April 22, 2015

American Journal of Alzheimer's Disease and Other Dementias February 2015

Full text articles are available to fee paying members of Alzheimer’s Australia NSW by emailing NSW.Library@alzheimers.org.au 
The Rehabilitation Engineering Research Center for the Advancement of Cognitive Technologies
Barring few exceptions, allied health professionals, engineers, manufacturers of assistive technologies (ATs), and consumer product manufacturers have developed few technologies for individuals with cognitive impairments (CIs). In 2004, the National Institute on Disability Rehabilitation Research (NIDRR) recognized the need to support research in this emergent field. They funded the first Rehabilitation Engineering Research Center for the Advancement of Cognitive Technologies (RERC-ACT). The RERC-ACT has since designed and evaluated existing and emerging technologies through rigorous research, improving upon existing AT devices, and creating new technologies for individuals with CIs. The RERC-ACT has contributed to the development and testing of AT products that assist persons with CIs to actively engage in tasks of daily living at home, school, work, and in the community. This article highlights the RERC-ACT’s engineering development and research projects and discusses how current research may impact the quality of life for an aging population.
p. 6-12

Computerized Cognitive Testing for Older Adults: A Review
Objective: This article is a review of computerized tests and batteries used in the cognitive assessment of older adults. Method: A literature search on Medline followed by cross-referencing yielded a total of 76 citations. Results: Seventeen test batteries were identified and categorized according to their scope. Computerized adaptive testing (CAT) and the Cambridge Cognitive Examination CAT battery as well as 3 experimental batteries and an experimental test are discussed in separate sections. All batteries exhibit strengths associated with computerized testing such as standardization of administration, accurate measurement of many variables, automated record keeping, and savings of time and costs. Discriminant validity and test–retest reliability were well documented for most batteries while documentation of other psychometric properties varied. Conclusion: The large number of available batteries can be beneficial to the clinician or researcher; however, care should be taken in order to choose the correct battery for each application.
p. 13-28 

Effects of Tracking Technology on Daily Life of Persons With Dementia: Three Experimental Single-Case Studies
Objectives: To investigate the effects of using tracking technology on independent outdoor activities and psychological well-being in 3 persons with dementia (PwDs) and their spouses. Methods: Three experimental single-case studies with an A1B1A2B2 design. The intervention entailed access to a passive positioning alarm and technical support. Continual daily measures of independent outdoor activities among PwDs’ and spouses’ worries about these activities were made during all phases. Results: Access to a tracking technology consistently increased the independent outdoor activities of 2 PwDs. One of the spouses consistently reported decreased worry during B phases, another’s worry decreased only in B2, and the third showed little variability in worrying across all phases. Conclusion: Tracking technology may support PwDs to engage in independent outdoor activities and decrease spouses’ worries; however, randomized controlled group studies are needed to investigate whether these results can be replicated on a group level.
p. 28-40 

Computer-Based Cognitive Training for Individuals With Intellectual and Developmental Disabilities: Pilot Study
Background: There is a growing focus in the United States on preserving cognitive functioning. However, individuals with intellectual and developmental disabilities (ID/DD) are not provided with opportunities to prevent cognitive decline. To investigate whether participants with ID/DD would improve in cognitive function after cognitive training, a cognitive training group (N ¼ 11) was compared to 2 control groups, a computer games group (N ¼ 11) and a waitlist group (N ¼ 10) on performance on 15 cognitive functions. Findings: (1) Very high adherence rates (94%) of the sample and 100% of the cognitive training group indicate that when given adequate individual support, adults with ID/DD can successfully use a cognitive stimulation program. (2) No significant between- or within-group effects were observed for cognitive training when a stringent a, corrected for multiple comparisons, was used. (3) Trends of improvement in cognitive function were observed for the cognitive training group.
p. 41-48 

Using Virtual Reality for Cognitive Training of the Elderly
There is a pressing demand for improving the quality and efficacy of health care and social support services needed by the world’s growing elderly population, especially by those affected by mild cognitive impairment (MCI) and Alzheimer’s disease (AD)-type early-stage dementia. Meeting that demand can significantly benefit from the deployment of innovative, computer-based applications capable of addressing specific needs, particularly in the area of cognitive impairment mitigation and rehabilitation. In that context, we present here our perspective viewpoint on the use of virtual reality (VR) tools for cognitive rehabilitation training, intended to assist medical personnel, health care workers, and other caregivers in improving the quality of daily life activities of people with MCI and AD. We discuss some effective design criteria and developmental strategies and suggest some possibly useful
protocols and procedures. The particular innovative supportive advantages offered by the immersive interactive characteristics inherent to VR technology are discussed.
p. 49-54 

Acceptability of an e-Learning Program to Help NursingAssistants Manage Relationship Conflict in Nursing Homes
Background: Management of nursing assistants’ (NAs) emotional stress from relationship conflicts with residents, families, and coworkers is rarely the focus of educational programs. Our objective was to gather feedback from NAs and their nursing supervisors (NSs) about the utility of our e-learning program for managing relationship stress. Methods: A total of 147 NAs and their NSs from 17 long-term care homes viewed the educational modules (DVD slides with voice-over), either individually or in small groups, and provided feedback using conference call focus groups. Results: Qualitative analysis of NA feedback showed that workplace relationship conflict stress was associated with workload and the absence of a forum for discussing relationship conflicts that was not acknowledged by NSs. Conclusion: This accessible e-learning program provides NAs with strategies for managing stressful emotions arising from workplace relationship conflict situations and underscores the importance of supervisory support and team collaboration in coping with emotionally evoked workplace stress.
p. 55-60

Beyond Reminiscence: Using Generic Video to Elicit Conversational Language
Videos and multimedia are increasingly used to stimulate reminiscence in dementia care. However, they are also valuable in eliciting a wide range of language patterns that are not necessarily keyed to reminiscence about self. Low-technology, home-made generic and personalized videos were tested with 2 samples of persons with dementia, to increase engagement and support the retention of identity. Participants showed a slight, though not significant, preference for looking first at personalized videos and produced a wider range of conversational language topics and phrasal patterns in response to the generic videos.
p. 61-68 

An Ambient Assisted Living Approach in Designing Domiciliary Services Combined With Innovative Technologies for Patients With Alzheimer’s Disease: A Case Study
Background: Alzheimer’s disease (AD) is one of the most disabling diseases to affect large numbers of elderly people worldwide. Because of the characteristics of this disease, patients with AD require daily assistance from service providers both in nursing homes and at home. Domiciliary assistance has been demonstrated to be cost effective and efficient in the first phase of the disease, helping to slow down the course of the illness, improve the quality of life and care, and extend independence for patients and caregivers. In this context, the aim of this work is to demonstrate the technical  effectiveness and acceptability of an innovative domiciliary smart sensor system for providing domiciliary assistance to patients with AD which has been developed with an Ambient Assisted Living (AAL) approach. The experience described in this article demonstrated that AAL technologies are feasible and effective nowadays and can be actively used in assisting patients with AD in their homes. The extensive involvement of caregivers in the experimentation allowed to assess that there is, through the use of the technological system, a proven improvement in care performance and efficiency of care provision by both formal and informal caregivers and consequently an increase in the quality of life of patients, their relatives, and their caregivers.
p. 69-77 

Correlates Among Nocturnal Agitation, Sleep, and Urinary Incontinence in Dementia
Family caregivers of elders with dementia often face the challenging behaviors of nighttime agitation, sleep disturbances, and urinary incontinence. To date, no study has examined the interrelationships of these behaviors in community-dwelling persons. This single group, descriptive study employs wireless body sensors to objectively collect data on nighttime agitation, sleep, and urinary incontinence in patients with dementia in their homes over a 5- to 7-day period. The aims are to (1) examine the feasibility and acceptability of the use of body sensors in community-dwelling persons with dementia; (2) describe patterns of nocturnal agitation, sleep continuity and duration, and nighttime urinary incontinence; and (3) examine the relationships among nocturnal agitation, sleep continuity and duration, and nighttime urinary incontinence. Data collection is in early stages and is still in progress.
Challenges and advantages from preliminary data collection are reported.
p. 78-84 

Personalized Technology to Support Older Adults With and Without Cognitive Impairment Living at Home
Although persons with dementia (PWD) and their family caregivers need in-home support for common neuropsychiatric symptoms (NPS), few if any assistive technologies are available to help manage NPS. This  implementation study tested the feasibility and adoption of a touch screen technology, the Companion, which delivers psychosocial, nondrug interventions to PWD in their home to address individual NPS and needs. Interventions were personalized and delivered in home for a minimum of 3 weeks. Post intervention measures indicated the technology was easy to use, significantly facilitated meaningful and positive engagement, and simplified caregivers’ daily lives. Although intervention goals were met, caregivers had high expectations of their loved one’s ability to regain independence. Care recipients used the system independently but were limited by cognitive and physical impairments. We conclude the Companion can help manage NPS and offer caregiver respite at home. These data provide important guidance for design and deployment of care technology for the home.
p. 85-97 

Using the Alzheimer’s Association Web Site to Improve Knowledge of Alzheimer’s Disease in Health Care Providers
Background: The purpose of the current study was to investigate whether an informative Web site is effective at producing higher scores for an individual’s knowledge of Alzheimer’s disease (AD) relative to those who do not visit a Web site. Methods: A total of 552 participants completed the study on Amazon’s Mechanical Turk; half were randomly assigned to visit alz.org, while a control group did not. Both groups were given the AD Knowledge Scale (ADKS) to assess their knowledge of AD. Results: Participants who visited alz.org scored significantly higher on the ADKS than those in the control group. Participants who were health care workers demonstrated higher scores than others in the experimental condition. Findings indicate that the Alzheimer’s Association Web site is effective at producing higher scores for AD knowledge relative to no Web site at all and that it is especially helpful for health care workers compared to those who are not health care workers.
p. 98-107

Developing CIRCA-BC and Exploring the Role of the Computer as a Third Participant in Conversation
The Computer Interactive Reminiscence Conversation Aid (CIRCA) is a software program using touch screen technology and digital materials from public archives to support conversation between people with dementia and their carers. In this 2-phase study, we first worked with seniors’ focus groups to identify and select relevant content for a regional adaptation of CIRCA (British Columbia version of CIRCA [CIRCA-BC]). We then pilot tested CIRCA-BC with 3 participants having dementia and a conversation partner, analyzing their interactions to explore how they drew on program content and format to shape their conversations together. Findings provide insight into, first, how participants’ shared and distinct social histories influence reminiscence-based conversations and, second, how the computer can be viewed as a third “participant” in the interaction. These findings offer guidelines for ongoing adaptation and application of the CIRCA program in addition to contributing further evidence regarding the role of technology in facilitating meaningful interaction between people with dementia and their carers.
p. 101-109


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