuals. However, most falls remain unwitnessed events. Furthermore, understanding why and how a fall occurred is a challenge. Video capture and secure transmission of real-world falls thus stands as a promising assistive tool. Objective: The objective of this study was to analyze how continuous video monitoring and review of falls of individuals with dementia can support better quality of care. Methods: A pilot observational study (July-September 2016) was carried out in a Californian memory care facility. Falls were video-captured (24{\texttimes}7), thanks to 43 wall-mounted cameras (deployed in all common areas and in 10 out of 40 private bedrooms of consenting residents and families). Video review was provided to facility staff, thanks to a customized mobile device app. The outcome measures were the count of residents' falls happening in the video-covered areas, the acceptability of video recording, the analysis of video review, and video replay possibilities for care practice. Results: Over 3 months, 16 falls were video-captured. A drop in fall rate was observed in the last month of the study. Acceptability was good. Video review enabled screening for the severity of falls and fall-related injuries. Video replay enabled identifying cognitive-behavioral deficiencies and environmental circumstances contributing to the fall. This allowed for secondary prevention in high-risk multi-faller individuals and for updated facility care policies regarding a safer living environment for all residents. Conclusions: Video monitoring offers high potential to support conventional care in memory care facilities. ", doi="10.2196/jmir.8095", url="http://www.jmir.org/2017/10/e339/", url="http://www.ncbi.nlm.nih.gov/pubmed/29042342" } @Article{info:doi/10.2196/resprot.6727, author="Pasman, J. Wilrike and Boessen, Ruud and Donner, Yoni and Clabbers, Nard and Boorsma, Andr{\'e}", title="Effect of Caffeine on Attention and Alertness Measured in a Home-Setting, Using Web-Based Cognition Tests", journal="JMIR Res Protoc", year="2017", month="Sep", day="07", volume="6", number="9", pages="e169", keywords="caffeine", keywords="at-home testing", keywords="cognition", keywords="EFSA claim", abstract="Background: There is an increasing interest among nutritional researchers to perform lifestyle and nutritional intervention studies in a home setting instead of testing subjects in a clinical unit. The term used in other disciplines is `ecological validity' stressing a realistic situation. This becomes more and more feasible because devices and self-tests that enable such studies are more commonly available. Here, we present such a study in which we reproduced the effect of caffeine on attention and alertness in an at-home setting. Objective: The study was aimed to reproduce the effect of caffeine on attention and alertness using a Web-based study environment of subjects, at home, performing different Web-based cognition tests. Methods: The study was designed as a randomized, placebo-controlled, double-blind, crossover study. Subjects were provided with coffee sachets (2 with and 2 without caffeine). They were also provided with a written instruction of the test days. Healthy volunteers consumed a cup of coffee after an overnight fast. Each intervention was repeated once. Before and 1 hour after coffee consumption subjects performed Web-based cognitive performance tests at home, which measured alertness and attention, established by 3 computerized tests provided by QuantifiedMind. Each test was performed for 5 minutes. Results: Web-based recruitment was fast and efficient. Within 2 weeks, 102 subjects applied, of whom 70 were eligible. Of the 66 subjects who started the study, 53 completed all 4 test sessions (80\%), indicating that they were able to perform the do it yourself tests, at home, correctly. The Go-No Go cognition test performed at home showed the same significant improvement in reaction time with caffeine as found in controlled studies in a metabolic ward (P=.02). For coding and N-back the second block was performed approximately 10\% faster. No effect was seen on correctness. Conclusions: The study showed that the effects of caffeine consumption on a cognition test in an at-home setting revealed similar results as in a controlled setting. The Go-No Go test applied showed improved results after caffeine intake, similar as seen in clinical trials. This type of study is a fast, reliable, economical, and easy way to demonstrate effectiveness of a supplement and is rapidly becoming a viable alternative for the classical randomized control trial to evaluate life style and nutritional interventions. Trial Registration: Clinicaltrials.gov NCT02061982; https://clinicaltrials.gov/ct2/show/NCT02061982 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02061982) ", doi="10.2196/resprot.6727", url="http://www.researchprotocols.org/2017/9/e169/", url="http://www.ncbi.nlm.nih.gov/pubmed/28882811" } @Article{info:doi/10.2196/jmir.7671, author="Austin, Johanna and Hollingshead, Kristy and Kaye, Jeffrey", title="Internet Searches and Their Relationship to Cognitive Function in Older Adults: Cross-Sectional Analysis", journal="J Med Internet Res", year="2017", month="Sep", day="06", volume="19", number="9", pages="e307", keywords="Internet", keywords="geriatrics", keywords="cognition", keywords="executive function", abstract="Background: Alzheimer disease (AD) is a very challenging experience for all those affected. Unfortunately, detection of Alzheimer disease in its early stages when clinical treatments may be most effective is challenging, as the clinical evaluations are time-consuming and costly. Recent studies have demonstrated a close relationship between cognitive function and everyday behavior, an avenue of research that holds great promise for the early detection of cognitive decline. One area of behavior that changes with cognitive decline is language use. Multiple groups have demonstrated a close relationship between cognitive function and vocabulary size, verbal fluency, and semantic ability, using conventional in-person cognitive testing. An alternative to this approach which is inherently ecologically valid may be to take advantage of automated computer monitoring software to continually capture and analyze language use while on the computer. Objective: The aim of this study was to understand the relationship between Internet searches as a measure of language and cognitive function in older adults. We hypothesize that individuals with poorer cognitive function will search using fewer unique terms, employ shorter words, and use less obscure words in their searches. Methods: Computer monitoring software (WorkTime, Nestersoft Inc) was used to continuously track the terms people entered while conducting searches in Google, Yahoo, Bing, and Ask.com. For all searches, punctuation, accents, and non-ASCII characters were removed, and the resulting search terms were spell-checked before any analysis. Cognitive function was evaluated as a z-normalized summary score capturing five unique cognitive domains. Linear regression was used to determine the relationship between cognitive function and Internet searches by controlling for variables such as age, sex, and education. Results: Over a 6-month monitoring period, 42 participants (mean age 81 years [SD 10.5], 83\% [35/42] female) conducted 2915 searches using these top search engines. Participants averaged 3.08 words per search (SD 1.6) and 5.77 letters per word (SD 2.2). Individuals with higher cognitive function used more unique terms per search (beta=.39, P=.002) and employed less common terms in their searches (beta=1.39, P=.02). Cognitive function was not significantly associated with the length of the words used in the searches. Conclusions: These results suggest that early decline in cognitive function may be detected from the terms people search for when they use the Internet. By continuously tracking basic aspects of Internet search terms, it may be possible to detect cognitive decline earlier than currently possible, thereby enabling proactive treatment and intervention. ", doi="10.2196/jmir.7671", url="http://www.jmir.org/2017/9/e307/", url="http://www.ncbi.nlm.nih.gov/pubmed/28877864" } @Article{info:doi/10.2196/jmir.7814, author="Bateman, R. Daniel and Srinivas, Bhavana and Emmett, W. Thomas and Schleyer, K. Titus and Holden, J. Richard and Hendrie, C. Hugh and Callahan, M. Christopher", title="Categorizing Health Outcomes and Efficacy of mHealth Apps for Persons With Cognitive Impairment: A Systematic Review", journal="J Med Internet Res", year="2017", month="Aug", day="30", volume="19", number="8", pages="e301", keywords="mHealth", keywords="mobile health", keywords="applications", keywords="Alzheimer disease", keywords="dementia", keywords="systematic review", abstract="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) ", doi="10.2196/jmir.7814", url="http://www.jmir.org/2017/8/e301/", url="http://www.ncbi.nlm.nih.gov/pubmed/28855146" } @Article{info:doi/10.2196/games.6514, author="Tziraki, Chariklia and Berenbaum, Rakel and Gross, Daniel and Abikhzer, Judith and Ben-David, M. Boaz", title="Designing Serious Computer Games for People With Moderate and Advanced Dementia: Interdisciplinary Theory-Driven Pilot Study", journal="JMIR Serious Games", year="2017", month="Jul", day="31", volume="5", number="3", pages="e16", keywords="serious games", keywords="dementia", keywords="functionality", keywords="learning in context", keywords="speed of processing", abstract="Background: The field of serious games for people with dementia (PwD) is mostly driven by game-design principals typically applied to games created by and for younger individuals. Little has been done developing serious games to help PwD maintain cognition and to support functionality. Objectives: We aimed to create a theory-based serious game for PwD, with input from a multi-disciplinary team familiar with aging, dementia, and gaming theory, as well as direct input from end users (the iterative process). Targeting enhanced self-efficacy in daily activities, the goal was to generate a game that is acceptable, accessible and engaging for PwD. Methods: The theory-driven game development was based on the following learning theories: learning in context, errorless learning, building on capacities, and acknowledging biological changes---all with the aim to boost self-efficacy. The iterative participatory process was used for game screen development with input of 34 PwD and 14 healthy community dwelling older adults, aged over 65 years. Development of game screens was informed by the bio-psychological aging related disabilities (ie, motor, visual, and perception) as well as remaining neuropsychological capacities (ie, implicit memory) of PwD. At the conclusion of the iterative development process, a prototype game with 39 screens was used for a pilot study with 24 PwD and 14 healthy community dwelling older adults. The game was played twice weekly for 10 weeks. Results: Quantitative analysis showed that the average speed of successful screen completion was significantly longer for PwD compared with healthy older adults. Both PwD and controls showed an equivalent linear increase in the speed for task completion with practice by the third session (P<.02). Most important, the rate of improved processing speed with practice was not statistically different between PwD and controls. This may imply that some form of learning occurred for PwD at a nonsignificantly different rate than for controls. Qualitative results indicate that PwD found the game engaging and fun. Healthy older adults found the game too easy. Increase in self-reported self-efficacy was documented with PwD only. Conclusions: Our study demonstrated that PwD's speed improved with practice at the same rate as healthy older adults. This implies that when tasks are designed to match PwD's abilities, learning ensues. In addition, this pilot study of a serious game, designed for PwD, was accessible, acceptable, and enjoyable for end users. Games designed based on learning theories and input of end users and a multi-disciplinary team familiar with dementia and aging may have the potential of maintaining capacity and improving functionality of PwD. A larger longer study is needed to confirm our findings and evaluate the use of these games in assessing cognitive status and functionality. ", doi="10.2196/games.6514", url="http://games.jmir.org/2017/3/e16/", url="http://www.ncbi.nlm.nih.gov/pubmed/28760730" } @Article{info:doi/10.2196/jmir.7482, author="Shaw, James and Shaw, Sara and Wherton, Joseph and Hughes, Gemma and Greenhalgh, Trisha", title="Studying Scale-Up and Spread as Social Practice: Theoretical Introduction and Empirical Case Study", journal="J Med Internet Res", year="2017", month="Jul", day="07", volume="19", number="7", pages="e244", keywords="sociology", keywords="medical", keywords="technological innovations", keywords="telemedicine", keywords="health policy", keywords="mHealth", abstract="Background: Health and care technologies often succeed on a small scale but fail to achieve widespread use (scale-up) or become routine practice in other settings (spread). One reason for this is under-theorization of the process of scale-up and spread, for which a potentially fruitful theoretical approach is to consider the adoption and use of technologies as social practices. Objective: This study aimed to use an in-depth case study of assisted living to explore the feasibility and usefulness of a social practice approach to explaining the scale-up of an assisted-living technology across a local system of health and social care. Methods: This was an individual case study of the implementation of a Global Positioning System (GPS) ``geo-fence'' for a person living with dementia, nested in a much wider program of ethnographic research and organizational case study of technology implementation across health and social care (Studies in Co-creating Assisted Living Solutions [SCALS] in the United Kingdom). A layered sociological analysis included micro-level data on the index case, meso-level data on the organization, and macro-level data on the wider social, technological, economic, and political context. Data (interviews, ethnographic notes, and documents) were analyzed and synthesized using structuration theory. Results: A social practice lens enabled the uptake of the GPS technology to be studied in the context of what human actors found salient, meaningful, ethical, legal, materially possible, and professionally or culturally appropriate in particular social situations. Data extracts were used to illustrate three exemplar findings. First, professional practice is (and probably always will be) oriented not to ``implementing technologies'' but to providing excellent, ethical care to sick and vulnerable individuals. Second, in order to ``work,'' health and care technologies rely heavily on human relationships and situated knowledge. Third, such technologies do not just need to be adopted by individuals; they need to be incorporated into personal habits and collaborative routines (both lay and professional). Conclusions: Health and care technologies need to be embedded within sociotechnical networks and made to work through situated knowledge, personal habits, and collaborative routines. A technology that ``works'' for one individual in a particular set of circumstances is unlikely to work in the same way for another in a different set of circumstances. We recommend the further study of social practices and the application of co-design principles. However, our findings suggest that even if this occurs, the scale-up and spread of many health and care technologies will be neither rapid nor smooth. ", doi="10.2196/jmir.7482", url="http://www.jmir.org/2017/7/e244/", url="http://www.ncbi.nlm.nih.gov/pubmed/28687532" } @Article{info:doi/10.2196/mhealth.6939, author="Jongstra, Susan and Wijsman, Willemijn Liselotte and Cachucho, Ricardo and Hoevenaar-Blom, Peternella Marieke and Mooijaart, Pieter Simon and Richard, Edo", title="Cognitive Testing in People at Increased Risk of Dementia Using a Smartphone App: The iVitality Proof-of-Principle Study", journal="JMIR Mhealth Uhealth", year="2017", month="May", day="25", volume="5", number="5", pages="e68", keywords="telemedicine", keywords="cognition", keywords="neuropsychological tests", abstract="Background: Smartphone-assisted technologies potentially provide the opportunity for large-scale, long-term, repeated monitoring of cognitive functioning at home. Objective: The aim of this proof-of-principle study was to evaluate the feasibility and validity of performing cognitive tests in people at increased risk of dementia using smartphone-based technology during a 6 months follow-up period. Methods: We used the smartphone-based app iVitality to evaluate five cognitive tests based on conventional neuropsychological tests (Memory-Word, Trail Making, Stroop, Reaction Time, and Letter-N-Back) in healthy adults. Feasibility was tested by studying adherence of all participants to perform smartphone-based cognitive tests. Validity was studied by assessing the correlation between conventional neuropsychological tests and smartphone-based cognitive tests and by studying the effect of repeated testing. Results: We included 151 participants (mean age in years=57.3, standard deviation=5.3). Mean adherence to assigned smartphone tests during 6 months was 60\% (SD 24.7). There was moderate correlation between the firstly made smartphone-based test and the conventional test for the Stroop test and the Trail Making test with Spearman $\rho$=.3-.5 (P<.001). Correlation increased for both tests when comparing the conventional test with the mean score of all attempts a participant had made, with the highest correlation for Stroop panel 3 ($\rho$=.62, P<.001). Performance on the Stroop and the Trail Making tests improved over time suggesting a learning effect, but the scores on the Letter-N-back, the Memory-Word, and the Reaction Time tests remained stable. Conclusions: Repeated smartphone-assisted cognitive testing is feasible with reasonable adherence and moderate relative validity for the Stroop and the Trail Making tests compared with conventional neuropsychological tests. Smartphone-based cognitive testing seems promising for large-scale data-collection in population studies. ", doi="10.2196/mhealth.6939", url="http://mhealth.jmir.org/2017/5/e68/", url="http://www.ncbi.nlm.nih.gov/pubmed/28546139" } @Article{info:doi/10.2196/resprot.6864, author="Boomsma, Funke Jooske Marije and Exalto, Geertje Lieza and Barkhof, Frederik and van den Berg, Esther and de Bresser, Jeroen and Heinen, Rutger and Koek, Lena Huiberdina and Prins, Dani{\"e}l Niels and Scheltens, Philip and Weinstein, Chanoch Henry and van der Flier, Maria Wiesje and Biessels, Jan Geert", title="Vascular Cognitive Impairment in a Memory Clinic Population: Rationale and Design of the ``Utrecht-Amsterdam Clinical Features and Prognosis in Vascular Cognitive Impairment'' (TRACE-VCI) Study", journal="JMIR Res Protoc", year="2017", month="Apr", day="19", volume="6", number="4", pages="e60", keywords="vascular cognitive impairment", keywords="memory clinic", keywords="small vessel disease", keywords="vascular disease", keywords="prognosis", keywords="dementia", abstract="Background: Vascular Cognitive Impairment (VCI) refers to cognitive dysfunction due to vascular brain injury, as a single cause or in combination with other, often neurodegenerative, etiologies. VCI is a broad construct that captures a heterogeneous patient population both in terms of cognitive and noncognitive symptoms and in terms of etiology and prognosis. This provides a challenge when applying this construct in clinical practice. Objective: This paper presents the rationale and design of the TRACE-VCI study, which investigates the clinical features and prognosis of VCI in a memory clinic setting. Methods: The TRACE-VCI project is an observational, prospective cohort study of 861 consecutive memory clinic patients with possible VCI. Between 2009 and 2013, patients were recruited through the Amsterdam Dementia Cohort of the VU University Medical Centre (VUMC) (N=665) and the outpatient memory clinic and VCI cohort of the University Medical Centre Utrecht (UMCU) (N=196). We included all patients attending the clinics with magnetic resonance imaging (MRI) evidence of vascular brain injury. Patients with a primary etiology other than vascular brain injury or neurodegeneration were excluded. Patients underwent an extensive 1-day memory clinic evaluation including an interview, physical and neurological examination, assessment of biomarkers (including those for Alzheimer-type pathologies), extensive neuropsychological testing, and an MRI scan of the brain. For prognostic analyses, the composite primary outcome measure was defined as accelerated cognitive decline (change of clinical dementia rating ?1 or institutionalization) or (recurrent) major vascular events or death over the course of 2 years. Results: The mean age at baseline was 67.7 (SD 8.5) years and 46.3\% of patients (399/861) were female. At baseline, the median Clinical Dementia Rating was 0.5 (interquartile range [IQR] 0.5-1.0) and the median Mini-Mental State Examination score was 25 (IQR 22-28). The clinical diagnosis at baseline was dementia in 52.4\% of patients (451/861), mild cognitive impairment in 24.6\% (212/861), and no objective cognitive impairment in the remaining 23.0\% (198/861). Conclusions: The TRACE-VCI study represents a large cohort of well-characterized patients with VCI in a memory clinic setting. Data processing and collection for follow-up are currently being completed. The TRACE-VCI study will provide insight into the clinical features of memory clinic patients that meet VCI criteria and establish key prognostic factors for further cognitive decline and (recurrent) major vascular events. ", doi="10.2196/resprot.6864", url="http://www.researchprotocols.org/2017/4/e60/", url="http://www.ncbi.nlm.nih.gov/pubmed/28428166" } @Article{info:doi/10.2196/resprot.6904, author="Bateman, Robert Daniel and Brady, Erin and Wilkerson, David and Yi, Eun-Hye and Karanam, Yamini and Callahan, M. Christopher", title="Comparing Crowdsourcing and Friendsourcing: A Social Media-Based Feasibility Study to Support Alzheimer Disease Caregivers", journal="JMIR Res Protoc", year="2017", month="Apr", day="10", volume="6", number="4", pages="e56", keywords="Alzheimer disease", keywords="Alzheimer disease and related dementias", keywords="caregivers", keywords="mobile health", keywords="social media", keywords="crowdsourcing", keywords="friendsourcing", keywords="emotional support", keywords="informational support", keywords="online support", abstract="Background: In the United States, over 15 million informal caregivers provide unpaid care to people with Alzheimer disease (AD). Compared with others in their age group, AD caregivers have higher rates of stress, and medical and psychiatric illnesses. Psychosocial interventions improve the health of caregivers. However, constraints of time, distance, and availability inhibit the use of these services. Newer online technologies, such as social media, online groups, friendsourcing, and crowdsourcing, present alternative methods of delivering support. However, limited work has been done in this area with caregivers. Objective: The primary aims of this study were to determine (1) the feasibility of innovating peer support group work delivered through social media with friendsourcing, (2) whether the intervention provides an acceptable method for AD caregivers to obtain support, and (3) whether caregiver outcomes were affected by the intervention. A Facebook app provided support to AD caregivers through collecting friendsourced answers to caregiver questions from participants' social networks. The study's secondary aim was to descriptively compare friendsourced answers versus crowdsourced answers. Methods: We recruited AD caregivers online to participate in a 6-week-long asynchronous, online, closed group on Facebook, where caregivers received support through moderator prompts, group member interactions, and friendsourced answers to caregiver questions. We surveyed and interviewed participants before and after the online group to assess their needs, views on technology, and experience with the intervention. Caregiver questions were pushed automatically to the participants' Facebook News Feed, allowing participants' Facebook friends to see and post answers to the caregiver questions (Friendsourced answers). Of these caregiver questions, 2 were pushed to crowdsource workers through the Amazon Mechanical Turk platform. We descriptively compared characteristics of these crowdsourced answers with the friendsourced answers. Results: In total, 6 AD caregivers completed the initial online survey and semistructured telephone interview. Of these, 4 AD caregivers agreed to participate in the online Facebook closed group activity portion of the study. Friendsourcing and crowdsourcing answers to caregiver questions had similar rates of acceptability as rated by content experts: 90\% (27/30) and 100\% (45/45), respectively. Rates of emotional support and informational support for both groups of answers appeared to trend with the type of support emphasized in the caregiver question (emotional vs informational support question). Friendsourced answers included more shared experiences (20/30, 67\%) than did crowdsourced answers (4/45, 9\%). Conclusions: We found an asynchronous, online, closed group on Facebook to be generally acceptable as a means to deliver support to caregivers of people with AD. This pilot is too small to make judgments on effectiveness; however, results trended toward an improvement in caregivers' self-efficacy, sense of support, and perceived stress, but these results were not statistically significant. Both friendsourced and crowdsourced answers may be an acceptable way to provide informational and emotional support to caregivers of people with AD. ", doi="10.2196/resprot.6904", url="http://www.researchprotocols.org/2017/4/e56/", url="http://www.ncbi.nlm.nih.gov/pubmed/28396304" } @Article{info:doi/10.2196/resprot.6570, author="Ballesteros, Soledad and Mayas, Julia and Ruiz-Marquez, Eloisa and Prieto, Antonio and Toril, Pilar and Ponce de Leon, Laura and de Ceballos, L. Maria and Reales Avil{\'e}s, Manuel Jos{\'e}", title="Effects of Video Game Training on Behavioral and Electrophysiological Measures of Attention and Memory: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2017", month="Jan", day="24", volume="6", number="1", pages="e8", keywords="attention", keywords="C-reactive protein", keywords="cognitive training", keywords="healthy aging", keywords="inflammation", keywords="electrophysiology", keywords="video games", keywords="working memory", abstract="Background: Neuroplasticity-based approaches seem to offer promising ways of maintaining cognitive health in older adults and postponing the onset of cognitive decline symptoms. Although previous research suggests that training can produce transfer effects, this study was designed to overcome some limitations of previous studies by incorporating an active control group and the assessment of training expectations. Objective: The main objectives of this study are (1) to evaluate the effects of a randomized computer-based intervention consisting of training older adults with nonaction video games on brain and cognitive functions that decline with age, including attention and spatial working memory, using behavioral measures and electrophysiological recordings (event-related potentials [ERPs]) just after training and after a 6-month no-contact period; (2) to explore whether motivation, engagement, or expectations might account for possible training-related improvements; and (3) to examine whether inflammatory mechanisms assessed with noninvasive measurement of C-reactive protein in saliva impair cognitive training-induced effects. A better understanding of these mechanisms could elucidate pathways that could be targeted in the future by either behavioral or neuropsychological interventions. Methods: A single-blinded randomized controlled trial with an experimental group and an active control group, pretest, posttest, and 6-month follow-up repeated measures design is used in this study. A total of 75 cognitively healthy older adults were randomly distributed into experimental and active control groups. Participants in the experimental group received 16 1-hour training sessions with cognitive nonaction video games selected from Lumosity, a commercial brain training package. The active control group received the same number of training sessions with The Sims and SimCity, a simulation strategy game. Results: We have recruited participants, have conducted the training protocol and pretest assessments, and are currently conducting posttest evaluations. The study will conclude in the first semester of 2017. Data analysis will take place during 2017. The primary outcome is transfer of benefit from training to attention and working memory functions and the neural mechanisms underlying possible cognitive improvements. Conclusions: We expect that mental stimulation with video games will improve attention and memory both at the behavioral level and in ERP components promoting brain and mental health and extending independence among elderly people by avoiding the negative personal and economic consequences of long-term care. Trial Registration: Clinicaltrials.gov NCT02796508; https://clinicaltrials.gov/ct2/show/NCT02796508 (archived by WebCite at http://www.webcitation.org/6nFeKeFNB) ", doi="10.2196/resprot.6570", url="http://www.researchprotocols.org/2017/1/e8/", url="http://www.ncbi.nlm.nih.gov/pubmed/28119279" } @Article{info:doi/10.2196/rehab.6376, author="Meiland, Franka and Innes, Anthea and Mountain, Gail and Robinson, Louise and van der Roest, Henri{\"e}tte and Garc{\'i}a-Casal, Antonio J. and Gove, Dianne and Thyrian, Ren{\'e} Jochen and Evans, Shirley and Dr{\"o}es, Rose-Marie and Kelly, Fiona and Kurz, Alexander and Casey, Dympna and Szcze?niak, Dorota and Dening, Tom and Craven, P. Michael and Span, Marijke and Felzmann, Heike and Tsolaki, Magda and Franco-Martin, Manuel", title="Technologies to Support Community-Dwelling Persons With Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and Cost-Effectiveness, Deployment, and Ethics", journal="JMIR Rehabil Assist Technol", year="2017", month="Jan", day="16", volume="4", number="1", pages="e1", keywords="dementia", keywords="technology", keywords="evaluation studies", keywords="diffusion of innovation", keywords="ethics", abstract="Background: With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. Objective: The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. Methods: Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases. Results: According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. Conclusions: Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them. ", doi="10.2196/rehab.6376", url="http://rehab.jmir.org/2017/1/e1/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582262" } @Article{info:doi/10.2196/jmir.6518, author="Dove, Erica and Astell, J. Arlene", title="The Use of Motion-Based Technology for People Living With Dementia or Mild Cognitive Impairment: A Literature Review", journal="J Med Internet Res", year="2017", month="Jan", day="11", volume="19", number="1", pages="e3", keywords="dementia", keywords="mild cognitive impairment", keywords="technology", keywords="review", abstract="Background: The number of people living with dementia and mild cognitive impairment (MCI) is increasing substantially. Although there are many research efforts directed toward the prevention and treatment of dementia and MCI, it is also important to learn more about supporting people to live well with dementia or MCI through cognitive, physical, and leisure means. While past research suggests that technology can be used to support positive aging for people with dementia or MCI, the use of motion-based technology has not been thoroughly explored with this population. Objective: The aim of this study was to identify and synthesize the current literature involving the use of motion-based technology for people living with dementia or MCI by identifying themes while noting areas requiring further research. Methods: A systematic review of studies involving the use of motion-based technology for human participants living with dementia or MCI was conducted. Results: A total of 31 articles met the inclusion criteria. Five questions are addressed concerning (1) context of use; (2) population included (ie, dementia, MCI, or both); (3) hardware and software selection; (4) use of motion-based technology in a group or individual setting; and (5) details about the introduction, teaching, and support methods applied when using the motion-based technology with people living with dementia or MCI. Conclusions: The findings of this review confirm the potential of motion-based technology to improve the lives of people living with dementia or MCI. The use of this technology also spans across several contexts including cognitive, physical, and leisure; all of which support multidimensional well-being. The literature provides evidence that people living with dementia or MCI can learn how to use this technology and that they enjoy doing so. However, there is a lack of information provided in the literature regarding the introduction, training, and support methods applied when using this form of technology with this population. Future research should address the appropriate introduction, teaching, and support required for people living with dementia or MCI to use the motion-based technology. In addition, it is recommended that the diverse needs of these specific end-users be considered in the design and development of this technology. ", doi="10.2196/jmir.6518", url="http://www.jmir.org/2017/1/e3/", url="http://www.ncbi.nlm.nih.gov/pubmed/28077346" } @Article{info:doi/10.2196/mhealth.4878, author="Hartin, J. Phillip and Nugent, D. Chris and McClean, I. Sally and Cleland, Ian and Tschanz, T. JoAnn and Clark, J. Christine and Norton, C. Maria", title="The Empowering Role of Mobile Apps in Behavior Change Interventions: The Gray Matters Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2016", month="Aug", day="02", volume="4", number="3", pages="e93", keywords="behavior", keywords="health behavior", keywords="behavior change", keywords="motivation", keywords="Alzheimer disease", keywords="smartphone", abstract="Background: Health education and behavior change programs targeting specific risk factors have demonstrated their effectiveness in reducing the development of future diseases. Alzheimer disease (AD) shares many of the same risk factors, most of which can be addressed via behavior change. It is therefore theorized that a behavior change intervention targeting these risk factors would likely result in favorable rates of AD prevention. Objective: The objective of this study was to reduce the future risk of developing AD, while in the short term promoting vascular health, through behavior change. Methods: The study was an interventional randomized controlled trial consisting of subjects who were randomly assigned into either treatment (n=102) or control group (n=42). Outcome measures included various blood-based biomarkers, anthropometric measures, and behaviors related to AD risk. The treatment group was provided with a bespoke ``Gray Matters'' mobile phone app designed to encourage and facilitate behavior change. The app presented evidence-based educational material relating to AD risk and prevention strategies, facilitated self-reporting of behaviors across 6 behavioral domains, and presented feedback on the user's performance, calculated from reported behaviors against recommended guidelines. Results: This paper explores the rationale for a mobile phone--led intervention and details the app's effect on behavior change and subsequent clinical outcomes. Via the app, the average participant submitted 7.3 (SD 3.2) behavioral logs/day (n=122,719). Analysis of these logs against primary outcome measures revealed that participants who improved their high-density lipoprotein cholesterol levels during the study duration answered a statistically significant higher number of questions per day (mean 8.30, SD 2.29) than those with no improvement (mean 6.52, SD 3.612), t97.74=?3.051, P=.003. Participants who decreased their body mass index (BMI) performed significantly better in attaining their recommended daily goals (mean 56.21 SD 30.4\%) than those who increased their BMI (mean 40.12 SD 29.1\%), t80 = ?2.449, P=.017. In total, 69.2\% (n=18) of those who achieved a mean performance percentage of 60\% or higher, across all domains, reduced their BMI during the study, whereas 60.7\% (n=34) who did not, increased their BMI. One-way analysis of variance of systolic blood pressure category changes showed a significant correlation between reported efforts to reduce stress and category change as a whole, P=.035. An exit survey highlighted that respondents (n=83) reported that the app motivated them to perform physical activity (85.4\%) and make healthier food choices (87.5\%). Conclusions: In this study, the ubiquitous nature of the mobile phone excelled as a delivery platform for the intervention, enabling the dissemination of educational intervention material while simultaneously monitoring and encouraging positive behavior change, resulting in desirable clinical effects. Sustained effort to maintain the achieved behaviors is expected to mitigate future AD risk. Trial Registration: ClinicalTrails.gov NCT02290912; https://clinicaltrials.gov/ct2/show/NCT02290912 (Archived by WebCite at http://www.webcitation.org/6ictUEwnm) ", doi="10.2196/mhealth.4878", url="http://mhealth.jmir.org/2016/3/e93/", url="http://www.ncbi.nlm.nih.gov/pubmed/27485822" } @Article{info:doi/10.2196/resprot.5040, author="Hattink, Bart and Droes, Rose-Marie and Sikkes, Sietske and Oostra, Ellen and Lemstra, W. Afina", title="Evaluation of the Digital Alzheimer Center: Testing Usability and Usefulness of an Online Portal for Patients with Dementia and Their Carers", journal="JMIR Res Protoc", year="2016", month="Jul", day="21", volume="5", number="3", pages="e144", keywords="dementia", keywords="Alzheimer disease", keywords="patient portal", keywords="electronic health record", keywords="eHealth", abstract="Background: Dementia is a progressive and highly disabling neurodegenerative disease that will likely become highly prevalent in the future due to the globally aging population. To improve health care efficiency and quality for dementia care, eHealth could help with, for example, an online portal, such as the Digital Alzheimer Center (DAC) of the Vrije Universiteit Medical Center Amsterdam. It provides up-to-date disease information, peer-to-peer contact, and methods for contacting the hospital and health professionals. Objective: We aimed to investigate the usability and usefulness of the DAC for patients with dementia and carers to get insight into the feasibility and value of this eHealth app in dementia care and to recommend potential improvements. Methods: A descriptive study among patients, carers, and health care professionals was performed. Mixed methods were used, consisting of observations (n=10, 4 people with dementia, 6 carers), an online survey (n=287; 88 patients, 199 carers), and semistructured interviews (n=18; 6 patients, 6 carers, 6 health care professionals). During the observations, participants performed a set of five different prescribed tasks on the portal. Speed, number of errors, and navigation were noted. The online survey aimed to assess users' opinions on the portal's usability and usefulness. Semistructured interviews were conducted in a subsample of patients, carers, and health care professionals to gain more in-depth information. Results: In the usability assessment, eight categories of errors were distinguished, of which three were of critical, two of medium, and three of low severity. In the survey, 45\% (40/88) of the patients and 53\% (105/199) of the carers indicated they used the portal. In all, 33\% (12/36) of patients and 61\% (62/102) of carers found it easy to learn to work with the portal. Most considered the DAC generally useful: 65\% (17/26) of patients and 78\% (67/86) of carers found the DAC useful, especially for understanding dementia (patients: 64\%, 16/25; carers: 62\%, 53/86). In the semistructured interviews, the site was generally rated positively on usability and usefulness and being well designed. People with dementia and carers indicated it helped them to understand and deal with dementia. Conclusions: To our knowledge, this is the first study investigating the usability and usefulness of an Internet portal especially designed for people with dementia and their carers. An online patient portal could be a useful means to help to support patients and carers in dealing with dementia: the majority of users positively evaluated usability and usefulness of the portal, and appreciated the information on it. However, only a minority of patients found it easy to work with the portal. Good design and frequent usability testing is essential to offer a good online portal. ", doi="10.2196/resprot.5040", url="http://www.researchprotocols.org/2016/3/e144/", url="http://www.ncbi.nlm.nih.gov/pubmed/27444209" } @Article{info:doi/10.2196/games.5696, author="Wiloth, Stefanie and Lemke, Nele and Werner, Christian and Hauer, Klaus", title="Validation of a Computerized, Game-based Assessment Strategy to Measure Training Effects on Motor-Cognitive Functions in People With Dementia", journal="JMIR Serious Games", year="2016", month="Jul", day="18", volume="4", number="2", pages="e12", keywords="serious games", keywords="computerized assessment", keywords="validation", keywords="motor-cognitive functions", keywords="elderly", keywords="older adults", keywords="cognitive impairment", keywords="dementia", abstract="Background: Exergames often used for training purpose can also be applied to create assessments based on quantitative data derived from the game. A number of studies relate to these use functionalities developing specific assessment tasks by using the game software and provided good data on psychometric properties. However, (1) assessments often include tasks other than the original game task used for training and therefore relate to similar but not to identical or integrated performances trained, (2) people with diagnosed dementia have insufficiently been addressed in validation studies, and (3) studies did commonly not present validation data such as sensitivity to change, although this is a paramount objective for validation to evaluate responsiveness in intervention studies. Objective: Specific assessment parameters have been developed using quantitative data directly derived from the data stream during the game task of a training device (Physiomat). The aim of this study was to present data on construct validity, test--retest reliability, sensitivity to change, and feasibility of this internal assessment approach, which allows the quantification of Physiomat training effects on motor-cognitive functions in 105 multimorbid patients with mild-to-moderate dementia (mean age 82.7{\textpm}5.9). Methods: Physiomat assessment includes various tasks at different complexity levels demanding balance and cognitive abilities. For construct validity, motor-cognitive Physiomat assessment tasks were compared with established motor and cognitive tests using Spearman's rank correlations (rs). For test--retest reliability, we used intra-class correlations (ICC3,1) and focused on all Physiomat tasks. Sensitivity to change of trained Physiomat tasks was tested using Wilcoxon statistic and standardized response means (SRMs). Completion rate and time were calculated for feasibility. Results: Analyses have mostly shown moderate-to-high correlations between established motor as well as cognitive tests and simple (rs=?.22 to .68, P ?.001-.03), moderate (rs=?.33 to .71, P ?.001-.004), and complex motor-cognitive Physiomat tasks (rs=?.22 to .83, P ?.001-.30) indicating a good construct validity. Moderate-to-high correlations between test and retest assessments were found for simple, moderate, and complex motor-cognitive tasks (ICC=.47-.83, P ?.001) indicating good test--retest reliability. Sensitivity to change was good to excellent for Physiomat assessment as it reproduced significant improvements (P ?.001) with mostly moderate-to-large effect sizes (SRM=0.5-2.0) regarding all trained tasks. Completion time averaged 25.8 minutes. Completion rate was high for initial Physiomat measures. No adverse events occurred during assessment. Conclusions: Overall, Physiomat proved to have good psychometric qualities in people with mild-to-moderate dementia representing a reliable, valid, responsive, and feasible assessment strategy for multimorbid older adults with or without cognitive impairment, which relates to identical and integrated performances trained by using the game. ", doi="10.2196/games.5696", url="http://games.jmir.org/2016/2/e12/", url="http://www.ncbi.nlm.nih.gov/pubmed/27432746" } @Article{info:doi/10.2196/rehab.5226, author="Mart{\'i}nez-Alcal{\'a}, I. Claudia and Pliego-Pastrana, Patricia and Rosales-Lagarde, Alejandra and Lopez-Noguerola, JS and Molina-Trinidad, M. Eva", title="Information and Communication Technologies in the Care of the Elderly: Systematic Review of Applications Aimed at Patients With Dementia and Caregivers", journal="JMIR Rehabil Assist Technol", year="2016", month="May", day="02", volume="3", number="1", pages="e6", keywords="information and communication technologies", keywords="eHealth", keywords="elderly", keywords="caregiver", keywords="Alzheimer's disease", keywords="systematic review", abstract="Background: The interest in applying information and communications technology (ICT) in older adult health care is frequently promoted by the increasing and unsustainable costs of health care services. In turn, the unprecedented growth of the elderly population around the globe has urged institutions, companies, industries, and governments to respond to older adults' medical needs. Objective: The aim of this review is to systematically identify the opportunities that ICT offers to health services, specifically for patients with dementia and their families. Methods: A systematic review of the literature about ICT applications that have been developed to assist patients with Alzheimer's disease (AD) and their primary caregivers was conducted. The bibliographic search included works published between January 2005 and July 2015 in the databases Springer Link, Scopus, and Google Scholar. Of the published papers, 902 were obtained in the initial search, of which 214 were potentially relevant. Included studies fulfilled the following inclusion criteria: (1) studies carried out between the years of 2005 and 2015, (2) studies were published in English or Spanish, (3) studies with titles containing the keywords, (4) studies with abstracts containing information on ICT applications and AD, and (5) studies published in indexed journals, proceedings, and book chapters. Results: A total of 26 studies satisfied the inclusion criteria for the current review. Among them, 16 were aimed at the patient with AD and 10 at the primary caregivers and/or family members. The studies targeted applications that included assistive technology (44\%, 7/16), telecare (37\%, 6/16), and telemedicine (31\%, 5/16). The information systems (56\%, 9/16) and Internet (44\%, 7/16) were the most commonly used enabling technologies for the studies. Finally, areas of attention more covered by the studies were care (56\%, 9/16), treatment (56\%, 9/16), and management (50\%, 8/16). Furthermore, it was found that 20 studies (77\%, 8/26) evaluated their ICT applications through carrying out tests with patients with dementia and caregivers. Conclusions: The key finding of this systematic review revealed that the use of ICT tools can be strongly recommended to be used as a lifestyle in the elderly in order to improve the quality of life for the elderly and their primary caregivers. Since patients with AD are completely dependent in most activities, it is necessary to give attention to their primary caregivers to avoid stress and depression. In addition, the use of ICT in the daily life of caregivers can help them understand the disease process and manage situations in a way that is beneficial for both parties. It is expected that future developments concerning technological projects can support this group of people. ", doi="10.2196/rehab.5226", url="http://rehab.jmir.org/2016/1/e6/", url="http://www.ncbi.nlm.nih.gov/pubmed/28582258" } @Article{info:doi/10.2196/resprot.4354, author="Schaller, Sandra and Marinova-Schmidt, Velislava and Setzer, Manuela and Kondylakis, Haridimos and Griebel, Lena and Sedlmayr, Martin and Graessel, Elmar and Maler, Manuel Juan and Kirn, Stefan and Kolominsky-Rabas, L. Peter", title="Usefulness of a Tailored eHealth Service for Informal Caregivers and Professionals in the Dementia Treatment and Care Setting: The eHealthMonitor Dementia Portal", journal="JMIR Res Protoc", year="2016", month="Apr", day="05", volume="5", number="2", pages="e47", keywords="eHealth", keywords="web portal", keywords="decision aid", keywords="personalized support", keywords="dementia", keywords="Alzheimer's disease", keywords="informal caregiver", keywords="medical professional", abstract="Background: The European eHealthMonitor project (eHM) developed a user-sensitive and interactive Web portal for the dementia care setting called the eHM Dementia Portal (eHM-DP). It aims to provide targeted support for informal caregivers of persons with dementia and professionals. Objective: The objective of this study was to assess the usefulness and impact of the eHM-DP service in the dementia care setting from two user perspectives: informal caregivers and professionals. Methods: The evaluation study was conducted from June to September 2014 and followed a before-after, user-participatory, mixed-method design with questionnaires and interviews. The used intervention was the eHM-DP: an interactive Web portal for informal caregivers and professionals that was tested for a 12-week period. Primary outcomes for caregivers included empowerment, quality of life, caregiver burden, decision aid, as well as perceived usefulness and benefits of the eHM-DP. Primary outcomes for professionals involved decision aid, perceived usefulness, and benefits of the eHM-DP. Results: A total of 25 informal caregivers and 6 professionals used the eHM-DP over the 12-week study period. Both professionals and informal caregivers indicated perceived benefits and support by the eHM-DP. In total, 65\% (16/25) of informal caregivers would use the eHM-DP if they had access to it. Major perceived benefits were individualized information acquisition, improved interaction between informal caregivers and professionals, access to support from home, and empowerment in health-related decisions (PrepDM Score: 67.9). Professionals highlighted the improved treatment and care over the disease course (83\%, 5/6) and improved health care access for people living in rural areas (67\%, 4/6). However, there was no improvement in caregiver burden (Burden Scale for Family Caregivers) and quality of life (EuroQol-5D-5L) over the study period. Conclusions: Our study provides insight into the different user perspectives on an eHealth support service in the dementia treatment and care setting. These results are of importance for future developments and the uptake of eHealth solutions in the dementia domain and reinforce the importance of early user involvement. Turning to the primary target of the eHM-DP service, our findings suggest that the eHM-DP service proved to be a valuable post-diagnostic support service, in particular for the home-based care setting. Further research on a larger scale is needed to enhance the implementation in existing health care infrastructures. ", doi="10.2196/resprot.4354", url="http://www.researchprotocols.org/2016/2/e47/", url="http://www.ncbi.nlm.nih.gov/pubmed/27050401" } @Article{info:doi/10.2196/resprot.5142, author="Boots, MM Lizzy and de Vugt, E. Marjolein and Withagen, EJ Hanneke and Kempen, IJM Gertrudis and Verhey, RJ Frans", title="Development and Initial Evaluation of the Web-Based Self-Management Program ``Partner in Balance'' for Family Caregivers of People With Early Stage Dementia: An Exploratory Mixed-Methods Study", journal="JMIR Res Protoc", year="2016", month="Mar", day="01", volume="5", number="1", pages="e33", keywords="carers", keywords="dementia", keywords="focus groups", keywords="Internet", keywords="psychosocial support systems", abstract="Background: People with dementia increasingly depend on informal caregivers. Internet-based self-management interventions hold considerable promise for meeting the educational and support needs of early stage dementia caregivers (EDCs) at a reduced cost. Objective: This study aimed to (1) develop an online self-management program for EDC to increase self-efficacy and goal attainment, and (2) evaluate the program's feasibility and report preliminary data on effectiveness. Methods: Based on the Medical Research Council (MRC) framework for the development and evaluation of complex interventions, a stepwise approach was adopted to explore potential user needs and develop and validate the content by means of (1) focus group discussions with dementia caregivers (N=28), (2) interviews with dementia care professionals (N=11), and (3) individual think-aloud usability tests with EDC (N=2) and experts (N=2). A pilot evaluation was conducted with EDC (N=17) to test the feasibility and establish preliminary effects. Self-report measures of feasibility were completed after the completion of intervention. Self-efficacy and goal attainment were evaluated before and after the intervention. Results: The different steps provided useful information about the needs of potential users regarding the content and delivery of the program. This resulted in the newly developed ``Partner in Balance'' program. At the start, system failures resulted in a high noncompleter rate (7/17, 41\%), but at the end, an acceptable feasibility score of 209 (range 54-234) was found. The convenience of completing the program at home, the tailored content, and the guidance (face-to-face and online) were appraised positively. Preliminary effects on caregiver self-efficacy (P<.05) and goal attainment (T>50) were promising. Conclusions: Adaptations were made to the program to limit the amount of system failures and prevent high noncompleter rates. As recommended by the MRC framework, confirming the feasibility and preliminary effectiveness is a valuable step toward examining the effectiveness of this newly developed intervention. Trial Registration: Dutch Trial Register (NTR): NTR4217; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4217 (Archived by WebCite at http://www.webcitation.org/6f6B8lvRP). ", doi="10.2196/resprot.5142", url="http://www.researchprotocols.org/2016/1/e33/", url="http://www.ncbi.nlm.nih.gov/pubmed/26932438" } @Article{info:doi/10.2196/jmir.4516, author="Wang, Ho-Wei and Chen, Duan-Rung and Yu, Hsiao-Wei and Chen, Ya-Mei", title="Forecasting the Incidence of Dementia and Dementia-Related Outpatient Visits With Google Trends: Evidence From Taiwan", journal="J Med Internet Res", year="2015", month="Nov", day="19", volume="17", number="11", pages="e264", keywords="dementia", keywords="Alzheimer's disease", keywords="Google Trends", keywords="big data", keywords="incidence", keywords="early detection", keywords="self-diagnosis", keywords="Internet search", keywords="health-seeking behaviors", abstract="Background: Google Trends has demonstrated the capability to both monitor and predict epidemic outbreaks. The connection between Internet searches for dementia information and dementia incidence and dementia-related outpatient visits remains unknown. Objective: This study aimed to determine whether Google Trends could provide insight into trends in dementia incidence and related outpatient visits in Taiwan. We investigated and validated the local search terms that would be the best predictors of new dementia cases and outpatient visits. We further evaluated the nowcasting (ie, forecasting the present) and forecasting effects of Google Trends search trends for new dementia cases and outpatient visits. The long-term goal is to develop a surveillance system to help early detection and interventions for dementia in Taiwan. Methods: This study collected (1) dementia data from Taiwan's National Health Insurance Research Database and (2) local Internet search data from Google Trends, both from January 2009 to December 2011. We investigated and validated search terms that would be the best predictors of new dementia cases and outpatient visits. We then evaluated both the nowcasting and the forecasting effects of Google Trends search trends through cross-correlation analysis of the dementia incidence and outpatient visit data with the Google Trends data. Results: The search term ``dementia + Alzheimer's disease'' demonstrated a 3-month lead effect for new dementia cases and a 6-month lead effect for outpatient visits (r=.503, P=.002; r=.431, P=.009, respectively). When gender was included in the analysis, the search term ``dementia'' showed 6-month predictive power for new female dementia cases (r=.520, P=.001), but only a nowcasting effect for male cases (r=.430, P=.009). The search term ``neurology'' demonstrated a 3-month leading effect for new dementia cases (r=.433, P=.008), for new male dementia cases (r=.434, P=.008), and for outpatient visits (r=.613, P<.001). Conclusions: Google Trends established a plausible relationship between search terms and new dementia cases and dementia-related outpatient visits in Taiwan. This data may allow the health care system in Taiwan to prepare for upcoming outpatient and dementia screening visits. In addition, the validated search term results can be used to provide caregivers with caregiving-related health, skills, and social welfare information by embedding dementia-related search keywords in relevant online articles. ", doi="10.2196/jmir.4516", url="http://www.jmir.org/2015/11/e264/", url="http://www.ncbi.nlm.nih.gov/pubmed/26586281" } @Article{info:doi/10.2196/resprot.4468, author="Aalbers, Teun and Baars, AE Maria and Qin, Li and de Lange, Annet and Kessels, PC Roy and Olde Rikkert, GM Marcel", title="Using an eHealth Intervention to Stimulate Health Behavior for the Prevention of Cognitive Decline in Dutch Adults: A Study Protocol for the Brain Aging Monitor", journal="JMIR Res Protoc", year="2015", month="Nov", day="10", volume="4", number="4", pages="e130", keywords="cognition", keywords="healthy lifestyle", keywords="eHealth", keywords="internet", keywords="prevention", keywords="applied games", keywords="protocol", abstract="Background: Internet-delivered intervention programs are an effective way of changing health behavior in an aging population. The same population has an increasing number of people with cognitive decline or cognitive impairments. Modifiable lifestyle risk factors such as physical activity, nutrition, smoking, alcohol consumption, sleep, and stress all influence the probability of developing neurodegenerative diseases such as Alzheimer's disease. Objective: This study aims to answer two questions: (1) Is the use of a self-motivated, complex eHealth intervention effective in changing multiple health behaviors related to cognitive aging in Dutch adults in the work force, especially those aged 40 and over? and (2) Does this health behavior change result in healthier cognitive aging patterns and contribute to preventing or delaying future onset of neurodegenerative syndromes? Methods: The Brain Aging Monitor study uses a quasi-experimental 2-year pre-posttest design. The Brain Aging Monitor is an online, self-motivated lifestyle intervention program. Recruitment is done both in medium to large organizations and in the Dutch general population over the age of 40. The main outcome measure is the relationship between lifestyle change and cognitive aging. The program uses different strategies and modalities such as Web content, email, online newsletters, and online games to aid its users in behavior change. To build self-regulatory skills, the Brain Aging Monitor offers its users goal-setting activities, skill-building activities, and self-monitoring. Results: Study results are expected to be published in early 2016. Conclusions: This study will add to the body of evidence on the effectiveness of eHealth intervention programs with the combined use of state-of-the-art applied games and established behavior change techniques. This will lead to new insights on how to use behavior change techniques and theory in multidimensional lifestyle eHealth research, and how these techniques and theories apply when they are used in a setting where no professional back-end is available. Trial Registration: Nederlands Trial Register: NTR4144; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4144 (Archived by WebCite at http://www.webcitation.org/6cZzwZSg3) ", doi="10.2196/resprot.4468", url="http://www.researchprotocols.org/2015/4/e130/", url="http://www.ncbi.nlm.nih.gov/pubmed/26554496" } @Article{info:doi/10.2196/resprot.4189, author="Yu, Ruby and Hui, Elsie and Lee, Jenny and Poon, Dawn and Ng, Ashley and Sit, Kitty and Ip, Kenny and Yeung, Fannie and Wong, Martin and Shibata, Takanori and Woo, Jean", title="Use of a Therapeutic, Socially Assistive Pet Robot (PARO) in Improving Mood and Stimulating Social Interaction and Communication for People With Dementia: Study Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2015", month="May", day="01", volume="4", number="2", pages="e45", keywords="dementia", keywords="elderly", keywords="PARO", keywords="randomized controlled trial", keywords="robot-assisted therapy", keywords="socially assistive robots", abstract="Background: Socially assistive robotics is a growing area for geriatric research. Objective: This single-blind, randomized controlled trial (RCT) aims to investigate the use of PARO, a therapeutic, socially assistive pet robot, in improving mood, and stimulating social interaction and communication for people with dementia in the community. Methods: For the study, 40 community-dwelling older Chinese adults (?60 years) with mild to moderate dementia will be recruited and randomly assigned to the PARO therapy group or the psychosocial activities control group. Both treatments consist of six, 30-minute weekly sessions, which will be conducted in a geriatric day hospital. Subjects in both groups will be assessed by a trained research assistant at baseline (pre-), during, and post-treatment. Mood (assessed with a simplified face scale), social interaction, and communication (ie, facial expressions and reactions towards each treatment, assessed with an observation table) will be the primary outcome measures. Secondary outcome measures will include assessments on cognitive function (Mini-Mental State Examination) and depressive symptoms (Cornell Scale for Depression in Dementia), as well as caregiver burden (Zarit Burden Inventory). Subjective impression towards each treatment and qualitative comments from the caregivers, facilitator, and therapists will also be obtained. Results: Recruitment to the pilot study began in 2014 and the last subject is expected to complete their post-treatment assessment in 2015. Conclusions: This will be the first RCT using PARO to improve mood, and stimulate social interaction and communication in the care of older people with dementia, as well as provide an evidence basis for the use of PARO in dementia care in Hong Kong. Trial Registration: The Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614000037606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000037606 (Archived by WebCite at http://www.webcitation.org/6Xi7uXdu9). ", doi="10.2196/resprot.4189", url="http://www.researchprotocols.org/2015/2/e45/", url="http://www.ncbi.nlm.nih.gov/pubmed/25934173" } @Article{info:doi/10.2196/mental.3654, author="O'Connor, Elodie and Farrow, Maree and Hatherly, Chris", title="Randomized Comparison of Mobile and Web-Tools to Provide Dementia Risk Reduction Education: Use, Engagement and Participant Satisfaction", journal="JMIR Mental Health", year="2014", month="Dec", day="22", volume="1", number="1", pages="e4", keywords="dementia", keywords="Alzheimer", keywords="engagement", keywords="health communication", keywords="Internet", keywords="intervention", keywords="mobile phone", keywords="risk reduction behavior", keywords="user perceptions", keywords="mhealth", abstract="Background: Encouraging middle-aged adults to maintain their physical and cognitive health may have a significant impact on reducing the prevalence of dementia in the future. Mobile phone apps and interactive websites may be one effective way to target this age group. However, to date there has been little research investigating the user experience of dementia risk reduction tools delivered in this way. Objective: The aim of this study was to explore participant engagement and evaluations of three different targeted smartphone and Web-based dementia risk reduction tools following a four-week intervention. Methods: Participants completed a Web-based screening questionnaire to collect eligibility information. Eligible participants were asked to complete a Web-based baseline questionnaire and were then randomly assigned to use one of the three dementia risk reduction tools for a period of four weeks: (1) a mobile phone application; (2) an information-based website; and (3) an interactive website. User evaluations were obtained via a Web-based follow-up questionnaire after completion of the intervention. Results: Of 415 eligible participants, 370 (89.16\%) completed the baseline questionnaire and were assigned to an intervention group; 200 (54.05\%) completed the post-intervention questionnaire. The average age of participants was 52 years, and 149 (75\%) were female. Findings indicated that participants from all three intervention groups reported a generally positive impression of the tools across a range of domains. Participants using the information-based website reported higher ratings of their overall impression of the tool, F2,191=4.12, P=.02; how interesting the information was, F2,189=3.53, P=.03; how helpful the information was, F2,192=4.15, P=.02; and how much they learned, F2,188=3.86, P=.02. Group differences were significant between the mobile phone app and information-based website users, but not between the interactive website users and the other two groups. Additionally, participants using the information-based website reported significantly higher scores on their ratings of the ease of navigation, F2,190=4.20, P=.02, than those using the mobile phone app and the interactive website. There were no significant differences between groups on ratings of ease of understanding the information, F2,188=0.27, P=.76. Most participants from each of the three intervention groups indicated that they intended to keep using the dementia risk reduction eHealth tool. Conclusions: Overall, results indicated that while participants across all three intervention groups reported a generally positive experience with the targeted dementia risk reduction tools, participants using the information-based website provided a more favorable evaluation across a range of areas than participants using the mobile phone app. Further research is required to investigate whether targeted dementia risk reduction tools, in the form of interactive websites and mobile apps, can be improved to provide benefits above those gained by providing static information alone. ", doi="10.2196/mental.3654", url="http://mental.jmir.org/2014/1/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/26543904" }